Completing the Bucket List: Leveraging Telehealth in Palliative Care to Support Legacy-making and Dignity

Abstract

Palliative Care Telemedicine research has focused on avoidance of patient travel, technology, reduction of acute healthcare utilization, access and efficacy of care. The field lacks emphasis on priorities of sick people with good functional status and how Telehealth may support other values, including existential concerns. We present a Telehealth use case to address palliative care patient priorities beyond clinical needs. Case: A 58 year old married man with advanced metastatic lung cancer is receiving oral targeted anticancer therapy and palliative care. He established goals of care, including the completion of his ‘bucket list'. To achieve his goals he wished to travel outside our service area ‘to live, connect, share unforgettable moments with precious people in my life, and create lasting memories for them'. We agreed to use Telehealth video conferencing to conduct regular assessment visits during his travels to maintain his comfort and guide care. Our most recent Telehealth videoconference was conducted while he was in the southwestern United States, where he had traveled to experience and photograph favorite majestic landscapes. The visit entailed symptom assessment, but also exploration of the events and sights he found most meaningful. In the course of our Tele-visit, he rotated his tablet screen to show us his view of the magnificent rock formations outside and narrated the shared awe-inspiring vista. As he reported the treasured memories he and his wife had recorded, he described the particular experiences that made him feel most alive and elevated his spirits. Our staff was inspired by palliative Telehealth encounters that enabled timely travel-based legacy-making and dignity-promoting experiences. Telehealth videoconferencing may facilitate patient legacy-making, dignity and staff resiliency. Rather than using Telehealth to avoid travel burden, technology was leveraged to foster patient travel toward realization of goals. Research will further examine Telehealth facilitation of legacy and dignity work.