In-person versus telehealth outpatient palliative care visits in oncology: A multicenter study.

Abstract

12056 Background: As telehealth becomes integral to outpatient palliative care delivery in oncology, evidence comparing consultation duration and time allocation between in-person and remote visits remains limited, especially in low- and middle-income countries. We compared consultation duration and time composition between in-person and telehealth visits after adjustment for visit type and clinical complexity. Methods: This observational study evaluated outpatient oncological palliative care consultations conducted between February and May 2025 across seven practices in Brazil. Total consultation time and predefined time components were recorded. Multivariable linear regression models estimated adjusted differences in consultation duration according to care modality, controlling for visit type (first appointment, follow-up, family meeting), performance status (ECOG), quality-of-life (IPOS), and number of participants. Results: A total of 269 consultations were analyzed, including 171 in-person and 98 telehealth visits. Care modality was associated with consultation type (p < 0.001): telehealth was less frequently used for first consultations (15% vs. 35%) and more frequently used for follow-up visits (76% vs. 63%) and family meetings (9% vs. 3%). Telehealth visits involved patients with worse performance status (ECOG 3-4: 36% vs. 17%; p=0.007) and poorer quality of life (higher IPOS distribution; p=0.037). In unadjusted analyses, telehealth consultations were shorter than in-person visits, particularly for follow-up visits. After multivariable adjustment, telehealth visits remained independently and significantly shorter by a mean of 10.5 minutes (95% confidence interval [CI] -15.6 to -5.4; p<0.001). Follow-up consultations were consistently shorter than first consultations by 19.4 minutes (95% CI -24.9 to -14.0; p<0.001), regardless of care modality, while family meetings showed no difference in duration compared with first consultations (95% CI -13.8 to 8.9; p=0.70). Each additional healthcare provider was associated with a 2.9 minute increase in consultation time (95% CI 0.1 to 5.6; p=0.04). ECOG was not independently associated with total consultation duration. Conclusions: After accounting for visit type and clinical context, differences in consultation duration between telehealth and in-person are modest. Telehealth was preferentially used for follow-up care and among patients with poorer functional status and quality of life, while preserving consultation complexity when clinically indicated. These findings support telehealth as a viable modality for outpatient palliative care delivery in resource-limited settings.