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Impact of Virtual vs. In-Person Palliative Care on Symptom Burden: A Multisite Cohort Study
Sarah Nouri1, Steven Z Pantilat1, Christine S Ritchie2
1Division of Palliative Medicine (S.N., S.Z.P., D.R.), Department of Medicine, University of California San Francisco, San Francisco, California, USA.
Journal of Pain and Symptom Management
|March 29, 2026
Summary
Mixed outpatient palliative care (OPC) significantly reduces symptom burden more than in-person or virtual care alone. This approach offers better symptom management for serious illnesses.
Area of Science:
- Palliative Care Research
- Health Services Research
- Symptom Management
Background:
- Outpatient palliative care (OPC) delivery is increasingly virtual.
- Outcomes related to symptom burden in virtual OPC are not well understood.
- Understanding the impact of different care modalities on patient symptoms is crucial.
Purpose of the Study:
- To investigate the relationship between symptom burden and visit modality in outpatient palliative care.
- To analyze changes in symptom burden over time based on in-person, virtual, or mixed care models.
- To identify optimal care delivery strategies for managing symptoms in serious illnesses.
Main Methods:
- Retrospective cohort study of 3,896 patients across 58 OPC programs.
- Examined changes in symptom burden (Edmonton Symptom Assessment Scale, ESAS) over the first four visits.
- Utilized mixed-effects multinomial regression to compare trends in ESAS scores by visit modality (in-person, virtual, mixed).
Main Results:
- Mixed-modality care showed a greater decrease in symptom burden (-5.9 points) compared to virtual care (+0.03).
- In-person care also demonstrated significant symptom reduction (-3.6 points) versus virtual care.
- Patients with moderate-to-severe baseline symptoms experienced the most significant improvement with mixed care (-24.1 points).
Conclusions:
- Mixed virtual and in-person outpatient palliative care is associated with superior symptom burden reduction.
- This hybrid model may offer enhanced symptom management compared to exclusive in-person or virtual approaches.
- Findings support the integration of virtual and in-person modalities for optimizing palliative care delivery.
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