In This Article
- With a growing population, the demand for palliative care physicians in the United States is set to increase
- Mihir Kamdar, MD, is working to identify innovative solutions to the impending increase in palliative care patients
- Digital health technologies are a promising tool that can help patients without requiring phone calls or in-person visits
Due to a growing population with a longer life expectancy, the need for better pain control is expected to increase dramatically over the next 25 years, particularly among geriatric and cancer patients. Mihir Kamdar, MD, associate director of the Division of Palliative Care and director of the Mass General Cancer Pain Clinic at the Mass General Cancer Center, is working to find solutions to the challenges facing clinicians to provide the best possible care.
In this Q&A, Dr. Kamdar discusses some of his ongoing research, including a push to encourage both patients and their clinicians to adopt digital health technologies that can help provide more effective palliative care and also reduce some of the barriers that medical professionals experience when trying to deliver that care.
Q: What is the focus of your research?
Kamdar: I'm very interested in developing new and innovative models of care to improve the quality of life for our patients. I have a particular interest in how we can better control cancer pain because it's such a huge problem. Pain affects around 70% to 90% of patients with advanced cancer. And in palliative care, a lot of what we do is the management of cancer pain, because cancer is such a common thing that we see.
Q: What are some of the ways you're working to address pain?
Kamdar: I'm most interested in thinking of novel solutions to address not only cancer pain, but also new models of palliative care delivery that can help meet the rising needs that our field will face in the coming decades. I think the thoughtful use of technology could help us meet these needs and actually bring our patients closer to us.
Q: What does innovation look like in this field?
Kamdar: We know that with the aging of our population, the number of people who are going to need some type of palliative care support in the next 25 years is estimated to double. And yet presently we only have about 5,000 to 6,000 palliative care clinicians in the U.S. So the question is: how can we possibly meet the needs of tens of millions of patients with a shortage of clinicians?
I'm looking at digital health and artificial intelligence (AI) to try to meet those needs. We created ePAL, which is a smartphone app that uses AI features to manage patients that have cancer-related pain. It checks in with patients to identify if someone's not doing well, and then it tries to figure out whether this is something the app can help with or is it something that needs immediate clinician help.
We studied ePAL in a randomized controlled trial and found that it not only helps patients with their pain, but it also makes them feel more engaged and empowered to control their pain. Perhaps the biggest finding was that ePAL reduced the likelihood of being admitted to a hospital because of cancer pain by nearly 70%. This was very significant since pain is one of the most common reason patients with cancer get admitted to the hospital.
Q: What are the challenges to getting an older population to use technology like this?
Kamdar: The average age of most of our patients in the study was in the mid-50s, but we did have patients above the age of 65. And certainly making sure that digital health solutions are age-friendly is something we have to address because we want all of our patients to be able to benefit. I'm interested in how we can make something that's applicable for geriatric patients, and how we can tailor these solutions to support caregivers as well.
Q: How does that affect the way clinicians delivery care in their practices?
Kamdar: This whole concept of ePAL came from seeing the gaps in our health care system and wondering how we could extend the reach of our care to help patients at home. For me, the ability to think creatively about how we can use innovation to target these problems is everything. It makes me feel more empowered as a clinician to find creative solutions to address these challenges and really push the envelope. At a place like Mass General, we can identify these solutions that hopefully can have a larger impact, ideally, across the country.
We might even see greater benefits in places that don't have access to palliative care, which is still a large part of the country—not only rural areas, but also urban areas. That's where the need is—to show that it works in those situations—in being able to provide virtual palliative care to places where patients cannot easily access these important resources.
Q: Do you feel less connection with your patients by seeing them virtually?
Kamdar: Interestingly, we didn't find that to be the case. The app was handling a lot of the problems patients were experiencing, and it wasn't triggering many phone calls. Anecdotally we heard patients say they felt as if their clinician was on the other side of the app, and that felt good. They knew if they needed their clinician, they were there.
Certainly, while there are patient barriers to integrating these digital health solutions, there may also be adoption challenges from clinicians who worry that technology is going to put distance between them and their patients, even though we didn't find this to be the case with ePAL.
Q: How do you convince hesitant physicians to take this on?
Kamdar: In the medical world, data is the currency of change, and so the fact that we have one of the few randomized controlled trials in all of digital health showing that we can improve patient outcomes and health care utilization is a game changer. Interestingly these improved outcomes also did not seem to increase the burden on providers since the app was only involving them at key moments of need. As clinicians begin to use it, they'll hopefully find this is something that's helpful rather than something that feels like another layer of complexity.
Q: Care at Mass General, and especially at the Mass General Cancer Center, is very multidisciplinary. How does digital health fit into that?
Kamdar: Palliative care has been built on multidisciplinary care. We utilize a team of doctors, nurses, social workers and chaplaincy to address the different elements of suffering that patients and families experience when dealing with illness. My hope is that digital health can integrate into and augment multidisciplinary care, whether it's pain or emotional distress or anything that affects quality of life for our patients.
For example, an app could not only identify specific patient needs, but also triage those needs more effectively. That could mean physical issues—like the need to adjust medications for pain or shortness of breath—would ping a nurse practitioner or physician, whereas a social worker, psychologist or chaplain could be notified if the app detects that someone is in emotional or spiritual distress. There are many ways we can use technology within a multidisciplinary care model to make that comprehensive care more effective and efficient for our patients and providers. And we're looking into that for future iterations of the app.
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