Abstract

Background: Palliative care improves quality of life in patients with serious illness, but access and uptake remain low.

Measures: To determine the impact of a digital, patient facing web application (Epilog) on the uptake of a palliative care benefit in a culturally, health literacy, and racially diverse group of patients with serious illness in South Africa.

Intervention: We analyzed data from Discovery Health, a South African commercial health plan. Participants were at least 18 years old, had stage four solid tumor or hematologic malignancy, and lived at home. They were enrolled for a fourteen-week intervention that took place between April 2023 and July 2023. Participants used the digital tool (Epilog) that supports patients in managing their symptoms, preferences and choices. Outcome was uptake of the palliative care benefit which includes a consultation with a palliative trained physician and access to a nurse and social worker experienced in palliative care. Patients who did not enroll were offered the palliative care benefit in the usual manner, by phone with the health plan care manager.

Outcomes: About 69 participants out of 138 enrolled with Epilog made use of the palliative care benefit. About 123 out of 4000 control patients made use of the same benefit (50% vs. 3%; P < 0.001).

Conclusions: Results of this preliminary study highlight the need for additional investigation of the benefits of the Epilog tool in patients with serious illness.

Keywords: Digital tool in palliative care; Palliative care access; Palliative care uptake.