Telehospice carries end-of-life care over the lines

Systematic Review of Telehospice Telemedicine and e-Health

Background: A 2012 systematic review by Oliver et al. of evidence-based research on telehospice included 26 research articles published between 2000 and 2010 on the use of telehospice connecting hospice professionals with caregivers and their care recipients. The present study replicated research by Oliver et al., extending the time frame from 2010 through 2020. The aim of this study was to answer the question-what is the current state of the evidence related to telehospice services? Materials and Methods: A systematic review was conducted for the time period 2010 to 2020 of the existing literature researching the topic of telehospice. Thirteen articles (five quantitative, six qualitative, and two mixed methods) were found that meet the inclusion criteria of the study. The Methodological Rigor Scoring Instrument was used to code the qualitative and quantitative articles separately to address methodological differences. Results: The most common findings were related to technology adaptation readiness for staff and caregivers. Studies assessed the use of telehospice that included incorporated technology, such as an electronic tablet, to provide synchronous communication between the provider and the patient/caregiver. Provider and caregiver attitudes regarding telehospice care were largely positive with studies reporting acceptance of telehospice as generally high. Conclusions: The past 10 years have yielded a small but significant body of research on telehospice. Published research on the topic reports a generally high level of patient and caregiver satisfaction about the experience, but limited findings have been published relating to patient outcomes. As adaptation of telehospice and technology has surged in the past year, it is expected that additional research on the impact of technology on clinical outcomes will emerge in the future.

Caregiver Comfort With Telehospice

The purpose of this mixed methods study was to examine comfort and emotional support that caregivers of home hospice patients derived from using electronic tablets for telehospice. The use of technology was intended to increase caregiver confidence in symptom management for individuals receiving home-based hospice care. Caregiver survey data were collected over a 2-year period. The survey included both quantitative and qualitative items. A total of 667 caregivers of home hospice patients participated. Most respondents reported being comfortable using telehospice, and as comfort levels increased, caregivers were more willing to use virtual healthcare again. Positive, negative, and neutral themes emerged from the comments by caregivers. The results of this study provide support for using telehospice with caregivers of home hospice patients. Caring for a person at the end of life is stressful and having the ability to contact a professional 24 hours a day provided comfort to the caregivers. Training is essential for caregivers to use technology and integration of technology in the care plans for all hospice patients is important for success.

TeleHospice: A Community-Engaged Model for Utilizing Mobile Tablets to Enhance Rural Hospice Care

Background:

In rural communities, providing hospice care can be a challenge. Hospice personnel sometimes travel great distances to reach patients, resulting in difficulty maintaining access, quality, cost-effectiveness, and safety. In 1998, the University of Kansas Medical Center piloted the country’s first TeleHospice (TH) service. At that time, challenges with broad adoption due to cost and attitudes regarding technology were noted. A second TH project was launched in early 2017 using newer technology; this article updates that ongoing implementation.

Methods:

The Organizational Change Manager was followed for the guided selection of the hospice partner. The University of Kansas Medical Center partnered with Hospice Services, Inc. (HSI), a leader in rural hospice care, providing services to 16 Kansas counties. Along with mobile tablets, a secure cloud-based videoconferencing solution was chosen for ease of use.

Results:

From August 2017 through January 2018, 218 TH videoconferencing encounters including 917 attendees occurred. Calls were made for direct patient care, family support, and administrative purposes. These TH calls have been shown to save HSI money, and initial reports suggest they may strengthen the communication and relationships between staff, patients, and the patient’s family.

Conclusion:

Finding innovative, cost-effective, and community-driven approaches such as TH are needed to continually advance hospice care. TeleHospice’s potential to supplement and improve hospice services while reducing costs is significant, but continued research is needed to understand best fit within frontier hospices, to inform future urban applications, and to address reimbursement.

Assessment and Treatment of Cognition and Communication Skills in Adults With Acquired Brain Injury via Telepractice: A Systematic Review

PURPOSE

This is a systematic review of assessment and treatment of cognitive and communicative abilities of individuals with acquired brain injury via telepractice versus in person. The a priori clinical questions were informed by previous research that highlights the importance of considering any functional implications of outcomes, determining disorder- and setting-specific concerns, and measuring the potential impact of diagnostic accuracy and treatment efficacy data on interpretation of findings.

METHOD

A literature search of multiple databases (e.g., PubMed) was conducted using key words and study inclusion criteria associated with the clinical questions.

RESULTS

Ten group studies were accepted that addressed assessment of motor speech, language, and cognitive impairments; assessment of motor speech and language activity limitations/participation restrictions; and treatment of cognitive impairments and activity limitations/participation restrictions. In most cases, equivalence of outcomes was noted across service delivery methods.

CONCLUSIONS

Limited findings, lack of diagnostic accuracy and treatment efficacy data, and heterogeneity of assessments and interventions precluded robust evaluation of clinical implications for telepractice equivalence and the broader area of telepractice efficacy. Future research is needed that will build upon current knowledge through replication. In addition, further evaluation at the impairment and activity limitation/participation restriction levels is needed.

Case Studies for Telepractice in AAC

As the field of telepractice grows, perceived barriers to service delivery must be anticipated and addressed in order to provide appropriate service delivery to individuals who will benefit from this model. When applying telepractice to the field of AAC, additional barriers are encountered when clients with complex communication needs are unable to speak, often present with severe quadriplegia and are unable to position themselves or access the computer independently, and/or may have cognitive impairments and limited computer experience. Some access methods, such as eye gaze, can also present technological challenges in the telepractice environment. These barriers can be overcome, and telepractice is not only practical and effective, but often a preferred means of service delivery for persons with complex communication needs.

The case for home based telehealth in pediatric palliative care: a systematic review

Background

Over the last decade technology has rapidly changed the ability to provide home telehealth services. At the same time, pediatric palliative care has developed as a small, but distinct speciality. Understanding the experiences of providing home telehealth services in pediatric palliative care is therefore important.

Methods

A literature review was undertaken to identify and critically appraise published work relevant to the area. Studies were identified by searching the electronic databases Medline, CINAHL and Google Scholar. The reference list of each paper was also inspected to identify any further studies.

Results

There were 33 studies that met the inclusion criteria of which only six were pediatric focussed. Outcome measures included effects on quality of life and anxiety, substitution of home visits, economic factors, barriers, feasibility, acceptability, satisfaction and readiness for telehealth. While studies generally identified benefits of using home telehealth in palliative care, the utilisation of home telehealth programs was limited by numerous challenges.

Conclusion

Research in this area is challenging; ethical issues and logistical factors such as recruitment and attrition because of patient death make determining effectiveness of telehealth interventions difficult. Future research in home telehealth for the pediatric palliative care population should focus on the factors that influence acceptance of telehealth applications, including goals of care, access to alternative modes of care, perceived need for care, and comfort with using technology.

Videoconferencing and dietitian services in rural Ontario communities

Registered dietitians (RDs) are regulated health professionals in short supply in Ontario and throughout Canada. Projected workforce studies indicate the situation will likely worsen. Accessing these nutrition specialists is an even greater concern for residents living in rural or remote regions of the province. Smaller communities are increasingly using telehealth as a way to deliver health care services and to improve access to health care professionals. The adoption of interactive videoconferencing as a telehealth application is examined as an alternative approach for accessing RDs in rural communities. While valid reasons exist for implementing videoconferencing, other issues must be considered. These include costs, technological requirements, organizational readiness, and legal and ethical concerns. Future research must fully address the concept of videoconferencing in relation to the Canadian dietetic workforce and practice requirements.

Telehospice: reasons for slow adoption in home hospice care

We investigated why hospice nurses were slow to adopt videophones to care for their patients. We used the unified theory of acceptance and use of technology (UTAUT) model and the organizational readiness for change (ORC) assessment via interviews and focus groups with hospice staff. Twenty-five hospice employees participated. Eighteen (72%) were in clinical positions and seven were in non-clinical positions (28%). Thirty-nine percent of respondents reported no videophone training, despite the fact that every employee had received training. Only four staff members actually used a videophone with patients. The respondents overwhelmingly stated that they had the organizational resources necessary to use the videophone and that it was easy to operate. Despite initial enthusiasm, leaders in the hospice agency did not endorse the videophones for work, nor offer incentives for using the videophones or providing them to patients. It is important to note that videophone technology is not meant to replace face-to-face visits, but to supplement them and to provide an additional tool for the nurses.

Patients and families experiences with video telehealth in rural/remote communities in Northern Canada

AIM

To explore patients' and families' experiences with video telehealth consultations as a method of health care delivery in rural/ remote communities in Northern Canada.

BACKGROUND

Accessing health services in isolated populations where human resources and infrastructure are constrained by vast geographical landmasses poses challenges and opportunities for nurses, health care providers, patients and families.

DESIGN

A qualitative approach was adopted with a purposeful sample of 10 patients and four family members representative of nine communities.

METHOD

Selection criteria included patients receiving telehealth visits for a minimum of a year and willing to share their experiences. Data were collected during the winter of 2006 using semi-structured video taped interviews and analysed using a qualitative thematic content analysis.

RESULTS

Patients and families experiences of their telehealth visits centered on three key themes: lessening the burden (costs of travel, accommodations, lost wages, lost time and physical limitations), maximising supports (access to family, friends, familiar home environment, nurses and other care providers), tailoring specific e-health systems to enhance patient and family needs.

CONCLUSION

The benefits of telehealth extend not only to patients and families but are linked to benefits for providers as well as the health care system.

RELEVANCE TO CLINICAL PRACTICE

This study indicates that video telehealth is an effective mechanism for delivering nursing and other health services to rural/remote communities and can impact positively on the quality of health care. The integration of telehealth practice can enhance the coordination, organisation and implementation of health care services.

Visioning technology for the future of telehealth

By its very nature, telehealth relies on technology. Throughout history, as new technologies emerged and afforded people the ability to send information across distances, it was not long before this capability was applied to the most basic need of all: maintaining health. While much of the early work in telehealth was driven by technology (e.g., making opportunistic use of the systems and devices that were available at the time), recent trends are beginning to push the demand for and the development of new technologies specific to the individual needs of telehealth applications. The future of telehealth will benefit greatly from this technology innovation, in particular, in areas such as home telehealth and remote monitoring, e-health and patient portal applications, personal health records, interactive Internet technologies, and robotics. Telehealth, while not a panacea for all of the challenges facing modern healthcare systems, has a substantial and ever-expanding potential to revolutionize the ways in which people receive medical care while offering the possibility to contain costs, manage chronic diseases, and prevent secondary complications. By demanding innovative solutions and speaking out in support of the field, the telehealth community can and should be leading the charge for greater attention to human factors in technology development, interoperable medical records, staff training and competencies, standards and guidelines, and support for expanded telehealth coverage at the national, state, and local levels.

Bridging the distance: educating nurses for telehealth practice

BACKGROUND

The aim of this research project was to explore the impact of telehealth technology on health assessments performed by nurses delivering health services to isolated populations.

METHOD

Nurses performing preoperative and oncology assessments for clients in remote communities via telehealth received training. Education workshops were delivered to nurses (N = 37) in 13 communities across Northwestern Ontario.

RESULTS/CONCLUSION

Presurveys and postsurveys indicated that the nurses were receptive to the mode of delivery and the content was relevant to their telehealth practice.

Nursing and the informatics revolution

The Institute of Medicine's quality initiatives have collectively emphasized the importance of information technology to the transformation of health care. Not coincidentally, federal initiatives in 2004 have signaled the start of "the decade of health information technology." Building on those reports, this article describes the informatics revolution in process, and nursing's readiness to move in that direction. The promise of informatics in reshaping practice is sketched out in terms of seven aims for improvement, followed by a listing of some of the issues that must be addressed for nursing to realize those possibilities. In similar fashion, changes in academia are discussed both in terms of the promise of informatics applications and the barriers to achieving that preferred future. The article ends with some policy recommendations and reflections on opportunities at hand, particularly the growing emphasis on patient self-management support.