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Shih KK, Arechiga AB, Chen X, Urbauer DL, De Moraes AR, Rodriguez AJ, Thomas L, Stanton PA, Bruera E, Hui D. Telehealth Preferences Among Patients With Advanced Cancer in the Post COVID-19 Vaccine Era. J Pain Symptom Manage 2024; 67:525-534.e1. [PMID: 38467349 DOI: 10.1016/j.jpainsymman.2024.02.572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 01/30/2024] [Accepted: 02/28/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND Few studies have examined patient preferences for telehealth in palliative care after the availability of COVID-19 vaccines. We examined patient preferences for video versus in-person visits and factors contributing to preferences in the postvaccine era. METHODS This is a cross-sectional survey of patients who were seen at our palliative care clinic between April 2021 and March 2022. Patients were surveyed directly their preference for either video or in-person visits for outpatient palliative care (primary outcome). We also surveyed preferences including convenience, cost, wait time, and perceptions of COVID-19 safety regarding their palliative virtual-video visit. We examined clinical factors associated with preferences with multivariate logistic regression. RESULTS About 200 patients completed the survey. 132 (67%, 95% confidence interval [CI]: 60%, 74%) preferred virtual-video, while 16 (8%) preferred in-person visits during the COVID-19 pandemic. About 120 (61%, 95%CI: 54%, 68%) preferred virtual-video after the pandemic. Patients perceived virtual-video favorably regarding travel and related costs (179 [91%]), convenience (175 [88%]), and wait time (136 [69%]). Multivariable analysis showed concerns for catching COVID-19 from healthcare providers (odds ratio [OR]: 4.20; 95%CI: 1.24-14.25; P = 0.02) and feeling comfortable with computers or mobile devices (OR: 4.59; 95%CI: 1.02, 20.60; P = 0.047) were significantly associated with preferring virtual-video. Patients who were of Hispanic or Latino ethnicity (OR: 0.25; 95%CI: 0.09, 0.71) and had increased dypsnea (OR: 0.74; 95%CI: 0.59, 0.93) were less likely to prefer video over in-person. CONCLUSION Patients expressed strong preference for video over in-person visits in the outpatient palliative care setting.
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Affiliation(s)
- Kaoswi K Shih
- Department of Palliative, Rehabilitation and Integrative Medicine (K.K.S., A.B.A., A.R.D.M., A.J.R., L.T., P.A.S., E.B., D.H.), The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Adrienne B Arechiga
- Department of Palliative, Rehabilitation and Integrative Medicine (K.K.S., A.B.A., A.R.D.M., A.J.R., L.T., P.A.S., E.B., D.H.), The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Xi Chen
- Department of Biostatistics (X.C., D.L.U.), The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Diana L Urbauer
- Department of Biostatistics (X.C., D.L.U.), The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Aline Rozman De Moraes
- Department of Palliative, Rehabilitation and Integrative Medicine (K.K.S., A.B.A., A.R.D.M., A.J.R., L.T., P.A.S., E.B., D.H.), The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ashley J Rodriguez
- Department of Palliative, Rehabilitation and Integrative Medicine (K.K.S., A.B.A., A.R.D.M., A.J.R., L.T., P.A.S., E.B., D.H.), The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Lisa Thomas
- Department of Palliative, Rehabilitation and Integrative Medicine (K.K.S., A.B.A., A.R.D.M., A.J.R., L.T., P.A.S., E.B., D.H.), The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Penny A Stanton
- Department of Palliative, Rehabilitation and Integrative Medicine (K.K.S., A.B.A., A.R.D.M., A.J.R., L.T., P.A.S., E.B., D.H.), The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Eduardo Bruera
- Department of Palliative, Rehabilitation and Integrative Medicine (K.K.S., A.B.A., A.R.D.M., A.J.R., L.T., P.A.S., E.B., D.H.), The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - David Hui
- Department of Palliative, Rehabilitation and Integrative Medicine (K.K.S., A.B.A., A.R.D.M., A.J.R., L.T., P.A.S., E.B., D.H.), The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
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Bernhardt F, Bückmann A, Krüger J, Bauer B, Hofmeister U, Juhra C, Eveslage M, Fischhuber K, Storck M, Brix TJ, Lenz P. Telemedicine Plus Standard Care Versus Standard Care Only in Specialized Outpatient Palliative Care: A Randomized Controlled Noninferiority Trial. Telemed J E Health 2024; 30:1459-1469. [PMID: 38294865 DOI: 10.1089/tmj.2023.0621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024] Open
Abstract
Background: Patients suffering from incurable diseases are more likely to die in the hospital than at home. Specialized outpatient palliative care (PC) may be able to counteract this tendency. Similarly, potential benefits of telemedicine in health care were scientifically reported. The aim of this research was to compare patients receiving specialized outpatient PC plus telemedicine with those receiving standard specialized outpatient PC only. In this study, telemedicine is assumed to decrease the number of home visits and therefore should not be considered a mere add-on. Methods: This is a randomized controlled noninferiority trial. Recruitment lasted between January 2020 and October 2021. Quality of care was evaluated using the Integrated Palliative Care Outcome Scale (IPOS) at day 0, 7, and 14 after randomization. Change from day 0 to 7 was defined as the primary outcome (noninferiority margin = 4 points). This study was conducted in an urban setting in collaboration with a university hospital and a local specialized outpatient PC service. Results: A total of 196 patients were screened with 34 patients included (18 telemedicine/16 standard care). The mean change in the total score of the IPOS from day 0 to 7 amounted to -1.8 ± 3.9 (telemedicine) versus 1.2 ± 5.7 (standard care). The telemedicine group was statistically not relevantly inferior to the standard care group (t-test for noninferiority, p = 0.005). Conclusions: Although, due to COVID-19, the sample size remained rather small, our findings indicate that telemedical approaches offer a promising and equally effective option to provide specialized outpatient PC. Clinical Trial Registration Number: NCT06054048.
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Affiliation(s)
- Florian Bernhardt
- Department of Palliative Care, University Hospital Muenster, Muenster, Germany
- West German Cancer Center Consortium, Network Partner Muenster, University Hospital Muenster, Muenster, Germany
| | - Andreas Bückmann
- Department of Palliative Care, University Hospital Muenster, Muenster, Germany
- West German Cancer Center Consortium, Network Partner Muenster, University Hospital Muenster, Muenster, Germany
| | - Janina Krüger
- Specialized Outpatient Palliative Care Service Muenster, Palliativnetz Muenster gGmbH, Muenster, Germany
| | - Birgit Bauer
- Specialized Outpatient Palliative Care Service Muenster, Palliativnetz Muenster gGmbH, Muenster, Germany
| | - Ulrike Hofmeister
- Specialized Outpatient Palliative Care Service Muenster, Palliativnetz Muenster gGmbH, Muenster, Germany
| | - Christian Juhra
- Office for eHealth, University Hospital Muenster, Muenster, Germany
| | - Maria Eveslage
- Institute of Biostatistics and Clinical Research, University of Muenster, Muenster, Germany
| | - Karen Fischhuber
- Institute of Biostatistics and Clinical Research, University of Muenster, Muenster, Germany
| | - Michael Storck
- Institute of Medical Informatics, University of Muenster, Muenster, Germany
| | - Tobias J Brix
- Institute of Medical Informatics, University of Muenster, Muenster, Germany
| | - Philipp Lenz
- Department of Palliative Care, University Hospital Muenster, Muenster, Germany
- West German Cancer Center Consortium, Network Partner Muenster, University Hospital Muenster, Muenster, Germany
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Dilhani WNS, Mitchell S, Dale J, Toor K, Javaid M, MacArtney JI. A mixed-methods systematic review investigating the use of digital health interventions to provide palliative and end-of-life care for patients in low- and middle-income countries. Palliat Care Soc Pract 2024; 18:26323524241236965. [PMID: 38617095 PMCID: PMC11010586 DOI: 10.1177/26323524241236965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 02/15/2024] [Indexed: 04/16/2024] Open
Abstract
Background The need for palliative care is rising globally with 76% of those who are in need living in low- and middle-income countries (LMICs). Digital health interventions (DHIs) have been identified as a means of making palliative care more widely accessible. This review summarizes the range and characteristics of DHIs used to deliver palliative care in LMICs and sought to identify factors that influence their implementation and utilization. Objectives This review aims to summarize the range and characteristics of DHIs used to deliver palliative care in LMICs and identify factors that influence their implementation and utilization. Design Mixed-method systematic review incorporating both quantitative and qualitative data. Data sources and methods All studies focusing on DHIs for patients who need palliative care (adults/children) and their caregivers (patient and caregiver centred) in LMICs and published in English were identified through a systematic search of MEDLINE, EMBASE, PsycINFO and CINAHL databases. Data synthesis and analysis were carried out following the convergent integrated approach based on the Joanna Briggs Institute (JBI) methodology for mixed-methods systematic reviews. Results Fifteen studies were included (three qualitative, four mixed-methods and eight quantitative studies). Telemedicine/mHealth was the most reported DHI utilized in LMICs in delivering palliative care. Patients and caregivers benefited from using DHIs in many ways including increased access to care with reduced discomfort, travel time and risk of health care-associated infections. Health care providers also reported that using DHI such as telemedicine enables them to provide care in a more effective and efficient way. Four factors were identified as the main barriers to implementation: resource constraints; literacy, training and skills; governance, operational and communication issues and technical issues. Conclusion DHIs, such as telemedicine, have the potential to enhance accessibility to palliative care in LMICs, particularly in rural areas. Comprehensive strategies for their use are required to address the identified barriers.
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Affiliation(s)
| | - Sarah Mitchell
- Division of Primary Care, Palliative Care and Public Health, University of Leeds, Leeds, UK
| | - Jeremy Dale
- Unit of Academic Primary Care, Warwick Medical School, University of Warwick, Coventry, UK
| | - Kavanbir Toor
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Mikail Javaid
- Warwick Medical School, University of Warwick, Coventry, UK
| | - John I. MacArtney
- Unit of Academic Primary Care, Warwick Medical School, University of Warwick, Medical School Building, Coventry, West Midlands CV4 7AL, UK
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Khou M, Lo A, Barclay G, Baytieh L. Exploration of Patient and Clinician Experience of Video Consultations in Community Palliative Care. J Pain Symptom Manage 2024; 67:e321-e331. [PMID: 38215897 DOI: 10.1016/j.jpainsymman.2023.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 12/03/2023] [Accepted: 12/21/2023] [Indexed: 01/14/2024]
Abstract
CONTEXT Telehealth video consultations (VCs) were implemented in the community palliative care team (CPCT) in a regional NSW health district, Australia, as a response to restrictions to the COVID-19 pandemic, using patient's device in the absence of a clinician. OBJECTIVES To evaluate patient/carer and clinician satisfaction in using VCs for CPC consultations; to explore advantages and challenges of VCs. METHODS Self-reported online questionnaires to community-dwelling patients under care of the CPCT; seeking patients/carers and clinician perspectives on the VCs from April to September 2020. RESULTS Of 126 eSurveys completed, (85 clinicians; 41 patients/carers), 97% patient/carers and 97% clinicians indicated they were satisfied with VC. Overall, 93% clinicians agreed they provided same level of care compared to face-to-face review; 85% patients/carers agreed they received same level of care compared to face-to-face consultations and 98% agreed their issues were addressed. Of eSurvey responses 97% clinicians and 78% patients/carers indicated they would continue to use VCs in practice. Comments indicated dissatisfaction with lack of personal examination; some found technological issues to be barriers. Benefits discovered incidentally were empowering patient independence to live out their end-of-life desires while being treated/supported, improved service delivery, increased staff autonomy and upskilling staff. CONCLUSION Users in this study perceived VCs to have a place in CPC consultations. Using patient device enabled patient freedom, improved timeliness of clinical assessment, and communication to complement face-to-face consults, while minimizing infection risk. Unexpected, but valuable benefits were revealed. Workable technology is paramount.
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Affiliation(s)
- Muoi Khou
- Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia.
| | - Angela Lo
- Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia
| | - Greg Barclay
- Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia
| | - Lina Baytieh
- Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia
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5
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Bange EM, Li Y, Kumar P, Doucette A, Gabriel P, Parikh R, Li EH, Mamtani R, Getz KD. The association between telemedicine, advance care planning, and unplanned hospitalizations among high-risk patients with cancer. Cancer 2024; 130:636-644. [PMID: 37987207 PMCID: PMC10922036 DOI: 10.1002/cncr.35116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 08/31/2023] [Accepted: 10/15/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND Despite the widespread implementation of telemedicine, there are limited data regarding its impact on key components of care for patients with incurable or high-risk cancer. For these patients, high-quality care requires detailed conversations regarding treatment priorities (advance care planning) and clinical care to minimize unnecessary acute care (unplanned hospitalizations). Whether telemedicine affects these outcomes relative to in-person clinic visits was examined among patients with cancer at high risk for 6-month mortality. METHODS This retrospective cohort study included adult patients with cancer with any tumor type treated at the University of Pennsylvania who were newly identified between April 1 and December 31, 2020, to be at high risk for 6-month mortality via a validated machine learning algorithm. Separate modified Poisson regressions were used to assess the occurrence of advance care planning and unplanned hospitalizations for telemedicine as compared to in-person visits. Additional analyses were done comparing telemedicine type (video or phone) as compared to in-person clinic visits. RESULTS The occurrence of advance care planning was similar between telemedicine and in-person visits (6.8% vs. 6.0%; adjusted risk ratio [aRR], 1.25; 95% CI, 0.92-1.69). In regard to telemedicine subtype, patients exposed to video encounters were modestly more likely to have documented advance care planning in comparison to those seen in person (7.5% vs. 6.0%; aRR, 1.48; 95% CI, 1.03-2.11). The 3-month risk for unplanned hospitalization was comparable for telemedicine compared to in-person clinic encounters (21% vs. 18%; aRR, 1.06; 95% CI, 0.81-1.38). CONCLUSIONS In this study, care delivered by telemedicine, compared to in-person clinic visits, produced comparable rates of advance care planning conversations without increasing hospitalizations, which suggests that vulnerable patients can be managed safely by telemedicine.
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Affiliation(s)
- Erin M Bange
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Yimei Li
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Pallavi Kumar
- Palliative and Hospice Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Abigail Doucette
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Peter Gabriel
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ravi Parikh
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Division of Hematology/Oncology, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
| | - Eric H Li
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ronac Mamtani
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Kelly D Getz
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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Lee J, Mc Carthy O, Ryan S, Kiely F. Video consultations in community palliative care - patient satisfaction: mixed methods study. BMJ Support Palliat Care 2024; 13:e1212-e1216. [PMID: 36418034 DOI: 10.1136/spcare-2022-003757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 10/27/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Community palliative care (CPC) has traditionally been delivered face to face in the home or in the outpatient clinic setting. The COVID-19 pandemic necessitated the introduction of video consultation (VC) as a modality of CPC service provision. Evidence supports the feasibility of VC in CPC. There is a paucity of evidence regarding patient satisfaction with key components of the palliative care consultation when delivered virtually. METHODS Mixed quantitative and qualitative study. The formulated telephone questionnaire evaluated satisfaction with VC in three domains: comfort with use of technology, communication using video technology and components of the palliative care consultation. Results were analysed descriptively with thematic analysis of free text additional information. RESULTS The majority (93%) of patients were satisfied with VC. All patients felt able to communicate what they wanted to say. The majority felt comfortable asking questions (90%) and a minority (16%) were dissatisfied that they could not be physically examined. Patients were satisfied with discussing physical symptoms (90%) and medications (90%). Areas which were not discussed or had less favourable feedback included exploration of spirituality and faith. Themes identified included: flexibility and convenience offered by VC, relationship and rapport building in the context of VC and technological challenges posed by VC. CONCLUSIONS Patients were satisfied with VC as a mechanism of CPC provision. Satisfaction, although generally high, varied across key components of the consultation demonstrating the strengths and limitations of this modality at present. This provides clinicians with valuable information to guide future research and service development.
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Affiliation(s)
- Jessica Lee
- Palliative Medicine, Marymount University Hospital and Hospice, Cork, Ireland
| | - Orfhlaith Mc Carthy
- Palliative Medicine, Marymount University Hospital and Hospice, Cork, Ireland
| | - Suzanne Ryan
- Palliative Medicine, Marymount University Hospital and Hospice, Cork, Ireland
| | - Fiona Kiely
- Palliative Medicine, Marymount University Hospital and Hospice, Cork, Ireland
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Hayes Bauer E, Schultz ANØ, Brandt F, Smith AC, Bollig G, Dieperink KB. Patient and families' perspectives on telepalliative care: A systematic integrative review. Palliat Med 2024; 38:42-56. [PMID: 38112009 PMCID: PMC10865769 DOI: 10.1177/02692163231217146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2023]
Abstract
BACKGROUND Telepalliative care is increasingly used in palliative care, but has yet to be examined from a patient and family perspective. A synthesis of evidence may provide knowledge on how to plan and provide telepalliative care that caters specifically to patients and families' needs. OBJECTIVE To synthesise evidence on patients and families' perspectives on telepalliative care. DESIGN A systematic integrative review (PROSPERO #CRD42022301206) reported in accordance with PRISMA 2020 guidelines. Inclusion criteria; primary peer-reviewed studies published 2011-2022, patient and family perspective, >18 years, telepalliative care and English/Danish language. Quality was appraised using the mixed-methods appraisal tool, version 2020. Guided by Toronto and Remington, data were extracted, thematically analysed and synthesised. DATA SOURCES MEDLINE, EMBASE, PsycINFO and CINAHL were searched in March 2022 and updated in February 2023. RESULTS Forty-four studies were included. Analysis revealed five themes; the effect of the Covid-19 pandemic on telepalliative care, adding value for patients and families, synchronous and asynchronous telepalliative care, the integration of telepalliative care with other services and the tailoring and timing of telepalliative care. CONCLUSION Enhanced access to care and convenience, as attributes of telepalliative care, are highly valued. Patients and families have varying needs during the illness trajectory that may be addressed by early integration of telepalliative care based on models of care that are flexible and combine synchronous and asynchronous solutions. Further research should examine telepalliative care in a post-pandemic context, use of models of care and identify meaningful outcome measures from patient and family perspectives for evaluation of telepalliative care.
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Affiliation(s)
- Eithne Hayes Bauer
- Institute of Regional Health Research, Hospital Soenderjylland, University of Southern Denmark, Odense, Denmark
- Department of Internal Medicine, Medical Research Unit, Hospital Soenderjylland, University Hospital of Southern Jutland, Aabenraa, Denmark
- Centre for Innovative Medical Technology, Odense University Hospital, Odense, Denmark
- Faculty of Health Sciences, Department of Clinical Research, Family Focused Healthcare Research Centre (FaCe), University of Southern Denmark, Odense, Denmark
| | - Anders Nikolai Ørsted Schultz
- Institute of Regional Health Research, Hospital Soenderjylland, University of Southern Denmark, Odense, Denmark
- Department of Internal Medicine, Medical Research Unit, Hospital Soenderjylland, University Hospital of Southern Jutland, Aabenraa, Denmark
- Centre for Innovative Medical Technology, Odense University Hospital, Odense, Denmark
| | - Frans Brandt
- Institute of Regional Health Research, Hospital Soenderjylland, University of Southern Denmark, Odense, Denmark
- Department of Internal Medicine, Medical Research Unit, Hospital Soenderjylland, University Hospital of Southern Jutland, Aabenraa, Denmark
| | - Anthony C Smith
- Centre for Innovative Medical Technology, Odense University Hospital, Odense, Denmark
- Faculty of Medicine, Centre for Online Health, The University of Queensland, Australia
| | - Georg Bollig
- HELIOS Klinikum Schleswig, Department of Anesthesiology, Intensive Care, Palliative Medicine and Pain Therapy, Schleswig, Schleswig-Holstein, Germany
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Karin Brochstedt Dieperink
- Faculty of Health Sciences, Department of Clinical Research, Family Focused Healthcare Research Centre (FaCe), University of Southern Denmark, Odense, Denmark
- Department of Oncology, Odense University Hospital, Odense, Denmark
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Nurtsch A, Teufel M, Jahre LM, Esber A, Rausch R, Tewes M, Schöbel C, Palm S, Schuler M, Schadendorf D, Skoda EM, Bäuerle A. Drivers and barriers of patients' acceptance of video consultation in cancer care. Digit Health 2024; 10:20552076231222108. [PMID: 38188860 PMCID: PMC10768612 DOI: 10.1177/20552076231222108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2023] [Indexed: 01/09/2024] Open
Abstract
Background Due to digitization in the medical sector, many healthcare interactions are switched to online services. This study assessed the acceptance of video consultations (VCs) in cancer care, and determined drivers and barriers of acceptance. Methods A cross-sectional online-based survey study was conducted in Germany from February 2022 to February 2023. Recruitment took place at oncology outpatient clinics, general practitioners, oncology practices and via cancer-related social media channels. Inclusion criteria were a cancer diagnosis, cancer treatment and internet access. Sociodemographic, medical data, eHealth-related data were acquired via an online assessment. The Unified Theory of Acceptance and Use of Technology (UTAUT) model was used to determine the acceptance of VC and its predictors. Results Of N = 350 cancer patients, 56.0% (n = 196) reported high acceptance of VC, 28.0% (n = 98) stated moderate acceptance and 16.0% (n = 56) indicated low acceptance. Factors influencing acceptance were younger age (β = -.28, p < .001), female gender (β = .35, p = .005), stage of disease (β = .11, p = .032), high digital confidence (β = .14, p = .010), low internet anxiety (β = -.21, p = .001), high digital overload (β = -.12, p = .022), high eHealth literacy (β = .14, p = .028), personal trust (β = -.25, p < .001), internet use (β = .17, p = .002), and the UTAUT predictors: performance expectancy (β = .24, p < .001), effort expectancy (β = .26, p < .001), and social influence (β = .34, p < .001). Conclusions Patients' acceptance of VC in cancer care is high. Drivers and barriers to acceptance identified should be considered for personalized applications. Considering the growing demand for cancer care establishing digital healthcare solutions is justified.
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Affiliation(s)
- Angelina Nurtsch
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Martin Teufel
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital, University of Duisburg-Essen, Essen, Germany
- West German Cancer Center, University Hospital Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Lisa Maria Jahre
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - André Esber
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Raya Rausch
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital, University of Duisburg-Essen, Essen, Germany
- West German Cancer Center, University Hospital Essen, Essen, Germany
| | - Mitra Tewes
- West German Cancer Center, University Hospital Essen, Essen, Germany
- Department of Palliative Medicine, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Christoph Schöbel
- Faculty of Sleep Medicine and Telemedicine, West German Lung Center, University Medicine Essen - Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany
| | - Stefan Palm
- West German Cancer Center, University Hospital Essen, Essen, Germany
| | - Martin Schuler
- West German Cancer Center, University Hospital Essen, Essen, Germany
- Department of Medical Oncology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Dirk Schadendorf
- West German Cancer Center, University Hospital Essen, Essen, Germany
- Department of Dermatology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Eva-Maria Skoda
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital, University of Duisburg-Essen, Essen, Germany
- West German Cancer Center, University Hospital Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Alexander Bäuerle
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital, University of Duisburg-Essen, Essen, Germany
- West German Cancer Center, University Hospital Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
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Martins MDLDC, Pinto S. Analysis of a telephone hotline for palliative care patients at home and their families. Int J Palliat Nurs 2023; 29:571-577. [PMID: 38085617 DOI: 10.12968/ijpn.2023.29.12.571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
BACKGROUND To describe the use of a telephone consultation (TC) hotline for palliative care (PC) patients and their families at home provided by a PC service, during the COVID-19 lockdown. METHODS Observational and cross-sectional study of a TC hotline performed by a PC service from 1 January to 31 December 2020. Data was collected through a record sheet completed during the call. Descriptive analyses were performed using the SPSS software (V.21 for Windows). RESULTS A total of 494 calls were retrieved (n=187 patients; 6500 minutes recorded). Compared to 2019, incoming calls increased 33.8%. Most callers were a family member (n=419) or a community health worker (n= 60). The peak of calls was registered in April (13.5%), May (13.2%) and October (15.0%). Main problems included uncontrolled symptoms (81.9%), need for medication (8.6%), information (4.8%) and consultation rescheduling (2.6%). In 81.9% of the cases, the call occurred during a crisis. The PC team solved 92.9% of the problems. Only 20 patients were admitted in the emergency department (this was 30.5% less compared to 2019). CONCLUSIONS The TC is a feasible alternative to traditional in-person follow-ups. Callers considered it very useful, especially during the COVID-19 lockdown. Communication was improved and admissions to emergency services were reduced.
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Affiliation(s)
- Maria de Lurdes da Costa Martins
- Researcher, Clinical Academic Center of Trás-os-Montes and Alto Douro-Professor Doutor Nuno Grande; Specialist's Nurse, Palliative Care, Hospital of Trás-os-montes e Alto Douro, Portugal
| | - Sara Pinto
- Nursing School of Porto, Portugal; Faculty of Medicine, University of Coimbra
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Sadang KG, Centracchio JA, Turk Y, Park E, Feliciano JL, Chua IS, Blackhall L, Silveira MJ, Fischer SM, Rabow M, Zachariah F, Grey C, Campbell TC, Strand J, Temel JS, Greer JA. Clinician Perceptions of Barriers and Facilitators for Delivering Early Integrated Palliative Care via Telehealth. Cancers (Basel) 2023; 15:5340. [PMID: 38001600 PMCID: PMC10670662 DOI: 10.3390/cancers15225340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 10/31/2023] [Accepted: 11/06/2023] [Indexed: 11/26/2023] Open
Abstract
Early integrated palliative care (EIPC) significantly improves clinical outcomes for patients with advanced cancer. Telehealth may be a useful tool to deliver EIPC sustainably and equitably. Palliative care clinicians completed a survey regarding their perceptions of the barriers, facilitators, and benefits of using telehealth video visits for delivering EIPC for patients with advanced lung cancer. Forty-eight clinicians across 22 cancer centers completed the survey between May and July 2022. Most (91.7%) agreed that telehealth increases access to EIPC and simplifies the process for patients to receive EIPC (79.2%). Clinicians noted that the elderly, those in rural areas, and those with less-resourced backgrounds have greater difficulty using telehealth. Perceived barriers were largely patient-based factors, including technological literacy, internet and device availability, and patient preferences. Clinicians agreed that several organizational factors facilitated telehealth EIPC delivery, including technological infrastructure (85.4%), training (83.3%), and support from study coordinators (81.3%). Other barriers included systems-based factors, such as insurance reimbursement and out-of-state coverage restrictions. Patient-, organization-, and systems-based factors are all important to providing and improving access to telehealth EIPC services. Further research is needed to investigate the efficacy of telehealth EIPC and how policies and interventions may improve access to and dissemination of this care modality.
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Affiliation(s)
- Katrina Grace Sadang
- Harvard T. H. Chan School of Public Health, Boston, MA 02115, USA;
- Lifelong Medical Care Family Medicine Residency, Richmond, CA 94801, USA
| | - Joely A. Centracchio
- Massachusetts General Hospital, Boston, MA 02114, USA; (J.A.C.); (Y.T.); (E.P.); (J.S.T.)
| | - Yael Turk
- Massachusetts General Hospital, Boston, MA 02114, USA; (J.A.C.); (Y.T.); (E.P.); (J.S.T.)
| | - Elyse Park
- Massachusetts General Hospital, Boston, MA 02114, USA; (J.A.C.); (Y.T.); (E.P.); (J.S.T.)
| | | | - Isaac S. Chua
- Brigham and Women’s Hospital & Dana-Farber Cancer Institute, Boston, MA 02215, USA;
| | - Leslie Blackhall
- Department of Palliative Care, University of Virginia, Charlottesville, VA 22903, USA;
| | - Maria J. Silveira
- Department of Geriatrics and Palliative Medicine, Ann Arbor Veterans Affairs (VA) Medical Center, University of Michigan, Ann Arbor, MI 48104, USA;
| | | | - Michael Rabow
- University of California San Francisco Medical Center, San Francisco, CA 94143, USA;
| | | | - Carl Grey
- Wake Forest Baptist Health, Winston-Salem, NC 27157, USA;
| | - Toby C. Campbell
- Department of Hematology/Oncology and Palliative Care, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705, USA;
| | | | - Jennifer S. Temel
- Massachusetts General Hospital, Boston, MA 02114, USA; (J.A.C.); (Y.T.); (E.P.); (J.S.T.)
| | - Joseph A. Greer
- Massachusetts General Hospital, Boston, MA 02114, USA; (J.A.C.); (Y.T.); (E.P.); (J.S.T.)
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11
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Marshall C, Virdun C, Phillips JL. Evidence-based models of rural palliative care: A systematic review. Palliat Med 2023; 37:1129-1143. [PMID: 37537971 DOI: 10.1177/02692163231183994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
BACKGROUND Forty-five percent of the world's population lives in rural areas, yet their access to palliative care is quite limited. Identifying the care elements rural populations with palliative care needs require is critical to improving care outcomes. AIM To identify the key care elements that optimise palliative care for people in rural communities. DESIGN AND DATA SOURCES A systematic review of articles studying the impact of novel rural model of care interventions was undertaken in May 2022. This study is reported using the PRISMA Statement and was registered with Prospero (CRD42020154273). Three databases were searched, and the data analysed according to Popay's narrative synthesis, and elements classified using the WHO Innovative Care for Chronic Conditions (ICCC) Framework. RESULTS Of the 9508 identified papers, 15 met the inclusion criteria, reporting on 14 studies involving 1820 rural patients. Care received spanned 12/18 of the WHO ICCC Framework elements, with wide variability in how these elements were operationalised. The five elements that signal improved outcomes were: (1) Promote continuity and coordination; (2) Prepared, informed and motivated health care teams; (3) Prepared, informed and motivated patients and families; (4) Organise and equip health care teams and (5) Promote consistent financing. CONCLUSIONS A well-coordinated multidisciplinary team approach, led by clinicians with specialist palliative care expertise, integrated across local health care settings, using information systems and care planning, is critical to optimising rural palliative care patient outcomes. Rural patients and their families require timely input from specialist palliative care clinicians and information to address their needs.Prospero registration ID: CRD42020154273 https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=154273.
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Affiliation(s)
- Claire Marshall
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), University of Technology Sydney, Sydney, NSW, Australia
| | - Claudia Virdun
- Faculty of Health, Queensland University of Technology, Kelvin Grove, QLD, Australia
| | - Jane L Phillips
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), University of Technology Sydney, Sydney, NSW, Australia
- Faculty of Health, Queensland University of Technology, Kelvin Grove, QLD, Australia
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12
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English W, Robinson J, Gott M. Health professionals' experiences of rapport during telehealth encounters in community palliative care: An interpretive description study. Palliat Med 2023:2692163231172243. [PMID: 37129344 DOI: 10.1177/02692163231172243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
BACKGROUND Despite the reported importance of rapport, there are knowledge gaps in the ways rapport is developed and experienced by health professionals during telehealth calls in palliative care. AIM To gain an understanding about developing rapport during telehealth calls by exploring the experiences of health professionals in community palliative care. DESIGN A qualitative Interpretive Description study was conducted with semi-structured interviews and focus groups between November 2020 and May 2021. Data was audio recorded, transcribed, and analysed using Reflexive thematic analysis. A COREQ checklist was completed. SETTING/PARTICIPANTS Thirty-one palliative care professionals who had participated in telehealth calls were recruited from four hospice locations in Aotearoa, New Zealand. RESULTS There were two themes identified: (1) 'Getting on together', which included how rapport shows up in telehealth, with examples of calls with rapport and without rapport, and (2) 'Rapport is a soft skill', which identified health professionals using body language and listening in specific ways in telehealth, while being aware of the privacy of calls, and lack of training concerns. CONCLUSION Based on health professionals experiences of rapport it was determined that rapport is vitally important in telehealth calls, as it is in-person interactions. Rapport is a soft skill that can potentially be learned, practiced and mastery developed, although rapport in each interaction is not guaranteed. Patient and family experiences of rapport in the palliative telehealth area warrants further research and there is some urgency for health professional training in telehealth interpersonal skills.
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Affiliation(s)
- Wendy English
- School of Nursing, University of Auckland, Auckland, New Zealand
| | - Jackie Robinson
- School of Nursing, University of Auckland, Auckland, New Zealand
| | - Merryn Gott
- School of Nursing, University of Auckland, Auckland, New Zealand
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Bückmann A, Bernhardt F, Eveslage M, Storck M, Thölking G, Buss H, Domagk D, Juhra C, Lenz P. Telemedical Consultations in Palliative Care: Benefits through Knowledge Exchange and Intercollegiate Collaboration-Findings from the German oVID Project. Cancers (Basel) 2023; 15:cancers15092512. [PMID: 37173978 PMCID: PMC10177576 DOI: 10.3390/cancers15092512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 04/19/2023] [Accepted: 04/25/2023] [Indexed: 05/15/2023] Open
Abstract
(1) Background: As the number of people receiving specialized palliative care (PC) continues to rise, there is a need to ensure the transfer of this expertise from university-based PC departments to primary care hospitals without such in-house access. The present study examines the potential of telemedicine to bridge these gaps. (2) Methods: This is a prospective multi-center feasibility trial. All physicians were appropriately pre-equipped and instructed to conduct telemedical consultations (TCs), which took place within fixed meetings or on-call appointments either related or unrelated to individual patients (allowing TCs also for educational and knowledge exchange purposes). (3) Results: An inquiry for participation was submitted to 11 hospitals, with 5 external hospitals actively cooperating. In the first study section, a total of 57 patient cases were included within 95 patient-related TCs during 80 meetings. Other university disciplines were involved in 21 meetings (26.2%). Therapy adjustments resulted following 25 of 71 affected TCs (35.2%). In 20 cases (21.1%), an on-site consultation at the university hospital was avoided, and in 12 cases (12.6%), a transfer was avoided. Overall, TCs were considered helpful in resolving issues for 97.9% of the cases (n = 93). Yet, technical problems arose in about one-third of all meetings for at least one physician (36.2%; n = 29). Besides, in the second study section, we also conducted 43 meetings between physicians for education and knowledge exchange only. (4) Conclusions: Telemedicine has the potential to transfer university expertise to external hospitals through simple means. It improves collaboration among physicians, may prevent unnecessary transfers or outpatient presentations, and is thus likely to lower costs.
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Affiliation(s)
- Andreas Bückmann
- Department of Palliative Care, University Hospital Muenster, 48149 Muenster, Germany
- West German Cancer Center Consortium (WTZ), Network Partner Muenster, University Hospital Muenster, 48149 Muenster, Germany
| | - Florian Bernhardt
- Department of Palliative Care, University Hospital Muenster, 48149 Muenster, Germany
- West German Cancer Center Consortium (WTZ), Network Partner Muenster, University Hospital Muenster, 48149 Muenster, Germany
| | - Maria Eveslage
- Institute of Biostatistics and Clinical Research, University of Muenster, 48149 Muenster, Germany
| | - Michael Storck
- Institute of Medical Informatics, University of Muenster, 48149 Muenster, Germany
| | - Gerold Thölking
- Department of Internal Medicine and Nephrology, University Hospital Muenster Marienhospital Steinfurt, 48565 Steinfurt, Germany
| | - Helga Buss
- Department of Geriatrics, EVK Muenster Alexianer Johannisstift GmbH, 48147 Muenster, Germany
| | - Dirk Domagk
- Department of Medicine I: Internal Medicine and Gastroenterology, Josephs-Hospital Warendorf, Academic Teaching Hospital of the University of Muenster, 48231 Warendorf, Germany
| | - Christian Juhra
- Office for eHealth, University Hospital Muenster, 48149 Muenster, Germany
| | - Philipp Lenz
- Department of Palliative Care, University Hospital Muenster, 48149 Muenster, Germany
- West German Cancer Center Consortium (WTZ), Network Partner Muenster, University Hospital Muenster, 48149 Muenster, Germany
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14
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Steindal SA, Nes AAG, Godskesen TE, Holmen H, Winger A, Österlind J, Dihle A, Klarare A. Advantages and Challenges of Using Telehealth for Home-Based Palliative Care: Systematic Mixed Studies Review. J Med Internet Res 2023; 25:e43684. [PMID: 36912876 PMCID: PMC10131904 DOI: 10.2196/43684] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 01/27/2023] [Accepted: 01/28/2023] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Owing to the increasing number of people with palliative care needs and the current shortage of health care professionals (HCPs), providing quality palliative care has become challenging. Telehealth could enable patients to spend as much time as possible at home. However, no previous systematic mixed studies reviews have synthesized evidence on patients' experiences of the advantages and challenges of telehealth in home-based palliative care. OBJECTIVE In this systematic mixed studies review, we aimed to critically appraise and synthesize the findings from studies that investigated patients' use of telehealth in home-based palliative care, focusing on the advantages and challenges experienced by patients. METHODS This is a systematic mixed studies review with a convergent design. The review is reported according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. A systematic search was performed in the following databases: Allied and Complementary Medicine Database, CINAHL, Cochrane Central Register of Controlled Trials, Embase, Latin American and Caribbean Health Sciences Literature, MEDLINE, PsycInfo, and Web of Science. The inclusion criteria were as follows: studies using quantitative, qualitative, or mixed methods; studies that investigated the experience of using telehealth with follow-up from HCPs of home-based patients aged ≥18; studies published between January 2010 and June 2022; and studies published in Norwegian, Danish, Swedish, English, Portuguese, or Spanish in peer-reviewed journals. Five pairs of authors independently assessed eligibility of the studies, appraised methodological quality, and extracted data. The data were synthesized using thematic synthesis. RESULTS This systematic mixed studies review included 41 reports from 40 studies. The following 4 analytical themes were synthesized: potential for a support system and self-governance at home; visibility supports interpersonal relationships and a joint understanding of care needs; optimized information flow facilitates tailoring of remote caring practices; and technology, relationships, and complexity as perpetual obstacles in telehealth. CONCLUSIONS The advantages of telehealth were that patients experience a potential support system that could enable them to remain at home, and the visual features of telehealth enable them to build interpersonal relationships with HCPs over time. Self-reporting provides HCPs with information about symptoms and circumstances that facilitates tailoring care to specific patients. Challenges with the use of telehealth were related to barriers to technology use and inflexible reporting of complex and fluctuating symptoms and circumstances using electronic questionnaires. Few studies have included the self-reporting of existential or spiritual concerns, emotions, and well-being. Some patients perceived telehealth as intrusive and a threat to their privacy at home. To optimize the advantages and minimize the challenges with the use of telehealth in home-based palliative care, future research should include users in the design and development process.
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Affiliation(s)
- Simen A Steindal
- Lovisenberg Diaconal University College, Oslo, Norway.,Institute of Nursing, Faculty of Health Studies, VID Specialized University, Oslo, Norway
| | | | - Tove E Godskesen
- Department of Health Care Sciences, Palliative Research Centre, Marie Cederschiöld University, Stockholm, Sweden.,Centre for Research Ethics & Bioethics, Uppsala University, Uppsala, Sweden
| | - Heidi Holmen
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway.,The Intervention Centre, Oslo University Hospital, Oslo, Norway
| | - Anette Winger
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Jane Österlind
- Department of Health Care Sciences, Palliative Research Centre, Marie Cederschiöld University, Stockholm, Sweden
| | - Alfhild Dihle
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Anna Klarare
- Department of Health Care Sciences, Palliative Research Centre, Marie Cederschiöld University, Stockholm, Sweden.,Healthcare Services and e-Health, Department for Women's and Children's Health, Uppsala University, Uppsala, Sweden
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15
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Finucane AM, Hulbert-Williams NJ, Swash B, Spiller JA, Wright B, Milton L, Gillanders D. Feasibility of RESTORE: An online Acceptance and Commitment Therapy intervention to improve palliative care staff wellbeing. Palliat Med 2023; 37:244-256. [PMID: 36576308 DOI: 10.1177/02692163221143817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Acceptance and Commitment Therapy is a form of Cognitive Behavioural Therapy which uses behavioural psychology, values, acceptance and mindfulness techniques to improve mental health and wellbeing. Acceptance and Commitment Therapy is efficacious in treating stress, anxiety and depression in a broad range of settings including occupational contexts where emotional labour is high. This approach could help palliative care staff to manage work-related stress and promote wellbeing. AIM To develop, and feasibility test, an online Acceptance and Commitment Therapy intervention to improve wellbeing of palliative care staff. DESIGN A single-arm feasibility trial of an 8-week Acceptance and Commitment Therapy based intervention for staff, consisting of three online facilitated group workshops and five online individual self-directed learning modules. Data was collected via online questionnaire at four time-points and online focus groups at follow-up. SETTING/PARTICIPANTS Participants were recruited from Marie Curie hospice and nursing services in Scotland. RESULTS Twenty five staff commenced and 23 completed the intervention (93%). Fifteen participated in focus groups. Twelve (48%) completed questionnaires at follow-up. Participants found the intervention enjoyable, informative and beneficial. There was preliminary evidence for improvements in psychological flexibility (Cohen's d = 0.7) and mental wellbeing (Cohen's d = 0.49) between baseline and follow-up, but minimal change in perceived stress, burnout or compassion satisfaction. CONCLUSION Online Acceptance and Commitment Therapy for wellbeing is acceptable to palliative care staff and feasible to implement using Microsoft Teams in a palliative care setting. Incorporating ways to promote long-term maintenance of behaviour changes, and strategies to optimise data collection at follow-up are key considerations for future intervention refinement and evaluation.
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Affiliation(s)
- Anne M Finucane
- Clinical Psychology, University of Edinburgh, UK.,Marie Curie Hospice Edinburgh, Edinburgh, UK
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16
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Patient behaviors during virtual clinic encounters in palliative care. Palliat Support Care 2023; 21:178-180. [PMID: 35670297 DOI: 10.1017/s1478951522000669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Telehealth use has accelerated since the COVID-19 pandemic and provided access for palliative care patients often facing challenges with travel and limited specialist availability. Our palliative care clinic at the University of Texas MD Anderson Cancer Center has rapidly adopted telehealth which continues to grow and provide care for patients since the pandemic, becoming a routine part of our center. While we strive to maintain consistency when it comes to compassionate, sensitive verbal and non-verbal communication, we have witnessed both advantages and disadvantages to telehealth services. We have come across unanticipated virtual visit challenges while trying to deliver quality care, surprising us from the other side of the camera. In this paper, we describe three cases of unexpected telehealth etiquette that posed new challenges in being able to complete virtual visits. We propose guidelines for setting patient etiquette for a productive telehealth palliative visit.
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Pinto CDS, Borsatto AZ, Vaz DC, Sampaio SGDSM, Oliveira LCD. Telemedicina em Cuidados Paliativos Oncológicos: um Legado da Pandemia. REVISTA BRASILEIRA DE CANCEROLOGIA 2023. [DOI: 10.32635/2176-9745.rbc.2023v69n1.2698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Introdução: A telemedicina pode ser um instrumento útil para o acompanhamento de pacientes em cuidados paliativos, especialmente no contexto da pandemia por covid-19. Objetivo: Descrever o uso da telemedicina para pacientes em cuidados paliativos oncológicos acompanhados ambulatorialmente em uma unidade de referência nacional. Método: Análise retrospectiva de teleatendimentos médicos realizados entre abril de 2020 e fevereiro de 2021 a pacientes da unidade acompanhados ambulatorialmente. Foram analisados dados demográficos e clínicos dos pacientes, características do teleatendimento e conduta médica, e feita uma avaliação subjetiva com os profissionais responsáveis pelos teleatendimentos. Resultados: Foram realizados 1.645 teleatendimentos médicos a 470 pacientes com idade média de 62 (54-73) anos, sendo a maioria do sexo feminino (n=258; 54,9%) e com Karnofsky Performance Status estimado em 40% ou superior (n=423; 90,0%) no momento do primeiro contato a distância. Os teleatendimentos foram realizados, em sua maior parte (n=928; 56,4%), para o monitoramento da carga de sintomas entre as consultas presenciais. Destes, em 612 (frequência relativa=65,9%), houve sintoma controlado no teleatendimento subsequente. A queixa mais prevalente foi dor (n=303; frequência relativa=32,7%) seguida por sintomas gripais (n=108; frequência relativa=11,6%). Entre as condutas traçadas, a mais prevalente (n=921; 56,0%) foi o comparecimento apenas do responsável pela retirada dos medicamentos, sem necessidade de deslocamento do paciente. Conclusão: A telemedicina mostrou-se útil na monitorização de sintomas de pacientes com câncer avançado e permitiu que pacientes e cuidadores se mantivessem em seus domicílios, reduzindo o deslocamento e, consequentemente, o risco de contágio por covid-19.
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Esber A, Teufel M, Jahre L, in der Schmitten J, Skoda EM, Bäuerle A. Predictors of patients' acceptance of video consultation in general practice during the coronavirus disease 2019 pandemic applying the unified theory of acceptance and use of technology model. Digit Health 2023; 9:20552076221149317. [PMID: 36815005 PMCID: PMC9940186 DOI: 10.1177/20552076221149317] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 12/18/2022] [Indexed: 01/20/2023] Open
Abstract
Background The coronavirus disease 2019 pandemic has led to an increase in remote consultations in health care. This study aimed to assess the acceptance of video consultation as an alternative to face-to-face in-office visits in general practice (GP) and to investigate its drivers and barriers. Methods A cross-sectional study was conducted in Germany during the coronavirus disease 2019 pandemic from December 2020 to April 2021. Participants were recruited among patients in 16 GP surgeries. Assessed were sociodemographic and medical data as well as information and communications technology related data. Acceptance of video consultation and its predictors were determined using a modified questionnaire based on a short version of the renowned unified theory of acceptance and use of technology model. Results In total, 371 participants were included in the data analysis. Acceptance of video consultation was moderate. A hierarchical regression revealed acceptance was significantly predicted by the PHQ-2, taking no regular medication, computer proficiency, knowledge about digital health care solutions, no prior use of video consultation, and the unified theory of acceptance and use of technology predictors performance expectancy, effort expectancy, and social influence. The extended unified theory of acceptance and use of technology model explained significantly more variance than the restricted unified theory of acceptance and use of technology model in acceptance of video consultation. Conclusions In this study computer proficiency, existing knowledge about digital health care solutions and depressive symptoms functioned as drivers to acceptance, no prior use of video consultation could be identified as a potential barrier. Patients with regular medication have been particularly receptive to video consultation. The study confirmed the validity of the unified theory of acceptance and use of technology model in determining acceptance of video consultation. Considering that there is growing demand and acceptance for different approaches to engage with health care providers, additional steps should be taken to establish video consultation as a genuine alternative.
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Affiliation(s)
- André Esber
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Martin Teufel
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany,Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Lisa Jahre
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany,Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Jürgen in der Schmitten
- Institute of General Practice, Center for Translational Neuro- and Behavioral Sciences, Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - Eva-Maria Skoda
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany,Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Alexander Bäuerle
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany,Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany,Alexander Bäuerle, Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
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Lantheaume S, Doublet L, Mory JE, Durand T, Lebosse W, Heudel PE. A qualitative study of teleconsultation practices among French oncologists in a post-COVID-19 period. Digit Health 2023; 9:20552076231215906. [PMID: 38033511 PMCID: PMC10685777 DOI: 10.1177/20552076231215906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 11/06/2023] [Indexed: 12/02/2023] Open
Abstract
Background The Covid-19 pandemic has prompted healthcare professionals to adapt and implement new tools to ensure continuity of patient care. Teleconsultation became the only option for some practitioners who had never used it previously and boosted its use for others who already used it. Several studies have reviewed the use of teleconsultation in oncology during the epidemic, but few have addressed its continued use and how practitioners view it in a post-epidemic period. The aim of this survey was to conduct a qualitative exploration of how oncologists use teleconsultation in their daily practice in a post-COVID 19 period. Materials and Methods For this qualitative study, semi-structured interviews were conducted with oncologists in France who utilized teleconsultation in the field of oncology during the COVID-19 period. The interview guide included questions on the interests and limitations of using teleconsultation in oncology, on reluctance to use it among oncologists, and invited participants to formulate proposals for more optimal use. Results Fourteen oncologists participated in the survey. Currently, 12% of the consultations of the surveyed practitioners are conducted via teleconsultation. Seven themes were identified in the analysis of the interviews: (a) The oncologist and teleconsultation; (b) Clinical motivations for using teleconsultation; (c) Comparison between teleconsultation and in-person consultation; (d) Advantages and disadvantages of teleconsultation; (e) Technical modalities of teleconsultation; (f) Role of Covid and confinement in the use of teleconsultation; (h) Epistemic judgments about teleconsultation. Optimal teleconsultation occurs when seamlessly incorporated into patient care, offering reduced patient inconvenience, and providing economic and environmental benefits. Although there's a lack of unified agreement in research literature regarding time efficiency, teleconsultation facilitates more customized patient monitoring and addresses the challenge of "medical deserts" nationally. Considering patient preferences is crucial when contemplating the use of teleconsultation. Predominantly, technical issues stand as the principal barriers to teleconsultation implementation. Conclusion Even after the end of the health crisis, teleconsultation is still used in clinical practice. Recommendations for effective use are suggested.
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Affiliation(s)
- Sophie Lantheaume
- Ramsay Santé Hôpital Privé Drôme Ardèche, 07500 Guilherand-Granges, France
- Univ. Grenoble Alpes, Univ. Savoie Mont Blanc, LIP/PC2S, 38000 Grenoble, France
| | - Louis Doublet
- Ramsay Santé Hôpital Privé Drôme Ardèche, 07500 Guilherand-Granges, France
| | - Jean-Eudes Mory
- Ramsay Santé Hôpital Privé Drôme Ardèche, 07500 Guilherand-Granges, France
- Centre de Coordination de Cancérologie Drôme Ardèche, 26000 Valence, France
| | - Thierry Durand
- Direction des systèmes d’information, centre Léon Bérard, 69008 Lyon, France
| | - William Lebosse
- Centre de Coordination de Cancérologie Rhodanien, Centre Léon Bérard, 69008 Lyon, France
| | - Pierre-Etienne Heudel
- Centre de Coordination de Cancérologie Rhodanien, Centre Léon Bérard, 69008 Lyon, France
- Département d’Oncologie Médicale, Centre Léon Bérard, 69008 Lyon, France
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20
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Dieperink KB, Vestergaard LV, Møller PK, Tolstrup LK. Using video consultations for clinical assessment and decision of treatment readiness before chemotherapy: A mixed-methods study among patients with gastrointestinal cancer and oncology nurses. Digit Health 2023; 9:20552076231197415. [PMID: 37675059 PMCID: PMC10478534 DOI: 10.1177/20552076231197415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 08/09/2023] [Indexed: 09/08/2023] Open
Abstract
Objective To investigate the feasibility of clinical assessment and decision of treatment readiness before chemotherapy using video consultations, as perceived by gastrointestinal cancer patients and oncology nurses. In addition, to estimate reductions in travel time for patients and environmental carbon dioxide (CO2) emissions. Methods In a mixed-method study, patients with gastrointestinal cancer who participated in at least one video consultation during April-October 2019 completed a questionnaire on socioeconomic status, time and kilometers saved on travel. Kilometers saved were converted into reduced CO2 emissions. Descriptive statistics were used for analysis. Patients (n = 15) participated in semi-structured individual interviews, and five oncology nurses participated in a focus group interview. Results A total of 84/119 patients (71%) consented to video consultation and responded to the questionnaire. 69% were male, with a mean age of 66 years. For 46% of patients, a video consultation saved more than an hour of travel time. Avoiding a median travel distance of 120 km per patient (range, 2-450 km) reduced CO2 emissions by 7018 lb. Video consultations had other positive effects on patients, including avoiding waiting rooms, having more energy, and experiencing more focused interactions with nurses. Technical issues occurred rarely. Nurses found technical issues more troublesome, sometimes precluding complete assessments. They reported a need to rethink nursing practice to effectively provide care during video consultations. Conclusions Video consultations reduced CO2 emissions. In addition, they were beneficial for patients with gastrointestinal cancer. However, providing an optimal clinical assessment and decision of treatment readiness before chemotherapy requires testing patient equipment, technical skills and new oncology nursing competencies.
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Affiliation(s)
- Karin Brochstedt Dieperink
- Research Unit of Oncology, The Academy of Geriatric Cancer Research (www.agecare.org), Odense University Hospital, Odense C, Denmark
- Family Focused Healthcare Research Center (FaCe), Odense C, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense C, Denmark
| | - Lene Vedel Vestergaard
- Research Unit of Oncology, The Academy of Geriatric Cancer Research (www.agecare.org), Odense University Hospital, Odense C, Denmark
| | - Pia Krause Møller
- Research Unit of Oncology, The Academy of Geriatric Cancer Research (www.agecare.org), Odense University Hospital, Odense C, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense C, Denmark
| | - Lærke Kjær Tolstrup
- Research Unit of Oncology, The Academy of Geriatric Cancer Research (www.agecare.org), Odense University Hospital, Odense C, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense C, Denmark
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21
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McDonald J, Marco D, Howard R, Fox E, Weil J. Implementation of an integrated respiratory palliative care service for patients with advanced lung disease. AUST HEALTH REV 2022; 46:713-721. [PMID: 36223731 DOI: 10.1071/ah22103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 09/21/2022] [Indexed: 12/13/2022]
Abstract
Objectives This study describes the model of care provided by an integrated respiratory and palliative care service for patients with advanced lung disease, and assesses the potential impact of the service on acute hospital utilisation and cost. Methods This study implemented an integrated specialist care service at a single tertiary teaching hospital in Melbourne, Victoria, Australia. The service provided disease-orientated care, alongside symptom management and advance care planning, and comprised both outpatient clinic (OPC) and home visit (HV) capacity for those with barriers to accessing OPC. Acute hospital utilisation and hospital cost were analysed with a paired t -test 90 days before/after the first physician review. Results Between April 2017 and 2019, 51 patients received 59 HVs, whereas between July 2018 and 2020, 58 patients received 206 OPC reviews. Acute hospital admissions decreased by 51% in the HV cohort (P < 0.05) and by 46% in the OPC cohort (P = 0.01); total bed days of acute admissions decreased by 29% in the HV cohort (P = n.s.), and by 60% in the OPC cohort (P < 0.05); and specialist outpatient clinic attendances decreased in the OPC cohort by 55% (P < 0.01). There was a decrease in hospital cost for the HV cohort by 3% (cost savings of A$18 579), and in the OPC cohort by 23% (cost savings of A$109 149). Conclusions This model of care provided specialist respiratory management with seamless integration of palliative care, with the capacity for home visits. There was a decrease in acute hospital utilisation and overall cost savings observed in both HV and OPC cohorts.
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Affiliation(s)
- Julie McDonald
- Respiratory and Sleep Medicine Department, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, Vic. 3065, Australia; and Palliative Care Department, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, Vic. 3065, Australia
| | - David Marco
- Centre for Palliative Care, St Vincent's Hospital Melbourne and University of Melbourne, Fitzroy, Vic. 3065, Australia
| | - Rebecca Howard
- Health Independence Program, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, Vic. 3065, Australia
| | - Euan Fox
- Respiratory and Sleep Medicine Department, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, Vic. 3065, Australia
| | - Jennifer Weil
- Palliative Care Department, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, Vic. 3065, Australia; and Centre for Palliative Care, St Vincent's Hospital Melbourne and University of Melbourne, Fitzroy, Vic. 3065, Australia; and Department of Medicine, University of Melbourne, Parkville, Vic. 3052, Australia
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22
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Evering RMH, Postel MG, van Os-Medendorp H, Bults M, den Ouden MEM. Intention of healthcare providers to use video-communication in terminal care: a cross-sectional study. BMC Palliat Care 2022; 21:213. [PMID: 36451219 PMCID: PMC9713136 DOI: 10.1186/s12904-022-01100-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 11/10/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Interdisciplinary collaboration between healthcare providers with regard to consultation, transfer and advice in terminal care is both important and challenging. The use of video communication in terminal care is low while in first-line healthcare it has the potential to improve quality of care, as it allows healthcare providers to assess the clinical situation in real time and determine collectively what care is needed. The aim of the present study is to explore the intention to use video communication by healthcare providers in interprofessional terminal care and predictors herein. METHODS In this cross-sectional study, an online survey was used to explore the intention to use video communication. The survey was sent to first-line healthcare providers involved in terminal care (at home, in hospices and/ or nursing homes) and consisted of 39 questions regarding demographics, experience with video communication and constructs of intention to use (i.e. Outcome expectancy, Effort expectancy, Attitude, Social influence, Facilitating conditions, Anxiety, Self-efficacy and Personal innovativeness) based on the Unified Theory of Acceptance and Use of Technology and Diffusion of Innovation Theory. Descriptive statistics were used to analyze demographics and experiences with video communication. A multiple linear regression analysis was performed to give insight in the intention to use video communication and predictors herein. RESULTS 90 respondents were included in the analysis.65 (72%) respondents had experience with video communication within their profession, although only 15 respondents (17%) used it in terminal care. In general, healthcare providers intended to use video communication in terminal care (Mean (M) = 3.6; Standard Deviation (SD) = .88). The regression model was significant (F = 9.809, p-value<.001) and explained 44% of the variance in intention to use video communication, with 'Outcome expectancy' (beta .420, p < .001) and 'Social influence' (beta .266, p = .004) as significant predictors. CONCLUSIONS Healthcare providers have in general the intention to use video communication in interprofessional terminal care. However, their actual use in terminal care is low. 'Outcome expectancy' and 'Social influence' seem to be important predictors for intention to use video communication. This implicates the importance of informing healthcare providers, and their colleagues and significant others, about the usefulness and efficiency of video communication.
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Affiliation(s)
- Richard M. H. Evering
- grid.5477.10000000120346234Research group Technology, Health & Care, Saxion, University of Applied Sciences, Enschede, Netherlands
| | - Marloes G. Postel
- grid.5477.10000000120346234Research group Technology, Health & Care, Saxion, University of Applied Sciences, Enschede, Netherlands
| | - Harmieke van Os-Medendorp
- grid.5477.10000000120346234Research group Smart Health, Saxion, University of Applied Sciences, School of Health, Deventer/ Enschede, Netherlands
| | - Marloes Bults
- grid.5477.10000000120346234Research group Technology, Health & Care, Saxion, University of Applied Sciences, Enschede, Netherlands
| | - Marjolein E. M. den Ouden
- grid.5477.10000000120346234Research group Technology, Health & Care, Saxion, University of Applied Sciences, Enschede, Netherlands ,Research group Care and Technology, Regional Community College of Twente, Hengelo, Netherlands
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23
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Uemoto Y, Yamanaka T, Kataoka Y, Wada Y, Aoyama Y, Kizawa R, Yamaguchi T, Kikawa Y, Mukai H, Taira N. Efficacy of Telemedicine Using Videoconferencing Systems in Outpatient Care for Patients With Cancer: A Systematic Review and Meta-Analysis. JCO Clin Cancer Inform 2022; 6:e2200084. [PMID: 36417685 DOI: 10.1200/cci.22.00084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE This systematic review aimed to investigate the efficacy of telemedicine (TM) using videoconferencing systems in outpatient care for patients with cancer. METHODS We searched six electronic databases (CENTRAL, MEDLINE, EMBASE, CINAHL, ICTRP, and ClinicalTrials.gov) through June 2021 to identify randomized controlled trials that evaluated the use of TM using videoconferencing systems compared with usual face-to-face care in outpatient care for patients with cancer. We assessed the certainty of evidence on the basis of the Grading of Recommendations, Assessment, Development, and Evaluation. RESULTS From the 2,400 articles screened, six randomized controlled trials were eligible for this study. Two studies evaluated the use of TM in cancer follow-up and four investigated psychotherapy for cancer. TM using videoconferencing systems may result in no differences in primary outcomes such as patient satisfaction (standardized mean difference, 0.11; 95% CI, -0.18 to 0.40) and outpatient attendance complete proportion (risk difference, 0.02%; 95% CI, -0.04 to 0.09), and secondary outcomes such as medical professional satisfaction, time devoted to outpatient care, and depression score. The certainty of evidence for these outcomes was low. Although the average money spent on outpatient visit was a primary outcome, the level of evidence was uncertain. CONCLUSION Our results suggest that TM using videoconferencing systems in outpatient care for patients with cancer may be as effective as usual face-to-face care. Use of TM more frequently may be considered for patients with cancer who are expected to obtain benefit from TM using videoconference systems.
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Affiliation(s)
- Yasuaki Uemoto
- Department of Breast Surgery, Nagoya City University Graduate School of Medical Sciences, Mizuho-cho, Mizuho-ku, Nagoya, Japan
| | - Taro Yamanaka
- Department of Medical Oncology, Toranomon Hospital, Minato-ku, Tokyo, Japan
| | - Yuki Kataoka
- Department of Internal Medicine, Kyoto Min-Iren Asukai Hospital, Sakyo-ku, Kyoto, Japan.,Department of Healthcare Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto, Japan.,Section of Clinical Epidemiology, Department of Community Medicine, Kyoto University Graduate School of Medicine, Yoshida Konoe-cho, Sakyo-ku, Kyoto, Japan.,Systematic Review Workshop Peer Support Group (SRWS-PSG), Osaka, Japan
| | - Yoshitaka Wada
- Systematic Review Workshop Peer Support Group (SRWS-PSG), Osaka, Japan.,Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Aichi, Japan
| | - Yosuke Aoyama
- Department of Medical Oncology, Toranomon Hospital, Minato-ku, Tokyo, Japan
| | - Rika Kizawa
- Department of Medical Oncology, Toranomon Hospital, Minato-ku, Tokyo, Japan
| | - Takeshi Yamaguchi
- Department of Medical Oncology, Toranomon Hospital, Minato-ku, Tokyo, Japan
| | - Yuichiro Kikawa
- Department of Breast Surgery, Kansai Medical University Hospital, Hirakata, Japan
| | - Hirofumi Mukai
- Division of Medical Oncology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Naruto Taira
- Department of Breast and Thyroid Surgery, Kawasaki Medical School, Kurashiki, Okayama, Japan
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24
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Lundereng ED, Nes AAG, Holmen H, Winger A, Thygesen H, Jøranson N, Borge CR, Dajani O, Mariussen KL, Steindal SA. Health Care Professionals’ Experiences and Perspectives on Using Telehealth for Home-based Palliative Care: A Scoping Review (Preprint). J Med Internet Res 2022; 25:e43429. [PMID: 36989024 PMCID: PMC10131609 DOI: 10.2196/43429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 02/10/2023] [Accepted: 02/24/2023] [Indexed: 02/26/2023] Open
Abstract
BACKGROUND Telehealth seems feasible for use in home-based palliative care (HBPC). It may improve access to health care professionals (HCPs) at patients' homes, reduce hospital admissions, enhance patients' feelings of security and safety, and increase the time spent at home for patients in HBPC. HBPC requires the involvement of various HCPs such as nurses, physicians, allied health professionals, dietitians, psychologists, religious counselors, and social workers. Acceptance of the use of technology among HCPs is essential for the successful delivery of telehealth in practice. No scoping review has mapped the experiences and perspectives of HCPs regarding the use of telehealth in HBPC. OBJECTIVE The aim of this review was to systematically map published studies on HCPs' experiences and perspectives on the use of telehealth in HBPC. METHODS A scoping review was conducted using the methodology of Arksey and O'Malley. The review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews. A systematic search was performed in AMED, CINAHL, Embase, MEDLINE, PsycINFO, and Web of Science for studies published in peer-reviewed journals between January 1, 2000, and August 23, 2022. The reference lists of the included papers were hand searched to identify additional studies. The inclusion criteria were (1) studies using qualitative, quantitative, or mixed methods; (2) studies including HCPs using telehealth with patients in HBPC; (3) studies on HCPs' experiences and perspectives on the use of telehealth in HBPC; (4) studies published between January 1, 2000, and August 23, 2022; and (5) studies published in English, Portuguese, Norwegian, Danish, Swedish, or Spanish. Pairs of authors independently included studies and extracted data. The first 2 stages of thematic synthesis were used to thematically organize the data. RESULTS This scoping review included 29 papers from 28 studies. Four descriptive themes were identified: (1) easy to use but technological issues undermine confidence, (2) adds value but personal and organizational barriers challenge adoption, (3) potential to provide useful and meaningful patient-reported data, and (4) mutual trust as a prerequisite for interpersonal relationships. CONCLUSIONS Telehealth in HBPC seems to be easy to use and may improve the coordination of care, time efficiency, clinical assessments, and help build and enhance personal and professional relationships. However, the introduction of technology in HBPC is complex, as it may not align well with the overall aim of palliative care from HCPs' point of view. Further, changes in practice and requirements for HCPs may reduce motivation for the use of telehealth in HBPC. HCPs consider themselves to have central roles in implementing telehealth, and a lack of acceptance and motivation is a key barrier to telehealth adoption. Policy makers and telehealth developers should be aware of this potential barrier when developing or implementing new technology for use in HBPC. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/33305.
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Affiliation(s)
- Elias David Lundereng
- Lovisenberg Diaconal University College, Oslo, Norway
- European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital, Oslo, Norway
| | | | - Heidi Holmen
- Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
- The Intervention Centre, Oslo University Hospital, Oslo, Norway
| | - Anette Winger
- Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
| | - Hilde Thygesen
- Faculty of Health Studies, VID Specialized University, Oslo, Norway
- Department of Occupational Therapy, Prosthetics and Orthotics, Oslo Metropolitan University, Oslo, Norway
| | - Nina Jøranson
- Faculty of Health Studies, VID Specialized University, Oslo, Norway
| | - Christine Råheim Borge
- Research Department, Lovisenberg Diaconal Hospital, Oslo, Norway
- Department of Interdisciplinary Health Sciences, University of Oslo, Oslo, Norway
| | - Olav Dajani
- European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital, Oslo, Norway
| | | | - Simen A Steindal
- Lovisenberg Diaconal University College, Oslo, Norway
- Faculty of Health Studies, VID Specialized University, Oslo, Norway
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25
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Vincent D, Peixoto C, Quinn KL, Kyeremanteng K, Lalumiere G, Kurahashi AM, Gilbert N, Isenberg SR. Virtual home-based palliative care during COVID-19: A qualitative exploration of the patient, caregiver, and healthcare provider experience. Palliat Med 2022; 36:1374-1388. [PMID: 36071621 PMCID: PMC9596681 DOI: 10.1177/02692163221116251] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Due to the COVID-19 pandemic, many community palliative healthcare providers shifted from providing care in a patient's home to providing almost exclusively virtual palliative care, or a combination of in-person and virtual care. Research on virtual palliative care is thus needed to provide evidence-based recommendations aiming to enhance the delivery of palliative care during and beyond the pandemic. AIM To explore the experiences and perceptions of community palliative care providers, patients and caregivers who delivered or received virtual palliative care as a component of home-based palliative care during the COVID-19 pandemic. DESIGN Qualitative study using phone and video-based semi-structured interviews. Data were analyzed using thematic analysis. SETTING/PARTICIPANTS A total of 37 participants, including community palliative care patients/caregivers (n = 19) and healthcare providers (n = 18) recruited from sites in Ottawa and Toronto, Ontario, Canada. RESULTS Overall, participants preferred in-person palliative care compared to virtual care, but suggested virtual care could be a useful supplement to in-person care. The findings are presented in three main themes: (1) Impact of COVID-19 pandemic on community palliative care services; (2) Factors influencing transition from exclusively virtual model of care back to a blended model of care; and (3) Recommended uses and implementation of virtual palliative care. CONCLUSIONS Incorporating virtual palliative care into healthcare provider practice models (blended care models) may be the ideal model of care and standard practice moving forward beyond the COVID-19 pandemic, which has important implications toward organization and delivery of community palliative care services and funding of healthcare providers.
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Affiliation(s)
- Daniel Vincent
- Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute (OHRI), Ottawa, ON, Canada
| | | | - Kieran L Quinn
- Department of Medicine, University of Toronto, Toronto, ON, Canada.,Temmy Latner Centre for Palliative Care, Sinai Health System, Toronto, ON, Canada
| | | | - Genevieve Lalumiere
- Regional Palliative Consultation Team, Elizabeth Bruyère Hospital, Ottawa, ON, Canada
| | - Allison M Kurahashi
- Temmy Latner Centre for Palliative Care, Sinai Health System, Toronto, ON, Canada
| | - Nathalie Gilbert
- Home and Community Care Support Services Champlain, Ottawa, ON, Canada
| | - Sarina R Isenberg
- Bruyère Research Institute, Ottawa, ON, Canada.,Department of Medicine, University of Ottawa, Ottawa, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
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26
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Bauer EH, Schultz ANØ, Brandt F, Smith AC, Bollig G, Dieperink KB. Protocol for an integrative review: patient and families' perspectives on telehealth in palliative care. BMJ Open 2022; 12:e062723. [PMID: 36688736 PMCID: PMC9454006 DOI: 10.1136/bmjopen-2022-062723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 08/09/2022] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION Increases in the use of telehealth in palliative care (telepalliative care) prior to, and during, the COVID-19 pandemic have resulted in a proliferation of studies on the topic. While knowledge is building on how providers and recipients adapt to telepalliative care, no reviews have, as of yet, examined telepalliative care from a patient and family perspective. Therefore, the aim of this integrative review is to explore patients and families' perspectives on telepalliative. METHODS AND ANALYSIS An integrative review will be performed inspired by the methodology of Remmington and Toronto from March 2022 to December 2022. Medline, Embase, PsycINFO and CINAHL will be searched for primary peer-reviewed studies that describe telepalliative care from patient and families' perspectives. Limiters will be used for age; 18 years+, time; 10 years, and language; English and Danish. Hand searches of authors of included articles and reference lists of included articles will be performed. Two reviewers will independently screen and appraise selected articles using the Mixed Method Appraisal Tool. Conflicts will be resolved through discussions with a third reviewer. Data will be extracted independently by two reviewers into a data matrix with predefined headings and analysed using thematic analysis. Findings will be reported thematically, summarised into a thematic synthesis and discussed in relation to relevant literature. ETHICS AND DISSEMINATION Ethical approval is not required for this review. Results will be published in an international peer-reviewed journal and presented at a relevant international conference. Reporting of this protocol was guided by the Preferred Reporting Items for Systematic reviews and Meta-Analyses Protocol checklist and prospectively reported to PROSPERO (CRD42022301206).
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Affiliation(s)
- Eithne Hayes Bauer
- Research Unit, Department of Internal Medicine, Hospital of Southern Jutland Sonderborg Branch, Aabenraa, Denmark
- Institute of Regional Health Research - University Hospital of Southern Denmark, University of Southern Denmark, Aabenraa, Denmark
| | | | - Frans Brandt
- Research Unit, Department of Internal Medicine, Hospital of Southern Jutland Sonderborg Branch, Aabenraa, Denmark
| | - Anthony C Smith
- Centre for Online Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Georg Bollig
- Department of Anesthesiology, Intensive Care, Palliative Medicine and Pain Therapy, Helios Klinikum, Schleswig, Germany
| | - Karin Brochstedt Dieperink
- Department of Oncology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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27
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Supporting dementia family care partners during COVID-19: Perspectives from hospice staff. Geriatr Nurs 2022; 47:265-272. [PMID: 36030641 PMCID: PMC9359485 DOI: 10.1016/j.gerinurse.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 08/03/2022] [Accepted: 08/05/2022] [Indexed: 11/23/2022]
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28
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Rosa WE, Lynch KA, Hadler RA, Mahoney C, Parker PA. "Doing palliative care with my hands tied behind my back": telepalliative care delivery for oncology inpatients during a COVID-19 surge. Transl Behav Med 2022; 12:816-824. [PMID: 35716077 PMCID: PMC9214169 DOI: 10.1093/tbm/ibac044] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
New York City was a “global COVID-19 hotspot” in spring 2020. Many health teams rapidly transitioned to telehealth platforms. Little is known about the experiences of inpatient palliative care services who delivered telehealth services during the pandemic. This study was aimed to explore the experiences of an interdisciplinary palliative care team in meeting the holistic needs of oncology inpatients via telehealth over a 10-week period during the first COVID-19 surge. A targeted sample of interdisciplinary palliative specialists at an urban comprehensive cancer center participated in in-depth interviews that explored participants’ experiences delivering physical, psychosocial, and spiritual care via telehealth. An interdisciplinary coding team followed a rigorous thematic text analysis approach and met regularly to reach consensus on emerging themes. Eleven palliative specialists from six disciplines (chaplaincy, medicine, nursing, pharmacy, physician assistant, and social work) participated. Seventy-three percent reported not receiving telehealth training prior to COVID-19 and 64% were “not at all” or “somewhat comfortable” delivering telepalliative care. Several themes were identified, including the barriers related to telehealth, the impact of telehealth on the quality of relationships with patients, their families, and coworkers, and the changes in perceived self-efficacy of fulfilling job responsibilities. Telehealth use has increased significantly during COVID-19, requiring further evaluation of its utility. Participants reported both positive and negative inpatient telepalliative care experiences associated with various domains of professional functioning, such as communication, relationships with key stakeholders, and self-efficacy. Enhanced telehealth training and support must be improved to sustain the palliative workforce and promote high-quality patient and family care in the future.
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Affiliation(s)
- William E Rosa
- Communication Skills Training Program and Research Laboratory, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kathleen A Lynch
- Patient-Reported Outcomes, Community-Engagement, and Language Core, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Rachel A Hadler
- Department of Anesthesiology, University of Iowa Hospital and Clinics, Iowa City, IA, USA
| | - Cassidy Mahoney
- Communication Skills Training Program and Research Laboratory, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Patricia A Parker
- Communication Skills Training Program and Research Laboratory, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Koppel PD, De Gagne JC, Docherty S, Smith S, Prose NS, Jabaley T. Exploring Nurse and Patient Experiences of Developing Rapport During Oncology Ambulatory Care Videoconferencing Visits: A Qualitative Study (Preprint). J Med Internet Res 2022; 24:e39920. [PMID: 36074558 PMCID: PMC9501656 DOI: 10.2196/39920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 07/08/2022] [Accepted: 07/29/2022] [Indexed: 11/13/2022] Open
Abstract
Background Although videoconferencing between oncology patients and nurses became routine during the pandemic, little is known about the development of clinician-patient rapport in this care environment. Evidence that virtual visits may challenge nurses’ ability to form connections with patients, demonstrate empathy, and provide support suggests that videoconferencing may not ensure optimal care for persons with cancer. Establishing rapport during videoconferencing visits (VCVs) is important in oncology nursing, as rapport enables the nurse to provide emotional support and assistance to patients as they navigate their cancer journey. Objective This study investigated the nature of nurse-patient rapport in ambulatory cancer care videoconferencing telehealth visits. Objectives included exploring (1) how patients with cancer and nurses describe experiences of and strategies for cultivating rapport and (2) similarities and differences between rapport in videoconferencing and in-person visits (IPVs). Methods In this qualitative descriptive study, interviews were conducted from October 2021 to March 2022 with 22 participants, including patients with cancer (n=10, 45%) and oncology nurses (n=12, 55%), about their experiences of rapport building during VCVs. All interviews were analyzed using conventional content analysis. Data from nurses and patients were analyzed separately using identical procedures, with a comparative analysis of patient and nurse results performed in the final analysis. Results Most patients in the study had experienced 3-5 video visits within the past 12 months (n=7, 70%). Half of the nurse participants (n=6, 50%) reported having participated in over 100 VCVs, and all had experiences with videoconferencing (ranging from 3 to 960 visits) over the past 12 months. In total, 3 themes and 6 categories were derived from the patient data, and 4 themes and 13 categories were derived from the nurse data. Comparisons of themes derived from participant interviews identified similarities in how nurses and patients described experiences of rapport during VCVs. Three themes fit the collective data: (1) person-centered and relationship-based care is valued and foundational to nurse-patient rapport in oncology ambulatory care regardless of how care is delivered, (2) adapting a bedside manner to facilitate rapport during VCVs is feasible, and (3) nurses and patients can work together to create person-centered options across the care trajectory to ensure quality care outcomes. Barriers to relationship building in VCVs included unexpected interruptions from others, breaks in the internet connection, concerns about privacy, and limitations associated with not being physically present. Conclusions Person-centered and relationship-based approaches can be adapted to support nurse-patient rapport in VCVs, including forming a personal connection with the patient and using active listening techniques. Balancing the challenges and limitations with the benefits of videoconferencing is an essential competency requiring additional research and guidelines. International Registered Report Identifier (IRRID) RR2-10.2196/27940
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Affiliation(s)
- Paula D Koppel
- School of Nursing, Duke University, Durham, NC, United States
| | | | | | - Sophia Smith
- School of Nursing, Duke University, Durham, NC, United States
- Duke Cancer Institute, Duke Health, Durham, NC, United States
| | - Neil S Prose
- Department of Dermatology, Duke University, Durham, NC, United States
- Department of Pediatrics, Duke University, Durham, NC, United States
| | - Terri Jabaley
- Phyllis F Cantor Center for Research in Nursing & Patient Care Services, Dana-Farber Cancer Institute, Boston, MA, United States
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30
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Nekhlyudov L, Fleisher LA, Jacobsen PB. Telemedicine Across the Cancer Care Continuum: Evidence and Opportunities for Clinical Care, Research, and Policy. Cancer J 2022; 28:121-124. [PMID: 35333497 DOI: 10.1097/ppo.0000000000000585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT In this commentary, we provide an overview about the surge of telemedicine services during the COVID-19 pandemic, describe the cancer care continuum and existing evidence regarding the use of telemedicine across the continuum, and offer our perspective on existing opportunities to advance the use of telemedicine in clinical care, research, and policy. While research implications are relevant to an international audience, our focus pertains specifically to health care delivery and policy in the United States.
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Affiliation(s)
- Larissa Nekhlyudov
- From the Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Lee A Fleisher
- Center for Clinical Standards & Quality, Centers for Medicare & Medicaid Services, Washington, DC
| | - Paul B Jacobsen
- Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
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31
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Lynnerup C, Nørreslet M, Graabæk T. Attitudes towards video communication for New Medicine Service at community pharmacies – A qualitative pilot study. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2022; 5:100103. [PMID: 35478522 PMCID: PMC9030321 DOI: 10.1016/j.rcsop.2022.100103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 01/03/2022] [Accepted: 01/07/2022] [Indexed: 11/24/2022] Open
Abstract
Background New Medicine Service (NMS) is a community pharmacy service that can increase adherence among patients with a newly diagnosed chronic disease. NMS must be carried out by a pharmacist, which is a barrier for some pharmacy units with no pharmacist physically present. Video communication might be a way to overcome this barrier. Objective This study aims to explore both patients' and community pharmacy staff's attitudes of video-based NMS in a community pharmacy setting. Methods Semi-structured, telephone interviews were conducted with patients who have participated in video-based NMS. Focus groups with pharmacists who have carried out the video-based NMS and with staff that referred patients to the video-based NMS were conducted at community pharmacies. Thematic inductive analysis was used to analyse the interviews and focus groups. Results In total, 10 patient interviews were conducted, along with one focus group with four pharmacists and one focus group with 10 referring staff. Three main themes emerged during the analysis: (i) Talking to a screen, (ii) content of the NMS, and (iii) tackling the technique. Patients reported that their questions for the pharmacists were the same as if the NMS had been face-to-face. Pharmacists felt that they appeared more professional on video and that non-medical related conversation was reduced compared with ordinary face-to-face NMS. The referring staff either preferred referring to a video-based NMS over an ordinary face-to-face NMS or had no preferences. Conclusions Both patients and pharmacy staff had a positive attitude towards the video-based NMS, the content of the NMS and the performance of the IT-system. The consulting time was reduced for video-based NMS compared to face-to-face NMS, but that did not affect the medical related content of the NMS, which indicates that video-based NMS is possible without compromising the health related content.
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32
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Salvador Vergès À, Cusí Sánchez MV, Bossio Grigera P, Fàbrega Agulló C, Gomes da Costa F, Serra Trullas A, García Abejas A. Determinants in Stakeholder Opinions About Telemedicine in Palliative Care: A Scoping Review. Telemed J E Health 2021; 28:932-941. [PMID: 34871034 DOI: 10.1089/tmj.2021.0441] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background: The use of Telemedicine is growing, and its application in palliative medicine may facilitate patient care and be a solution to the growing pressures on hospital services in these pandemic times. Aim: The main objective of this review is to describe the current use of telemedicine in palliative care and assess stakeholders' views on the initiatives that have been implemented worldwide regarding digital service standards. Materials and Methods: Articles published between 2010 and 2020 were identified through PubMed, SCOPUS, Web of Science, and Google Scholar searches. We used Arksey and O'Malley's five-step framework to delimit and guide the initial search results. Results: The search identified 291 articles, of which 16 are included in this review. The selected studies were sufficiently detailed to allow their evaluation and answer our research questions. In addition, Telemedicine was used for patient and caregiver support and professional education. Conclusions: The use of Telemedicine for patient and caregiver support and professional education. Telemedicine empowers patients and increases their functional capacity. The imperative need to dictate implementation policies and ethical issues are some of the pending questions. In countries where a Telemedicine project has been initiated, it is valued as a good option for continuity of care, but all those involved would like face-to-face contact first, even if it is not mandatory.
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Affiliation(s)
- Àngels Salvador Vergès
- Iberian Society of Telemedicine and Telehealth, Madrid, Spain.,Digital Care Research Group, UVIC-UCC, Barcelona, Spain
| | | | - Paz Bossio Grigera
- Digital Health, School of Health, The National University of Jujuy, San Salvador de Jujuy, Argentina
| | - Carles Fàbrega Agulló
- Iberian Society of Telemedicine and Telehealth, Madrid, Spain.,Digital Health, School of Health, The National University of Jujuy, San Salvador de Jujuy, Argentina
| | - Fernando Gomes da Costa
- Iberian Society of Telemedicine and Telehealth, Madrid, Spain.,Portuguese Ministry of Health, Lisbon, Portugal
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33
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Rainsford S, Hall Dykgraaf S, Phillips C. Effectiveness of telehealth palliative care Needs Rounds in rural residential aged care during the COVID-19 pandemic: A hybrid effectiveness-implementation study. Aust J Rural Health 2021; 30:108-114. [PMID: 34757687 PMCID: PMC8652689 DOI: 10.1111/ajr.12789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 06/17/2021] [Accepted: 07/20/2021] [Indexed: 01/08/2023] Open
Affiliation(s)
- Suzanne Rainsford
- Medical School, Australian National University, Canberra, ACT, Australia.,Clare Holland House, Calvary Health Care Bruce, Canberra, ACT, Australia
| | | | - Christine Phillips
- Medical School, Australian National University, Canberra, ACT, Australia
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34
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Dolan H, Eggett C, Holliday L, Delves S, Parkes D, Sutherland K. Virtual care in end of life and palliative care: A rapid evidence check. J Telemed Telecare 2021; 27:631-637. [PMID: 34726997 DOI: 10.1177/1357633x211046118] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The purpose of this rapid evidence check was to identify virtual care modalities that are safe and effective in the delivery of end of life and palliative care. Thirty-three peer reviewed articles which were either review articles or interventional/evaluative studies presenting comparative data were identified through PubMed, Google, and Google Scholar searches. Extracted data was synthesized narratively and outcomes were categorised separately for patients, healthcare providers, caregivers and health system. Included studies reported on a wide range of virtual care modalities, including video consultation, mobile apps, videos, websites, telephone support, email and alert messages. Generally, studies reported similar or favourable quality of life outcomes to face-to-face palliative care, especially when virtual care was used as a supplement rather than a substitute for face-to-face care. Positive attitudes for perceived usefulness and helpfulness were reported by patients, caregivers and healthcare providers. Challenges identified related to technology limitations, trust, ethical concerns, administrative burden and evidence gaps. Overall, most studies found virtual care modalities to be safe and effective in end of life and palliative care with no detrimental adverse outcomes, when used as a supplement to face-to-face care.
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Affiliation(s)
- Hankiz Dolan
- NSW 144952Agency for Clinical Innovation, Sydney, NSW, Australia
| | - Catherine Eggett
- NSW 144952Agency for Clinical Innovation, Sydney, NSW, Australia
| | - Laura Holliday
- NSW 144952Agency for Clinical Innovation, Sydney, NSW, Australia
| | - Shane Delves
- NSW 144952Agency for Clinical Innovation, Sydney, NSW, Australia
| | - Donna Parkes
- NSW 144952Agency for Clinical Innovation, Sydney, NSW, Australia
| | - Kim Sutherland
- NSW 144952Agency for Clinical Innovation, Sydney, NSW, Australia
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35
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Haydon HM, Snoswell CL, Thomas EE, Broadbent A, Caffery LJ, Brydon JA, Smith AC. Enhancing a community palliative care service with telehealth leads to efficiency gains and improves job satisfaction. J Telemed Telecare 2021; 27:625-630. [PMID: 34726990 DOI: 10.1177/1357633x211048952] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Telepalliative care services enable clinicians to provide essential palliation services to people with a life-limiting illness in or closer to home. This study aims to explore the costs, service activity and staff experiences resulting from the introduction of telehealth in a community palliative care service in Queensland, Australia. Pre- and post-activity and cost data from the 2016-2017 and 2019-2020 financial years were examined and staff members interviewed. Accounting for inflation and standard wage increases, the labour costs before and after the addition of telehealth were approximately equal. There were small variations in non-labour costs, but these were not directly attributable to the expansion of the telehealth services. Overall, the service activity increased by 189% for standard doctor and nurse consultations, due to the increased efficiency of telehealth compared to the previous outreach (travel) model. Thematic analysis of the staff interview data generated an overarching theme of Increased Job Satisfaction which staff attributed to the patient-centred nature of the telepalliative care service, the increased peer support and increased professional development. Compared with the traditional in-person service, the new telehealth-supported model resulted in equivalent costs, greater efficiency by allowing palliative care to reach more patients and improved staff job satisfaction.
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Affiliation(s)
- Helen M Haydon
- Centre for Online Health, 1974The University of Queensland, Australia
- Centre for Health Services Research, 1974The University of Queensland, Australia
| | - Centaine L Snoswell
- Centre for Online Health, 1974The University of Queensland, Australia
- Centre for Health Services Research, 1974The University of Queensland, Australia
| | - Emma E Thomas
- Centre for Online Health, 1974The University of Queensland, Australia
- Centre for Health Services Research, 1974The University of Queensland, Australia
| | - Andrew Broadbent
- 3556Gold Coast Specialist and Supportive Palliative Care Service, Gold Coast Hospital, Australia
| | - Liam J Caffery
- Centre for Online Health, 1974The University of Queensland, Australia
- Centre for Health Services Research, 1974The University of Queensland, Australia
| | - Julie-Ann Brydon
- 3556Gold Coast Specialist and Supportive Palliative Care Service, Gold Coast Hospital, Australia
| | - Anthony C Smith
- Centre for Online Health, 1974The University of Queensland, Australia
- Centre for Health Services Research, 1974The University of Queensland, Australia
- Centre for Innovative Medical Technology, University of Southern Denmark, Denmark
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36
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Ebneter AS, Fliedner M, Trapp D, Ramseier F, Sauter TC, Eychmüller S. [Telemedicine in Palliative Care: Digital Communication in a Relationship-Based Speciality - Does It Make Sense?]. PRAXIS 2021; 110:845-850. [PMID: 34814716 DOI: 10.1024/1661-8157/a003781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Telemedicine in Palliative Care: Digital Communication in a Relationship-Based Speciality - Does It Make Sense? Abstract. Telemedicine in palliative care is established especially in countries with large geographical distances. Digital forms of communication (virtual consultations) are most frequently used and well-accepted by patients and caregivers. The main benefit lies in the reduction of the access barrier in the outpatient setting. Advantages are stress reduction for patients (travel, accessibility) and reduction in the care burden for relatives. Additional benefits compared to the physical visit for symptom-control, quality of life and costs are unclear. Risks are influenced by the lack of physical interaction and data security. To what extent telepalliative care makes sense in a high-density health system is difficult to predict. It is therefore important to use these new tools in a carefully adapted and scientifically verified way.
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Affiliation(s)
| | - Monica Fliedner
- Universitäres Zentrum für Palliative Care, Inselspital, Bern
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37
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Lundereng ED, Nes AAG, Holmen H, Winger A, Thygesen H, Jøranson N, Borge CR, Chen W, Dajani O, Mariussen KL, Steindal SA. Health Care Professionals' Experiences and Perspectives on Using Telehealth for Home-Based Palliative Care: Protocol for a Scoping Review. JMIR Res Protoc 2021; 10:e33305. [PMID: 34714254 PMCID: PMC8590185 DOI: 10.2196/33305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 09/22/2021] [Accepted: 09/28/2021] [Indexed: 12/29/2022] Open
Abstract
Background Telehealth seems feasible for use in home-based palliative care. However, acceptance among health care professionals (HCPs) is essential for the successful delivery of telehealth in practice. No scoping review has mapped the experiences and perspectives of HCPs on the use of telehealth for home-based palliative care. Objective The aim of this review is to systematically map published studies on HCPs’ experiences and perspectives on the use of telehealth in home-based palliative care. Methods The proposed scoping review will employ the methodology of Arksey and O’Malley. This protocol is guided by the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocol (PRISMA-P). A systematic search will be performed in MEDLINE, PsycINFO, EMBASE, CINAHL, Allied and Complementary Medicine (AMED), and Web of Science for studies published between January 2000 and July 5, 2021. We will also hand search the reference lists of included papers to identify additional studies of relevance. The search will be updated in 2022. Pairs of authors will independently assess the eligibility of studies and extract data. The first 2 stages of thematic synthesis will be used to thematically organize the data. Because the scoping review methodology consists of reviewing and collecting data from publicly available materials, this study does not require ethics approval. Results The database searches; testing of eligibility criteria; and screening of titles, abstracts, and full-text papers will be performed by fall 2021. The results from this scoping review will be presented as a descriptive summary of the results from all included papers, and will be inductively organized into descriptive themes. A frequency table illustrating which papers were included in which descriptive themes will be made. Results are anticipated by the fall of 2022. Conclusions A mapping of studies could identify research gaps regarding HCPs’ experiences and perspectives on the use of telehealth in home-based palliative care and may determine the value and feasibility of conducting a full systematic review. International Registered Report Identifier (IRRID) PRR1-10.2196/33305
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Affiliation(s)
- Elias David Lundereng
- Section for Palliative Treatment, Department of Oncology, Oslo University Hospital, Oslo, Norway
| | | | - Heidi Holmen
- Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
| | - Anette Winger
- Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
| | - Hilde Thygesen
- Faculty of Health Studies, VID Specialized University, Oslo, Norway.,Department of Occupational Therapy, Prosthetics and Orthotics, Oslo Metropolitan University, Oslo, Norway
| | - Nina Jøranson
- Faculty of Health Studies, VID Specialized University, Oslo, Norway
| | - Chrstine Råheim Borge
- Lovisenberg Diaconal Hospital, Oslo, Norway.,Department of Interdisciplinary Health Sciences, University of Oslo, Oslo, Norway
| | - Weiqin Chen
- Department of Computer Science, Oslo Metropolitan University, Oslo, Norway
| | - Olav Dajani
- Section for Gastrointestinal Oncology, Department of Oncology, Oslo University Hospital, Oslo, Norway
| | | | - Simen A Steindal
- Lovisenberg Diaconal University College, Oslo, Norway.,Faculty of Health Studies, VID Specialized University, Oslo, Norway
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Cormi C, Petit M, Auclair J, Bagaragaza E, Colombet I, Sanchez S. Building a telepalliative care strategy in nursing homes: a qualitative study with mobile palliative care teams. BMC Palliat Care 2021; 20:156. [PMID: 34645445 PMCID: PMC8514278 DOI: 10.1186/s12904-021-00864-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 10/01/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Despite increasing use of telemedicine in the field of palliative care, studies about the best circumstances and processes where it could replace face-to-face interaction are lacking. This study aimed to: (1) identify situations that are most amenable to the use of telemedicine for the provision of palliative care to patients in nursing homes; and (2) understand how telemedicine could best be integrated into the routine practice of mobile palliative care teams. METHODS A qualitative study based on semi-structured focus groups (n = 7) with professionals (n = 33) working in mobile palliative care teams in France. RESULTS Between June and July 2019, 7 mobile palliative care teams participated in one focus group each. Using thematic analysis, we found that telemedicine use in palliative care is about navigating between usual and new practices. Several influencing factors also emerged, which influence the use of telemedicine for palliative care, depending on the situation. Finally, we built a use-case model of palliative care to help mobile palliative care teams identify circumstances where telemedicine could be useful, or not. CONCLUSIONS The potential utility of telemedicine for delivering palliative care in nursing homes largely depends on the motive for calling on the mobile palliative care team. Requests regarding symptoms may be particularly amenable to telemedicine, whereas psycho-social distress may not. Further studies are warranted to assess the impact of influencing factors on real-life palliative care practices. Telemedicine could nonetheless be a useful addition to the mobile palliative care teams' armamentarium.
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Affiliation(s)
- Clément Cormi
- Pôle Territorial Santé Publique et Performance des Hôpitaux Champagne Sud, Centre Hospitalier de Troyes, 101 avenue Anatole France, CS 20718, 10003, Troyes, France.
- LIST3N/Tech-CICO, Troyes University of Technology, F-10000, Troyes, France.
| | - Marie Petit
- Unité de soins palliatifs Laroque, CHU Angers, F-49000, Angers, France
| | - Juline Auclair
- Service de médecine palliative et d'accompagnement, CHU Bordeaux, F-33000, Bordeaux, France
| | - Emmanuel Bagaragaza
- Pôle Recherche et enseignement universitaire (SPES), Maison Médicale Jeanne Garnier, F-75015, Paris, France
| | | | - Stéphane Sanchez
- Pôle Territorial Santé Publique et Performance des Hôpitaux Champagne Sud, Centre Hospitalier de Troyes, 101 avenue Anatole France, CS 20718, 10003, Troyes, France
- Fondation Korian pour le Bien Vieillir, F-75008, Paris, France
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Baxter KE, Kochar S, Williams C, Blackman C, Himmelvo J. Development of a Palliative Telehealth Pilot to Meet the Needs of the Nursing Home Population. J Hosp Palliat Nurs 2021; 23:478-483. [PMID: 34225341 DOI: 10.1097/njh.0000000000000784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Many older adults will spend their final days in a skilled nursing facility because of multiple complex conditions. Patients with unclear goals of care are at higher risk of rehospitalization and burdensome care at end of life. Palliative care has been shown to improve outcomes for this patient population; however, access is limited because of the small number of boarded specialists nationwide. Telehealth offers the ability to expand the reach of palliative care to both underserved geographies and community settings. This quality improvement pilot project details the development and implementation of a telehealth palliative care program available to nursing home residents. Eight nursing homes, in the New England region of the United States, participated in the 4-month pilot. The palliative telehealth program offered real-time access to a palliative care specialist able to provide symptom management, goals-of-care discussions, and Medical Orders for Life-Sustaining Treatment completion. The pilot shows promising outcomes including code status change, Medical Order for Life-Sustaining Treatment form completion, and reduced hospitalizations supporting the benefit of comprehensive goals-of-care discussions for frail older adults living in a nursing home. As health care moves into the digital age, telemedicine plays a large role in the delivery of essential patient care. Provision of palliative specialists by telehealth allows the opportunity to address the unmet needs of this frail population.
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Oelschlägel L, Dihle A, Christensen VL, Heggdal K, Moen A, Österlind J, Steindal SA. Implementing welfare technology in palliative homecare for patients with cancer: a qualitative study of health-care professionals' experiences. BMC Palliat Care 2021; 20:146. [PMID: 34535125 PMCID: PMC8448170 DOI: 10.1186/s12904-021-00844-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 09/09/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Introducing welfare technology in home-based palliative care has been suggested to be beneficial for improving access to health care at home and enhancing patients' feelings of security and safety. However, little is known about the experiences of municipal health-care professionals using welfare technology in palliative home care. The aim of this study was to explore municipal health-care professionals' experiences regarding the significant challenges, facilitators, and assessments associated with implementing a technological solution named "remote home care" in palliative home care for patients with cancer. METHODS A qualitative, descriptive, exploratory design was used. Data were collected through focus-group interviews and individual semi-structured interviews with interdisciplinary health-care professionals who had experience using remote home care in clinical encounters with cancer patients who were in the palliative phase and living at home. Data were analyzed using qualitative content analysis. RESULTS Three themes were identified: 1) shifting from objective measures to assessing priorities for patients, 2) lack of experience and personal distress regarding cancer inhibits professional care, and 3) prominent organizational challenges undermine the premise of remote home care. CONCLUSION The results showed that shifting from a disease-focused to a person-centered approach enables health-care professionals to assess patients' personal priorities. However, health-care professionals' uncertainty and lack of knowledge and experience, along with organizational issues concerning information-sharing, represent great challenges that have the potential to inhibit professional care. The availability of networks through which difficult issues can be discussed was highlighted as being a fundamental resource for facilitating the provision of care.
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Affiliation(s)
- Lina Oelschlägel
- Lovisenberg Diaconal University College, Lovisenberggata 15B, 0456, Oslo, Norway.
- Department of Nursing, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Alfhild Dihle
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Vivi L Christensen
- Lovisenberg Diaconal University College, Lovisenberggata 15B, 0456, Oslo, Norway
- University of South-Eastern Norway, Drammen, Norway
| | - Kristin Heggdal
- Lovisenberg Diaconal University College, Lovisenberggata 15B, 0456, Oslo, Norway
| | - Anne Moen
- Department of Nursing, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Jane Österlind
- Department of Healthcare Sciences/Palliative Research Center, Ersta Sköndal Bräcke University College, Stockholm, Sweden
| | - Simen A Steindal
- Lovisenberg Diaconal University College, Lovisenberggata 15B, 0456, Oslo, Norway
- Faculty of Health Studies, VID Specialized University, Oslo, Norway
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Disalvo D, Agar M, Caplan G, Murtagh FE, Luckett T, Heneka N, Hickman L, Kinchin I, Trethewie S, Sheehan C, Urban K, Cohen J, Harlum J, Long B, Parker T, Schaefer I, Phillips J. Virtual models of care for people with palliative care needs living in their own home: A systematic meta-review and narrative synthesis. Palliat Med 2021; 35:1385-1406. [PMID: 34169759 DOI: 10.1177/02692163211024451] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Access to palliative care in the community enables people to live in their preferred place of care, which is often home. Community palliative care services struggle to provide timely 24-h services to patients and family. This has resulted in calls for 'accessible and flexible' models of care that are 'responsive' to peoples' changing palliative care needs. Digital health technologies provide opportunities to meet these requirements 24-h a day. AIM To identify digital health technologies that have been evaluated for supporting timely assessment and management of people living at home with palliative care needs and/or their carer(s), and the evidence-base for each. DESIGN A systematic review of systematic reviews ('meta-review'). Systematic reviews evaluating evidence for virtual models of palliative or end-of-life care using one or more digital health technologies were included. Systematic reviews were evaluated using the Risk of Bias Tool for Systematic Reviews. A narrative approach was used to synthesise results. DATA SOURCES Medline, Embase, Web of Science, CINAHL and Cochrane Database of systematic reviews were searched for English-language reviews published between 2015 and 2020. RESULTS The search yielded 2266 articles, of which 12 systematic reviews met criteria. Sixteen reviews were included in total, after four reviews were found via handsearching. Other than scheduled telehealth, video-conferencing, or after-hours telephone support, little evidence was found for digital health technologies used to deliver virtual models of palliative care. CONCLUSIONS There are opportunities to test new models of virtual care, beyond telehealth and/or video conferencing, such as 24-h command centres, and rapid response teams. SYSTEMATIC REVIEW REGISTRATION NUMBER Prospero CRD42020200266.
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Affiliation(s)
- Domenica Disalvo
- IMPACCT - Improving Palliative, Aged and Chronic Care through Clinical Research and Translation, University of Technology Sydney, NSW, Australia
| | - Meera Agar
- IMPACCT - Improving Palliative, Aged and Chronic Care through Clinical Research and Translation, University of Technology Sydney, NSW, Australia
| | | | - Fliss Em Murtagh
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Tim Luckett
- IMPACCT - Improving Palliative, Aged and Chronic Care through Clinical Research and Translation, University of Technology Sydney, NSW, Australia
| | - Nicole Heneka
- IMPACCT - Improving Palliative, Aged and Chronic Care through Clinical Research and Translation, University of Technology Sydney, NSW, Australia
| | - Louise Hickman
- IMPACCT - Improving Palliative, Aged and Chronic Care through Clinical Research and Translation, University of Technology Sydney, NSW, Australia
| | - Irina Kinchin
- IMPACCT - Improving Palliative, Aged and Chronic Care through Clinical Research and Translation, University of Technology Sydney, NSW, Australia
| | - Susan Trethewie
- Sydney Children's Hospital, Randwick, SCH Pain and Palliative Care Service Sydney Children's Hospital, Sydney, NSW, Australia
| | | | - Kat Urban
- Department of Palliative Care, Prince of Wales Hospital and Community Health Services, Sydney, Australia
| | - Joshua Cohen
- Calvary Health Care Kogarah, Sydney, NSW, Australia
| | - Janeane Harlum
- South Western Sydney Local Health District, Sydney, NSW, Australia
| | - Brian Long
- IMPACCT - Improving Palliative, Aged and Chronic Care through Clinical Research and Translation, University of Technology Sydney, NSW, Australia
| | - Tricia Parker
- IMPACCT - Improving Palliative, Aged and Chronic Care through Clinical Research and Translation, University of Technology Sydney, NSW, Australia
| | - Isabelle Schaefer
- IMPACCT - Improving Palliative, Aged and Chronic Care through Clinical Research and Translation, University of Technology Sydney, NSW, Australia
| | - Jane Phillips
- School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, NSW, Australia
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Madden G, Rose T, Crystal L. Using video consultations to support family carers of people living with dementia. Nurs Older People 2021; 34:28-33. [PMID: 34431259 DOI: 10.7748/nop.2021.e1346] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2021] [Indexed: 11/09/2022]
Abstract
Established in 2019, the Lincolnshire Admiral Nurse Service supports family carers of people living with dementia through psychosocial interventions. Before the coronavirus disease 2019 (COVID-19) pandemic, the team provided home visits as standard, but the fact that Lincolnshire is a large rural county affected the team's ability to provide timely support to all the carers who needed it. In 2019-20, a practice development project underpinned by participatory action research was undertaken to trial the use of video consultations with carers. However, carers' uptake of video consultations was low and the project was affected by the COVID-19 pandemic. This article describes the project and discusses the findings of its evaluation. The Admiral Nurse team had mixed experiences and felt that, overall, its support was more effective when delivered face to face. The project provides insights into the challenges and benefits of video consultations for delivering psychosocial interventions to carers of people living with dementia.
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Affiliation(s)
| | - Tom Rose
- St Barnabas Hospice, Lincolnshire, England
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43
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Ersek M, Smith D, Griffin H, Carpenter JG, Feder SL, Shreve ST, Nelson FX, Kinder D, Thorpe JM, Kutney-Lee A. End-Of-Life Care in the Time of COVID-19: Communication Matters More Than Ever. J Pain Symptom Manage 2021; 62:213-222.e2. [PMID: 33412269 PMCID: PMC7784540 DOI: 10.1016/j.jpainsymman.2020.12.024] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/23/2020] [Accepted: 12/26/2020] [Indexed: 11/28/2022]
Abstract
CONTEXT The COVID-19 pandemic resulted in visitation restrictions across most health care settings, necessitating the use of remote communication to facilitate communication among families, patients and health care teams. OBJECTIVE To examine the impact of remote communication on families' evaluation of end-of-life care during the COVID-19 pandemic. METHODS Retrospective, cross-sectional, mixed methods study using data from an after-death survey administered from March 17-June 30, 2020. The primary outcome was the next of kin's global assessment of care during the Veteran's last month of life. RESULTS Data were obtained from the next-of-kin of 328 Veterans who died in an inpatient unit (i.e., acute care, intensive care, nursing home, hospice units) in one of 37 VA medical centers with the highest numbers of COVID-19 cases. The adjusted percentage of bereaved families reporting excellent overall end-of-life care was statistically significantly higher among those reporting Very Effective remote communication compared to those reporting that remote communication was Mostly, Somewhat, or Not at All Effective (69.5% vs. 35.7%). Similar differences were observed in evaluations of remote communication effectiveness with the health care team. Overall, 81.3% of family members who offered positive comments about communication with either the Veteran or the health care team reported excellent overall end-of-life care vs. 28.4% who made negative comments. CONCLUSIONS Effective remote communication with the patient and the health care team was associated with significantly better ratings of the overall experience of end-of-life care by bereaved family members. Our findings offer timely insights into the importance of remote communication strategies.
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Affiliation(s)
- Mary Ersek
- Veteran Experience Center, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA; University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA; Leonard Davis Institute of Health Economics at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
| | - Dawn Smith
- Veteran Experience Center, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
| | - Hilary Griffin
- Veteran Experience Center, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
| | - Joan G Carpenter
- Veteran Experience Center, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA; University of Maryland School of Nursing, Baltimore, Maryland, USA
| | - Shelli L Feder
- Yale University School of Nursing, New Haven, Connecticut, USA; VA Connecticut Health Care System, West Haven, Connecticut, USA
| | - Scott T Shreve
- Palliative and Hospice Care Program, US Department of Veterans Affairs, Washington, District of Columbia, USA; Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Francis X Nelson
- Veteran Experience Center, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
| | - Daniel Kinder
- Veteran Experience Center, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
| | - Joshua M Thorpe
- Center for Health Equity Research and Promotion, Pittsburgh VA Medical Center, Pittsburgh, Pennsylvania, USA; University of North Carolina School of Pharmacy, Chapel Hill, NC, USA
| | - Ann Kutney-Lee
- Veteran Experience Center, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA; University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
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44
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Zon RT, Kennedy EB, Adelson K, Blau S, Dickson N, Gill D, Laferriere N, Lopez AM, Mulvey TM, Patt D, Pickard TA, Purdom T, Royce TJ, Sumrall AL, Page RD. Telehealth in Oncology: ASCO Standards and Practice Recommendations. JCO Oncol Pract 2021; 17:546-564. [PMID: 34319760 DOI: 10.1200/op.21.00438] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
PURPOSE To provide standards and practice recommendations specific to telehealth in oncology. METHODS A systematic review of the literature on telehealth in oncology was performed, including the use of technologies and telecommunications systems, and other electronic methods of care delivery and sharing of information with patients. The evidence base was combined with the opinion of the ASCO Telehealth Expert Panel to develop telehealth standards and guidance. Public comments were solicited and considered in preparation of the final manuscript. RESULTS The Expert Panel determined that general guidance on implementing telehealth across general and specialty settings has been published previously and these resources are endorsed. A systematic search for studies on topics specific to oncology resulted in the inclusion of two clinical practice guidelines, 12 systematic reviews, and six primary studies. STANDARDS AND GUIDANCE Standards and guidance are provided for which patients in oncology can be seen via telehealth, establishment of the doctor-physician relationship, role of allied health professionals, role of advanced practice providers, multidisciplinary cancer conferences, and teletrials in oncology. Additional information is available at www.asco.org/standards.
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Affiliation(s)
| | | | - Kerin Adelson
- Smilow Cancer Hospital, Yale School of Medicine, Guilford, CT
| | - Sibel Blau
- Northwest Medical Specialties, Seattle, WA
| | | | - David Gill
- Intermountain Healthcare, Salt Lake City, UT
| | - Nicole Laferriere
- North West Regional Cancer Center and Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | - Ana Maria Lopez
- Jefferson Health New Jersey, Sidney Kimmel Cancer Center, Sewell, NJ
| | | | | | - Todd A Pickard
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Trevor J Royce
- Lineberger Comprehensive Cancer Center, Chapel Hill, NC.,Flatiron Health, New York, NY
| | | | - Ray D Page
- The Center for Cancer and Blood Disorders, Fort Worth, TX
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45
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Asprec L, Blinderman CD, Berlin A, Callahan ME, Widera E, Periyakoil VS, Smith AK, Nakagawa S. Virtual Interinstitutional Palliative Care Consultation during the COVID-19 Pandemic in New York City. J Palliat Med 2021; 24:1387-1390. [PMID: 34191591 DOI: 10.1089/jpm.2021.0208] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Context: Amid the COVID-19 surge in New York City, the need for palliative care was highlighted. Virtual consultation was introduced to expand specialist-level care to meet demand. Objectives: To examine the outcomes of COVID-19 patients who received virtual palliative care consultation from outside institutions. Design: This is a retrospective case series. Setting/Subjects: Subjects were 34 patients who received virtual palliative care consultation between April 13, 2020, and June 14, 2020. Measurements: Follow-up frequency and duration, code status change, withdrawal of life-sustaining treatment (LST), and multidisciplinary involvement. Results: Twenty-eight patients (82.3%) were in the intensive care unit and 29 patients (85.3%) were on at least two LSTs. Fifteen patients (44.1%) died in the hospital, 9 patients (26.4%) were discharged alive, and 10 patients (29.4%) were signed off. The median frequency of visits was 4.5 (IQR 6) over 11 days follow-up (IQR 17). Code status change was more frequent in deceased patients. LSTs were withdrawn in eight patients (23.5%). Conclusions: Virtual palliative care consultation was feasible during the height of the COVID-19 pandemic.
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Affiliation(s)
- Lawrence Asprec
- Adult Palliative Care Service, Department of Medicine, Department of Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - Craig D Blinderman
- Adult Palliative Care Service, Department of Medicine, Department of Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - Ana Berlin
- Adult Palliative Care Service, Department of Medicine, Department of Surgery, Columbia University Irving Medical Center, New York, New York, USA.,Division of General Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - Mary E Callahan
- Adult Palliative Care Service, Department of Medicine, Department of Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - Eric Widera
- Division of Geriatrics, Department of Medicine, University of California San Francisco, San Francisco, California, USA.,Geriatrics, Palliative, and Extended Care Service, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Vyjeyanthi S Periyakoil
- Department of Medicine, Stanford University, Palo Alto, California, USA.,Extended Care and Palliative Medicine Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
| | - Alexander K Smith
- Division of Geriatrics, Department of Medicine, University of California San Francisco, San Francisco, California, USA.,Geriatrics, Palliative, and Extended Care Service, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Shunichi Nakagawa
- Adult Palliative Care Service, Department of Medicine, Department of Surgery, Columbia University Irving Medical Center, New York, New York, USA
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46
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Milne S, Palfrey J, Berg J, Todd J. Video hospice consultation in COVID-19: professional and patient evaluations. BMJ Support Palliat Care 2021:bmjspcare-2020-002861. [PMID: 34162580 DOI: 10.1136/bmjspcare-2020-002861] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 05/19/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Providing care for our patients during the COVID-19 pandemic required a rapid shift to video consultations (VCs). A service evaluation was performed to capture hospice professionals' (HPs) and patients' experiences of VC. METHODS Online or postal surveys were sent to HPs and patients, who had participated in VC between March and July 2020, focusing on their experience and satisfaction with the service. RESULTS 31 responses from HPs were received. 19 (61.3%) rated their experience of VC as good, despite 29 (93.5%) having no prior VC experience. One-third of HPs had undertaken potentially sensitive consultations, including resuscitation discussions. 23 (74.2%) undertook a VC that included a family member and 18 (58.1%) had included an external healthcare professional. 25 (80.6%) wanted to offer VC as an option going forward. Well-being staff successfully provided multiple group support sessions via video. 26 responses from patients (23) and carers (3) were received. 22 (84.6%) had access to a smartphone. 8 (30.8%) included a family member in their consultation. All patients/carers reported satisfaction with their VC, although 10 (38.5%) expressed a preference for face-to-face consultations. 22 (84.6%) patients would be happy to receive care via VC going forward and 21 (80.8%) stated they would recommend the use of VC to others. CONCLUSION Patients reported VC to be an acceptable way to receive support from a hospice service and HPs would like to continue to offer VC in the future. VC can be offered as an alternative to face-to-face consultations with the potential to continue and improve access to a wide range of hospice services.
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Affiliation(s)
- Shannon Milne
- Education and Research, Princess Alice Hospice, Esher, UK
| | | | - Jane Berg
- Education and Research, Princess Alice Hospice, Esher, UK
| | - Jennifer Todd
- Palliative Medicine, Princess Alice Hospice, Esher, UK
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47
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Koppel PD, De Gagne JC. Exploring Nurse and Patient Experiences of Developing Rapport During Oncology Ambulatory Care Videoconferencing Visits: Protocol for a Qualitative Study. JMIR Res Protoc 2021; 10:e27940. [PMID: 34125073 PMCID: PMC8240804 DOI: 10.2196/27940] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 05/11/2021] [Accepted: 05/12/2021] [Indexed: 01/23/2023] Open
Abstract
Background Telehealth videoconferencing has largely been embraced by health care providers and patients during the COVID-19 pandemic; however, little is known about specific techniques for building rapport and provider-patient relationships in this care environment. Although research suggests that videoconferencing is feasible and can be effective for some types of care, concerns about the impact of technology on provider-patient relationships exist across health disciplines. Suggestions for adapting some in-person rapport techniques, such as the use of small talk, eye contact, and body language to facilitate trust, personal connection, and communication during videoconferencing encounters, have been discussed in the popular press and clinical commentaries. Notably, evidence regarding the effects of these strategies on rapport and clinical care outcomes is lacking. Understanding how to establish rapport in videoconferencing visits is especially important in oncology nursing, where rapport with patients enables nurses to become a source of emotional support, helping patients adapt and navigate the cancer journey. Objective This study aims to investigate the nature of nurse-patient rapport in ambulatory cancer care videoconferencing visits. The objectives include exploring how patients with cancer and nurses describe experiences of rapport and strategies for cultivating rapport in videoconferencing visits and similarities and differences identified by patients with cancer and nurses between experiences of rapport in videoconferencing and in-person visits. Methods Semistructured narrative interviews of patients with cancer and nurses will be conducted to understand the experience of rapport building in videoconferencing visits. Nurses and patients will be interviewed separately to facilitate an understanding of the perspectives of both types of participants. Interviews will be conducted on a secure videoconferencing platform. This qualitative descriptive study will describe participant experiences in a manner that, although not without interpretation, is as close to the data as possible. The research team will meet regularly to discuss, define, and document codes, categories, and themes, and the team will maintain a detailed audit trail of analytical decisions. In addition, member checking will enhance the rigor of the study. Nurse and patient interviews will be analyzed separately using identical procedures and may be explored side by side in the final analysis to provide a comparative analysis. Data management and analysis will be performed using NVivo 12. Results Data collection will begin during summer 2021, with results from the data analysis anticipated by winter 2021. A research team trained in qualitative methodology will use conventional content analysis to analyze the data using first- and second-level codes derived directly from the transcribed text data. Conclusions This study aims to determine what behaviors, communication techniques, and relational practices need to be adapted in videoconferencing telehealth visits, setting the foundation for future development of interventions and evidence-based practice guidelines for relationship building during videoconferencing telehealth visits. International Registered Report Identifier (IRRID) PRR1-10.2196/27940
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Affiliation(s)
- Paula D Koppel
- Duke University School of Nursing, Durham, NC, United States
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48
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Steindal SA, Nes AAG, Godskesen TE, Lind S, Dhle A, Winger A, Österlind J, Pettersen FS, Holmen H, Klarare A. Advantages and Challenges in Using Telehealth for Home-Based Palliative Care: Protocol for a Systematic Mixed Studies Review. JMIR Res Protoc 2021; 10:e22626. [PMID: 34018964 PMCID: PMC8178736 DOI: 10.2196/22626] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 10/14/2020] [Accepted: 04/19/2021] [Indexed: 01/03/2023] Open
Abstract
Background Given the increasing number of people in need of palliative care services and the current health care professional workforce strain, providing equitable, quality palliative care has become a challenge. Telehealth could be an innovative approach to palliative care delivery, enabling patients to spend more time or even remain at home, if they wish, throughout the illness trajectory. However, no previous systematic mixed studies reviews have synthesized evidence on patients’ experiences of the advantages and challenges of telehealth for home-based palliative care. Objective The aim of this systematic mixed studies review is to critically appraise and synthesize findings from studies that investigated patients’ use of telehealth in home-based palliative care with a focus on the advantages and challenges experienced by the patients. Methods This article describes the protocol for a systematic mixed studies review with a convergent design. The reporting will be guided by the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. A systematic search was performed in eight databases for studies published from January 2010 to June 2020. The search will be updated in 2021. Pairs of authors will independently assess eligibility, extract data, and assess methodological quality. The data will then be analyzed using thematic synthesis. Results We describe the rationale and design of a systematic mixed studies review. The database searches were performed on June 25, 2020. Assessment of eligibility and further steps have not yet been performed. Results are anticipated by August 2021. Conclusions Following the ethos of patient-centered palliative care, this systematic mixed studies review could lead to recommendations for practice and policy, enabling the development and implementation of telehealth applications and services that align with patients’ preferences and needs at home. International Registered Report Identifier (IRRID) PRR1-10.2196/22626
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Affiliation(s)
| | | | - Tove E Godskesen
- Department of Health Care Sciences, Ersta Sköndal Bräcke University College, Stockholm, Sweden.,Centre for Research Ethics & Bioethics, Uppsala University, Uppsala, Sweden
| | - Susanne Lind
- Department of Health Care Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden
| | - Alfhild Dhle
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Anette Winger
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Jane Österlind
- Department of Health Care Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden
| | | | - Heidi Holmen
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Anna Klarare
- Department of Health Care Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden.,Clinical Psychology in Healthcare, Department for Women's and Children's Health, Uppsala University, Uppsala, Sweden
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49
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Hansen DG, Trabjerg TB, Sisler JJ, Søndergaard J, Jensen LH. Cross-sectoral communication by bringing together patient with cancer, general practitioner and oncologist in a video-based consultation: a qualitative study of oncologists' and nurse specialists' perspectives. BMJ Open 2021; 11:e043038. [PMID: 33952540 PMCID: PMC8103367 DOI: 10.1136/bmjopen-2020-043038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
UNLABELLED Shared care models in the field of cancer aim to improve care coordination, role clarification and patient satisfaction. Cross-sectoral communication is pivotal. Involvement of patients may add to intended mechanisms.A randomised controlled trial 'The Partnership Study' tested the effect of bringing together patient, general practitioner (GP) and oncologist for a consultation conducted by video. PURPOSE As part of the process evaluation, this study aimed to explore experiences, attitudes and perspectives of the oncological department on sharing patient consultations with GPs using video. METHODS Four semistructured interviews with five oncologists and four nurse specialists were conducted in February 2020. We focused on the informants' experiences and reflections on the potential of future implementation of the concept 'inviting the GP for a shared consultation by video'. The analyses were based on an inductive, open-minded, hermeneutic phenomenological approach. RESULTS A total of six overall themes were identified: structuring consultation and communication, perceptions of GP involvement in cancer care, stressors, making a difference, alternative ways of cross-sector communication and needs for redesigning the model. The concept made sense and was deemed useful, but solving the many technical and organisational problems is pivotal. Case-specific tasks and relational issues were targeted by pragmatically rethinking protocol expectations and the usual way of communication and structuring patient encounters. Case selection was discussed as one way of maturing the concept. CONCLUSION This Danish study adds new insight into understanding different aspects of the process, causal mechanisms as well as the potential of future implementation of video-based tripartite encounters. Beyond solving the technical problems, case selection and organisational issues are important. Acknowledging the disruption of the usual workflow, the introduction of new phases of the usual encounter and the variety of patient-GP relationships to be embraced may help to better understand and comply with barriers and facilitators of communication and sharing. TRIAL REGISTRATION NUMBER NCT02716168.
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Affiliation(s)
- Dorte Gilså Hansen
- Research Unit for General Practice, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
- Center for Shared Decision Making, Lillebælt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
- Institute of Regional Health Research, University of Southern Denmark, Vejle, Denmark
| | - Theis Bitz Trabjerg
- Research Unit for General Practice, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Jeffrey James Sisler
- Department of Family Medicine, University of Manitoba Faculty of Health Sciences, Winnipeg, Manitoba, Canada
| | - Jens Søndergaard
- Research Unit for General Practice, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Lars Henrik Jensen
- Institute of Regional Health Research, University of Southern Denmark, Vejle, Denmark
- Department of Oncology, Lillebælt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
- Danish Colorectal Cancer Center South, Center of Clinical Excellence, Lillebaelt Hospital, University Hospital of Southern Denmark, University of Southern Denmark, Vejle, Denmark
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50
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Franchini L, Varani S, Ostan R, Bocchi I, Pannuti R, Biasco G, Bruera E. Home palliative care professionals perception of challenges during the Covid-19 outbreak: A qualitative study. Palliat Med 2021; 35:862-874. [PMID: 33829909 DOI: 10.1177/02692163211008732] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Home palliative care services have played an essential role during the first wave of the SARS-CoV-2 outbreak by providing symptom control, drug procurement, and psychological support for frail patients and their families unable to leave their homes. AIM To understand how home palliative care professionals were affected by the outbreak, describing changes and challenges in their daily work as well as their reactions to the Covid-19 pandemic in Italy. DESIGN Qualitative study conducted using telephone semi-structured interviews, with thematic analysis. SETTING/PARTICIPANTS Thirty home care professionals working for an Italian non-profit organization which provides home palliative care for cancer patients and their families. RESULTS Three main themes were identified. The first theme showed both patient-related and practice-related challenges participants faced in their daily work, requiring the implementation of different communication methods and patient and family education on risk prevention. The second theme showed the perception of increased responsibility and being the only landmark for family played a decisive role in participants' positive attitude. The third theme highlighted the participants' perception of the critical role of a home care setting in this emergency situation. CONCLUSIONS The first wave of the Covid-19 pandemic brought many challenges and stressors for home palliative care professionals. On the other side, they reported a satisfaction with their critical role in carrying out their work with patients at risk.
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Affiliation(s)
| | | | - Rita Ostan
- National Tumor Assistance (ANT), Bologna, Italy
| | | | | | | | - Eduardo Bruera
- Department of Palliative Care, Rehabilitation and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
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