An analysis of provider perceptions for telehospice

Telehospice in Michigan: Use and patient acceptance

Telehospice, the use of telemedicine technologies to provide services to hospice patients, offers an innovative solution to the challenges of providing high-quality, cost-effective end-of-life care. Specifically, the technology allows caregivers to transmit video images of patients, which provide off-site nurses with the information they need to assist the caregiver. Our telehospice project was conducted in urban and rural Michigan between 2000-2002 and collected data from 187 patients receiving telehospice services in their homes during this study. Overall, nurses were the primary providers of telehospice services and initiated the majority of routine televisits. Often, patients who described themselves as “overwhelmed” at the time of enrollment declined telehospice. However, patients were extremely satisfied with telehospice and often expressed frustration that nurses did not use the telehospice equipment more frequently.

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

Background

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

Methods

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

Results

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

Conclusion

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

How effective is video consultation in clinical oncology? A systematic review

BACKGROUND

Video-consultation (VC) is a specialized type of telemedicine that uses technology to provide real-time visual and audio patient assessment at a distance. In the present review, we set out to evaluate whether vc is feasible for the assessment, monitoring, and management of oncology patients.

METHODS

A search strategy designed to capture studies that addressed the use of telemedicine to deliver cancer care identified relevant articles in the medline (1966 to September 2008) and PubMed (to 2008) databases. Articles were included if they described studies incorporating video-conferencing between patient and provider for assessment or monitoring,physicians or nurses as the care providers,cancer patients,consultation in real-time, and reporting of 1 or more outcomes.

RESULTS

Of the more than three hundred articles retrieved, nineteen articles describing 15 unique patient populations involving 709 patients were inclusded in the analysis. No randomized trials were located. Eight studies included a control group; seven involved a case series. The most commonly reported outcomes were patient satisfaction (ten studies), cost to perform consultation (six studies), patient preference for vc compared with in-person consultation (five studies), provider satisfaction (four studies), and provider convenience (four studies). Of these outcomes, satisfaction on the part of patients and physicians has been positive overall, total costs were comparable to or less than those for in-person consultations, and patients valued having vc as an option for consultation. Outcomes evaluating the effect on clinical care were infrequently reported.

CONCLUSIONS

While there is evidence to suggest that vc is both feasible and effective for use in the clinical care of oncology patients, studies are generally small and methodologically weak, with limited power of inference.

An empirical chart analysis of the suitability of telemedicine for hospice visits

Telehospice (TH) utilizes telemedicine technology to provide care at the end of life. A bistate project was launched in 1998 to study the use of home-based telemedicine for routine hospice care. Videophones were deployed for telenursing visits and evaluations by social workers. In order to determine what proportion of home hospice visits could be performed using currently available telemedicine technology, we reviewed clinical records retrospectively for hospice nurse home visits. Clinical notes documenting home nursing visits were obtained from two large hospices, one based in Kansas, and the other in Michigan. Records were randomly selected for patients who received hospice nurse visits during the month of January 2000. The charts were reviewed for patient demographic information, patient assessments, teaching activities, and interventions. Five hundred ninety-seven nursing notes were analyzed using an 85-item coding instrument. After careful review of the records, the coders also made a subjective observation regarding the suitability of each visit for telemedicine. As part of this analysis, we found that 64.5% of home hospice nursing visits could be performed by telemedicine. Using TH, it is possible to reduce the number of in-person visits, thereby significantly decreasing the cost of providing hospice care.

Administrator and provider perceptions of the factors relating to programme effectiveness in implementing telemedicine to provide end-of-life care

Two large hospice organizations in Kansas and Michigan began a telehospice project with the goal of improving care at the end of life using telemedicine. Hospice nurses provided services using video directly to the homes of hospice patients. The telemedicine equipment operated over ordinary telephone lines. Nursing services included symptom assessment and psychospiritual evaluations. Patients lived in both urban and rural settings. Studies were designed to evaluate utilization patterns, access to care, patient/carer acceptance, medical outcomes and cost. During the first year of the project, telehospice care was initiated at five rural sites (two in Michigan and three in Kansas) and three urban sites (two in Michigan and one in Kansas). There was greater telehospice activity in Michigan than in Kansas, with 118 and 44 patients served, respectively. The urban site in Kansas withdrew from the study after participating for only nine months. In an effort to understand the difference in utilization patterns and reasons for withdrawing from the project, in-depth interviews of key study participants, including hospice administrators, nurses and research personnel, were conducted. Human factors appear to be important in the adoption of novel telemedicine applications.

Telemedicine in Kansas: the successes and the challenges

Based on our experience of telemedicine in Kansas, we have identified several key factors in the success of a telemedicine practice. Very early in any project, it is important to bring together all participants (especially the physicians who are expected to refer patients) to define the need, outline specific goals, analyse and test the technology, and develop a plan for the implementation. As with traditional health-care, many partners must come together, including primary-care practitioners willing to shoulder day-to-day responsibility for management of complex patients, nurses with special expertise and consultants willing to work with a remote team using telemedicine. These individuals must accept the challenges and appreciate the rewards of working in a different practice model, in which communication and interdependence are critical for success. The telemedicine consultant is only as good as the local health-care team. The technology itself is only a small part of the equation.

Change of patients' perceptions of TeleHomeCare

The study's objectives were to measure patients' perceptions of a telehomecare system before and after they have participated in it and identify the features of the system that patients perceived differently after experiencing it. The study setting was the TeleHomeCare Project, which uses videoconferencing and Internet equipment to enable interactions between patients and nurses. An instrument that measures perceptions of telehomecare was used. Patients viewed a videotape that demonstrates a "virtual home care visit" and filled out the questionnaire (pre-test). They were then randomly assigned to a control group receiving standard care or to an experimental group receiving videoconferencing and Internet access in addition to standard care. Both groups filled out the questionnaire when exiting the system (post-test). Paired t-tests were performed to compare total scores and responses to each of the items within the groups and an unpaired t-test was used to compare change of perceptions between groups. The control group consisted of 11 patients, and the experimental group included 17 patients. There was no statistically significant change of perception in the control group. The experimental group showed an overall more positive perception of the system after their experience (total score increase by 6.059, p < 0.0001), and the mean score difference was higher compared to the control group (mean 6.241, p < 0.0001). Elderly patients evaluated their telehomecare experience as being positive, and they felt more comfortable with the technology, believing that the nurse can understand their medical problem over the television. This suggests that telehomecare has the potential for wide acceptance among patients.

Telehealth: a new venue for health care delivery

OBJECTIVES

To inform oncology nurses about how telehealth technologies have changed the way in which health care is delivered.

DATA SOURCES

Published articles, research studies, and review articles pertaining to telemedicine, telenursing, and telehealth.

CONCLUSIONS

Telehealth technologies connect health professionals and patients worldwide, facilitating consultations among professionals, diagnosing and assessing disease, interviewing, history taking, and prescribing therapy and medication. New telehealth projects connecting providers and patients are emerging rapidly.

IMPLICATIONS FOR NURSING PRACTICE

Oncology nurses are prime candidates to transport their expertise to patients and other providers via telehealth technologies.