Internet Use by Hospice Families and Providers: A Review

Measurement equivalence of the paper-based and electronic version of the Integrated Palliative care Outcome Scale (IPOS): A randomised crossover trial

BACKGROUND

The Integrated Palliative Care Outcome Scale (IPOS) validly and reliably measures symptoms and concerns of those receiving palliative care.

AIM

To determine the equivalence of the paper version with an electronic version of the IPOS (eIPOS).

DESIGN

Multicentre randomised crossover trial (NCT03879668) with a within-subject comparison of the two modes (washout period 30 min).

SETTING/PARTICIPANTS

Convenience sample of specialist inpatient and palliative home care patients aged over 18 years with cancer and non-cancer conditions was recruited. Scores were compared using intraclass correlation coefficients (ICC), Bland-Altman plots and via a mixed-effects analysis of variance.

RESULTS

Fifty patients were randomised to complete paper-electronic (n = 24) and electronic-paper (n = 26) IPOS with median age 69 years (range 24-95), 56% male, 16% non-cancer. The ICCs showed very high concordance for the total score (ICC 0.99, 95% CI 0.98-1.00), lowest ICCs being observed for symptoms 'Appetite loss' and 'Drowsiness' (ICC 0.95, 95% CI 0.92-0.97). Nine of seventeen items had ICCs above 0.98, as did all subscales. No statistically significant mode, order, age, and interaction effects were observed for IPOS total score and subscales, except for 'Communication' (F_mode = 5.9, p = 0.019). Fifty-eight percent preferred the electronic version. In the group 75+ years, 53% preferred the paper version. Only three entries in the free-text main problems differed between the versions.

CONCLUSION

The very high equivalence in scores and free text between the IPOS and the eIPOS demonstrates that eIPOS is feasible and reliable in an older palliative population.

Digital health interventions in palliative care: a systematic meta-review

Digital health interventions (DHIs) have the potential to improve the accessibility and effectiveness of palliative care but heterogeneity amongst existing systematic reviews presents a challenge for evidence synthesis. This meta-review applied a structured search of ten databases from 2006 to 2020, revealing 21 relevant systematic reviews, encompassing 332 publications. Interventions delivered via videoconferencing (17%), electronic healthcare records (16%) and phone (13%) were most frequently described in studies within reviews. DHIs were typically used in palliative care for education (20%), symptom management (15%), decision-making (13%), information provision or management (13%) and communication (9%). Across all reviews, mostly positive impacts were reported on education, information sharing, decision-making, communication and costs. Impacts on quality of life and physical and psychological symptoms were inconclusive. Applying AMSTAR 2 criteria, most reviews were judged as low quality as they lacked a protocol or did not consider risk of bias, so findings need to be interpreted with caution.

Effectiveness of eHealth interventions and information needs in palliative care: a systematic literature review

Background

One of the key components in palliative care is communication. eHealth technologies can be an effective way to support communications among participants in the process of palliative care. However, it is unclear to what extent information technology has been established in this field.

Objective

Our goal was to systematically identify studies and analyze the effectiveness of eHealth interventions in palliative care and the information needs of people involved in the palliative care process.

Methods

We conducted a systematic literature search using PubMed, Embase, and LILACS according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We collected and analyzed quantitative and qualitative data regarding effectiveness of eHealth interventions and users’ information needs in palliative care.

Results

Our search returned a total of 240 articles, 17 of which met our inclusion criteria. We found no randomized controlled trial studying the effects of eHealth interventions in palliative care. Studies tended to be observational, noncontrolled studies, and a few quasi-experimental studies. Overall there was great heterogeneity in the types of interventions and outcome assessments; some studies reported some improvement on quality of care, documentation effort, cost, and communications. The most frequently reported information need concerned pain management.

Conclusions

There is limited evidence around the effectiveness of eHealth interventions for palliative care patients, caregivers, and health care professionals. Focused research on information needs and high-quality clinical trials to assess their effectiveness are needed.

Assessing the readiness of hospice volunteers to utilize technology

Although hospice volunteer programs contribute to patient care, little is known about their utilization and adaptation of technology. A survey was posted to the Hospice Volunteer Association Web site to assess technology use among volunteer coordinators and volunteers. Results revealed that participants have access to computers, Internet, and e-mail at the hospice agency and routinely use cellular phones and e-mail. Despite the use of technology, communication problems with volunteers hindered the coordinator's ability to manage scheduling, training, and volunteer assignments for patient care. Coordinators and volunteers felt comfortable utilizing technology but were less comfortable using technology in the patients' home. Several areas are identified for development and integration of advanced technology in volunteer programs. Future research is needed to ease technology implementation and increase volunteer acceptance.

An online expert network for high quality information on occupational safety and health: cross-sectional study of user satisfaction and impact

Background

Many people have difficulties finding information on health questions, including occupational safety and health (OSH) issues. One solution to alleviate these difficulties could be to offer questioners free-of-charge, online access to a network of OSH experts who provide tailored, high-quality information. The aim of this study was to assess whether network quality, respectively information quality, as perceived by the questioners, is associated with questioners' overall satisfaction and to explore the impact of the information received on questioners' knowledge, work and work functioning.

Methods

We evaluated the experiences of OSH questioners with the online network ArboAntwoord.com over a two-year period. In this network, approximately 80 qualified experts are available to answer OSH questions. By means of a questionnaire, we assessed questioners' overall satisfaction with the network, whether the network was user-friendly, easily accessible and easy to handle and whether the information provided was complete, applicable and received in a timely manner. The impact of the information on questioners' knowledge, work or work functioning was explored with seven questions. In the study period, 460 unique OSH questioners asked 851 OSH questions. In total, 205 of the 460 questioners completed the questionnaire (response rate 45%).

Results

Of the responders, 71% were satisfied with the ArboAntwoord network. Multiple logistic regression analysis showed that the applicability of the information had a positive influence on the questioners' overall satisfaction (OR = 16.0, 95% CI: 7.0-36.4). Also, user friendliness of the network (OR = 3.3, 95% CI: 1.3-8.6) and completeness of the information provided (OR = 3.0, 95% CI: 1.3-6.8) were positively related to the questioners' satisfaction. For 74% of the questioners, the information helped to increase their knowledge and understanding. Overall, 25% of the questioners indicated that the received information improved their work, work functioning or health.

Conclusions

A free-of-charge, online expert network in the field of OSH can be a useful strategy to provide OSH questioners with applicable, complete and timely information that may help improve safety and health at work. This study provides more insight in how to satisfy network questioners and about the potential impact of provided information on OSH.

Technologies to support end-of-life care

OBJECTIVES

To describe the current level of utilization of informatics systems in hospice and palliative care and to discuss two projects that highlight the role of informatics applications for hospice informal caregivers.

DATA SOURCES

Published articles, Web resources, clinical practice, and ongoing research initiatives.

CONCLUSION

There are currently few informatics interventions designed specifically for palliative and hospice care. Challenges such as interoperability, user acceptance, privacy, the digital divide, and allocation of resources all affect the diffusion of informatics tools in hospice.

IMPLICATIONS FOR NURSING PRACTICE

Caregiver support through use of information technology is feasible and may enhance hospice care.

Information seeking behaviors of parents whose children have life-threatening illnesses

OBJECTIVES

For children with life-threatening illnesses we sought to (1) understand the associations between parental characteristics and preferred health information sources, and (2) assess the e-health literacy of Internet-users.

STUDY DESIGN

Cross-sectional, telephone survey of 129 parents whose children are in a pediatric palliative care program in Florida.

RESULTS

Four out of five parents report that they use the Internet, and 64% of Internet-users use it daily. Parents who never use the Internet, versus parents who do use the Internet, are predominately Hispanic (50%) and have less than a high school education (64%) (P ≤ 0.023). Internet-users have high levels of e-health literacy; however, they are not confident or are unsure about the quality of information on the Internet. Not having graduated from high school was associated with a decrease in e-health literacy and using the Internet as the primary information source (vs. doctor as primary source) was associated with an increase in e-health literacy.

CONCLUSION

Parents of children with life-threatening illnesses have access to and use the Internet as a source of information about their children's health. More information is needed to explore how electronic-based interventions could be used to impact information seeking of parents whose children are in pediatric palliative care programs.

e-Health in pediatric palliative care

e-Health has the potential to improve pediatric palliative care. e-Health initiatives use the Internet or health information technology to improve quality of care and have the potential to decrease costs by reducing medical errors, reducing duplication of services, improving access to diagnostic and laboratory results, and improving communication between providers and patients, and so on. The majority of e-health initiatives are for adults and only a limited amount of evidence exists in the literature on e-health interventions in palliative care that are focused on pediatrics. To explore what role e-health could play in pediatric palliative care programs, this article aims to describe the Internet use in general in the United States and in palliative care, describe the use of health information technology in general in the United States and in palliative care, and suggest areas in pediatric palliative care that might benefit from e-health interventions.

Telehospice: reasons for slow adoption in home hospice care

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

Emotional and informational support messages in an online hospice support community

Social support is commonly thought to reduce negative health outcomes for patients and their family members, particularly when experiencing end-of-life issues. Although numerous people turn to hospice when dealing with end-of-life circumstances, many individuals do not have access to or may not be able to use hospice services. As an alternative to traditional hospice, individuals may seek social support in online hospice support communities. Although a large body of research focuses on individual disease/condition-specific communities, to date, online hospice support communities have remained unexplored. This investigation sought to describe how social support was provided within a publicly accessible, online hospice support community located within Yahoo! groups. A content analysis was conducted on 443 messages from 4 months of posts in an online hospice community. During the sample period, 28 community members, ranging from hospice professionals to family members of hospice patients, posted messages. As optimal matching theory may predict, it was found that emotional support interactions were far more frequent than informational support exchanges. Overall, encouragement/support themes were the most common type of emotional support, and medication/treatment themes were the most common type of informational support.

One size doesn't fit all: bringing telehealth services to special populations

Telehealth applications and information communication technologies can be customized and scaled to meet the healthcare service needs of a wide variety of special populations. Categorization of those special groups can be viewed from a spectrum of perspectives such as by gender, age, culture, families, communities, chronic conditions, or particular types of locations, as well as when addressing a specific or unique health need. The emergence of innovations in the use of a range of technologies and connectivity offers exciting new approaches to the integration of telehealth aimed at improving quality and continuity of care to better meet the needs of special populations.