Exploring the acceptance of telehealth within palliative care: A self-determination theory perspective

Profiles of physician motivation towards using virtual care: differences in workplace need fulfillment

BACKGROUND

Physicians appear to vary in their motivation towards using virtual care, but to what extent is unclear. To better understand this variance, which is important for supporting physician wellbeing and therefore patient care, the authors used self-determination theory's (SDT) framework. According to SDT, different types of motivation exist, ranging from controlled to autonomous, that lend to differences in engagement, performance, and wellbeing. The authors aimed to determine: (a) if there were distinct groups of physicians based on their quality of motivation towards using virtual care, and if so, (b) how these groups varied in fulfillment of basic psychological needs (autonomy, competence, and relatedness) in the workplace.

METHODS

In March-August 2022, the authors collected quantitative, survey-based data from a cross-section of 156 family physicians in Alberta, Canada. The survey contained existing scales that measure types of motivation (autonomous vs. controlled) and basic psychological need satisfaction/frustration at work. Cluster analysis was used to explore profiles of physician motivation towards using virtual care, and analysis of variance was used to determine how each profile differed with respect to workplace need fulfillment.

RESULTS

With motivation towards using virtual care, three higher-order profiles of physician motivation were identified: autonomous (19% family physicians), controlled (16% of family physicians), and ambivalent (66% of family physicians). The three profiles differed significantly in terms of psychological need fulfillment at work.

CONCLUSIONS

This study identifies specific profiles that family physicians currently fall into when it comes to motivation towards using virtual care. In line with SDT, findings suggest that basic psychological needs are fundamental nutrients for physicians to internalize and endorse the value of using virtual care in their practices. Implications for physician wellbeing are discussed.

Enablers and inhibitors to the adoption of mHealth apps by patients - A qualitative analysis of German doctors' perspectives

OBJECTIVE

Germany is the first country that approved validated mobile health apps (called DiGA) for prescription by doctors and psychotherapists. The aim of this study is to investigate doctors' perspectives towards these mobile health apps and their intentions to prescribe them. Additionally, we investigated the influence of different roles and expectations of outcomes.

METHODS

We used a qualitative study design to determine doctors' viewpoints on prescribing DiGAs. We conducted 28 semi-structured interviews and used the grounded theory method for analysis. We adopted a classical conceptualist approach to gain theoretical insights.

RESULTS

The results show that doctors' acceptance and support of DiGAs are critical in mobile health uptake and utilisation. Although mobile health is seen to be supportive of patient management and patient education doctors nevertheless need to adopt a motivating and persuasive role in the process.

CONCLUSIONS

Doctors consider DiGAs complementary to their role in patient management and are predominantly positive about DiGAs. A trusted relationship with patients must be developed to ensure the appropriate support of DiGAs.

PRACTICE IMPLICATIONS

Our study suggests that targeted education, user-centred DiGAs, consideration of social presence and user engagement, and co-development with doctors can improve longer-term DiGA use and effectiveness.

Health professionals' experiences of rapport during telehealth encounters in community palliative care: An interpretive description study

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.

Advantages and Challenges of Using Telehealth for Home-Based Palliative Care: Systematic Mixed Studies Review

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.

Patient Receptivity to Integration of Telehealth in Pelvic Floor Physical Therapy Regimens

IMPORTANCE

Limited research has focused on patient perceptions and barriers to integration of virtual care in the pelvic health arena.

OBJECTIVES

The purpose of this study was to determine the willingness of patients to consider telehealth as a means to seek pelvic floor physical therapy (PFPT) care and the promoters and deterrents for deployment in this treatment modality.

METHODS

This is a cross-sectional study of patients (≥18 years of age) at a multidisciplinary pelvic health service in an academic medical center in Northwest Ohio. The data collection occurred over 6 months in the latter half of 2021 using a novel 21-question survey based on focus group perceived patient requests, needs, and concerns that were aligned and cross-referenced with published literature.

RESULTS

The survey was completed by 210 patients, with up to 40% (n = 83) being new PFPT patients. Of those interested in telehealth being a component of their PFPT therapeutic regimen (n = 142 [68%]), interest was driven by convenience (78%). Privacy (n = 52 [76%]) was the main barrier impeding interest in this modality. Up to 80% (n = 169) preferred to establish care through in-person visits before initiating PFPT regimens remotely, with 44% (n = 93) suggesting that incorporation of telehealth would positively affect their adherence with care regimens.

CONCLUSION

Offering patients in-person visits or hybrid alternatives may be optimal for improving adherence to therapeutic regimens especially when considering access to care.

Perceived Autonomy Support in Telerehabilitation by People With Chronic Respiratory Disease: A Mixed Methods Study

BACKGROUND

Autonomy-supportive health environments can assist patients in achieving behavior change and can influence adherence positively. Telerehabilitation may increase access to rehabilitation services, but creating an autonomy-supportive environment may be challenging.

RESEARCH QUESTION

To what degree does telerehabilitation provide an autonomy-supportive environment? What is the patient experience of an 8-week telerehabilitation program?

STUDY DESIGN AND METHODS

Individuals undertaking telerehabilitation or center-based pulmonary rehabilitation within a larger randomized controlled equivalence trial completed the Health Care Climate Questionnaire (HCCQ; short form) to assess perceived autonomy support. Telerehabilitation participants were invited 1:1 to undertake semistructured interviews. Interviews were transcribed verbatim and coded thematically to identify major themes and subthemes.

RESULTS

One hundred thirty-six participants (n = 69 telerehabilitation) completed the HCCQ and 30 telerehabilitation participants (42%) undertook interviews. HCCQ summary scores indicated that participants strongly agreed that the telerehabilitation environment was autonomy supportive, which was similar to center-based participants (HCCQ summary score, P = .6; individual HCCQ items, P ≥ .3). Telerehabilitation interview data supported quantitative findings identifying five major themes, with subthemes, as follows: (1) making it easier to participate in pulmonary rehabilitation, because telerehabilitation was convenient, saved time and money, and offered flexibility; (2) receiving support in a variety of ways, including opportunities for peer support and receiving an individualized program guided by expert staff; (3) internal and external motivation to exercise as a consequence of being in a supervised group, seeing results for effort, and being inspired by others; (4) achieving success through provision of equipment and processes to prepare and support operation of equipment and technology; and (5) after the rehabilitation program, continuing to exercise, but dealing with feelings of loss.

INTERPRETATION

Telerehabilitation was perceived as an autonomy-supportive environment, in part by making it easier to undertake pulmonary rehabilitation. Support for behavior change, understanding, and motivation were derived from clinicians and patient-peers. The extent to which autonomy support translates into ongoing self-management and behavior change is not clear.

TRIAL REGISTRY

ClinicalTrials.gov; No.: ACTRN12616000360415; URL: www.

CLINICALTRIALS

gov.

The use of telehealth in the provision of after-hours palliative care services in rural and remote Australia: A scoping review

Background

Accessing quality palliative care, especially at the end of life is vital in reducing physical and emotional distress and optimising quality of life. For people living in rural and remote Australia, telehealth services can be effective in providing access to after-hours palliative care.

Objective

To review and map the available evidence on the use of telehealth in providing after-hours palliative care services in rural and remote Australia.

Method

Scoping review using Arksey and O’Malley methodological framework. Findings are reported in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Scopus, Web of Science, CINAHL Complete, Embase via Ovid, Emcare via Ovid, and Medline via Ovid databases were searched. Peer-reviewed studies and grey literature published in English from 2000 to May 2021 were included.

Results

Twelve studies were included in the review. Four main themes were identified: 1) Stakeholder perceptions of service; 2) benefits to services and users; 3) service challenges; and 4) recommendations for service improvement.

Conclusion

Telehealth can connect patients and families with healthcare professionals and enable patients to continue receiving care at home. However, challenges relating to patients, service, staff skills, and experience need to be overcome to ensure the success and sustainability of this service. Improved communication and care coordination, better access to patient records, and ongoing healthcare professional education are required.

Implications

Protocols, comprehensive policy documents and standardized operating procedures to guide healthcare professionals to provide after-hours palliative care is needed. Ongoing education and training for staff is crucial in managing patients’ symptoms. Existing service gaps need to be explored and alternative models of after-hours palliative care need to be tested.

Digital healthcare in COPD management: a narrative review on the advantages, pitfalls, and need for further research

Chronic obstructive pulmonary disease (COPD) remains a leading cause of morbidity and mortality despite current treatment strategies which focus on smoking cessation, pulmonary rehabilitation, and symptomatic relief. A focus of COPD care is to encourage self-management, particularly during COVID-19, where much face-to-face care has been reduced or ceased. Digital health solutions may offer affordable and scalable solutions to support COPD patient education and self-management, such solutions could improve clinical outcomes and expand service reach for limited additional cost. However, optimal ways to deliver digital medicine are still in development, and there are a number of important considerations for clinicians, commissioners, and patients to ensure successful implementation of digitally augmented care. In this narrative review, we discuss advantages, pitfalls, and future prospects of digital healthcare, which offer a variety of tools including self-management plans, education videos, inhaler training videos, feedback to patients and healthcare professionals (HCPs), exacerbation monitoring, and pulmonary rehabilitation. We discuss the key issues with sustaining patient and HCP engagement and limiting attrition of use, interoperability with devices, integration into healthcare systems, and ensuring inclusivity and accessibility. We explore the essential areas of research beyond determining safety and efficacy to understand the acceptability of digital healthcare solutions to patients, clinicians, and healthcare systems, and hence ways to improve this and sustain engagement. Finally, we explore the regulatory challenges to ensure quality and engagement and effective integration into current healthcare systems and care pathways, while maintaining patients’ autonomy and privacy. Understanding and addressing these issues and successful incorporation of an acceptable, simple, scalable, affordable, and future-proof digital solution into healthcare systems could help remodel global chronic disease management and fractured healthcare systems to provide best patient care and optimisation of healthcare resources to meet the global burden and unmet clinical need of COPD.

Reflexive thematic analysis exploring stakeholder experiences of virtual pulmonary rehabilitation (VIPAR)

Introduction

To enable greater availability of pulmonary rehabilitation (PR), video-conferencing technology was employed to link a community site to a standard outpatient PR service to deliver the programme closer to those with chronic respiratory disease. The service was called virtual pulmonary rehabilitation (VIPAR). To understand the experiences of those involved in this service, this study aimed to answer the question: How do the different stakeholders that interact with VIPAR experience the programme?

Methods

Focus groups were conducted with people with chronic lung disease attending either the community or outpatient PR site, in addition to the staff involved in the running of the PR groups. A total of five focus groups were conducted. Reflexive thematic analysis was used to analyse the transcripts.

Results

Participants who received VIPAR were positive regarding the programme and described the benefits of the service. Additionally, participants discussed the trade-off between convenience and relatedness. Staff described barriers to the service and solutions that could be employed to mitigate these, including greater training, organisation and understanding of risk.

Discussion

Using technology to increase the availability of PR is acceptable to the stakeholders involved, providing problems and organisational issues are resolved with training.

Motivation of Physicians to Use and Recommend Apps for the Treatment of Haemophilia

Digitalization of health care and the availability of suitable end devices lead to an increase in the use of telehealth applications. Most research on telehealth focuses on patients or organizations (like hospitals), while the role of physicians in this context is often neglected. In case of serious and chronic diseases, they play two major roles in the use of telehealth. Firstly, they may influence the patient's decision whether to use it at all (if more than one option is available, they may also influence the patient's choice of software). Secondly, if there is a need for a physicians' participation (eg, in telecare), an adoption decision by the physician to use the system is necessary. We develop a model to understand a physician's motivations to recommend the use of telehealth software to patients and to adopt it himself. The results demonstrate that physicians recommend telehealth based on their own use intention and the perceived performance improvements in patient treatment. Further, their own use intention is dependent on the usefulness of the system for their work. Potential disadvantages like decreased patient autonomy or cost of the system use do not influence the physician's decisions.