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Suslow A, Giehl C, Hergesell J, Vollmar HC, Otte I. Impact of information and communication software on multiprofessional team collaboration in outpatient palliative care - a qualitative study on providers' perspectives. BMC Palliat Care 2023; 22:19. [PMID: 36882733 PMCID: PMC9991877 DOI: 10.1186/s12904-023-01141-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 03/01/2023] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND The communication processes between different stakeholders in outpatient palliative care face challenges when multiprofessional teams want to keep each other updated on patient information. Meanwhile, the software market offers different tools to connect these teams in real-time to improve communication. In the research project ADAPTIVE (Impact of Digital Technologies in Palliative Care), we investigated how information and communication technology affects collaboration and work in multiprofessional teams and what advantages and disadvantages the use of said software might entail. METHODS We conducted 26 semi-structured interviews between August and November 2020 with general practitioners (n = 8), palliative care nurses (n = 17), and a pharmacist (n = 1). They were conducted in a hybrid format, meaning that both face-to-face interviews and telephone interviews were carried out. Subsequently, we analyzed the interviews following the qualitative content analysis according to Kuckartz. RESULTS Information and communication software has the potential to enable faster communication and delegation of tasks and to simplify communication and task management between providers. Furthermore, it creates the opportunity to decrease unnecessary supervision of duties and responsibilities for physicians in multiprofessional teams. Therefore, it allows facilitating the collaboration between multiprofessional teams that work independently of each other but care for the same patients. All providers have the same knowledge about their patients without time-consuming coordination such as phone calls or search processes in paper documentation. On the other hand, mishandling, poor Internet connection, and unfamiliarity with various features can diminish these benefits. CONCLUSION Even though the use of such software offers many advantages, these advantages only reveal themselves if the software is used as it was intended by the developers. Misuse and unawareness of the individual functions can lead to the full potential not being realized. The software developers frequently offer specialized training, and the multiprofessional teams should utilize that to improve team communication, facilitate tasks, and allow physicians to delegate tasks. TRIAL REGISTRATION The study is registered in the German Clinical Trials Register (DRKS): https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00021603 (Registration number: DRKS00021603; date of first registration: 02/07/2020).
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Affiliation(s)
- Anastasia Suslow
- Institute of General Practice and Family Medicine (AM RUB), Ruhr University Bochum, Universitätsstraße 150, 44801, Bochum, Germany.
| | - Chantal Giehl
- Institute of General Practice and Family Medicine (AM RUB), Ruhr University Bochum, Universitätsstraße 150, 44801, Bochum, Germany
| | - Jannis Hergesell
- Research Network of Old-Age Provision, Deutsche Rentenversicherung Bund, Ruhrstraße 2, 10709, Berlin, Germany
| | - Horst Christian Vollmar
- Institute of General Practice and Family Medicine (AM RUB), Ruhr University Bochum, Universitätsstraße 150, 44801, Bochum, Germany
| | - Ina Otte
- Institute of General Practice and Family Medicine (AM RUB), Ruhr University Bochum, Universitätsstraße 150, 44801, Bochum, Germany
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Portz JD, Powers J, Baldwin M, Gleason K, Casillas A, Bekelman DB, Boxer R, Bayliss E, Palen TE. How can patient portals support caregivers of older adults near the end-of-life? A mixed-methods study. J Am Geriatr Soc 2022; 70:2431-2435. [PMID: 35488465 PMCID: PMC9378599 DOI: 10.1111/jgs.17818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 03/07/2022] [Accepted: 03/25/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Jennifer Dickman Portz
- Division of General Internal Medicine, School of Medicine, University of Colorado, Aurora, Colorado
- Insitute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado
| | - J.D. Powers
- Insitute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado
| | - Megan Baldwin
- Insitute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado
| | - Kathy Gleason
- Insitute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado
| | - Alejandra Casillas
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, UCLA, Los Angeles, California
| | - David B. Bekelman
- Division of General Internal Medicine, School of Medicine, University of Colorado, Aurora, Colorado
- Department of Medicine, Department of Veterans Affairs, Eastern Colorado Health Care System, Aurora, Colorado
| | - Rebecca Boxer
- Insitute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado
| | - Elizabeth Bayliss
- Insitute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado
- Department of Family Medicine, School of Medicine, University of Colorado, Aurora, Colorado
| | - Ted E. Palen
- Insitute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado
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Krooupa AM, Stone P, McKeever S, Seddon K, Davis S, Sampson EL, Tookman A, Martin J, Nambisan V, Vivat B. Do palliative care patients and relatives think it would be acceptable to use Bispectral index (BIS) technology to monitor palliative care patients' levels of consciousness? A qualitative exploration with interviews and focus groups for the I-CAN-CARE research programme. BMC Palliat Care 2022; 21:86. [PMID: 35610644 PMCID: PMC9131519 DOI: 10.1186/s12904-022-00949-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 04/14/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Bispectral index (BIS) monitoring uses electroencephalographic data as an indicator of patients' consciousness level. This technology might be a useful adjunct to clinical observation when titrating sedative medications for palliative care patients. However, the use of BIS in palliative care generally, and in the UK in particular, is under-researched. A key area is this technology's acceptability for palliative care service users. Ahead of trialling BIS in practice, and in order to ascertain whether such a trial would be reasonable, we conducted a study to explore UK palliative care patients' and relatives' perceptions of the technology, including whether they thought its use in palliative care practice would be acceptable. METHODS A qualitative exploration was undertaken. Participants were recruited through a UK hospice. Focus groups and semi-structured interviews were conducted with separate groups of palliative care patients, relatives of current patients, and bereaved relatives. We explored their views on acceptability of using BIS with palliative care patients, and analysed their responses following the five key stages of the Framework method. RESULTS We recruited 25 participants. There were ten current hospice patients in three focus groups, four relatives of current patients in one focus group and one individual interview, and eleven bereaved relatives in three focus groups and two individual interviews. Our study participants considered BIS acceptable for monitoring palliative care patients' consciousness levels, and that it might be of use in end-of-life care, provided that it was additional to (rather than a replacement of) usual care, and patients and/or family members were involved in decisions about its use. Participants also noted that BIS, while possibly obtrusive, is not invasive, with some seeing it as equivalent to wearable technological devices such as activity watches. CONCLUSIONS Participants considered BIS technology might be of benefit to palliative care as a non-intrusive means of assisting clinical assessment and decision-making at the end of life, and concluded that it would therefore be acceptable to trial the technology with patients.
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Affiliation(s)
- Anna-Maria Krooupa
- Division of Psychiatry, Marie Curie Palliative Care Research Department, University College London, London, UK.
| | - Patrick Stone
- grid.83440.3b0000000121901201Division of Psychiatry, Marie Curie Palliative Care Research Department, University College London, London, UK
| | - Stephen McKeever
- grid.83440.3b0000000121901201Division of Psychiatry, Marie Curie Palliative Care Research Department, University College London, London, UK ,grid.1008.90000 0001 2179 088XDepartment of Nursing, The University of Melbourne, Melbourne, Australia
| | - Kathy Seddon
- grid.419428.20000 0000 9768 8171Marie Curie Palliative Care Research Voices, London, UK
| | - Sarah Davis
- grid.83440.3b0000000121901201Division of Psychiatry, Marie Curie Palliative Care Research Department, University College London, London, UK
| | - Elizabeth L. Sampson
- grid.83440.3b0000000121901201Division of Psychiatry, University College London, London, UK
| | - Adrian Tookman
- grid.419428.20000 0000 9768 8171Marie Curie Hospice Hampstead, London, UK ,Field Editor Cochrane; Palliative and Supportive Care, Oxford, UK
| | - Jonathan Martin
- grid.450578.b0000 0001 1550 1922Central & North West London NHS Foundation Trust, London, UK ,grid.52996.310000 0000 8937 2257National Hospital for Neurology & Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Bella Vivat
- grid.83440.3b0000000121901201Division of Psychiatry, Marie Curie Palliative Care Research Department, University College London, London, UK
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Sultana A, Tasnim S, Sharma R, Pawar P, Bhattcharya S, Hossain MM. Psychosocial Challenges in Palliative Care: Bridging the Gaps Using Digital Health. Indian J Palliat Care 2021; 27:442-447. [PMID: 34898939 PMCID: PMC8655652 DOI: 10.25259/ijpc_381_20] [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: 07/09/2021] [Accepted: 08/10/2021] [Indexed: 11/24/2022] Open
Abstract
Psychosocial health is a major palliative care concern globally. Patients and caregivers engaged in palliative care may experience deteriorated mental and social health conditions. Global evidence informs a high burden of depression, anxiety, psychological distress and other mental health problems among the palliative care populations. Those challenges aggravate the preexisting palliative care issues, such as lack of access and suboptimal quality of care. Palliative caregiving, both in the institutional and community settings, should be strengthened, incorporating psychosocial support for the patients and their caregivers. The recent advancements in digital health technologies have shown promising impacts in facilitating health communication, decision-making and delivering psychosocial interventions using digital devices and platforms. Adopting evidence-based interventions can help the users to access mental health resources and communicate with each other to promote shared decision-making and management of health problems. Health-care organisations and systems may explore opportunities to advance psychosocial care using digital technologies. Leveraging advanced technologies in palliative caregiving may require multifaceted research exploring potential barriers and opportunities at the user, institutional and systems levels. Nonetheless, palliative care policies and health systems measures should be strengthened to develop and implement digital support systems that may improve psychosocial health and overall palliative care outcome.
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Affiliation(s)
- Abida Sultana
- Department of Mental Health, EviSyn Health, Khulna, Bangladesh
| | - Samia Tasnim
- Department of Health Promotion and Community Health Sciences, Texas A&M University, Texas, United States
| | - Rachit Sharma
- Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University, Philadelphia, United States
| | - Priyanka Pawar
- Department of Programs, GRID Council, Delhi-NCR, Delhi, India
| | - Sudip Bhattcharya
- Department of Community Medicine, Himalayan Institute of Medical Sciences, Dehradun, India
| | - Md Mahbub Hossain
- Department of Health Promotion and Community Health Sciences, Texas A&M University, Texas, United States
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Stakeholder perspectives and requirements to guide the development of digital technology for palliative cancer services: a multi-country, cross-sectional, qualitative study in Nigeria, Uganda and Zimbabwe. BMC Palliat Care 2021; 20:4. [PMID: 33397321 PMCID: PMC7784352 DOI: 10.1186/s12904-020-00694-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 12/10/2020] [Indexed: 12/20/2022] Open
Abstract
Introduction Coverage of palliative care in low and middle-income countries is very limited, and global projections suggest large increases in need. Novel approaches are needed to achieve the palliative care goals of Universal Health Coverage. This study aimed to identify stakeholders’ data and information needs and the role of digital technologies to improve access to and delivery of palliative care for people with advanced cancer in Nigeria, Uganda and Zimbabwe. Methods We conducted a multi-country cross-sectional qualitative study in sub-Saharan Africa. In-depth qualitative stakeholder interviews were conducted with N = 195 participants across Nigeria, Uganda and Zimbabwe (advanced cancer patients n = 62, informal caregivers n = 48, health care professionals n = 59, policymakers n = 26). Verbatim transcripts were subjected to deductive and inductive framework analysis to identify stakeholders needs and their preferences for digital technology in supporting the capture, transfer and use of patient-level data to improve delivery of palliative care. Results Our coding framework identified four main themes: i) acceptability of digital technology; ii) current context of technology use; iii) current vision for digital technology to support health and palliative care, and; iv) digital technologies for the generation, reporting and receipt of data. Digital heath is an acceptable approach, stakeholders support the use of secure data systems, and patients welcome improved communication with providers. There are varying preferences for how and when digital technologies should be utilised as part of palliative cancer care provision, including for increasing timely patient access to trained palliative care providers and the triaging of contact from patients. Conclusion We identified design and practical challenges to optimise potential for success in developing digital health approaches to improve access to and enhance the delivery of palliative cancer care in Nigeria, Uganda and Zimbabwe. Synthesis of findings identified 15 requirements to guide the development of digital health approaches that can support the attainment of global health palliative care policy goals. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-020-00694-y.
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Baik D, Cho H, Masterson Creber RM. Examining Interventions Designed to Support Shared Decision Making and Subsequent Patient Outcomes in Palliative Care: A Systematic Review of the Literature. Am J Hosp Palliat Care 2018; 36:76-88. [PMID: 29925244 DOI: 10.1177/1049909118783688] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND: Shared decision making (SDM) is a key attribute of patient-centered care, which empowers palliative care patients to be able to make optimal medical decisions about end-of-life treatments based on their own values and preferences. AIM: The aim of this systematic literature review is to detail and compare interventions supporting SDM over the last 10 years (January 2008 to December 2017) and to analyze patient/caregiver outcomes at the end of life. METHODS: This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, CINAHL, Embase, and Cochrane Library were searched with key search terms: SDM, decision aid, decision support, palliative care, and hospice care. The Mixed Methods Appraisal Tool was used to assess the quality of the included studies. RESULTS: The initial search yielded 2705 articles, and 12 studies were included in the final review. The quality of the studies was modest and technology-enabled delivery modes (e.g., video, DVD, web-based tool) were most commonly used. Patient/caregiver knowledge of end-of-life care was the most common primary outcome across studies. The strength of the association between the SDM interventions and patient/caregiver outcomes varied. CONCLUSION: The findings from the studies that examined the effects of the SDM intervention on patient outcomes were inconsistent, highlighting the need for further SDM intervention studies among diverse patient populations using consistent measures. Given the availability of health technologies, future studies should focus on developing individual-tailored, technology-enabled interventions to support patient-centered medical decision making.
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Affiliation(s)
- Dawon Baik
- 1 School of Nursing, Columbia University, New York, NY, USA
| | - Hwayoung Cho
- 1 School of Nursing, Columbia University, New York, NY, USA
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Electronic patient-reported symptom assessment in palliative end-of-life home care. Health Syst (Basingstoke) 2017. [DOI: 10.1057/hs.2013.4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Moore AR, Bastian RG, Apenteng BA. Communication Within Hospice Interdisciplinary Teams: A Narrative Review. Am J Hosp Palliat Care 2015; 33:996-1012. [PMID: 26518351 DOI: 10.1177/1049909115613315] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Hospice care is coordinated through an interdisciplinary team (IDT), which assures that a holistic care plan based on the patient's wishes is implemented. The extent to which an IDT provides quality care may be associated with how effectively they communicate within the team as well as with patients, caregivers, and families. This review seeks to characterize communication strategies among hospice IDT members and to determine how such strategies impact patient care. Although the existing literature sheds some light on communication within hospice IDTs, further research is needed. Inquiry into the communicative process of IDTs in settings other than team meetings, such as during patient visits or informal settings, would provide a more comprehensive representation of how communication influences IDT dynamics and overall team functioning.
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Affiliation(s)
- Angela R Moore
- Department of Health Policy and Management, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA, USA
| | - Randi Ginger Bastian
- Department of Health Policy and Management, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA, USA
| | - Bettye A Apenteng
- Department of Health Policy and Management, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA, USA
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Tieman JJ, Morgan DD, Swetenham K, To THM, Currow DC. Designing clinically valuable telehealth resources: processes to develop a community-based palliative care prototype. JMIR Res Protoc 2014; 3:e41. [PMID: 25189279 PMCID: PMC4180353 DOI: 10.2196/resprot.3266] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 07/18/2014] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Changing population demography and patterns of disease are increasing demands on the health system. Telehealth is seen as providing a mechanism to support community-based care, thus reducing pressure on hospital services and supporting consumer preferences for care in the home. OBJECTIVE This study examined the processes involved in developing a prototype telehealth intervention to support palliative care patients involved with a palliative care service living in the community. METHODS The challenges and considerations in developing the palliative care telehealth prototype were reviewed against the Center for eHealth Research (CeHRes) framework, a telehealth development model. The project activities to develop the prototype were specifically mapped against the model's first four phases: multidisciplinary project management, contextual inquiry, value specification, and design. This project has been developed as part of the Telehealth in the Home: Aged and Palliative Care in South Australia initiative. RESULTS Significant issues were identified and subsequently addressed during concept and prototype development. The CeHRes approach highlighted the implicit diversity in views and opinions among participants and stakeholders and enabled issues to be considered, resolved, and incorporated during design through continuous engagement. CONCLUSIONS The CeHRes model provided a mechanism that facilitated "better" solutions in the development of the palliative care prototype by addressing the inherent but potentially unrecognized differences in values and beliefs of participants. This collaboration enabled greater interaction and exchange among participants resulting in a more useful and clinically valuable telehealth prototype.
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Affiliation(s)
- Jennifer Joy Tieman
- Discipline of Palliative and Supportive Services, Department of Health Sciences, Flinders University of South Australia, Adelaide, Australia.
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Abstract
PURPOSE OF REVIEW The support of family caregivers in palliative care is critical and well recognized; yet the fact that caregivers still face significant unmet needs highlights a considerable gap in addressing this issue. Current themes on the caregiving experience in palliative care are presented. RECENT FINDINGS The recent literature suggests a shift towards a broader understanding of the caregiving experience in palliative care in terms of better integration of caregivers of patients with noncancer illnesses into palliative care, improved continuity of care among different settings and better integration of guidelines and evidence into practice. Several risk groups and factors of caregiving in palliative care have been identified. The literature review emphasizes a public health approach as an important step in addressing the caregivers' burden. While 'the right way' of supporting caregivers is still to be established, consideration of caregivers' roles as co-providers and co-recipients of care offers numerous implications for research and clinical practice. SUMMARY This review demonstrates the need for the development of specific strategies aimed at supporting informal caregivers in caring for their loved ones in different settings and periods of advanced life-threatening illnesses. Open issues in searching for 'the right way' to care for caregivers in palliative care are presented.
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Abstract
OBJECTIVES Consumer empowerment in health and rapid change in health information and communication technologies have their roots in broader social trends. This article reviews the activities at the intersection of consumer empowerment and technology. DATA SOURCES Technical reports, white papers, books, journal articles, and Web sites. CONCLUSION Social trends are visible in the integration of information and communication technologies into health care, in both searching for and sharing information on the Internet, in the use of social media to create new types of interactions with family, providers, and peers, and in the e-patient, who integrates these new roles and new technologies. IMPLICATIONS FOR NURSING PRACTICE Changes in both patients and technology will impact oncology nursing practice as new, patient-centered, interactions emerge.
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