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Hudson P, Francis J, Cohen J, Kapp S, De Abreu Lourenco R, Beatty L, Gray K, Jefford M, Juraskova I, Northouse L, de Vleminck A, Chang S, Yates P, Athan S, Baptista S, Klaic M, Philip J. Improving the Well-Being of People With Advanced Cancer and Their Family Caregivers: Protocol for an Effectiveness-Implementation Trial of a Dyadic Digital Health Intervention (FOCUSau). JMIR Res Protoc 2024; 13:e55252. [PMID: 39137414 DOI: 10.2196/55252] [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] [Received: 12/08/2023] [Revised: 03/19/2024] [Accepted: 05/21/2024] [Indexed: 08/15/2024] Open
Abstract
BACKGROUND Advanced cancer significantly impacts patients' and family caregivers' quality of life. When patients and caregivers are supported concurrently as a dyad, the well-being of each person is optimized. Family, Outlook, Communication, Uncertainty, Symptom management (FOCUS) is a dyadic, psychoeducational intervention developed in the United States, shown to improve the well-being and quality of life of patients with advanced cancer and their primary caregivers. Originally, a nurse-delivered in-person intervention, FOCUS has been adapted into a self-administered web-based intervention for European delivery. OBJECTIVE The aims of this study are to (1) adapt FOCUS to the Australian context (FOCUSau); (2) evaluate the effectiveness of FOCUSau in improving the emotional well-being and self-efficacy of patients with advanced cancer and their primary caregiver relative to usual care control group; (3) compare health care use between the intervention and control groups; and (4) assess the acceptability, feasibility, and scalability of FOCUSau in order to inform future maintainable implementation of the intervention within the Australian health care system. METHODS FOCUS will be adapted prior to trial commencement, using an iterative stakeholder feedback process to create FOCUSau. To examine the efficacy and cost-effectiveness of FOCUSau and assess its acceptability, feasibility, and scalability, we will undertake a hybrid type 1 implementation study consisting of a phase 3 (clinical effectiveness) trial along with an observational implementation study. Participants will include patients with cancer who are older than 18 years, able to access the internet, and able to identify a primary support person or caregiver who can also be approached for participation. The sample size consists of 173 dyads in each arm (ie, 346 dyads in total). Patient-caregiver dyad data will be collected at 3 time points-baseline (T0) completed prerandomization; first follow-up (T1; N=346) at 12 weeks post baseline; and second follow-up (T2) at 24 weeks post baseline. RESULTS The study was funded in March 2022. Recruitment commenced in July 2024. CONCLUSIONS If shown to be effective, this intervention will improve the well-being of patients with advanced cancer and their family caregivers, regardless of their location or current level of health care support. TRIAL REGISTRATION ClinicalTrials.gov NCT06082128; https://clinicaltrials.gov/study/NCT06082128. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/55252.
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Affiliation(s)
- Peter Hudson
- Centre for Palliative Care, c/o St Vincent's Hospital and The University of Melbourne, Melbourne, Australia
- End of Life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium
| | - Jill Francis
- Melbourne School of Health Sciences, The University of Melbourne, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
- Centre for Implementation Research, Ottawa Hospital Research, Ottawa, ON, Canada
| | - Joachim Cohen
- End of Life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium
| | - Suzanne Kapp
- Melbourne School of Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Richard De Abreu Lourenco
- Centre for Health Economics Research and Evaluation (CHERE), University of Technology Sydney, Sydney, Australia
| | - Lisa Beatty
- College of Education, Psychology and Social Work, Flinders Institute for Mental Health and Wellbeing, Flinders University, Adelaide, Australia
| | - Kathleen Gray
- Centre for Digital Transformation of Health, The University of Melbourne, Melbourne, Australia
| | - Michael Jefford
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Ilona Juraskova
- Faculty of Science, School of Psychology, University of Sydney, Sydney, Australia
| | - Laurel Northouse
- School of Nursing, University of Michigan, Ann Arbor, MI, United States
| | - Aline de Vleminck
- End of Life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium
| | - Sungwon Chang
- Faculty of Health, Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), University of Technology Sydney, Sydney, Australia
| | - Patsy Yates
- Cancer and Palliative Care Outcomes Centre, Queensland University of Technology, Queensland, Australia
| | - Sophy Athan
- Cancer Consumer Advisory Committee, Victorian Comprehensive Cancer Centre Alliance, Melbourne, Australia
| | - Shaira Baptista
- Melbourne School of Health Sciences, The University of Melbourne, Melbourne, Australia
- School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia
| | - Marlena Klaic
- Melbourne School of Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Jennifer Philip
- St. Vincent's Hospital and the Victorian Comprehensive Cancer Centre, The University of Melbourne, Melbourne, Australia
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Fereidooni M, Toni E, Toni E, Ayatollahi H. Application of virtual reality for supportive care in cancer patients: a systematic review. Support Care Cancer 2024; 32:570. [PMID: 39103681 DOI: 10.1007/s00520-024-08763-1] [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: 02/21/2024] [Accepted: 07/23/2024] [Indexed: 08/07/2024]
Abstract
BACKGROUND In recent years, virtual reality (VR) technology has been widely used to support cancer patients with physical, emotional, and functional needs. This systematic review aimed to investigate the application of VR in the supportive care of cancer patients. METHOD This systematic review was conducted in 2024. In this study, various databases including PubMed, Web of Science, Scopus, the Cochrane Library, Ovid, IEEE Xplore, and ProQuest were searched, and quantitative, qualitative, and mixed-method studies which were in English and published up to 20th May 2024 were included. The keywords consisted of "virtual reality," "supportive care," and "cancer". Studies were assessed in terms of quality and risk of bias using standard tools, and results were analyzed and reported narratively. RESULTS A total of 33 articles were reviewed. VR interventions, primarily using fully immersive head-mounted displays, were associated with significant reductions in anxiety, pain, and fatigue. VR also improved mood, relaxation, and overall quality of life, and some studies noted enhanced vital signs such as heart rate and blood pressure. This technology could be used along with other medical interventions. Both patients and healthcare providers reported high level of satisfaction with VR, and appreciated its ease of use and therapeutic benefits. However, some technical barriers, like inadequate visual performance and realism, were reported. CONCLUSION VR demonstrates substantial potential benefits as a supportive care tool for cancer patients, effectively addressing their psychological, physiological, psychosocial needs. Despite technical challenges, high level of user satisfaction and benefits underscore the need for further research to optimize VR interventions in cancer care.
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Affiliation(s)
- Mahsa Fereidooni
- Department of Health Information Technology, Urmia University of Medical Sciences, Urmia, Iran
| | - Esmaeel Toni
- Student Research Committee, Iran University of Medical Sciences, Tehran, Iran.
| | - Elham Toni
- Department of Health Information Management and Technology, Faculty of Management and Health Information Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Haleh Ayatollahi
- Health Management and Economics Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran.
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Silwanah AS, Suriah S, Jafar N, Areni IS, Yusuf RA. Content and features of Mobile health (mHealth) for mother and child nutrition in the first 1000 days of life (family based intervention): A systematic review. Nutr Health 2024:2601060241265550. [PMID: 39043216 DOI: 10.1177/02601060241265550] [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: 07/25/2024]
Abstract
Background: Improving mother and child nutrition during the first 1000 days of life (DoL) is one of the major areas where mHealth has demonstrated great promise. A lot of mHealth is already used in society. However, no study examines the content and features of mobile health. Aim: This study aims to examine the difference in content and features of mHealth intervention for maternal and child nutrition throughout the first 1000 days of life. Thus, new apps can be enhanced. Methods: The online journal databases that offer free papers from Scopus-indexed journals published in 2017-2022 served as the primary sources for the literature included in this study. Several keywords were used in the literature search, which used the databases Google Scholar, Science Direct, and PubMed. A total of 8 articles were included in the literature review. Results: Existing mHealth provides content and features to support and improve the health status of pregnant women, breastfeeding mothers, and children aged 0-24 months. mHealth interventions have the potential to improve maternal and child nutrition health in the first 1000 days of life by providing education, communication, support, data collection and analysis, cultural appropriateness, accessibility, and capacity building for health workers. However, it is crucial to address challenges such as evidence-based design, privacy and security, sustainability, and data management, and to ensure cultural appropriateness and accessibility for all populations. Conclusions: The more complete the content, features, and uses of mHealth, the greater the users' acceptance.
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Affiliation(s)
- Andi Sani Silwanah
- Faculty of Public Health, Sekolah Tinggi Ilmu Kesehatan Makassar, Makassar, Indonesia
- Faculty of Public Health, Hasanuddin University, Makassar, Indonesia
| | - Suriah Suriah
- Faculty of Public Health, Hasanuddin University, Makassar, Indonesia
| | - Nurhaedar Jafar
- Faculty of Public Health, Hasanuddin University, Makassar, Indonesia
| | - Intan Sari Areni
- Faculty of Engineering, Hasanuddin University, Makassar, Indonesia
| | - Rezky Aulia Yusuf
- Faculty of Public Health, Universitas Muslim Indonesia, Makassar, Indonesia
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May S, Gehlhaar A, Stahlhut K, Kamp MA, Heinze M, Allsop M, Muehlensiepen F. "Let's put it this way: you can't really live without it" - digital technologies in routine palliative care delivery: an explorative qualitative study with patients and their family caregivers in Germany. BMC Health Serv Res 2024; 24:702. [PMID: 38831314 PMCID: PMC11149286 DOI: 10.1186/s12913-024-11150-5] [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: 03/05/2024] [Accepted: 05/27/2024] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND Despite ongoing efforts to integrate palliative care into the German healthcare system, challenges persist, particularly in areas where infrastructure does not fully support digital technologies (DT). The increasing importance of digital technology (DT) in palliative care delivery presents both opportunities and challenges. OBJECTIVE This study aimed to explore the perspectives and preferences of palliative care patients and their family caregivers regarding the use of DT in care delivery. METHODS An exploratory qualitative study was conducted using semi-structured interviews with palliative care patients and their family caregivers across various settings. Participants were selected through gatekeeper-supported purposive sampling. Interviews were analysed using structured qualitative content analysis. RESULTS Nineteen interviews were conducted.Three themes emerged: (1) Application of DTs in palliative care; (2) Potential of DTs; (3) Barriers to the use of DTs. Key findings highlighted the preference for real-time communication using DTs that participants are familiar with. Participants reported limited perceived value for digital transformation in the presence of in-person care. The study identified requirements for DT development and use in palliative care, including the need for direct and immediate functionality, efficiency in healthcare professional (HCP) work, and continuous access to services. CONCLUSION The findings highlight a demonstrate the importance of familiarity with DTs and real-time access for patients and their families. While DT can enhance palliative care efficiency and accessibility, its integration must complement, not replace, in-person interaction in palliative care. As DTs continue to grow in scope and use in palliative care, maintaining continued user engagement is essential to optimise their adoption and ensure they benefit patients and their caregivers.
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Affiliation(s)
- Susann May
- Center for Health Services Research, Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Seebad 82/83, 15562, Rüdersdorf, Brandenburg, Germany
| | - Anne Gehlhaar
- Center for Health Services Research, Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Seebad 82/83, 15562, Rüdersdorf, Brandenburg, Germany
| | - Kerstin Stahlhut
- Department of Oncology and Palliative Medicine, Brandenburg Medical School, Immanuel Klinik Rüdersdorf, 15562, Rüdersdorf, Brandenburg, Germany
| | - Marcel-Alexander Kamp
- Department of Oncology and Palliative Medicine, Brandenburg Medical School, Immanuel Klinik Rüdersdorf, 15562, Rüdersdorf, Brandenburg, Germany
| | - Martin Heinze
- Center for Health Services Research, Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Seebad 82/83, 15562, Rüdersdorf, Brandenburg, Germany
- Department of Psychiatry and Psychotherapy, Brandenburg Medical School, Immanuel Klinik Rüdersdorf, 15562, Rüdersdorf, Germany
| | - Matthew Allsop
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, LS2 9JT, UK
| | - Felix Muehlensiepen
- Center for Health Services Research, Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Seebad 82/83, 15562, Rüdersdorf, Brandenburg, Germany.
- AGEIS, Université Grenoble-Alpes, Grenoble, 38000, France.
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Johansson T, Chambers RL, Curtis T, Pask S, Greenley S, Brittain M, Bone AE, Laidlaw L, Okamoto I, Barclay S, Higginson IJ, Murtagh FE, Sleeman KE. The effectiveness of out-of-hours palliative care telephone advice lines: A rapid systematic review. Palliat Med 2024; 38:625-643. [PMID: 38708864 PMCID: PMC11158006 DOI: 10.1177/02692163241248544] [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: 05/07/2024]
Abstract
BACKGROUND People with palliative care needs and their carers often rely on out-of-hours services to remain at home. Policymakers have recommended implementing telephone advice lines to ensure 24/7 access to support. However, the impact of these services on patient and carer outcomes, as well as the health care system, remains poorly understood. AIM To evaluate the clinical- and cost-effectiveness of out-of-hours palliative care telephone advice lines, and to identify service characteristics associated with effectiveness. DESIGN Rapid systematic review (PROSPERO ID: CRD42023400370) with narrative synthesis. DATA SOURCES Three databases (Medline, EMBASE and CINAHL) were searched in February 2023 for studies of any design reporting on telephone advice lines with at least partial out-of-hours availability. Study quality was assessed using the Mixed Methods Appraisal Tool, and quantitative and qualitative data were synthesised narratively. RESULTS Twenty-one studies, published 2000-2022, were included. Most studies were observational, none were experimental. While some evidence suggested that telephone advice lines offer guidance and reassurance, supporting care at home and potentially reducing avoidable emergency care use in the last months of life, variability in reporting and poor methodological quality across studies limit our understanding of patient/carer and health care system outcomes. CONCLUSION Despite their increasing use, evidence for the clinical- and cost-effectiveness of palliative care telephone advice lines remains limited, primarily due to the lack of robust comparative studies. There is a need for more rigorous evaluations incorporating experimental or quasi-experimental methods and longer follow-up, and standardised reporting of telephone advice line models and outcomes, to guide policy and practice.
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Affiliation(s)
- Therese Johansson
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, London, UK
| | - Rachel L. Chambers
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, London, UK
| | - Thomas Curtis
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, London, UK
| | - Sophie Pask
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Sarah Greenley
- Institute of Clinical and Applied Health Research, Hull York Medical School, University of Hull, Hull, UK
| | - Molly Brittain
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, London, UK
| | - Anna E. Bone
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, London, UK
| | - Lynn Laidlaw
- Cicely Saunders Institute Patient & Public Involvement Group, King’s College London, London, UK
| | - Ikumi Okamoto
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Stephen Barclay
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Irene J. Higginson
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, London, UK
- King’s College Hospital NHS Foundation Trust, London, UK
| | - Fliss E.M. Murtagh
- Institute of Clinical and Applied Health Research, Hull York Medical School, University of Hull, Hull, UK
| | - Katherine E. Sleeman
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, London, UK
- King’s College Hospital NHS Foundation Trust, London, UK
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Schröder J, Riiser K, Holmen H. Healthcare personnel's perspectives on health technology in home-based pediatric palliative care: a qualitative study. BMC Palliat Care 2024; 23:137. [PMID: 38811957 PMCID: PMC11134737 DOI: 10.1186/s12904-024-01464-w] [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: 02/07/2024] [Accepted: 05/22/2024] [Indexed: 05/31/2024] Open
Abstract
BACKGROUND In the context of pediatric palliative care, where the quality of life of children with life-limiting or life-threatening conditions is of utmost importance, the integration of health technology must support the provision of care. Research has highlighted the role of healthcare personnel when utilizing health technology in home-based pediatric palliative care, but specific knowledge of healthcare personnel's views on the technological relevance remains limited. Therefore, our study has explored potentials and limitations of health technology in home-based pediatric palliative care from the perspectives of healthcare personnel. METHODS Our study utilized a qualitative, descriptive, and exploratory design, including five focus groups with a total of 22 healthcare personnel. The participants were selected from various health regions in Norway and were experienced in providing home-based pediatric palliative care. Using reflexive thematic analysis, we interpreted data obtained from focus groups, identified patterns, and developed themes. RESULTS The analysis resulted in the development of three intersecting themes: balancing in-person interaction and time in home-based pediatric palliative care; exchange of information can improve timely and appropriate care; and the power of visual documentation in pediatric palliative care. The healthcare personnel acknowledged difficulties in fully replacing in-person interaction with health technology. However, they also emphasized potentials of health technology to facilitate information sharing and the ability to access a child's health record within interdisciplinary teams. CONCLUSION The results underscored that technology can support pediatric palliative care but must be thoughtfully integrated to ensure an individualized patient-centered approach. To maximize the benefits of health technology in enhancing home-based pediatric palliative care, future research should address the limitations of current health technology and consider the opinions for information sharing between relevant healthcare team members, the child, and their family.
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Affiliation(s)
- Judith Schröder
- Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo Metropolitan University, St. Olavs plass, P.O. Box 4, Oslo, NO-0130, Norway.
| | - Kirsti Riiser
- Faculty of Health Sciences, Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, St. Olavs plass, P.O. Box 4, Oslo, NO-0130, Norway
| | - Heidi Holmen
- Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo Metropolitan University, St. Olavs plass, P.O. Box 4, Oslo, NO-0130, Norway
- Division of Technology and Innovation, Intervention Centre, Oslo University Hospital, Oslo, Norway
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Hwang IY, Woo GU, Lee SY, Yoo SH, Kim KH, Kim MS, Shin J, Jeong HJ, Jang MS, Baek SK, Jung EH, Lee DW, Cho B. Home-based supportive care in advanced cancer: systematic review. BMJ Support Palliat Care 2024; 14:132-148. [PMID: 38160048 PMCID: PMC11103295 DOI: 10.1136/spcare-2023-004721] [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: 11/30/2023] [Accepted: 12/04/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVES This study systematically reviewed the literature on the effect of home-based supportive care (HbSC) programmes on the quality of life (QoL) of patients with advanced cancer. METHODS The research question 'Do home-based supportive care programmes for patients with advanced cancer improve their QoL?' was addressed. After registering the plan with PROSPERO (CRD42022341237), literature published from 1 January 1990 to 30 May 2023 was searched on PubMed, Embase, Cochrane database, CINAHL and Web of Science, and reviewed for inclusion based on predefined criteria. This review only included trial studies published in English. RESULTS Of 5,276 articles identified, 17 studies were judged suitable for inclusion in this review. The components of HbSC programmes included home visits, patient and caregiver education, home nursing, psychotherapy, exercise, telephone consultation, and multidisciplinary team meetings. Nine studies reported improvements in QoL, including social functioning, emotional functioning, and subjective QoL. CONCLUSION HbSC programmes appear to enable the improvement of the QoL of patients with advanced cancer. The area of QoL that shows improvement could vary depending on the HbSC components. More studies that address HbSC programmes are needed to select patients at the proper time and provide suitable programmes for patients to benefit most.
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Affiliation(s)
- In Young Hwang
- Public Healthcare Center, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Familly Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Family Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Go-Un Woo
- Department of Internal Medicine, Dongguk University Medical Center, Goyang, Republic of Korea
| | - Sun Young Lee
- Public Healthcare Center, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Human System Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Shin Hye Yoo
- Department of Human System Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Center for Palliative Care and Clinical Ethics, Seoul National University Hospital, Seoul, Republic of Korea
| | - Kyae Hyung Kim
- Public Healthcare Center, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Family Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Min-Sun Kim
- Public Healthcare Center, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Pediatrics, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jeongmi Shin
- Public Healthcare Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hye Jin Jeong
- Public Healthcare Center, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Human System Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Min Seol Jang
- Public Healthcare Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sun Kyung Baek
- Department of Internal Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea
| | - Eun Hee Jung
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Dong-Wook Lee
- Department of Occupational and Environmental Medicine, Inha University Hospital, Inha University, Incheon, Republic of Korea
| | - Belong Cho
- Public Healthcare Center, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Familly Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Family Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Human System Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
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Qureshi SP, Judson E, Cummins C, Gadoud A, Sanders K, Doherty M. Resisting the (re-)medicalisation of dying and grief in the post-digital age: Natural language processing and qualitative analysis of data from internet support forums. Soc Sci Med 2024; 348:116517. [PMID: 38593612 DOI: 10.1016/j.socscimed.2023.116517] [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: 08/22/2023] [Revised: 12/11/2023] [Accepted: 12/13/2023] [Indexed: 04/11/2024]
Abstract
In the mid-twentieth century, the social movement of death revivalism sought to resist the medicalisation of dying and grief through promotion of the dying person retaining autonomy, and societal openness toward death and bereavement. Despite this advocacy, present-day dying in high income countries is largely institutionalised, with value placed on control over the body and emotions. These phenomena are at odds with the ambitions of death revivalism, and demonstrate the re-medicalisation of dying and grief. Furthermore, contemporary society is continually advancing into the post-digital age, reflected in digital technologies being a tacit part of human existence. Within this framework, this study aims to investigate how people living with life-limiting illness and their loved ones experience, negotiate, and resist medicalisation of dying and grief through online internet forums. We collected posts through web-scraping and utilised Natural Language Processing techniques to select 7048 forum posts from 2003 to 2020, and initially categorise data, before utilising Inductive Thematic Analysis, which generated two major themes. The theme of 'Comfort' describes online forums facilitating psychosocial support which was often used to compensate for systemic deficiencies, especially during the Covid-19 pandemic. Common sources of comfort included animal companions and spirituality, in stark contrast with the medicalised model. The theme of 'Capability' describes online forums acting as solutions for people facing disempowering care systems, including providing information on legal rights and benefits which may not be otherwise easily available, and facilitating collective advocacy. Our findings indicate that community-led online forums can play an effective and sustainable role in democratising care and retaining agency when facing life-limiting illness and grief. Future palliative and bereavement care research must focus on how online forums can be integrated into existing systems, made transparent and accessible, be adequately funded and structured, and be optimised, including compensating for service disruption encountered during future pandemics.
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Affiliation(s)
- Shaun Peter Qureshi
- Centre for the Art of Dying Well, Faculty of Business and Law, St Mary's University Twickenham, London, TW1 4SX, United Kingdom.
| | - Ellen Judson
- Centre for the Analysis of Social Media, Demos, 15 Whitehall, London, SW1A 2DD, United Kingdom.
| | - Ciaran Cummins
- Centre for the Analysis of Social Media, Demos, 15 Whitehall, London, SW1A 2DD, United Kingdom.
| | - Amy Gadoud
- Lancaster Medical School, Lancaster University, Sir John Fisher Drive, LA1 4AT, United Kingdom; Trinity Hospice, Low Moor Road, Blackpool, FY2 OGB, United Kingdom.
| | - Karen Sanders
- Centre for the Art of Dying Well, Faculty of Business and Law, St Mary's University Twickenham, London, TW1 4SX, United Kingdom.
| | - Margaret Doherty
- Centre for the Art of Dying Well, Faculty of Business and Law, St Mary's University Twickenham, London, TW1 4SX, United Kingdom.
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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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10
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Yang X, Li X, Jiang S, Yu X. Effects of Telemedicine on Informal Caregivers of Patients in Palliative Care: Systematic Review and Meta-Analysis. JMIR Mhealth Uhealth 2024; 12:e54244. [PMID: 38602303 PMCID: PMC11024400 DOI: 10.2196/54244] [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] [Received: 11/03/2023] [Revised: 02/28/2024] [Accepted: 02/28/2024] [Indexed: 04/12/2024] Open
Abstract
Background Telemedicine technology is a rapidly developing field that shows immense potential for improving medical services. In palliative care, informal caregivers assume the primary responsibility in patient care and often face challenges such as increased physical and mental stress and declining health. In such cases, telemedicine interventions can provide support and improve their health outcomes. However, research findings regarding the use of telemedicine among informal caregivers are controversial, and the efficacy of telemedicine remains unclear. Objective This study aimed to evaluate the impacts of telemedicine on the burden, anxiety, depression, and quality of life of informal caregivers of patients in palliative care. Methods A systematic literature search was conducted using the PubMed, Embase, Web of Science, CENTRAL, PsycINFO, CINAHL Plus with Full Text, CBM, CNKI, WanFang, and VIP databases to identify relevant randomized controlled trials published from inception to March 2023. Two authors independently screened the studies and extracted the relevant information. The methodological quality of the included studies was assessed using the Cochrane risk-of-bias tool. Intervention effects were estimated and sensitivity analysis was conducted using Review Manager 5.4, whereas 95% prediction intervals (PIs) were calculated using R (version 4.3.2) and RStudio. Results A total of 9 randomized controlled trials were included in this study. The meta-analysis indicated that telemedicine has reduced the caregiving burden (standardized mean differences [SMD] -0.49, 95% CI -0.72 to -0.27; P<.001; 95% PI -0.86 to -0.13) and anxiety (SMD -0.23, 95% CI -0.40 to -0.06; P=.009; 95% PI -0.98 to 0.39) of informal caregivers; however, it did not affect depression (SMD -0.21, 95% CI -0.47 to 0.05; P=.11; 95% PI -0.94 to 0.51) or quality of life (SMD 0.35, 95% CI -0.20 to 0.89; P=.21; 95% PI -2.15 to 2.85). Conclusions Although telemedicine can alleviate the caregiving burden and anxiety of informal caregivers, it does not significantly reduce depression or improve their quality of life. Further high-quality, large-sample studies are needed to validate the effects of telemedicine. Furthermore, personalized intervention programs based on theoretical foundations are required to support caregivers.
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Affiliation(s)
- Xiaoyu Yang
- Department of Oncology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xueting Li
- College of Nursing, China Medical University, Shenyang, China
| | - Shanshan Jiang
- College of Nursing, China Medical University, Shenyang, China
| | - Xinying Yu
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
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11
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Guo J, Liu J, Liu C, Wang Y, Xu X, Chen Y. Nursing informatics competency and its associated factors among palliative care nurses: an online survey in mainland China. BMC Nurs 2024; 23:157. [PMID: 38443955 PMCID: PMC10913251 DOI: 10.1186/s12912-024-01803-5] [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: 08/22/2023] [Accepted: 02/16/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Nursing informatics (NI) competency is a required core competency for high-quality care in digitally enabled healthcare environments. Given the increasing reliance on digital health in palliative care settings, it becomes crucial to evaluate the NI competency of nurses to ensure the seamless integration and effective utilization of digital health in their clinical practice. This study aimed to investigate the level of NI competency and explore its associated factors among palliative care nurses in mainland China. METHODS A cross-sectional design was conducted for this study, involving a total of 409 palliative care nurses from 302 hospitals in mainland China. Anonymous data were collected through a self-designed sociodemographic questionnaire, the Nursing Informatics Competency Scale (NICS) and the Innovative Self-Efficacy Scale. RESULTS The total score of the NICS was 129.19 ± 22.02, which indicated that Chinese palliative care nurses had a moderate level of NI competency. There was a positive correlation between innovative self-efficacy and NI competency (r = 0.602, P < 0.01). The hospital level and innovative self-efficacy were identified as statistically significant factors influencing nurses' NI competency based on multiple linear regression analysis results. These associated factors could explain 35.1% of the difference in NI competency. CONCLUSIONS This study found that palliative care nurses in mainland China exhibited moderate levels of NI competency and identified the hospital level and innovative self-efficacy as associated factors of nurses' NI competency. Measures such as developing supported strategies, including targeted NI training programs by nursing education managers of primary-level hospitals and creating a positive culture of innovation by healthcare institutions can be considered to improve the level of NI competency among Chinese palliative care nurses.
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Affiliation(s)
- Junchen Guo
- Department of Palliative Care, Hunan Cancer Hospital, No. 283, Tongzipo Road, Yuelu District, 410006, Changsha, Hunan, China
- School of Nursing, University of South China, No. 28, Changsheng West Road, 421001, Hengyang, Hunan, China
| | - Junqingzhao Liu
- Department of Palliative Care, Hunan Cancer Hospital, No. 283, Tongzipo Road, Yuelu District, 410006, Changsha, Hunan, China
| | - Chaoyi Liu
- Department of Palliative Care, Hunan Cancer Hospital, No. 283, Tongzipo Road, Yuelu District, 410006, Changsha, Hunan, China
| | - Ying Wang
- Department of Palliative Care, Hunan Cancer Hospital, No. 283, Tongzipo Road, Yuelu District, 410006, Changsha, Hunan, China
| | - Xianghua Xu
- Department of Palliative Care, Hunan Cancer Hospital, No. 283, Tongzipo Road, Yuelu District, 410006, Changsha, Hunan, China
| | - Yongyi Chen
- Department of Palliative Care, Hunan Cancer Hospital, No. 283, Tongzipo Road, Yuelu District, 410006, Changsha, Hunan, China.
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12
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Schenker Y, Abdullah S, Arnold R, Schmitz KH. Conversational Agents in Palliative Care: Potential Benefits, Risks, and Next Steps. J Palliat Med 2024; 27:296-300. [PMID: 38215235 DOI: 10.1089/jpm.2023.0534] [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: 01/14/2024] Open
Abstract
Conversational agents (sometimes called chatbots) are technology-based systems that use artificial intelligence to simulate human-to-human conversations. Research on conversational agents in health care is nascent but growing, with recent reviews highlighting the need for more robust evaluations in diverse settings and populations. In this article, we consider how conversational agents might function in palliative care-not by replacing clinicians, but by interacting with patients around select uncomplicated needs while facilitating more targeted and appropriate referrals to specialty palliative care services. We describe potential roles for conversational agents aligned with the core domains of quality palliative care and identify risks that must be considered and addressed in the development and use of these systems for people with serious illness. With careful consideration of risks and benefits, conversational agents represent promising tools that should be explored as one component of a multipronged approach for improving patient and family outcomes in serious illness.
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Affiliation(s)
- Yael Schenker
- Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, University of Pittsbiurgh, Pittsburgh, Pennsylvania, USA
- Palliative Research Center (PaRC), University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania, USA
| | - Saeed Abdullah
- College of Information Sciences and Technology, Penn State University, University Park, Pennsylvania, USA
| | - Robert Arnold
- Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, University of Pittsbiurgh, Pittsburgh, Pennsylvania, USA
- Palliative Research Center (PaRC), University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kathryn H Schmitz
- UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania, USA
- Division of Hematology and Oncology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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13
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Yoon S, Goh H, Yeo ZZ, Yang GM, Chong PH, Zhuang Q. Comparing situational influences on differential healthcare utilization trajectories in patients on home palliative care: A qualitative study. Palliat Support Care 2024:1-8. [PMID: 38299377 DOI: 10.1017/s1478951524000014] [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: 02/02/2024]
Abstract
OBJECTIVES Patients with terminal cancer receiving home palliative care present differential healthcare utilization trajectories before death. It remains unclear which situational elements influence these trajectories among disparate patient groups. The aim of this study was to compare situational influences on "persistently high" and "low stable" trajectories of healthcare utilization in patients who received palliative care support at home. METHODS Bereaved family caregivers were recruited from our prior quantitative study investigating healthcare utilization trajectories in oncology patients on home-based palliative care. In-depth interviews were conducted with 30 family caregivers. Data were analyzed using thematic analysis. RESULTS Analysis of data uncovered how the 2 utilization trajectories were influenced by the interplay of 1 or more of 4 situational elements. Perceived symptom control in patients, influenced by their determination to die at home, shapes the susceptibility to situational contingencies, resulting in differential utilization trajectories. Caregivers' mental readiness in dealing with unexpected circumstances has a significant impact on the overall manageability of care, ultimately affecting decisions related to healthcare utilization. The concordance between symptom needs and scope of homecare services in a given situation proves to be an important determinant. Lastly, perceived accessibility to informal support in times of need acts as a contextual reinforcement, either preventing or precipitating decisions regarding healthcare utilizations. SIGNIFICANCE OF RESULTS Our findings hold important implications for the provision of homecare services, in particular, the need for comprehensive assessment of end-of-life wishes during homecare enrolment and strengthening psychological preparedness of caregivers. Expansion of home-based clinical interventions tailored to high utilizers, and funding for temporary in-home respite should be considered to optimally manage potentially preventable acute healthcare utilization.
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Affiliation(s)
- Sungwon Yoon
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Centre for Population Health Research and Implementation, SingHealth Regional Health System, SingHealth, Singapore, Singapore
| | - Hendra Goh
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | | | - Grace Meijuan Yang
- Division of Supportive & Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
| | | | - Qingyuan Zhuang
- Division of Supportive & Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
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14
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Payne S, Begovic D, Salifu Y, Nelson A, Payne C, Downing J, Natsiavas P, Ling J. Applying Digital Health in Cancer and Palliative Care in Europe: Policy Recommendations from an International Expert Workshop (MyPal Project). J Palliat Med 2024; 27:216-223. [PMID: 37738323 PMCID: PMC11339547 DOI: 10.1089/jpm.2023.0309] [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] [Accepted: 08/09/2023] [Indexed: 09/24/2023] Open
Abstract
Background: Digital health interventions are becoming increasingly important for adults, children, and young people with cancer and palliative care needs, but there is little research to guide policy and practice. Objectives: To identify recommendations for policy development of digital health interventions in cancer and palliative care. Design: Expert elicitation workshop. Setting: European clinical (cancer and palliative care, adult and pediatric), policy, technical, and research experts attended a one-day workshop in London, England, in October 2022, along with MyPal research consortium members. Methods: As part of the European Commission-funded MyPal project, we elicited experts' views on global, national, and institutional policies within structured facilitated groups, and conducted qualitative analysis on these discussions. Results/Implementation: Thirty-two experts from eight countries attended. Key policy drivers and levers in digital health were highlighted. Global level: global technology regulation, definitions, access to information technology, standardizing citizens' rights and data safety, digital infrastructure and implementation guidance, and incorporation of technology into existing health systems. National level: country-specific policy, compatibility of health apps, access to digital infrastructure including vulnerable groups and settings, development of guidelines, and promoting digital literacy. Institutional level: undertaking a needs assessment of service users and clinicians, identifying best practice guidelines, providing education and training for clinicians on digital health and safe digital data sharing, implementing plans to minimize barriers to accessing digital health care, minimizing bureaucracy, and providing technical support. Conclusions: Developers and regulators of digital health interventions may find the identified recommendations useful in guiding policy making and future research initiatives. MyPal child study Clinical Trial Registration NCT04381221; MyPal adult study Clinical Trial Registration NCT04370457.
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Affiliation(s)
- Sheila Payne
- International Observatory on End of Life Care, Faculty of Health and Medicine, Lancaster University, Lancaster, United Kingdom
| | - Dunja Begovic
- International Observatory on End of Life Care, Faculty of Health and Medicine, Lancaster University, Lancaster, United Kingdom
| | - Yakubu Salifu
- International Observatory on End of Life Care, Faculty of Health and Medicine, Lancaster University, Lancaster, United Kingdom
| | - Anna Nelson
- International Observatory on End of Life Care, Faculty of Health and Medicine, Lancaster University, Lancaster, United Kingdom
| | - Cathy Payne
- European Association for Palliative Care, Vilvoorde, Belgium
| | - Julia Downing
- International Children's Palliative Care Network, Bristol, United Kingdom
| | - Pantelis Natsiavas
- Institute of Applied Biosciences, Centre for Research and Technology Hellas, Thermi Thessaloniki, Greece
| | - Julie Ling
- European Association for Palliative Care, Vilvoorde, Belgium
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15
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Oelschlägel L, Moen A, Dihle A, Christensen VL, Heggdal K, Österlind J, Steindal SA. Implementation of remote home care: assessment guided by the RE-AIM framework. BMC Health Serv Res 2024; 24:145. [PMID: 38287394 PMCID: PMC10825998 DOI: 10.1186/s12913-024-10625-9] [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] [Received: 04/24/2023] [Accepted: 01/22/2024] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND Welfare technology interventions have become increasingly important in home-based palliative care for facilitating safe, time-efficient, and cost-effective methods to support patients living independently. However, studies evaluating the implementation of welfare technology innovations are scarce, and the empirical evidence for sustainable models using technology in home-based palliative care remains low. This study aimed to report on the use of the Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) framework to assess the implementation of remote home care (RHC) a technology-mediated service for home-living patients in the palliative phase of cancer. Furthermore, it aimed to explore areas of particular importance determining the sustainability of technologies for remote palliative home-based care. METHODS A secondary analysis of data collected by semi-structured interviews with patients with cancer in the palliative phase, focus groups, and semi-structured interviews with healthcare professionals (HCPs) experienced with RHC was performed. A deductive reflexive thematic analysis using RE-AIM dimensions was conducted. RESULTS Five themes illustrating the five RE-AIM dimensions were identified: (1) Reach: protective actions in recruitment - gatekeeping, (2) Effectiveness: potential to offer person-centered care, (3) Adoption: balancing high touch with high tech, (4) Implementation: moving towards a common understanding, and (5) Maintenance: adjusting to what really matters. The RE-AIM framework highlighted that RHC implementation for patients in the palliative phase of cancer was influenced by HCP gatekeeping behavior, concerns regarding abandoning palliative care as a high-touch specialty, and a lack of competence in palliative care. Although RHC facilitated improved routines in patients' daily lives, it was perceived as a static service unable to keep pace with disease progression. CONCLUSIONS A person-centered approach that prioritizes individual needs and preferences is necessary for providing optimal care. Although technologies such as RHC are not a panacea, they can be integrated as support for increasingly strained health services.
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Affiliation(s)
- Lina Oelschlägel
- Lovisenberg Diaconal University College, Lovisenberggata 15B, Oslo, 0456, Norway.
- Department of Public Health Sciences, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Anne Moen
- Department of Public Health Sciences, 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
- Department of Nursing and Health Sciences, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Kristin Heggdal
- Faculty of Health Sciences, VID Specialized University, Oslo, Norway
| | - Jane Österlind
- Department of Healthcare Sciences/Palliative Research Center, Marie Cederschiöld University, Stockholm, Sweden
| | - Simen A Steindal
- Lovisenberg Diaconal University College, Lovisenberggata 15B, Oslo, 0456, Norway
- Faculty of Health Sciences, VID Specialized University, Oslo, Norway
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16
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Wicki S, Clark IC, Amann M, Christ SM, Schettle M, Hertler C, Theile G, Blum D. Acceptance of Digital Health Technologies in Palliative Care Patients. Palliat Med Rep 2024; 5:34-42. [PMID: 38249831 PMCID: PMC10797306 DOI: 10.1089/pmr.2023.0062] [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] [Accepted: 11/28/2023] [Indexed: 01/23/2024] Open
Abstract
Background Digital health technologies have potential to transform palliative care (PC) services. The global aging population poses unique challenges for PC, which digital health technologies may help overcome. Evaluation of attitudes and perceptions combined with quantification of prior use habits favor an understanding of psychological barriers to PC patient acceptance of digital health technologies including artificial intelligence (AI). Objectives We aimed to evaluate the attitudes and perceptions of PC patients regarding a broad range of digital health technologies used in their routine monitoring and treatment and identify barriers to use. Methods We used a 39-item questionnaire to evaluate acceptance and use of smartphone-based electronic patient report outcome measures, wearables, AI, data privacy, and virtual reality (VR) in 29 female and male PC inpatients. Results A majority of patients indicated an interest in (69.0%) and positive attitude toward (75.9%) digital health technologies. Nearly all (93.1%) patients believe that digital health technologies will become more important in medicine in the future. Most patients would consider using their smartphone (79.3%) or wearable (69.0%) more often for their health. The most feasible technologies were smartphones, wearables, and VR. Barriers to acceptance included unfamiliarity, data security, errors in data interpretation, and loss of personal interaction through AI. Conclusion In this patient survey, acceptance of new technologies in a PC patient population was high, encouraging its use also at the end-of-life.
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Affiliation(s)
- Stefan Wicki
- Department of Radiation Oncology, Competence Center Palliative Care, University Hospital and University of Zurich, Zurich, Switzerland
| | - Ian C. Clark
- Department of Radiation Oncology, Competence Center Palliative Care, University Hospital and University of Zurich, Zurich, Switzerland
- Department of Radiation Oncology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Manuel Amann
- Department of Radiation Oncology, Competence Center Palliative Care, University Hospital and University of Zurich, Zurich, Switzerland
| | - Sebastian M. Christ
- Department of Radiation Oncology, Competence Center Palliative Care, University Hospital and University of Zurich, Zurich, Switzerland
- Department of Radiation Oncology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Markus Schettle
- Department of Radiation Oncology, Competence Center Palliative Care, University Hospital and University of Zurich, Zurich, Switzerland
| | - Caroline Hertler
- Department of Radiation Oncology, Competence Center Palliative Care, University Hospital and University of Zurich, Zurich, Switzerland
| | - Gudrun Theile
- Department of Radiation Oncology, Competence Center Palliative Care, University Hospital and University of Zurich, Zurich, Switzerland
| | - David Blum
- Department of Radiation Oncology, Competence Center Palliative Care, University Hospital and University of Zurich, Zurich, Switzerland
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Ebneter AS, Maessen M, Sauter TC, Jenelten G, Eychmueller S. Perceptions and needs of an outpatient palliative care team regarding digital care conferences in palliative care: a mixed-method online survey. Swiss Med Wkly 2024; 154:3487. [PMID: 38579295 DOI: 10.57187/s.3487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND Telemedicine in palliative care (PC) is increasingly being used, especially in outpatient settings with large geographic distances. Its proven benefits include improved communication, coordination quality and time savings. However, the effect on symptom control is less evident. Whether these benefits apply to the Swiss setting and the needs of healthcare professionals (HCPs) is unknown. OBJECTIVES To identify the perceptions and needs of healthcare professionals (nurses and physicians) regarding telemedicine (generally and specifically for care conferences) in a Swiss outpatient palliative care network. METHODS We conducted a cross-sectional, mixed-method online survey with purposefully sampled healthcare professionals from an outpatient palliative care team as baseline data during the planning phase of a quality improvement project (digital care conferences). FINDINGS/RESULTS Of the 251 HCPs approached, 66 responded, including nurses (n = 37) and physicians (n = 29), with an overall response rate of 26.6%. These were distributed into two groups: general palliative care HCPs (n = 48, return rate 21.3%) and specialised palliative care HCPs (n = 18, return rate 69.2%). Generally, telemedicine was perceived as useful. Potential easy access to other HCPs and hence improved communication and coordination were perceived as advantages. Barriers included a lack of acceptance and physical contact, unsolved questions about potential data breaches and technical obstacles. Regarding digital care conferences, the perceived acceptance and feasibility were good; preferred participants were the specialised palliative care HCPs (nurses and physicians), primary physicians and home care nurses, as well as the leadership of a nurse. The needs of the HCPs were as follows: (a) clear and efficient planning, (b) usability and security and (c) visual contact with the patient. CONCLUSION Digital care conferences are perceived as a feasible and useful tool by healthcare professionals in a local palliative care network in Switzerland. A pilot phase will be the next step towards systematic integration of this telemedicine modality into outpatient palliative care.
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Affiliation(s)
- Andreas Samuel Ebneter
- University Centre for Palliative Care, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Maud Maessen
- University Centre for Palliative Care, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Thomas C Sauter
- Department of Emergency Medicine, Inselspital, University Hospital Bern, Switzerland
| | - Georgette Jenelten
- Mobile Palliative Care Service Bern-Aare, Spitex Bern, Bern, Switzerland
| | - Steffen Eychmueller
- University Centre for Palliative Care, Inselspital, University Hospital Bern, Bern, Switzerland
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18
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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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19
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Narayanan SP, Mohanty S, Mohanti BK, Rath H, Atreya S, Rout A, Mahapatra S. Comparative effectiveness of verbal instruction versus video-based education (VIVid) among family caregivers for improving the quality of life in advanced head and neck cancer patients receiving palliative care in Eastern India: a randomized controlled trial. Qual Life Res 2023; 32:3495-3506. [PMID: 37530959 DOI: 10.1007/s11136-023-03484-0] [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] [Accepted: 07/08/2023] [Indexed: 08/03/2023]
Abstract
PURPOSE To determine if video-based educational intervention compared to the standard verbal guidelines, provided to caregivers on home-based palliative care could enhance the quality of life (QoL) in advanced head and neck cancer (HNC) patients. METHODS The study employed a prospective, two-arm parallel-group, randomized controlled trial design. Investigators prepared a real-world demonstrational video of ten minutes duration regarding home-based care for family caregivers, with voice-over in Odia language (Eastern India). The contents of the video addressed the management of common problems in palliative care among HNC patients. This study included 180 participants, 90 patient & caregiver dyads randomized to interventional (video-based education) or control (verbal instruction) groups. Patients' QoL was measured at baseline and 3 weeks follow-up using EORTC QLQ C30. Data were analyzed descriptively, and the Chi-square, Mann-Whitney U, T-test, spearman correlation, and multiple hierarchical regression analyses were employed for statistical analysis, with a significance level of p < 0.05. RESULTS Seventy participant dyads completed the planned two assessments: baseline and at the end of 3rd week (Intervention = 37; Control = 33). The intervention group showed a significant improvement in the patient's health-related QoL, physical, emotional, and social functioning. Symptom burden reduction was observed for pain, nausea, and fatigue. A significant increase in the change in QoL with the video-based education group (VBE) compared to the verbal instruction (VI) group after adjusting for age, gender, physical functioning, and pain symptomology (adjusted R2 = 0.402) was noted. CONCLUSION VBE intervention using smart-phone may offer caregivers a viable means of enhancing self-management while improving patients' QoL within the socio-cultural challenges for home-based palliative care in India. Further research on training caregivers using digital interventions and home-based visits is recommended. TRIAL REGISTRATION NUMBER CTRI/2021/06/034473 [Registered on: 30/06/2021].
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Affiliation(s)
- Sri Priya Narayanan
- Department of Public Health Dentistry, S.C.B. Dental College & Hospital, Cuttack, Odisha, 753007, India.
- Pain and Palliative Unit, Acharya Harihar Post-Graduate Institute of Cancer, Cuttack, Odisha, 753007, India.
| | - Sumita Mohanty
- Pain and Palliative Unit, Acharya Harihar Post-Graduate Institute of Cancer, Cuttack, Odisha, 753007, India
| | - Bidhu Kalyan Mohanti
- Bagchi Sri Shankara Cancer Centre, Infovalley, Bhubaneswar, Odisha, 751024, India
| | - Hemamalini Rath
- Department of Public Health Dentistry, S.C.B. Dental College & Hospital, Cuttack, Odisha, 753007, India
| | - Shrikant Atreya
- Department of Palliative Care and Psychooncology, Tata Medical Center, Kolkata, West Bengal, 700160, India
| | - Archana Rout
- Pain and Palliative Unit, Acharya Harihar Post-Graduate Institute of Cancer, Cuttack, Odisha, 753007, India
| | - Shilpa Mahapatra
- Department of Public Health Dentistry, S.C.B. Dental College & Hospital, Cuttack, Odisha, 753007, India
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de Bell S, Zhelev Z, Shaw N, Bethel A, Anderson R, Thompson Coon J. Remote monitoring for long-term physical health conditions: an evidence and gap map. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2023; 11:1-74. [PMID: 38014553 DOI: 10.3310/bvcf6192] [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: 11/29/2023]
Abstract
Background Remote monitoring involves the measurement of an aspect of a patient's health without that person being seen face to face. It could benefit the individual and aid the efficient provision of health services. However, remote monitoring can be used to monitor different aspects of health in different ways. This evidence map allows users to find evidence on different forms of remote monitoring for different conditions easily to support the commissioning and implementation of interventions. Objectives The aim of this map was to provide an overview of the volume, diversity and nature of recent systematic reviews on the effectiveness, acceptability and implementation of remote monitoring for adults with long-term physical health conditions. Data sources We searched MEDLINE, nine further databases and Epistemonikos for systematic reviews published between 2018 and March 2022, PROSPERO for continuing reviews, and completed citation chasing on included studies. Review methods (Study selection and Study appraisal): Included systematic reviews focused on adult populations with a long-term physical health condition and reported on the effectiveness, acceptability or implementation of remote monitoring. All forms of remote monitoring where data were passed to a healthcare professional as part of the intervention were included. Data were extracted on the characteristics of the remote monitoring intervention and outcomes assessed in the review. AMSTAR 2 was used to assess quality. Results were presented in an interactive evidence and gap map and summarised narratively. Stakeholder and public and patient involvement groups provided feedback throughout the project. Results We included 72 systematic reviews. Of these, 61 focus on the effectiveness of remote monitoring and 24 on its acceptability and/or implementation, with some reviews reporting on both. The majority contained studies from North America and Europe (38 included studies from the United Kingdom). Patients with cardiovascular disease, diabetes and respiratory conditions were the most studied populations. Data were collected predominantly using common devices such as blood pressure monitors and transmitted via applications, websites, e-mail or patient portals, feedback provided via telephone call and by nurses. In terms of outcomes, most reviews focused on physical health, mental health and well-being, health service use, acceptability or implementation. Few reviews reported on less common conditions or on the views of carers or healthcare professionals. Most reviews were of low or critically low quality. Limitations Many terms are used to describe remote monitoring; we searched as widely as possible but may have missed some relevant reviews. Poor reporting of remote monitoring interventions may mean some included reviews contain interventions that do not meet our definition, while relevant reviews might have been excluded. This also made the interpretation of results difficult. Conclusions and future work The map provides an interactive, visual representation of evidence on the effectiveness of remote monitoring and its acceptability and successful implementation. This evidence could support the commissioning and delivery of remote monitoring interventions, while the limitations and gaps could inform further research and technological development. Future reviews should follow the guidelines for conducting and reporting systematic reviews and investigate the application of remote monitoring in less common conditions. Review registration A protocol was registered on the OSF registry (https://doi.org/10.17605/OSF.IO/6Q7P4). Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Services and Delivery Research programme (NIHR award ref: NIHR135450) as part of a series of evidence syntheses under award NIHR130538. For more information, visit https://fundingawards.nihr.ac.uk/award/NIHR135450 and https://fundingawards.nihr.ac.uk/award/NIHR130538. The report is published in full in Health and Social Care Delivery Research; Vol. 11, No. 22. See the NIHR Funding and Awards website for further project information.
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Affiliation(s)
- Siân de Bell
- Exeter HS&DR Evidence Synthesis Centre, Department of Health and Community Sciences, Medical School, University of Exeter, Exeter, UK
| | - Zhivko Zhelev
- Exeter HS&DR Evidence Synthesis Centre, Department of Health and Community Sciences, Medical School, University of Exeter, Exeter, UK
| | - Naomi Shaw
- Exeter HS&DR Evidence Synthesis Centre, Department of Health and Community Sciences, Medical School, University of Exeter, Exeter, UK
| | - Alison Bethel
- Exeter HS&DR Evidence Synthesis Centre, Department of Health and Community Sciences, Medical School, University of Exeter, Exeter, UK
| | - Rob Anderson
- Exeter HS&DR Evidence Synthesis Centre, Department of Health and Community Sciences, Medical School, University of Exeter, Exeter, UK
| | - Jo Thompson Coon
- Exeter HS&DR Evidence Synthesis Centre, Department of Health and Community Sciences, Medical School, University of Exeter, Exeter, UK
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Viana JN, Pilbeam C, Howard M, Scholz B, Ge Z, Fisser C, Mitchell I, Raman S, Leach J. Maintaining High-Touch in High-Tech Digital Health Monitoring and Multi-Omics Prognostication: Ethical, Equity, and Societal Considerations in Precision Health for Palliative Care. OMICS : A JOURNAL OF INTEGRATIVE BIOLOGY 2023; 27:461-473. [PMID: 37861713 DOI: 10.1089/omi.2023.0120] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
Advances in digital health, systems biology, environmental monitoring, and artificial intelligence (AI) continue to revolutionize health care, ushering a precision health future. More than disease treatment and prevention, precision health aims at maintaining good health throughout the lifespan. However, how can precision health impact care for people with a terminal or life-limiting condition? We examine here the ethical, equity, and societal/relational implications of two precision health modalities, (1) integrated systems biology/multi-omics analysis for disease prognostication and (2) digital health technologies for health status monitoring and communication. We focus on three main ethical and societal considerations: benefits and risks associated with integration of these modalities into the palliative care system; inclusion of underrepresented and marginalized groups in technology development and deployment; and the impact of high-tech modalities on palliative care's highly personalized and "high-touch" practice. We conclude with 10 recommendations for ensuring that precision health technologies, such as multi-omics prognostication and digital health monitoring, for palliative care are developed, tested, and implemented ethically, inclusively, and equitably.
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Affiliation(s)
- John Noel Viana
- Australian National Centre for the Public Awareness of Science, College of Science, The Australian National University, Canberra, Australia
- Responsible Innovation Future Science Platform, Commonwealth Scientific and Industrial Research Organisation, Brisbane, Australia
| | - Caitlin Pilbeam
- School of Medicine and Psychology, College of Health and Medicine, The Australian National University, Canberra, Australia
| | - Mark Howard
- Monash Data Futures Institute, Monash University, Clayton, Australia
- Department of Philosophy, School of Philosophical, Historical and International Studies, Monash University, Clayton, Australia
| | - Brett Scholz
- School of Medicine and Psychology, College of Health and Medicine, The Australian National University, Canberra, Australia
| | - Zongyuan Ge
- Monash Data Futures Institute, Monash University, Clayton, Australia
- Department of Data Science & AI, Monash University, Clayton, Australia
| | - Carys Fisser
- Australian National Centre for the Public Awareness of Science, College of Science, The Australian National University, Canberra, Australia
- School of Medicine and Psychology, College of Health and Medicine, The Australian National University, Canberra, Australia
| | - Imogen Mitchell
- School of Medicine and Psychology, College of Health and Medicine, The Australian National University, Canberra, Australia
- Intensive Care Unit, Canberra Hospital, Canberra, Australia
| | - Sujatha Raman
- Australian National Centre for the Public Awareness of Science, College of Science, The Australian National University, Canberra, Australia
| | - Joan Leach
- Australian National Centre for the Public Awareness of Science, College of Science, The Australian National University, Canberra, Australia
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Aalami O, Hittle M, Ravi V, Griffin A, Schmiedmayer P, Shenoy V, Gutierrez S, Venook R. CardinalKit: open-source standards-based, interoperable mobile development platform to help translate the promise of digital health. JAMIA Open 2023; 6:ooad044. [PMID: 37485467 PMCID: PMC10356573 DOI: 10.1093/jamiaopen/ooad044] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 12/20/2022] [Accepted: 06/19/2023] [Indexed: 07/25/2023] Open
Abstract
Smartphone devices capable of monitoring users' health, physiology, activity, and environment revolutionize care delivery, medical research, and remote patient monitoring. Such devices, laden with clinical-grade sensors and cloud connectivity, allow clinicians, researchers, and patients to monitor health longitudinally, passively, and persistently, shifting the paradigm of care and research from low-resolution, intermittent, and discrete to one of persistent, continuous, and high resolution. The collection, transmission, and storage of sensitive health data using mobile devices presents unique challenges that serve as significant barriers to entry for care providers and researchers alike. Compliance with standards like HIPAA and GDPR requires unique skills and practices. These requirements make off-the-shelf technologies insufficient for use in the digital health space. As a result, budget, timeline, talent, and resource constraints are the largest barriers to new digital technologies. The CardinalKit platform is an open-source project addressing these challenges by focusing on reducing these barriers and accelerating the innovation, adoption, and use of digital health technologies. CardinalKit provides a mobile template application and web dashboard to enable an interoperable foundation for developing digital health applications. We demonstrate the applicability of CardinalKit to a wide variety of digital health applications across 18 innovative digital health prototypes.
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Affiliation(s)
- Oliver Aalami
- Stanford Byers Center for Biodesign, Stanford University School of Medicine, Palo Alto, California, USA
| | - Mike Hittle
- Department of Epidemiology, Stanford University School of Medicine, Palo Alto, California, USA
| | - Vishnu Ravi
- Stanford Byers Center for Biodesign, Stanford University School of Medicine, Palo Alto, California, USA
| | - Ashley Griffin
- Department of Health Policy, Stanford University School of Medicine; VA Palo Alto Health Care System, Palo Alto, California, USA
| | - Paul Schmiedmayer
- Stanford Byers Center for Biodesign, Stanford University School of Medicine, Palo Alto, California, USA
| | - Varun Shenoy
- Stanford Byers Center for Biodesign, Stanford University School of Medicine, Palo Alto, California, USA
| | - Santiago Gutierrez
- Stanford Byers Center for Biodesign, Stanford University School of Medicine, Palo Alto, California, USA
| | - Ross Venook
- Stanford Byers Center for Biodesign, Stanford University School of Medicine, Palo Alto, California, USA
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Liu JH, Shih CY, Huang HL, Peng JK, Cheng SY, Tsai JS, Lai F. Evaluating the Potential of Machine Learning and Wearable Devices in End-of-Life Care in Predicting 7-Day Death Events Among Patients With Terminal Cancer: Cohort Study. J Med Internet Res 2023; 25:e47366. [PMID: 37594793 PMCID: PMC10474512 DOI: 10.2196/47366] [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] [Received: 03/17/2023] [Revised: 07/02/2023] [Accepted: 07/14/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND An accurate prediction of mortality in end-of-life care is crucial but presents challenges. Existing prognostic tools demonstrate moderate performance in predicting survival across various time frames, primarily in in-hospital settings and single-time evaluations. However, these tools may fail to capture the individualized and diverse trajectories of patients. Limited evidence exists regarding the use of artificial intelligence (AI) and wearable devices, specifically among patients with cancer at the end of life. OBJECTIVE This study aimed to investigate the potential of using wearable devices and AI to predict death events among patients with cancer at the end of life. Our hypothesis was that continuous monitoring through smartwatches can offer valuable insights into the progression of patients at the end of life and enable the prediction of changes in their condition, which could ultimately enhance personalized care, particularly in outpatient or home care settings. METHODS This prospective study was conducted at the National Taiwan University Hospital. Patients diagnosed with cancer and receiving end-of-life care were invited to enroll in wards, outpatient clinics, and home-based care settings. Each participant was given a smartwatch to collect physiological data, including steps taken, heart rate, sleep time, and blood oxygen saturation. Clinical assessments were conducted weekly. The participants were followed until the end of life or up to 52 weeks. With these input features, we evaluated the prediction performance of several machine learning-based classifiers and a deep neural network in 7-day death events. We used area under the receiver operating characteristic curve (AUROC), F1-score, accuracy, and specificity as evaluation metrics. A Shapley additive explanations value analysis was performed to further explore the models with good performance. RESULTS From September 2021 to August 2022, overall, 1657 data points were collected from 40 patients with a median survival time of 34 days, with the detection of 28 death events. Among the proposed models, extreme gradient boost (XGBoost) yielded the best result, with an AUROC of 96%, F1-score of 78.5%, accuracy of 93%, and specificity of 97% on the testing set. The Shapley additive explanations value analysis identified the average heart rate as the most important feature. Other important features included steps taken, appetite, urination status, and clinical care phase. CONCLUSIONS We demonstrated the successful prediction of patient deaths within the next 7 days using a combination of wearable devices and AI. Our findings highlight the potential of integrating AI and wearable technology into clinical end-of-life care, offering valuable insights and supporting clinical decision-making for personalized patient care. It is important to acknowledge that our study was conducted in a relatively small cohort; thus, further research is needed to validate our approach and assess its impact on clinical care. TRIAL REGISTRATION ClinicalTrials.gov NCT05054907; https://classic.clinicaltrials.gov/ct2/show/NCT05054907.
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Affiliation(s)
- Jen-Hsuan Liu
- Department of Family Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan
- Department of Family Medicine, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan
| | - Chih-Yuan Shih
- Department of Family Medicine, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan
- Department of Family Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Hsien-Liang Huang
- Department of Family Medicine, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan
- Department of Family Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Jen-Kuei Peng
- Department of Family Medicine, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan
- Department of Family Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Shao-Yi Cheng
- Department of Family Medicine, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan
- Department of Family Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Jaw-Shiun Tsai
- Department of Family Medicine, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan
- Department of Family Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Feipei Lai
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan
- Department of Computer Science and Information Engineering, National Taiwan University, Taipei, Taiwan
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Burner-Fritsch I, Kolmhuber S, Hodiamont F, Bausewein C, Hriskova K. Implementing ePROM in specialist palliative home care: the professionals' perspective - a mixed-methods study. Palliat Care Soc Pract 2023; 17:26323524231186827. [PMID: 37560175 PMCID: PMC10408331 DOI: 10.1177/26323524231186827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 06/21/2023] [Indexed: 08/11/2023] Open
Abstract
Background Over the last decades, patient-reported outcome measures (PROM) have been developed for a better understanding of patient needs. The Integrated Palliative Care Outcome Scale (IPOS) is an internationally recommended PROM in palliative care. The validated electronic version of IPOS (eIPOS) was implemented in four German specialist palliative home care (SPHC) teams for use in everyday clinical practice. Patients reported symptoms and concerns via eIPOS, which were transmitted directly to the electronic patient record of the respective SPHC team. Objectives The aim of the study was to describe and explore the health care professionals' (HCPs') experiences regarding acceptance and use of eIPOS in clinical practice in SPHC. Design The mixed-methods sequential explanatory design comprised an anonymized quantitative online survey followed by qualitative focus groups. Methods The online survey asked in both closed and open questions for HCP's experience with eIPOS. Ambiguous results from the survey were discussed in two focus groups. Survey data were analysed with descriptive and univariable statistics, and the framework approach was used for qualitative data. In a further step, we conducted integrated analysis of quantitative and qualitative results using joint displays. Results All HCPs of the four SPHC teams (n = 52) were invited to participate. HCPs participating in the survey (n = 32) and the focus groups (n = 7) saw potentials for implementing ePROM in palliative home care - as far as it is technically easy to handle and can be easily integrated into clinical practice. Conclusion Successful use of ePROMs is affected by the possibility of easy integration into the teams' different structures and processes and the HCPs' perceptions of potentials regarding ePROM use in SPHC. Registration The study is registered on clinicaltrials.org (NCT03879668).
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Affiliation(s)
- Isabel Burner-Fritsch
- Department of Palliative Medicine, University Hospital, LMU Munich, Bahnhofstraße 20, 83673 Bichl, Germany
| | - Stefanie Kolmhuber
- Department of Palliative Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Farina Hodiamont
- Department of Palliative Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Claudia Bausewein
- Department of Palliative Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Katerina Hriskova
- Department of Palliative Medicine, University Hospital, LMU Munich, Munich, Germany
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25
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Sánchez-Cárdenas MA, Iriarte-Aristizábal MF, León-Delgado MX, Rodríguez-Campos LF, Correa-Morales JE, Cañón-Piñeros A, Parra SL. Rural Palliative Care Telemedicine for Advanced Cancer Patients: A Systematic Review. Am J Hosp Palliat Care 2023; 40:936-944. [PMID: 36331174 DOI: 10.1177/10499091221130329] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023] Open
Abstract
Context: Telemedicine offers the opportunity to provide remote palliative care for patients to control symptoms and improve quality of life, even for patients with advanced diseases. Objectives: Establish a telemedicine model of rural palliative care for advanced cancer patients with difficulties in accessing standard care. Methods: This review comports with the minimum standards described in the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) and uses the palliative care literature review iterative method (PALETTE) proposed by Zwakman et al in 2018. Results: Three hundred, ninety-two articles were identified in PubMed and EMBASE databases and alternative search engines such as Google Scholar and OpenGrey. A telemedicine delivery model was developed for patients with limited access to standard care, which consists of identifying the candidate population, establishing the most convenient telemedicine modality, agreeing with patients and caregivers on palliative care needs, and evaluating the interventions effectiveness. Conclusion: Telemedicine is a revolutionary tool to provide palliative care to advanced cancer patients whose clinical condition or location prevent them from accessing conventional care.
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Affiliation(s)
| | | | | | | | - Juan Esteban Correa-Morales
- School of Medicine, Universidad de La Sabana, Chía, Colombia
- Department of Pain Medicine and Palliative Care, National Cancer Institute, Bogotá, Colombia
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Grimminger S, Heckel M, Markgraf M, Peuten S, Wöhl M, Gimpel H, Klein C, Ostgathe C, Steigleder T, Schneider W. Palliative care as a digital working world (PALLADiUM) - A mixed-method research protocol. BMC Palliat Care 2023; 22:102. [PMID: 37481524 PMCID: PMC10362664 DOI: 10.1186/s12904-023-01173-w] [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: 12/13/2021] [Accepted: 04/12/2023] [Indexed: 07/24/2023] Open
Abstract
BACKGROUND In Palliative Care, actors from different professional backgrounds work together and exchange case-specific and expert knowledge and information. Since Palliative Care is traditionally distant from digitalization due to its holistically person-centered approach, there is a lack of suitable concepts enabling digitalization regarding multi-professional team processes. Yet, a digitalised information and collaboration environment geared to the requirements of palliative care and the needs of the members of the multi-professional team might facilitate communication and collaboration processes and improve information and knowledge flows. Taking this chance, the presented three-year project, PALLADiUM, aims to improve the effectiveness of Palliative Care teams by jointly sharing available inter-subjective knowledge and orientation-giving as well as action-guiding practical knowledge. Thus, PALLADiUM will explore the potentials and limitations of digitally supported communication and collaboration solutions. METHODS PALLADiUM follows an open and iterative mixed methods approach. First, ethnographic methods - participant observations, interviews, and focus groups - aim to explore knowledge and information flow in investigating Palliative Care units as well as the requirements and barriers to digitalization. Second, to extend this body, the analysis of the historical hospital data provides quantitative insights. Condensing all findings results in a to-be work system. Adhering to the work systems transformation method, a technical prototype including artificial intelligence components will enhance the collaborative teamwork in the Palliative Care unit. DISCUSSION PALLADiUM aims to deliver decisive new insights into the preconditions, processes, and success factors of the digitalization of a medical working environment as well as communication and collaboration processes in multi-professional teams. TRIAL REGISTRATION The study was registered prospectively at DRKS (Deutsches Register Klinischer Studien) Registration-ID: DRKS0025356 Date of registration: 03.06.21.
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Affiliation(s)
- Sandra Grimminger
- Palliativmedizinische Abteilung, Comprehensive Cancer Center CCC Erlangen-EMN, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Krankenhausstraße 12, 91054, Erlangen, Germany.
| | - Maria Heckel
- Palliativmedizinische Abteilung, Comprehensive Cancer Center CCC Erlangen-EMN, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Krankenhausstraße 12, 91054, Erlangen, Germany
| | - Moritz Markgraf
- FIM Research Center, University of Augsburg, Universitätsstraße 12, 86159, Augsburg, Germany
- Project Group Business & Information Systems Engineering of the Fraunhofer FIT, Universitätsstraße 12, 86159, Augsburg, Germany
| | - Sarah Peuten
- Professorship for Sociology, University of Augsburg, Universitätsstraße 10, 86159, Augsburg, Germany
| | - Moritz Wöhl
- FIM Research Center, University of Augsburg, Universitätsstraße 12, 86159, Augsburg, Germany
- Project Group Business & Information Systems Engineering of the Fraunhofer FIT, Universitätsstraße 12, 86159, Augsburg, Germany
| | - Henner Gimpel
- FIM Research Center, University of Augsburg, Universitätsstraße 12, 86159, Augsburg, Germany
- Project Group Business & Information Systems Engineering of the Fraunhofer FIT, Universitätsstraße 12, 86159, Augsburg, Germany
- Chair of Digital Management, University of Hohenheim, Schloß Hohenheim 1, 70599, Stuttgart, Germany
| | - Carsten Klein
- Palliativmedizinische Abteilung, Comprehensive Cancer Center CCC Erlangen-EMN, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Krankenhausstraße 12, 91054, Erlangen, Germany
| | - Christoph Ostgathe
- Palliativmedizinische Abteilung, Comprehensive Cancer Center CCC Erlangen-EMN, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Krankenhausstraße 12, 91054, Erlangen, Germany
| | - Tobias Steigleder
- Palliativmedizinische Abteilung, Comprehensive Cancer Center CCC Erlangen-EMN, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Krankenhausstraße 12, 91054, Erlangen, Germany
| | - Werner Schneider
- Professorship for Sociology, University of Augsburg, Universitätsstraße 10, 86159, Augsburg, Germany
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Kluger BM, Hudson P, Hanson LC, Bužgovà R, Creutzfeldt CJ, Gursahani R, Sumrall M, White C, Oliver DJ, Pantilat SZ, Miyasaki J. Palliative care to support the needs of adults with neurological disease. Lancet Neurol 2023; 22:619-631. [PMID: 37353280 DOI: 10.1016/s1474-4422(23)00129-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 03/08/2023] [Accepted: 03/27/2023] [Indexed: 06/25/2023]
Abstract
Neurological diseases cause physical, psychosocial, and spiritual or existential suffering from the time of their diagnosis. Palliative care focuses on improving quality of life for people with serious illness and their families by addressing this multidimensional suffering. Evidence from clinical trials supports the ability of palliative care to improve patient and caregiver outcomes by the use of outpatient or home-based palliative care interventions for people with motor neuron disease, multiple sclerosis, or Parkinson's disease; inpatient palliative care consultations for people with advanced dementia; telephone-based case management for people with dementia in the community; and nurse-led discussions with decision aids for people with advanced dementia in long-term care. Unfortunately, most people with neurological diseases do not get the support that they need for their palliative care under current standards of healthcare. Improving this situation requires the deployment of routine screening to identify individual palliative care needs, the integration of palliative care approaches into routine neurological care, and collaboration between neurologists and palliative care specialists. Research, education, and advocacy are also needed to raise standards of care.
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Affiliation(s)
- Benzi M Kluger
- University of Rochester Medical Center, Rochester, NY, USA.
| | - Peter Hudson
- The University of Melbourne, Fitzroy, VIC, Australia; St Vincent's Hospital, Melbourne, Fitzroy, VIC, Australia; Vrije Universiteit Brussel, Brussel, Belgium
| | - Laura C Hanson
- University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Radka Bužgovà
- Department of Nursing and Midwifery, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | | | - Roop Gursahani
- Hinduja Hospital & Medical Research Centre, Mumbai, Maharashtra, India
| | - Malenna Sumrall
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Charles White
- University of Rochester Medical Center, Rochester, NY, USA
| | | | - Steven Z Pantilat
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
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Carey N, Abathun E, Maguire R, Wodaje Y, Royce C, Ayers N. Co-design and prototype development of the 'Ayzot App': A mobile phone based remote monitoring system for palliative care. Palliat Med 2023; 37:771-781. [PMID: 37002562 DOI: 10.1177/02692163231162408] [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: 05/30/2023]
Abstract
BACKGROUND Palliative care, a recognised component of care by the World Health Organization is poorly developed in low- and middle-income countries. Mobile phone technology, an effective way to increase access and sustainability of healthcare systems globally, has demonstrated benefits within palliative care service delivery, but is yet to be utilised in Ethiopia. AIM To co-design, develop and evaluate a mobile phone based remote monitoring system for use by palliative care patients in Ethiopia. DESIGN Two-phase co-design approach comprising multiple methods that is stakeholder interviews, focus groups, user-co-creation activities and healthcare worker prioritisation discussions 2019-2020. Phase-1 interviews (n = 40), Phase-2 focus groups (n = 3) and interviews (n = 10). SETTING/PARTICIPANTS Hospice Ethiopia and Yekatit 12 Medical College Hospital: healthcare workers, palliative care patients, family carers & software-developers. RESULTS Co-design activities lead to development of the prototype 'Ayzot' application, which was well received and reported to be easy to use. Patients, and family caregivers saw provision of self-care information and symptom management as a key function of the App and expressed very positive attitudes towards such information being included. Healthcare workers found the App offered service benefits, in terms of time and cost-savings. CONCLUSION This paper provides a detailed example of the development and design of a prototype remote monitoring system using mobile phone technology for palliative care use in Ethiopia. Further development and real-world testing are required, to not only understand how it acts within usual care to deliver anticipated benefits but also to explore its effectiveness and provide cost estimates for wider implementation.
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Affiliation(s)
- Nicola Carey
- Department of Nursing and Midwifery, University of the Highlands and Islands, UK
| | | | - Roma Maguire
- Digital Health and Care and Research, University of Strathclyde, UK
| | | | | | - Nicola Ayers
- Palliative Care Advisor, Ministry of Health, Ethiopia
- School of Nursing, BPP University, Waterloo, London, UK
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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: 5] [Impact Index Per Article: 5.0] [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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Adams A, Miller-Lewis L, Tieman J. Learning Designers as Expert Evaluators of Usability: Understanding Their Potential Contribution to Improving the Universality of Interface Design for Health Resources. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4608. [PMID: 36901617 PMCID: PMC10001568 DOI: 10.3390/ijerph20054608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 02/25/2023] [Accepted: 02/28/2023] [Indexed: 06/18/2023]
Abstract
User-based evaluation by end users is an essential step in designing useful interfaces. Inspection methods can offer an alternate approach when end-user recruitment is problematic. A Learning Designers' usability scholarship could offer usability evaluation expertise adjunct to multidisciplinary teams in academic settings. The feasibility of Learning Designers as 'expert evaluators' is assessed within this study. Two groups, healthcare professionals and Learning Designers, applied a hybrid evaluation method to generate usability feedback from a palliative care toolkit prototype. Expert data were compared to end-user errors detected from usability testing. Interface errors were categorised, meta-aggregated and severity calculated. The analysis found that reviewers detected N = 333 errors, with N = 167 uniquely occurring within the interface. Learning Designers identified errors at greater frequencies (60.66% total interface errors, mean (M) = 28.86 per expert) than other evaluator groups (healthcare professionals 23.12%, M = 19.25 and end users 16.22%, M = 9.0). Patterns in severity and error types were also observed between reviewer groups. The findings suggest that Learning Designers are skilled in detecting interface errors, which benefits developers assessing usability when access to end users is limited. Whilst not offering rich narrative feedback generated by user-based evaluations, Learning Designers complement healthcare professionals' content-specific knowledge as a 'composite expert reviewer' with the ability to generate meaningful feedback to shape digital health interfaces.
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Affiliation(s)
- Amanda Adams
- Research Centre for Palliative Care, Death and Dying, College of Nursing and Health Sciences, Flinders University, Bedford Park, Adelaide, SA 5042, Australia
| | - Lauren Miller-Lewis
- Research Centre for Palliative Care, Death and Dying, College of Nursing and Health Sciences, Flinders University, Bedford Park, Adelaide, SA 5042, Australia
- School of Health, Medical and Applied Sciences, CQUniversity Australia, Wayville, Adelaide, SA 5034, Australia
| | - Jennifer Tieman
- Research Centre for Palliative Care, Death and Dying, College of Nursing and Health Sciences, Flinders University, Bedford Park, Adelaide, SA 5042, Australia
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Barry C, Paes P, Noble S, Davies A. Challenges to delivering evidence-based palliative medicine. Clin Med (Lond) 2023; 23:182-184. [PMID: 36806204 PMCID: PMC11046501 DOI: 10.7861/clinmed.2022-0336] [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] [Indexed: 02/22/2023]
Abstract
Established as a medical specialty in 1987, palliative medicine approaches middle age facing existential questions of identity, purpose and vision. Time has weakened strong foundations laid by Dame Cicely Saunders in research, education and clinical excellence. Clinical knowledge gaps are wide, and widening. Palliative medicine research is underfunded and underrepresented in discourse. Despite huge advances in modern medicine, there is still clinical uncertainty about simple interventions, such as whether artificial hydration at the end of life is helpful or harmful. Where good quality data do exist, the pace of change is slow, if change is happening at all. Trial design often fails to assess the holistic impact of interventions, using primary endpoints that are inconsistent with outcomes most valued to the patient. Recent years have seen a rapid expansion in innovation and investment in digital technologies, embraced by many in palliative medicine. Experience shows that caution must be applied where the evidence base is sparse. While as a specialty we must remain forward looking and progressive in our mindset, it cannot be assumed that these new interventions alone will provide the solutions to the old problems that exist in palliative medicine.This review summarises the key points presented in the Palliative Medicine section of the RCP Clinical Medicine Conference, 2022.
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Affiliation(s)
- Caroline Barry
- Norfolk and Norwich NHS Foundation Trust, Norwich, UK, and clinical associate professor in translational and clinical medicine, University of East Anglia, Norwich, UK
| | - Paul Paes
- Northumbria Healthcare NHS Foundation Trust, Northumbria, UK
| | | | - Andrew Davies
- Trinity College Dublin, University College Dublin and Our Lady's Hospice, Dublin, Ireland
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32
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Whitehead L, Talevski J, Fatehi F, Beauchamp A. Barriers to and Facilitators of Digital Health Among Culturally and Linguistically Diverse Populations: Qualitative Systematic Review. J Med Internet Res 2023; 25:e42719. [PMID: 36853742 PMCID: PMC10015358 DOI: 10.2196/42719] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 11/09/2022] [Accepted: 01/19/2023] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Health care systems have become increasingly more reliant on patients' ability to navigate the digital world. However, little research has been conducted on why some communities are less able or less likely to successfully engage with digital health technologies (DHTs), particularly among culturally and linguistically diverse (CaLD) populations. OBJECTIVE This systematic review aimed to determine the barriers to and facilitators of interacting with DHTs from the perspectives of CaLD population groups, including racial or ethnic minority groups, immigrants and refugees, and Indigenous or First Nations people. METHODS A systematic review and thematic synthesis of qualitative studies was conducted. Peer-reviewed literature published between January 2011 and June 2022 was searched across 3 electronic databases. Terms for digital health were combined with terms for cultural or linguistic diversity, ethnic minority groups, or Indigenous and First Nations people and terms related to barriers to accessing digital technologies. A qualitative thematic synthesis was conducted to identify descriptive and analytical themes of barriers to and facilitators of interacting with DHTs. Quality appraisal was performed using the Mixed Methods Appraisal Tool. RESULTS Of the 1418 studies identified in the electronic search, a total of 34 (2.4%) were included in this review. Half of the included studies (17/34, 50%) were conducted in the United States. There was considerable variation in terms of the CaLD backgrounds of the participants. In total, 26% (9/34) of the studies focused on Indigenous or First Nations communities, 41% (14/34) were conducted among ethnic minority populations, 15% (5/34) of the studies were conducted among immigrants, and 18% (6/34) were conducted in refugee communities. Of the 34 studies, 21 (62%) described the development or evaluation of a digital health intervention, whereas 13 (38%) studies did not include an intervention but instead focused on elucidating participants' views and behaviors in relation to digital health. From the 34 studies analyzed, 18 descriptive themes were identified, each describing barriers to and facilitators of interacting with DHTs, which were grouped into 7 overarching analytical themes: using technology, design components, language, culture, health and medical, trustworthiness, and interaction with others. CONCLUSIONS This study identified several analytic and descriptive themes influencing access to and uptake of DHTs among CaLD populations, including Indigenous and First Nations groups. We found that cultural factors affected all identified themes to some degree and that cultural and linguistic perspectives should be considered in the design and delivery of DHTs, with this best served through the inclusion of the target communities at all stages of development. This may improve the potential of DHTs to be more acceptable, appropriate, and accessible to population groups currently at risk of not obtaining the full benefits of digital health.
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Affiliation(s)
- Lara Whitehead
- School of Rural Health, Faculty of Medicine, Nursing and Health Science, Monash University, Warragul, Australia
| | - Jason Talevski
- School of Rural Health, Faculty of Medicine, Nursing and Health Science, Monash University, Warragul, Australia.,Institute for Physical Activity and Nutrition Research (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia.,Australian Institute for Musculoskeletal Science, The University of Melbourne and Western Health, Melbourne, Australia
| | - Farhad Fatehi
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia.,School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Alison Beauchamp
- School of Rural Health, Faculty of Medicine, Nursing and Health Science, Monash University, Warragul, Australia
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Ostan R, Varani S, Giannelli A, Malavasi I, Pannuti F, Pannuti R, Biasco G, Mattioli AV. Distance Monitoring of Advanced Cancer Patients with Impaired Cardiac and Respiratory Function Assisted at Home: A Study Protocol in Italy. J Clin Med 2023; 12:jcm12051922. [PMID: 36902706 PMCID: PMC10004121 DOI: 10.3390/jcm12051922] [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: 02/08/2023] [Revised: 02/24/2023] [Accepted: 02/25/2023] [Indexed: 03/05/2023] Open
Abstract
During the pandemic, telemedicine and telehealth interventions have been leading in maintaining the continuity of care independently of patients' physical location. However, the evidence available about the effectiveness of the telehealth approach for advanced cancer patients with chronic disease is limited. This interventional randomized pilot study aims to evaluate the acceptability of a daily telemonitoring of five vital parameters (heart rate, respiratory rate, blood oxygenation, blood pressure, and body temperature) using a medical device in advanced cancer patients with relevant cardiovascular and respiratory comorbidities assisted at home. The purpose of the current paper is to describe the design of the telemonitoring intervention in a home palliative and supportive care setting with the objective of optimizing the management of patients, improving both their quality of life and psychological status and the caregiver's perceived care burden. This study may improve scientific knowledge regarding the impact of telemonitoring. Moreover, this intervention could foster continuous healthcare delivery and closer communication among the physician, patient and family, enabling the physician to have an updated overview of the clinical trajectory of the disease. Finally, the study may help family caregivers to maintain their habits and professional position and to limit financial consequences.
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Affiliation(s)
- Rita Ostan
- Training and Research Department, National Tumor Assistance (ANT) Foundation, Via Jacopo di Paolo, 36, 40128 Bologna, Italy
| | - Silvia Varani
- Training and Research Department, National Tumor Assistance (ANT) Foundation, Via Jacopo di Paolo, 36, 40128 Bologna, Italy
- Correspondence: (S.V.); (A.V.M.)
| | - Andrea Giannelli
- Training and Research Department, National Tumor Assistance (ANT) Foundation, Via Jacopo di Paolo, 36, 40128 Bologna, Italy
| | - Italo Malavasi
- Training and Research Department, National Tumor Assistance (ANT) Foundation, Via Jacopo di Paolo, 36, 40128 Bologna, Italy
| | | | - Raffaella Pannuti
- Training and Research Department, National Tumor Assistance (ANT) Foundation, Via Jacopo di Paolo, 36, 40128 Bologna, Italy
| | - Guido Biasco
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Via Giuseppe Massarenti, 9, 40138 Bologna, Italy
| | - Anna Vittoria Mattioli
- Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Via del Pozzo, 71, 41124 Modena, Italy
- Correspondence: (S.V.); (A.V.M.)
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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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35
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Blanes-Selva V, Asensio-Cuesta S, Doñate-Martínez A, Pereira Mesquita F, García-Gómez JM. User-centred design of a clinical decision support system for palliative care: Insights from healthcare professionals. Digit Health 2023; 9:20552076221150735. [PMID: 36644661 PMCID: PMC9837281 DOI: 10.1177/20552076221150735] [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: 06/30/2022] [Accepted: 12/26/2022] [Indexed: 01/13/2023] Open
Abstract
Objective Although clinical decision support systems (CDSS) have many benefits for clinical practice, they also have several barriers to their acceptance by professionals. Our objective in this study was to design and validate The Aleph palliative care (PC) CDSS through a user-centred method, considering the predictions of the artificial intelligence (AI) core, usability and user experience (UX). Methods We performed two rounds of individual evaluation sessions with potential users. Each session included a model evaluation, a task test and a usability and UX assessment. Results The machine learning (ML) predictive models outperformed the participants in the three predictive tasks. System Usability Scale (SUS) reported 62.7 ± 14.1 and 65 ± 26.2 on a 100-point rating scale for both rounds, respectively, while User Experience Questionnaire - Short Version (UEQ-S) scores were 1.42 and 1.5 on the -3 to 3 scale. Conclusions The think-aloud method and including the UX dimension helped us to identify most of the workflow implementation issues. The system has good UX hedonic qualities; participants were interested in the tool and responded positively to it. Performance regarding usability was modest but acceptable.
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Affiliation(s)
- Vicent Blanes-Selva
- Biomedical Data Science Lab, Instituto Universitarios de Tecnologías de La Información y Comunicaciones (ITACA), Universitat Politècnica de València, Valencia, Spain,Vicent Blanes-Selva, Biomedical Data Science Lab, Instituto Universitarios de Tecnologías de La Información y Comunicaciones (ITACA), Universitat Politècnica de València, Valencia, 46022, Spain.
| | - Sabina Asensio-Cuesta
- Biomedical Data Science Lab, Instituto Universitarios de Tecnologías de La Información y Comunicaciones (ITACA), Universitat Politècnica de València, Valencia, Spain
| | | | - Felipe Pereira Mesquita
- Divisão de Hematologia, departamento de Clínica Médica, da Universidade Federal de Juiz de Fora, Minas Gerais, Brasil
| | - Juan M. García-Gómez
- Biomedical Data Science Lab, Instituto Universitarios de Tecnologías de La Información y Comunicaciones (ITACA), Universitat Politècnica de València, Valencia, Spain
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Motahari-Nezhad H, Al-Abdulkarim H, Fgaier M, Abid MM, Péntek M, Gulácsi L, Zrubka Z. Digital Biomarker-Based Interventions: Systematic Review of Systematic Reviews. J Med Internet Res 2022; 24:e41042. [PMID: 36542427 PMCID: PMC9813819 DOI: 10.2196/41042] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 09/22/2022] [Accepted: 10/07/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND The introduction of new medical technologies such as sensors has accelerated the process of collecting patient data for relevant clinical decisions, which has led to the introduction of a new technology known as digital biomarkers. OBJECTIVE This study aims to assess the methodological quality and quality of evidence from meta-analyses of digital biomarker-based interventions. METHODS This study follows the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guideline for reporting systematic reviews, including original English publications of systematic reviews reporting meta-analyses of clinical outcomes (efficacy and safety endpoints) of digital biomarker-based interventions compared with alternative interventions without digital biomarkers. Imaging or other technologies that do not measure objective physiological or behavioral data were excluded from this study. A literature search of PubMed and the Cochrane Library was conducted, limited to 2019-2020. The quality of the methodology and evidence synthesis of the meta-analyses were assessed using AMSTAR-2 (A Measurement Tool to Assess Systematic Reviews 2) and GRADE (Grading of Recommendations, Assessment, Development, and Evaluations), respectively. This study was funded by the National Research, Development and Innovation Fund of Hungary. RESULTS A total of 25 studies with 91 reported outcomes were included in the final analysis; 1 (4%), 1 (4%), and 23 (92%) studies had high, low, and critically low methodologic quality, respectively. As many as 6 clinical outcomes (7%) had high-quality evidence and 80 outcomes (88%) had moderate-quality evidence; 5 outcomes (5%) were rated with a low level of certainty, mainly due to risk of bias (85/91, 93%), inconsistency (27/91, 30%), and imprecision (27/91, 30%). There is high-quality evidence of improvements in mortality, transplant risk, cardiac arrhythmia detection, and stroke incidence with cardiac devices, albeit with low reporting quality. High-quality reviews of pedometers reported moderate-quality evidence, including effects on physical activity and BMI. No reports with high-quality evidence and high methodological quality were found. CONCLUSIONS Researchers in this field should consider the AMSTAR-2 criteria and GRADE to produce high-quality studies in the future. In addition, patients, clinicians, and policymakers are advised to consider the results of this study before making clinical decisions regarding digital biomarkers to be informed of the degree of certainty of the various interventions investigated in this study. The results of this study should be considered with its limitations, such as the narrow time frame. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/28204.
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Affiliation(s)
- Hossein Motahari-Nezhad
- Health Economics Research Center, University Research and Innovation Center, Óbuda University, Budapest, Hungary
- Doctoral School of Business and Management, Corvinus University of Budapest, Budapest, Hungary
| | - Hana Al-Abdulkarim
- Doctoral School of Applied Informatics and Applied Mathematics, Óbuda University, Budapest, Hungary
- Drug Policy and Economic Center, National Guard Health Affairs, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Meriem Fgaier
- Doctoral School of Applied Informatics and Applied Mathematics, Óbuda University, Budapest, Hungary
| | - Mohamed Mahdi Abid
- Research Center of Epidemiology and Statistics, Université Sorbonne Paris Cité, Paris, France
| | - Márta Péntek
- Health Economics Research Center, University Research and Innovation Center, Óbuda University, Budapest, Hungary
| | - László Gulácsi
- Health Economics Research Center, University Research and Innovation Center, Óbuda University, Budapest, Hungary
- Corvinus Institute for Advanced Studies, Corvinus University of Budapest, Budapest, Hungary
| | - Zsombor Zrubka
- Health Economics Research Center, University Research and Innovation Center, Óbuda University, Budapest, Hungary
- Corvinus Institute for Advanced Studies, Corvinus University of Budapest, Budapest, Hungary
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Tibell LH, Alvariza A, Kreicbergs U, Wallin V, Steineck G, Holm M. Web-based support for spouses of patients with life-threatening illness cared for in specialized home care - A feasibility study. Palliat Support Care 2022:1-9. [PMID: 36537025 DOI: 10.1017/s1478951522001602] [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: 12/24/2022]
Abstract
OBJECTIVES Psychoeducational interventions for family caregivers have shown to be effective but not possible for all caregivers to attend; thus, web-based interventions may be a complement. This study aimed to evaluate feasibility of a web-based intervention, "narstaende.se," from the perspective of spouses of patients receiving specialized home care. METHODS A website was developed, containing videos with conversations between health-care professionals and family caregivers (actors), informative texts, links to further information, and a chat forum. The aim of the website is to provide support and promote preparedness for caregiving and death, and the content is theoretically and empirically grounded. The study had a descriptive cross-sectional design. Altogether, 26 spouses answered a questionnaire, before accessing the website, and 4 weeks after this, 12 spouses were interviewed. Descriptive statistics and qualitative content analysis were used. RESULTS Spouses experienced the website as being easy to use, welcoming, and with relevant content. Participating spouses would recommend "narstaende.se" to others in similar situations, and the majority found the website introduced timely. Videos seemed easily accessible and were most used, contributing to a feeling of recognition and sharing the situation. The online format was perceived as flexible, but still not all spouses visited the website, stating the desire for support in real life. SIGNIFICANCE OF RESULTS A web-based intervention can be feasible for spouses in specialized home care; however, the digital format is not suitable for everyone. Further research is needed to determine the website's potential to provide support and increase preparedness for family caregivers in general.
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Affiliation(s)
- Louise Häger Tibell
- The Department of Health Care Science/Palliative Research Centre, Marie Cederschiöld University, Stockholm, Sweden
- Theme Cancer, BES: Breast-Endocrine Tumours and Sarcoma, Karolinska University Hospital, Stockholm, Sweden
| | - Anette Alvariza
- The Department of Health Care Science/Palliative Research Centre, Marie Cederschiöld University, Stockholm, Sweden
- Stockholms Sjukhem, Research and Development Unit/Palliative Care, Stockholms Sjukhem Foundation, Stockholm, Sweden
| | - Ulrika Kreicbergs
- The Department of Health Care Science/Palliative Research Centre, Marie Cederschiöld University, Stockholm, Sweden
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Viktoria Wallin
- The Department of Health Care Science/Palliative Research Centre, Marie Cederschiöld University, Stockholm, Sweden
| | - Gunnar Steineck
- Department of Clinical Cancer Epidemiology, Karolinska Institutet, Stockholm, Sweden
- Division of Clinical Cancer Epidemiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Maja Holm
- The Department of Health Care Science/Palliative Research Centre, Marie Cederschiöld University, Stockholm, Sweden
- Department of Nursing Science, Sophiahemmet University, Stockholm, Sweden
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May S, Bruch D, Gehlhaar A, Linderkamp F, Stahlhut K, Heinze M, Allsop M, Muehlensiepen F. Digital technologies in routine palliative care delivery: an exploratory qualitative study with health care professionals in Germany. BMC Health Serv Res 2022; 22:1516. [PMID: 36514156 PMCID: PMC9745710 DOI: 10.1186/s12913-022-08802-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 11/07/2022] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To explore health care professionals' (HCPs) perspectives, experiences and preferences towards digital technology use in routine palliative care delivery. METHODS HCPs (n = 19) purposively selected from a sample of settings that reflect routine palliative care delivery (i.e. specialized outpatient palliative care, inpatient palliative care, inpatient hospice care in both rural and urban areas of the German states of Brandenburg and Berlin) participated in an explorative, qualitative study using semi-structured interviews. Interview data were analyzed using structured qualitative content analysis. RESULTS Digital technologies are widely used in routine palliative care and are well accepted by HCPs. Central functions of digital technologies as experienced in palliative care are coordination of work processes, patient-centered care, and communication. Especially in outpatient care, they facilitate overcoming spatial and temporal distances. HCPs attribute various benefits to digital technologies that contribute to better coordinated, faster, more responsive, and overall more effective palliative care. Simultaneously, participants preferred technology as an enhancement not replacement of care delivery. HCPs fear that digital technologies, if overused, will contribute to dehumanization and thus significantly reduce the quality of palliative care. CONCLUSION Digital technology is already an essential part of routine palliative care delivery. While generally perceived as useful by HCPs, digital technologies are considered as having limitations and carrying risks. Hence, their use and consequences must be carefully considered, as they should discreetly complement but not replace human interaction in palliative care delivery.
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Affiliation(s)
- Susann May
- grid.473452.3Center for Health Services Research, Brandenburg Medical School, Seebad 82/83, Rüdersdorf bei Berlin, Germany
| | - Dunja Bruch
- Department of Cardiovascular Surgery, Heart Center Brandenburg, Brandenburg Medical School, Bernau bei Berlin, Germany ,grid.473452.3Faculty of Health Sciences Brandenburg, Brandenburg Medical School, Neuruppin, Germany
| | - Anne Gehlhaar
- grid.473452.3Center for Health Services Research, Brandenburg Medical School, Seebad 82/83, Rüdersdorf bei Berlin, Germany
| | - Felizitas Linderkamp
- grid.473452.3Center for Health Services Research, Brandenburg Medical School, Seebad 82/83, Rüdersdorf bei Berlin, Germany
| | - Kerstin Stahlhut
- grid.473452.3Department of Oncology and Palliative Medicine, Brandenburg Medical School, Immanuel Klinik Rüdersdorf, Rüdersdorf, Brandenburg Germany
| | - Martin Heinze
- grid.473452.3Center for Health Services Research, Brandenburg Medical School, Seebad 82/83, Rüdersdorf bei Berlin, Germany ,grid.473452.3Department of Psychiatry and Psychotherapy, Brandenburg Medical School, Immanuel Klinik Rüdersdorf, Rüdersdorf, Germany
| | - Matthew Allsop
- grid.9909.90000 0004 1936 8403Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, West Yorkshire UK
| | - Felix Muehlensiepen
- grid.473452.3Center for Health Services Research, Brandenburg Medical School, Seebad 82/83, Rüdersdorf bei Berlin, Germany ,grid.473452.3Faculty of Health Sciences Brandenburg, Brandenburg Medical School, Neuruppin, Germany ,grid.450307.50000 0001 0944 2786AGEIS, Université Grenoble Alpes, Grenoble, France
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Huang Y, Kabir MA, Upadhyay U, Dhar E, Uddin M, Syed-Abdul S. Exploring the Potential Use of Wearable Devices as a Prognostic Tool among Patients in Hospice Care. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58121824. [PMID: 36557026 PMCID: PMC9783865 DOI: 10.3390/medicina58121824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 12/05/2022] [Accepted: 12/09/2022] [Indexed: 12/14/2022]
Abstract
Background: Smartphones and wearable devices have become a part and parcel of the healthcare industry. The use of wearable technology has already proved its potentials in improving healthcare research, clinical work, and patient care. The real time data allows the care providers to monitor the patients' symptoms remotely, prioritize the patients' visits, assist in decision-making, and carry out advanced care planning. Objectives: The primary objective of our study was to investigate the potential use of wearable devices as a prognosis tool among patients in hospice care and palliative care, and the secondary objective was to examine the association between wearable devices and clinical data in the context of patient outcomes, such as discharge and deceased at various time intervals. Methods: We employed a prospective observational research approach to continuously monitor the hand movements of the selected 68 patients between December 2019 and June 2022 via an actigraphy device at hospice or palliative care ward of Taipei Medical University Hospital (TMUH) in Taiwan. Results: The results revealed that the patients with higher scores in the Karnofsky Performance Status (KPS), and Palliative Performance Scale (PPS) tended to live at discharge, while Palliative Prognostic Score (PaP) and Palliative prognostic Index (PPI) also shared the similar trend. In addition, the results also confirmed that all these evaluating tools only suggested rough rather than accurate and definite prediction. The outcomes (May be Discharge (MBD) or expired) were positively correlated with accumulated angle and spin values, i.e., the patients who survived had higher angle and spin values as compared to those who died/expired. Conclusion: The outcomes had higher correlation with angle value compared to spin and ACT. The correlation value increased within the first 48 h and then began to decline. We recommend rigorous prospective observational studies/randomized control trials with many participants for the investigations in the future.
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Affiliation(s)
- Yaoru Huang
- Department of Radiation Oncology, Taipei Medical University Hospital, Taipei 110, Taiwan
- Graduate Institute of Biomedical Materials and Tissue Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei 110, Taiwan
| | - Muhammad Ashad Kabir
- School of Computing, Mathematics and Engineering, Charles Sturt University, Bathurst, NSW 2795, Australia
| | - Umashankar Upadhyay
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei 106, Taiwan
- International Center for Health Information Technology, College of Medical Science and Technology, Taipei Medical University, Taipei 106, Taiwan
- Faculty of Applied Sciences and Biotechnology, Shoolini University of Biotechnology and Management Sciences, Solan 173212, Himachal Pradesh, India
| | - Eshita Dhar
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei 106, Taiwan
- International Center for Health Information Technology, College of Medical Science and Technology, Taipei Medical University, Taipei 106, Taiwan
| | - Mohy Uddin
- Research Quality Management Section, King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Ministry of National Guard-Health Affairs, Riyadh 11481, Saudi Arabia
| | - Shabbir Syed-Abdul
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei 106, Taiwan
- International Center for Health Information Technology, College of Medical Science and Technology, Taipei Medical University, Taipei 106, Taiwan
- School of Gerontology and Long-Term Care, College of Nursing, Taipei Medical University, Taipei 110, Taiwan
- Correspondence: ; Tel.: +886-2-6638-2736 (ext. 1514)
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Narvaez RA, Canaria A, Nifras SR, Listones N, Topacio R, Baua ME. The role of telehealth on quality of life of palliative care patients during the COVID-19 pandemic: an integrative review. Int J Palliat Nurs 2022; 28:583-589. [DOI: 10.12968/ijpn.2022.28.12.583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Telehealth looks to be a viable tool to meet patients’ expectations and requirements during home treatment; however, there are obstacles to overcome. Palliative care has been described as ‘high touch’ rather than ‘high tech’, which may restrict healthcare workers’ enthusiasm in integrating technological advances into the development and refinement of interventions. As a result, the goal of this integrative review was to map and evaluate existing research on the use of telemedicine and telehealth in palliative care patients during the COVID-19 outbreak. This review was guided using the PRISMA Model and CASP guidelines. A total of 17 articles on the use of telehealth in palliative care satisfied the inclusion and exclusion criteria of the review. This integrative review provided more evidence for the function and application of telehealth in palliative care. It demonstrated the resiliency of individuals in swiftly adjusting to a new system or application and the adaptability of healthcare systems and providers in establishing an alternate means of providing treatment to patients during a crisis.
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Yang-Huang J, Doñate-Martínez A, Garcés J, Campos MSG, Romero RV, López MEG, Fernandes A, Camacho M, Gama A, Reppou S, Bamidis PD, Linklater G, Hines F, Eze J, Raat H. Evaluation design of the patient-centred pathways of early palliative care, supportive ecosystems and appraisal standard (InAdvance): a randomised controlled trial. BMC Geriatr 2022; 22:812. [PMID: 36271332 PMCID: PMC9587630 DOI: 10.1186/s12877-022-03508-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 10/08/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Palliative care aims to contribute to pain relief, improvement with regard to symptoms and enhancement of health-related quality of life (HRQoL) of patients with chronic conditions. Most of the palliative care protocols, programmes and units are predominantly focused on patients with cancer and their specific needs. Patients with non-cancer chronic conditions may also have significantly impaired HRQoL and poor survival, but do not yet receive appropriate and holistic care. The traditional focus of palliative care has been at the end-of-life stages instead of the relatively early phases of serious chronic conditions. The 'Patient-centred pathways of early palliative care, supportive ecosystems and appraisal standard' (InAdvance) project implements and evaluates early palliative care in the daily clinical routine addressing patients with complex chronic conditions in the evolution towards advanced stages. The objective of the current study is to evaluate the acceptability, feasibility, effectiveness and cost-effectiveness of this novel model of palliative care in the relatively early phases in patients with chronic conditions. METHODS In this study, a single blind randomised controlled trial design will be employed. A total of 320 participants (80 in each study site and 4 sites in total) will be randomised on a 1:1 basis to the Palliative Care Needs Assessment (PCNA) arm or the Care-as-Usual arm. This study includes a formative evaluation approach as well as a cost-effectiveness analysis with a within-trial horizon. Study outcomes will be assessed at baseline, 6 weeks, 6 months, 12 months and 18 months after the implementation of the interventions. Study outcomes include HRQoL, intensity of symptoms, functional status, emotional distress, caregiving burden, perceived quality of care, adherence to treatment, feasibility, acceptability, and appropriateness of the intervention, intervention costs, other healthcare costs and informal care costs. DISCUSSION The InAdvance project will evaluate the effect of the implementation of the PCNA intervention on the target population in terms of effectiveness and cost-effectiveness in four European settings. The evidence of the project will provide step-wise guidance to contribute an increased evidence base for policy recommendations and clinical guidelines, in an effort to augment the supportive ecosystem for palliative care. TRIAL REGISTRATION ISRCTN, ISRCTN24825698 . Registered 17/12/2020.
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Affiliation(s)
- Junwen Yang-Huang
- Department of Public Health, Erasmus Medical Center, P.O. Box 2040, 3000, Rotterdam, CA, Netherlands
| | | | - Jorge Garcés
- Polibienestar Research Institute, University of Valencia, Valencia, Spain
| | | | | | | | | | - Mariana Camacho
- Santa Casa da Misericórdia da Amadora (SCMA), Amadora, Portugal
| | - Ana Gama
- Santa Casa da Misericórdia da Amadora (SCMA), Amadora, Portugal
| | - Sofia Reppou
- Lab of Medical Physics and Digital Innovation; and Special Unit for Biomedical Research and Education, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Panagiotis D Bamidis
- Lab of Medical Physics and Digital Innovation; and Special Unit for Biomedical Research and Education, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | | | - Jude Eze
- Department of Veterinary and Animal Science, Northern Faculty, Scotland's Rural College, Inverness, UK
| | - Hein Raat
- Department of Public Health, Erasmus Medical Center, P.O. Box 2040, 3000, Rotterdam, CA, Netherlands.
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Virtual Access to Subspecialty Care. Prim Care 2022; 49:557-573. [PMCID: PMC9581700 DOI: 10.1016/j.pop.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Kremeike K, Bausewein C, Freytag A, Junghanss C, Marx G, Schnakenberg R, Schneider N, Schulz H, Wedding U, Voltz R. [DNVF Memorandum: Health Services Research in the Last Year of Life]. DAS GESUNDHEITSWESEN 2022. [PMID: 36220106 DOI: 10.1055/a-1889-4705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
This memorandum outlines current issues concerning health services research on seriously ill and dying people in the last year of their lives as well as support available for their relatives. Patients in the last phase of life can belong to different disease groups, they may have special characteristics (e. g., people with cognitive and complex impairments, economic disadvantage or migration background) and be in certain phases of life (e. g., parents of minor children, (old) age). The need for a designated memorandum on health services research in the last year of life results from the special situation of those affected and from the special features of health services in this phase of life. With reference to these special features, this memorandum describes methodological and ethical specifics as well as current issues in health services research and how these can be adequately addressed using quantitative, qualitative and mixed methods. It has been developed by the palliative medicine section of the German Network for Health Services Research (DNVF) according to the guidelines for DNVF memoranda.
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Affiliation(s)
- Kerstin Kremeike
- Zentrum für Palliativmedizin, Universitätsklinikum Köln, Köln, Deutschland
| | - Claudia Bausewein
- Klinik und Poliklinik für Palliativmedizin, LMU Klinikum München, München, Deutschland
| | - Antje Freytag
- Institut für Allgemeinmedizin, Universitätsklinikum Jena, Jena, Deutschland
| | - Christian Junghanss
- Hämatologie, Onkologie und Palliativmedizin, Zentrum für Innere Medizin, Universitätsmedizin Rostock, Rostock, Deutschland
| | - Gabriella Marx
- Institut und Poliklinik Allgemeinmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | | | - Nils Schneider
- Institut für Allgemeinmedizin und Palliativmedizin, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Holger Schulz
- Institut und Poliklinik für Medizinische Psychologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Ulrich Wedding
- Abteilung Palliativmedizin, Universitätsklinikum Jena, Jena, Deutschland
| | - Raymond Voltz
- Zentrum für Palliativmedizin, Universitätsklinikum Köln, Köln, Deutschland
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Villalobos JP, Bull SS, Portz JD. Usability and Acceptability of a Palliative Care Mobile Intervention for Older Adults With Heart Failure and Caregivers: Observational Study. JMIR Aging 2022; 5:e35592. [PMID: 36201402 PMCID: PMC9585449 DOI: 10.2196/35592] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 05/24/2022] [Accepted: 07/26/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Heart failure is a leading cause of death among older adults. Digital health can increase access to and awareness of palliative care for patients with advanced heart failure and their caregivers. However, few palliative care digital interventions target heart failure or patients' caregivers, family, and friends, termed here as the social convoy. To address this need, the Social Convoy Palliative Care (Convoy-Pal) mobile intervention was developed to deliver self-management tools and palliative care resources to older adults with advanced heart failure and their social convoys. OBJECTIVE The goal of the research was to test the acceptability and usability of Convoy-Pal among older adults with advanced heart failure and their social convoys. METHODS Convoy-Pal includes tablet-based and smartwatch tools facilitating self-management and access to palliative care resources. Older adults and social convoy caregivers completed an acceptability and usability interview via Zoom, including open-ended questions and the Mobile Application Rating Scale: User Version (uMARS). Descriptive analysis was conducted to summarize the results of open-ended feedback and self-reported acceptability and usability. RESULTS A total of 26 participants (16 older adults and 10 social convoy caregivers) participated in the interview. Overall, the feedback from users was good (uMARS mean 3.96/5 [SD 0.81]). Both older adults and social convoy caregivers scored information provided by Convoy-Pal the highest (mean 4.22 [SD 0.75] and mean 4.21 [SD 0.64], respectively). Aesthetics, functionality, and engagement were also perceived as acceptable (mean >3.5). Open-ended feedback resulted in 5 themes including improvements to goal setting, monitoring tools, daily check-in call feature, portal and mobile app, and convoy assessment. CONCLUSIONS Convoy-Pal was perceived as acceptable with good usability among older adults with heart failure and their social convoy caregivers. With good acceptability, Convoy-Pal may ultimately lead to increased access to palliative care resources and facilitate self-management among older adults with heart failure and their social convoy caregivers.
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Affiliation(s)
| | - Sheana Salyers Bull
- Colorado School of Public Health, University of Colorado, Aurora, CO, United States
| | - Jennifer Dickman Portz
- Division of General Internal Medicine, University of Colorado, Aurora, CO, United States
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Schuit AS, Holtmaat K, Coupé VMH, Eerenstein SEJ, Zijlstra JM, Eeltink C, Becker-Commissaris A, van Zuylen L, van Linde ME, Menke-van der Houven van Oordt CW, Sommeijer DW, Verbeek N, Bosscha K, Nandoe Tewarie R, Sedee RJ, de Bree R, de Graeff A, de Vos F, Cuijpers P, Verdonck-de Leeuw IM, Jansen F. Cost-Utility of the eHealth Application ‘Oncokompas’, Supporting Incurably Ill Cancer Patients to Self-Manage Their Cancer-Related Symptoms: Results of a Randomized Controlled Trial. Curr Oncol 2022; 29:6186-6202. [PMID: 36135055 PMCID: PMC9497666 DOI: 10.3390/curroncol29090486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/14/2022] [Accepted: 08/18/2022] [Indexed: 11/16/2022] Open
Abstract
Evidence on the cost-effectiveness of eHealth in palliative care is scarce. Oncokompas, a fully automated behavioral intervention technology, aims to support self-management in cancer patients. This study aimed to assess the cost-utility of the eHealth application Oncokompas among incurably ill cancer patients, compared to care as usual. In this randomized controlled trial, patients were randomized into the intervention group (access to Oncokompas) or the waiting-list control group (access after three months). Healthcare costs, productivity losses, and health status were measured at baseline and three months. Intervention costs were also taken into account. Non-parametric bootstrapping with 5000 replications was used to obtain 95% confidence intervals around the incremental costs and quality-adjusted life years (QALYs). A probabilistic approach was used because of the skewness of cost data. Altogether, 138 patients completed the baseline questionnaire and were randomly assigned to the intervention group (69) or the control group (69). In the base case analysis, mean total costs and mean total effects were non-significantly lower in the intervention group (−€806 and −0.01 QALYs). The probability that the intervention was more effective and less costly was 4%, whereas the probability of being less effective and less costly was 74%. Among patients with incurable cancer, Oncokompas does not impact incremental costs and seems slightly less effective in terms of QALYs, compared to care as usual. Future research on the costs of eHealth in palliative cancer care is warranted to assess the generalizability of the findings of this study.
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Affiliation(s)
- Anouk S. Schuit
- Department Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 7-9, 1081 BT Amsterdam, The Netherlands
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, 1081 HV Amsterdam, The Netherlands
- Mental Health, Amsterdam Public Health, 1081 HV Amsterdam, The Netherlands
| | - Karen Holtmaat
- Department Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 7-9, 1081 BT Amsterdam, The Netherlands
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, 1081 HV Amsterdam, The Netherlands
- Mental Health, Amsterdam Public Health, 1081 HV Amsterdam, The Netherlands
| | - Veerle M. H. Coupé
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, 1081 HV Amsterdam, The Netherlands
- Department of Epidemiology and Data Science, Amsterdam UMC, Location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Simone E. J. Eerenstein
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, 1081 HV Amsterdam, The Netherlands
- Department of Otolaryngology-Head and Neck Surgery, Amsterdam UMC, Location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Josée M. Zijlstra
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, 1081 HV Amsterdam, The Netherlands
- Department of Hematology, Amsterdam UMC, Location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Corien Eeltink
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, 1081 HV Amsterdam, The Netherlands
- Department of Hematology, Amsterdam UMC, Location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Annemarie Becker-Commissaris
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, 1081 HV Amsterdam, The Netherlands
- Department of Pulmonary Diseases, Amsterdam UMC, Location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Lia van Zuylen
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, 1081 HV Amsterdam, The Netherlands
- Department of Medical Oncology, Amsterdam UMC, LocationVrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Myra E. van Linde
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, 1081 HV Amsterdam, The Netherlands
- Department of Medical Oncology, Amsterdam UMC, LocationVrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - C. Willemien Menke-van der Houven van Oordt
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, 1081 HV Amsterdam, The Netherlands
- Department of Medical Oncology, Amsterdam UMC, LocationVrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Dirkje W. Sommeijer
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, 1081 HV Amsterdam, The Netherlands
- Department of Internal Medicine, Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, 1012 WX Amsterdam, The Netherlands
- Department of Internal Medicine, Flevo Hospital, Hospitaalweg 1, 1315 RA Almere, The Netherlands
| | - Nol Verbeek
- Department of Oncology, St. Antonius Hospital, Soestwetering 1, 3543 AZ Utrecht, The Netherlands
| | - Koop Bosscha
- Department of Surgery, Jeroen Bosch Hospital, Henri Dunantstraat 1, 5223 GZ Den Bosch, The Netherlands
| | - Rishi Nandoe Tewarie
- Department of Neurosurgery, Haaglanden MC, Lijnbaan 32, 2512 VA The Hague, The Netherlands
| | - Robert-Jan Sedee
- Department of Otolaryngology, Head and Neck Surgery, Haaglanden MC, Lijnbaan 32, 2512 VA The Hague, The Netherlands
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Alexander de Graeff
- Department of Medical Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Filip de Vos
- Department of Medical Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Pim Cuijpers
- Department Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 7-9, 1081 BT Amsterdam, The Netherlands
- International Institute for Psychotherapy, Babeș-Bolyai University, Str. Mihail Kogălniceanu 1, 400084 Cluj-Napoca, Romania
| | - Irma M. Verdonck-de Leeuw
- Department Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 7-9, 1081 BT Amsterdam, The Netherlands
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, 1081 HV Amsterdam, The Netherlands
- Mental Health, Amsterdam Public Health, 1081 HV Amsterdam, The Netherlands
- Department of Otolaryngology-Head and Neck Surgery, Amsterdam UMC, Location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Femke Jansen
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, 1081 HV Amsterdam, The Netherlands
- Department of Otolaryngology-Head and Neck Surgery, Amsterdam UMC, Location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
- Correspondence:
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Schuit AS, Holtmaat K, Lissenberg-Witte BI, Eerenstein SE, Zijlstra JM, Eeltink C, Becker-Commissaris A, van Zuylen L, van Linde ME, Menke-van der Houven van Oordt CW, Sommeijer DW, Verbeek N, Bosscha K, Tewarie RN, Sedee RJ, de Bree R, de Graeff A, de Vos F, Cuijpers P, Verdonck-de Leeuw IM. Efficacy of the eHealth application Oncokompas, facilitating incurably ill cancer patients to self-manage their palliative care needs: A randomized controlled trial. THE LANCET REGIONAL HEALTH. EUROPE 2022; 18:100390. [PMID: 35496496 PMCID: PMC9046636 DOI: 10.1016/j.lanepe.2022.100390] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Many patients with incurable cancer have symptoms affecting their health-related quality of life. The eHealth application 'Oncokompas' supports patients to take an active role in managing their palliative care needs, to reduce symptoms and improve health-related quality of life (HRQOL). This randomized controlled trial was conducted to determine the efficacy of Oncokompas compared to care as usual among incurably ill cancer patients with a life expectancy of more than three months. METHODS Patients were recruited in six hospitals in the Netherlands. Eligible patients were randomly assigned to the intervention (direct access to Oncokompas) or the control group (access to Oncokompas after three months). The primary outcome measure was patient activation (i.e., patients' knowledge, skills and confidence for self-management). Secondary outcomes were general self-efficacy and HRQOL. Measures were assessed at baseline, two weeks after randomization, and three months after the baseline measurement. Linear mixed models were used to compare longitudinal changes between both groups from baseline to the three-month follow-up. FINDINGS In total, 219 patients were eligible of which 138 patients completed the baseline questionnaire (response rate 63%), and were randomized to the intervention (69) or control group (69). There were no significant differences between the intervention and control group over time in patient activation (estimated difference in change T0-T2; 1·8 (90% CI: -1·0 to 4·7)), neither in general self-efficacy and HRQOL. Of the patients in the intervention group who activated their account, 74% used Oncokompas as intended. The course of patient activation, general self-efficacy, and HRQOL was not significantly different between patients who used Oncokompas as intended versus those who did not. INTERPRETATION Among incurably ill cancer patients with a life expectancy of more than three months and recruited in the hospital setting, Oncokompas did not significantly improve patient activation, self-efficacy, or HRQOL. FUNDING ZonMw, Netherlands Organization for Health Research and Development (844001105).
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Affiliation(s)
- Anouk S. Schuit
- Department of Clinical, Neuro and Developmental Psychology, Faculty of Behavioral and Movement Sciences, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, the Netherlands
- Cancer Center Amsterdam (CCA), Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Karen Holtmaat
- Department of Clinical, Neuro and Developmental Psychology, Faculty of Behavioral and Movement Sciences, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, the Netherlands
- Cancer Center Amsterdam (CCA), Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | | | - Simone E.J. Eerenstein
- Amsterdam UMC, Vrije Universiteit Amsterdam, Otolaryngology – Head and Neck Surgery, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Josée M. Zijlstra
- Department of Hematology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Corien Eeltink
- Department of Hematology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Annemarie Becker-Commissaris
- Department of Pulmonary Diseases, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Lia van Zuylen
- Department of Medical Oncology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Myra E. van Linde
- Department of Medical Oncology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | | | - Dirkje W. Sommeijer
- Department of Medical Oncology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
- Department of Internal Medicine, Flevo Hospital, Almere, the Netherlands
| | - Nol Verbeek
- Department of Oncology, St. Antonius hospital, Utrecht, the Netherlands
| | - Koop Bosscha
- Department of Surgery, Jeroen Bosch hospital, Den Bosch, the Netherlands
| | | | - Robert-Jan Sedee
- Department of Otolaryngology, Head and Neck Surgery, Haaglanden MC, The Hague, the Netherlands
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, University Utrecht, the Netherlands
| | - Alexander de Graeff
- Department of Medical Oncology, Cancer Center, University Medical Center Utrecht, University Utrecht, the Netherlands
| | - Filip de Vos
- Department of Medical Oncology, Cancer Center, University Medical Center Utrecht, University Utrecht, the Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Faculty of Behavioral and Movement Sciences, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, the Netherlands
| | - Irma M. Verdonck-de Leeuw
- Department of Clinical, Neuro and Developmental Psychology, Faculty of Behavioral and Movement Sciences, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, the Netherlands
- Cancer Center Amsterdam (CCA), Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam UMC, Vrije Universiteit Amsterdam, Otolaryngology – Head and Neck Surgery, Cancer Center Amsterdam, Amsterdam, the Netherlands
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Laranjeira C, Dixe MA, Martinho R, Rijo R, Querido A. Building Bridges for "Palliative Care-in-Place": Development of a mHealth Intervention for Informal Home Care. Front Psychol 2022; 13:862347. [PMID: 35401349 PMCID: PMC8993184 DOI: 10.3389/fpsyg.2022.862347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 03/09/2022] [Indexed: 12/12/2022] Open
Abstract
Background In Palliative Care (PC), family and close people are an essential part of provision of care. They assume highly complex tasks for which they are not prepared, with considerable physical, psychological, social and economic impact. Informal Caregivers (ICs) often falter in the final stage of life and develop distress, enhancing emotional burden and complicated grief. The lack of available and accessible in-person counselling resources is often reported by ICs. Online resources can promote early access to help and support for patient-IC dyads in palliative care. The primary aim of this research is to co-design, develop and test the feasibility of the Help2Care-PAL mHealth app that addresses the needs of ICs of palliative patients cared for at home. This Digital Health Intervention (DHI) in palliative care will be used for education, symptom management, communication and decision-making, to enhance Quality of Life (QoL) of patients and ICs, fostering anticipatory grief and the reach and efficiency of services. Methods This study will use an iterative co-design process and convergent mixed-methods design, following the MORECare consensus for developing a complex intervention. Construction of the DHI will follow four main phases: (I) a needs assessment (a cross-sectional survey, individual interviews with ICs and focus groups with professionals with community palliative care experience); (II) design and co-production of mHealth materials and interventions to support ICs; (III) the development of a mHealth app; and (IV) usability and feasibility of the mHealth app. The Help2Care-PAL platform seeks to build resources from the perspectives and needs of both family dyads and nursing professionals working in the field of community palliative care. User-centeredness will be ensured by the active participation of patient-IC dyads and professionals of the palliative care community. Discussion This mixed-method study will offer new insights on needs and expectations of patient-IC dyads and nurses in community palliative care regarding caregiving preparedness and online health resources. Through the implementation of an adaptive digital tool, we aim to improve access to palliative care family support, which is highly linked with the wellbeing of patients and especially new ICs.
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Affiliation(s)
- Carlos Laranjeira
- School of Health Sciences of Polytechnic of Leiria, Leiria, Portugal.,Centre for Innovative Care and Health Technology (ciTechCare), Polytechnic of Leiria, Leiria, Portugal.,Research in Education and Community Intervention (RECI I&D), Piaget Institute, Viseu, Portugal
| | - Maria Anjos Dixe
- School of Health Sciences of Polytechnic of Leiria, Leiria, Portugal.,Centre for Innovative Care and Health Technology (ciTechCare), Polytechnic of Leiria, Leiria, Portugal
| | - Ricardo Martinho
- Center for Health Technology and Services Research (CINTESIS), University of Porto, Porto, Portugal.,Technology and Management School of Polytechnic of Leiria, Leiria, Portugal
| | - Rui Rijo
- Technology and Management School of Polytechnic of Leiria, Leiria, Portugal
| | - Ana Querido
- School of Health Sciences of Polytechnic of Leiria, Leiria, Portugal.,Centre for Innovative Care and Health Technology (ciTechCare), Polytechnic of Leiria, Leiria, Portugal.,Center for Health Technology and Services Research (CINTESIS), University of Porto, Porto, Portugal
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Nwosu AC, McGlinchey T, Sanders J, Stanley S, Palfrey J, Lubbers P, Chapman L, Finucane A, Mason S. Identification of Digital Health Priorities for Palliative Care Research: Modified Delphi Study. JMIR Aging 2022; 5:e32075. [PMID: 35311674 PMCID: PMC9090235 DOI: 10.2196/32075] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 11/09/2021] [Accepted: 12/02/2021] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Developments in digital health have the potential to transform the delivery of health and social care to help citizens manage their health. Currently, there is a lack of consensus about digital health research priorities in palliative care and a lack of theories about how these technologies might improve care outcomes. Therefore, it is important for health care leaders to identify innovations to ensure that an increasingly frail population has appropriate access to palliative care services. Consequently, it is important to articulate research priorities as the first step in determining how finite resources should be allocated to a field saturated with rapidly developing innovation. OBJECTIVE The aim of this study is to identify research priority areas for digital health in palliative care. METHODS We selected digital health trends, most relevant to palliative care, from a list of emerging trends reported by a leading institute of quantitative futurists. We conducted 2 rounds of the Delphi questionnaire, followed by a consensus meeting and public engagement workshop to establish a final consensus on research priorities for digital technology in palliative care. We used the views of public representatives to gain their perspectives on the agreed priorities. RESULTS A total of 103 experts (representing 11 countries) participated in the first Delphi round. Of the 103 experts, 55 (53.3%) participated in the second round. The final consensus meetings were attended by 10.7% (11/103) of the experts. We identified 16 priority areas, which involved many applications of technologies, including care for patients and caregivers, self-management and reporting of diseases, education and training, communication, care coordination, and research methodology. We summarized the priority areas into eight topics: big data, mobile devices, telehealth and telemedicine, virtual reality, artificial intelligence, smart home, biotechnology, and digital legacy. CONCLUSIONS The priorities identified in this study represent a wide range of important emerging areas in the fields of digital health, personalized medicine, and data science. Human-centered design and robust governance systems should be considered in future research. It is important that the risks of using these technologies in palliative care are properly addressed to ensure that these tools are used meaningfully, wisely, and safely and do not cause unintentional harm.
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Affiliation(s)
- Amara Callistus Nwosu
- Lancaster Medical School, Lancaster University, Lancaster, United Kingdom
- Marie Curie Hospice Liverpool, Liverpool, United Kingdom
- Liverpool University Hospitals National Health Service Foundation Trust, Liverpool, United Kingdom
| | - Tamsin McGlinchey
- Palliative Care Unit, University of Liverpool, Liverpool, United Kingdom
| | - Justin Sanders
- Dana-Farber Cancer Institute, Boston, MA, United States
- Ariadne Labs, Brigham and Women's Hospital and Harvard T H Chan School of Public Health, Boston, MA, United States
- Harvard Medical School, Harvard University, Boston, MA, United States
| | - Sarah Stanley
- Marie Curie Hospice Liverpool, Liverpool, United Kingdom
| | | | - Patrick Lubbers
- Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, Netherlands
| | - Laura Chapman
- Marie Curie Hospice Liverpool, Liverpool, United Kingdom
| | - Anne Finucane
- Clinical Psychology, University of Edinburgh, Edinburgh, United Kingdom
| | - Stephen Mason
- Palliative Care Unit, University of Liverpool, Liverpool, United Kingdom
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49
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Koumakis L, Schera F, Parker H, Bonotis P, Chatzimina M, Argyropaidas P, Zacharioudakis G, Schäfer M, Kakalou C, Karamanidou C, Didi J, Kazantzaki E, Scarfo L, Marias K, Natsiavas P. Fostering Palliative Care Through Digital Intervention: A Platform for Adult Patients With Hematologic Malignancies. Front Digit Health 2021; 3:730722. [PMID: 34977857 PMCID: PMC8718505 DOI: 10.3389/fdgth.2021.730722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 11/16/2021] [Indexed: 11/13/2022] Open
Abstract
Patient-reported outcomes (PROs) are an emerging paradigm in clinical research and healthcare, aiming to capture the patient's self-assessed health status in order to gauge efficacy of treatment from their perspective. As these patient-generated health data provide insights into the effects of healthcare processes in real-life settings beyond the clinical setting, they can also be viewed as a resolution beyond what can be gleaned directly by the clinician. To this end, patients are identified as a key stakeholder of the healthcare decision making process, instead of passively following their doctor's guidance. As this joint decision-making process requires constant and high-quality communication between the patient and his/her healthcare providers, novel methodologies and tools have been proposed to promote richer and preemptive communication to facilitate earlier recognition of potential complications. To this end, as PROs can be used to quantify the patient impact (especially important for chronic conditions such as cancer), they can play a prominent role in providing patient-centric care. In this paper, we introduce the MyPal platform that aims to support adults suffering from hematologic malignancies, focusing on the technical design and highlighting the respective challenges. MyPal is a Horizon 2020 European project aiming to support palliative care for cancer patients via the electronic PROs (ePROs) paradigm, building upon modern eHealth technologies. To this end, MyPal project evaluate the proposed eHealth intervention via clinical studies and assess its potential impact on the provided palliative care. More specifically, MyPal platform provides specialized applications supporting the regular answering of well-defined and standardized questionnaires, spontaneous symptoms reporting, educational material provision, notifications etc. The presented platform has been validated by end-users and is currently in the phase of pilot testing in a clinical study to evaluate its feasibility and its potential impact on the quality of life of palliative care patients with hematologic malignancies.
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Affiliation(s)
- Lefteris Koumakis
- Institute of Computer Science, Foundation for Research and Technology–Hellas (FORTH), Heraklion, Greece
- *Correspondence: Lefteris Koumakis
| | - Fatima Schera
- Institute for Biomedical Engineering, Sulzbach, Germany
| | | | - Panos Bonotis
- Institute of Applied Biosciences, Centre for Research and Technology Hellas, Thessaloniki, Greece
| | - Maria Chatzimina
- Institute of Computer Science, Foundation for Research and Technology–Hellas (FORTH), Heraklion, Greece
| | - Panagiotis Argyropaidas
- Institute of Computer Science, Foundation for Research and Technology–Hellas (FORTH), Heraklion, Greece
| | - Giorgos Zacharioudakis
- Institute of Computer Science, Foundation for Research and Technology–Hellas (FORTH), Heraklion, Greece
| | | | - Christine Kakalou
- Institute of Applied Biosciences, Centre for Research and Technology Hellas, Thessaloniki, Greece
| | - Christina Karamanidou
- Institute of Applied Biosciences, Centre for Research and Technology Hellas, Thessaloniki, Greece
| | - Jana Didi
- Center for Molecular Medicine, Central European Institute of Technology, Masaryk University, Brno, Czechia
| | - Eleni Kazantzaki
- Department of Hematology, University Hospital of Heraklion, Heraklion, Greece
| | - Lydia Scarfo
- Universita Vita-Salute San Raffaele, Milan, Italy
| | - Kostas Marias
- Institute of Computer Science, Foundation for Research and Technology–Hellas (FORTH), Heraklion, Greece
| | - Pantelis Natsiavas
- Institute of Applied Biosciences, Centre for Research and Technology Hellas, Thessaloniki, Greece
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50
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Khalili-Mahani N, Holowka E, Woods S, Khaled R, Roy M, Lashley M, Glatard T, Timm-Bottos J, Dahan A, Niesters M, Hovey RB, Simon B, Kirmayer LJ. Play the Pain: A Digital Strategy for Play-Oriented Research and Action. Front Psychiatry 2021; 12:746477. [PMID: 34975566 PMCID: PMC8714795 DOI: 10.3389/fpsyt.2021.746477] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 11/11/2021] [Indexed: 12/26/2022] Open
Abstract
The value of understanding patients' illness experience and social contexts for advancing medicine and clinical care is widely acknowledged. However, methodologies for rigorous and inclusive data gathering and integrative analysis of biomedical, cultural, and social factors are limited. In this paper, we propose a digital strategy for large-scale qualitative health research, using play (as a state of being, a communication mode or context, and a set of imaginative, expressive, and game-like activities) as a research method for recursive learning and action planning. Our proposal builds on Gregory Bateson's cybernetic approach to knowledge production. Using chronic pain as an example, we show how pragmatic, structural and cultural constraints that define the relationship of patients to the healthcare system can give rise to conflicted messaging that impedes inclusive health research. We then review existing literature to illustrate how different types of play including games, chatbots, virtual worlds, and creative art making can contribute to research in chronic pain. Inspired by Frederick Steier's application of Bateson's theory to designing a science museum, we propose DiSPORA (Digital Strategy for Play-Oriented Research and Action), a virtual citizen science laboratory which provides a framework for delivering health information, tools for play-based experimentation, and data collection capacity, but is flexible in allowing participants to choose the mode and the extent of their interaction. Combined with other data management platforms used in epidemiological studies of neuropsychiatric illness, DiSPORA offers a tool for large-scale qualitative research, digital phenotyping, and advancing personalized medicine.
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Affiliation(s)
- Najmeh Khalili-Mahani
- McGill Centre for Integrative Neuroscience, Montreal Neurological Institute, McGill University, Montreal, QC, Canada
- Division of Social & Transcultural Psychiatry, McGill University, Montreal, QC, Canada
- Culture and Mental Health Research Unit, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada
- Technoculture, Arts and Game Centre, Milieux Institute for Art, Culture and Technology, Concordia University, Montreal, QC, Canada
| | - Eileen Holowka
- Technoculture, Arts and Game Centre, Milieux Institute for Art, Culture and Technology, Concordia University, Montreal, QC, Canada
| | | | - Rilla Khaled
- Technoculture, Arts and Game Centre, Milieux Institute for Art, Culture and Technology, Concordia University, Montreal, QC, Canada
| | - Mathieu Roy
- Department of Psychology, McGill University, Montreal, QC, Canada
| | - Myrna Lashley
- Division of Social & Transcultural Psychiatry, McGill University, Montreal, QC, Canada
- Culture and Mental Health Research Unit, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada
| | - Tristan Glatard
- Department of Computer Science, Concordia University, Montreal, QC, Canada
- PERFORM Centre, Concordia University, Montreal, QC, Canada
| | - Janis Timm-Bottos
- Department of Creative Art Therapies, Concordia University, Montreal, QC, Canada
| | - Albert Dahan
- Department of Anesthesiology, Leiden University Medical Centre, Leiden University, Leiden, Netherlands
| | - Marieke Niesters
- Department of Anesthesiology, Leiden University Medical Centre, Leiden University, Leiden, Netherlands
| | | | - Bart Simon
- Technoculture, Arts and Game Centre, Milieux Institute for Art, Culture and Technology, Concordia University, Montreal, QC, Canada
- Department of Sociology, Concordia University, Montreal, QC, Canada
| | - Laurence J. Kirmayer
- Division of Social & Transcultural Psychiatry, McGill University, Montreal, QC, Canada
- Culture and Mental Health Research Unit, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada
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