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Brännström M, Philipsson J, Andersson S. Healthcare professionals' experiences of video consultations in palliative care in rural areas: an intervention study in community care. BMC Health Serv Res 2024; 24:740. [PMID: 38886714 DOI: 10.1186/s12913-024-11196-5] [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: 03/05/2024] [Accepted: 06/12/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND The population is aging, leading to an increased need for palliative care and end-of-life care. There is a lack of research on the use of video consultations for knowledge transfer between specialist and general palliative care. The aim of this study was to describe healthcare professionals' experiences of video consultations in palliative care in community homecare and nursing homes in rural areas. METHODS Individual interviews (n = 11) were conducted with five community nurses, one occupational therapist, two specialist palliative nurses, and three specialist palliative care physicians. The data were analysed using reflexive thematic analysis. RESULTS The analysis identified three themes: feeling comfortable with increased availability of specialist expertise; seeing each other facilitates communication; and being supported by physically present care professionals is essential. CONCLUSION HCPs suggest that video consultations are an effective way to increase access to specialist palliative care and provide more equal care to patients with palliative care needs in rural community care.
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Slightam C, Wray C, Tisdale RL, Zulman DM, Gray C. Opportunities to Enhance the Implementation of Veterans Affairs Video-Based Care: Qualitative Perspectives of Providers from Diverse Specialties. J Med Internet Res 2023; 25:e43314. [PMID: 37093642 PMCID: PMC10167580 DOI: 10.2196/43314] [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: 10/07/2022] [Revised: 02/02/2023] [Accepted: 03/12/2023] [Indexed: 04/25/2023] Open
Abstract
BACKGROUND Increasing the adoption of digital care tools, including video visits, is a long-term goal for the US Department of Veterans Affairs (VA). While previous work has highlighted patient-specific barriers to the use of video visits, few have examined how clinicians view such barriers and how they have overcome them during the rapid uptake of web-based care. OBJECTIVE This study sought input from providers, given their role as critical participants in video visit implementation, to qualitatively describe successful strategies providers used to adapt their practices to a web-based care setting. METHODS We conducted interviews with 28 VA providers (physicians and nurse practitioners) from 4 specialties that represent diverse clinical services: primary care (n=11), cardiology (n=7), palliative care (n=5), and spinal cord injury (n=5). All interviews were audio recorded and transcribed, and transcripts were reviewed and coded according to an iteratively created codebook. To identify themes, codes were grouped together into categories, and participant comments were reviewed for repetition and emphasis on specific points. Finally, themes were mapped to Expert Recommendations for Implementing Change (ERIC) strategies to identify evidence-based opportunities to support video visit uptake in the VA. RESULTS Interviewees were mostly female (57%, 16/28), with an average age of 49 years and with 2-20 years of experience working in the VA across 16 unique VA facilities. Most providers (82%, 23/28) worked in urban facilities. Many interviewees (78%, 22/28) had some experience with video visits prior to the COVID-19 pandemic, though a majority (61%, 17/28) had conducted fewer than 50 video visits in the quarter prior to recruitment. We identified four primary themes related to how providers adapt their practices to a web-based care setting: (1) peer-based learning and support improved providers' perceived value of and confidence in video visits, (2) providers developed new and refined existing communication and clinical skills to optimize video visits, (3) providers saw opportunities to revisit and refine team roles to optimize the value of video visits for their care teams, and (4) implementing and sustaining web-based care requires institutional and organizational support. We identified several ERIC implementation strategies to support the use of video visits across the individual-, clinic-, and system-levels that correspond to these themes: (1) individual-level strategies include the development of educational materials and conducting education meetings, (2) clinic-level strategies include identifying champions and revising workflows and professional roles, and (3) system-level strategies include altering incentive structures, preparing implementation blueprints, developing and implementing tools for quality monitoring, and involving executive leadership to encourage adoption. CONCLUSIONS This work highlights strategies to support video visits that align with established ERIC implementation constructs, which can be used by health care systems to improve video visit implementation.
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Affiliation(s)
- Cindie Slightam
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, United States
| | - Charlie Wray
- Department of Medicine, University of California, San Francisco, CA, United States
- Hospital Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, CA, United States
| | - Rebecca L Tisdale
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, United States
- Department of Health Policy, Stanford University School of Medicine, Stanford, CA, United States
| | - Donna M Zulman
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, United States
- Department of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, United States
| | - Caroline Gray
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, United States
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Evering RMH, Postel MG, van Os-Medendorp H, Bults M, den Ouden MEM. Intention of healthcare providers to use video-communication in terminal care: a cross-sectional study. BMC Palliat Care 2022; 21:213. [PMID: 36451219 PMCID: PMC9713136 DOI: 10.1186/s12904-022-01100-5] [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: 02/21/2022] [Accepted: 11/10/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Interdisciplinary collaboration between healthcare providers with regard to consultation, transfer and advice in terminal care is both important and challenging. The use of video communication in terminal care is low while in first-line healthcare it has the potential to improve quality of care, as it allows healthcare providers to assess the clinical situation in real time and determine collectively what care is needed. The aim of the present study is to explore the intention to use video communication by healthcare providers in interprofessional terminal care and predictors herein. METHODS In this cross-sectional study, an online survey was used to explore the intention to use video communication. The survey was sent to first-line healthcare providers involved in terminal care (at home, in hospices and/ or nursing homes) and consisted of 39 questions regarding demographics, experience with video communication and constructs of intention to use (i.e. Outcome expectancy, Effort expectancy, Attitude, Social influence, Facilitating conditions, Anxiety, Self-efficacy and Personal innovativeness) based on the Unified Theory of Acceptance and Use of Technology and Diffusion of Innovation Theory. Descriptive statistics were used to analyze demographics and experiences with video communication. A multiple linear regression analysis was performed to give insight in the intention to use video communication and predictors herein. RESULTS 90 respondents were included in the analysis.65 (72%) respondents had experience with video communication within their profession, although only 15 respondents (17%) used it in terminal care. In general, healthcare providers intended to use video communication in terminal care (Mean (M) = 3.6; Standard Deviation (SD) = .88). The regression model was significant (F = 9.809, p-value<.001) and explained 44% of the variance in intention to use video communication, with 'Outcome expectancy' (beta .420, p < .001) and 'Social influence' (beta .266, p = .004) as significant predictors. CONCLUSIONS Healthcare providers have in general the intention to use video communication in interprofessional terminal care. However, their actual use in terminal care is low. 'Outcome expectancy' and 'Social influence' seem to be important predictors for intention to use video communication. This implicates the importance of informing healthcare providers, and their colleagues and significant others, about the usefulness and efficiency of video communication.
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Affiliation(s)
- Richard M. H. Evering
- grid.5477.10000000120346234Research group Technology, Health & Care, Saxion, University of Applied Sciences, Enschede, Netherlands
| | - Marloes G. Postel
- grid.5477.10000000120346234Research group Technology, Health & Care, Saxion, University of Applied Sciences, Enschede, Netherlands
| | - Harmieke van Os-Medendorp
- grid.5477.10000000120346234Research group Smart Health, Saxion, University of Applied Sciences, School of Health, Deventer/ Enschede, Netherlands
| | - Marloes Bults
- grid.5477.10000000120346234Research group Technology, Health & Care, Saxion, University of Applied Sciences, Enschede, Netherlands
| | - Marjolein E. M. den Ouden
- grid.5477.10000000120346234Research group Technology, Health & Care, Saxion, University of Applied Sciences, Enschede, Netherlands ,Research group Care and Technology, Regional Community College of Twente, Hengelo, Netherlands
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Lundereng ED, Nes AAG, Holmen H, Winger A, Thygesen H, Jøranson N, Borge CR, Dajani O, Mariussen KL, Steindal SA. Health Care Professionals’ Experiences and Perspectives on Using Telehealth for Home-based Palliative Care: A Scoping Review (Preprint). J Med Internet Res 2022; 25:e43429. [PMID: 36989024 PMCID: PMC10131609 DOI: 10.2196/43429] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 02/10/2023] [Accepted: 02/24/2023] [Indexed: 02/26/2023] Open
Abstract
BACKGROUND Telehealth seems feasible for use in home-based palliative care (HBPC). It may improve access to health care professionals (HCPs) at patients' homes, reduce hospital admissions, enhance patients' feelings of security and safety, and increase the time spent at home for patients in HBPC. HBPC requires the involvement of various HCPs such as nurses, physicians, allied health professionals, dietitians, psychologists, religious counselors, and social workers. Acceptance of the use of technology among HCPs is essential for the successful delivery of telehealth in practice. No scoping review has mapped the experiences and perspectives of HCPs regarding the use of telehealth in HBPC. OBJECTIVE The aim of this review was to systematically map published studies on HCPs' experiences and perspectives on the use of telehealth in HBPC. METHODS A scoping review was conducted using the methodology of Arksey and O'Malley. The review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews. A systematic search was performed in AMED, CINAHL, Embase, MEDLINE, PsycINFO, and Web of Science for studies published in peer-reviewed journals between January 1, 2000, and August 23, 2022. The reference lists of the included papers were hand searched to identify additional studies. The inclusion criteria were (1) studies using qualitative, quantitative, or mixed methods; (2) studies including HCPs using telehealth with patients in HBPC; (3) studies on HCPs' experiences and perspectives on the use of telehealth in HBPC; (4) studies published between January 1, 2000, and August 23, 2022; and (5) studies published in English, Portuguese, Norwegian, Danish, Swedish, or Spanish. Pairs of authors independently included studies and extracted data. The first 2 stages of thematic synthesis were used to thematically organize the data. RESULTS This scoping review included 29 papers from 28 studies. Four descriptive themes were identified: (1) easy to use but technological issues undermine confidence, (2) adds value but personal and organizational barriers challenge adoption, (3) potential to provide useful and meaningful patient-reported data, and (4) mutual trust as a prerequisite for interpersonal relationships. CONCLUSIONS Telehealth in HBPC seems to be easy to use and may improve the coordination of care, time efficiency, clinical assessments, and help build and enhance personal and professional relationships. However, the introduction of technology in HBPC is complex, as it may not align well with the overall aim of palliative care from HCPs' point of view. Further, changes in practice and requirements for HCPs may reduce motivation for the use of telehealth in HBPC. HCPs consider themselves to have central roles in implementing telehealth, and a lack of acceptance and motivation is a key barrier to telehealth adoption. Policy makers and telehealth developers should be aware of this potential barrier when developing or implementing new technology for use in HBPC. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/33305.
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Affiliation(s)
- Elias David Lundereng
- Lovisenberg Diaconal University College, Oslo, Norway
- European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital, Oslo, Norway
| | | | - Heidi Holmen
- Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
- The Intervention Centre, Oslo University Hospital, Oslo, Norway
| | - Anette Winger
- Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
| | - Hilde Thygesen
- Faculty of Health Studies, VID Specialized University, Oslo, Norway
- Department of Occupational Therapy, Prosthetics and Orthotics, Oslo Metropolitan University, Oslo, Norway
| | - Nina Jøranson
- Faculty of Health Studies, VID Specialized University, Oslo, Norway
| | - Christine Råheim Borge
- Research Department, Lovisenberg Diaconal Hospital, Oslo, Norway
- Department of Interdisciplinary Health Sciences, University of Oslo, Oslo, Norway
| | - Olav Dajani
- European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital, Oslo, Norway
| | | | - Simen A Steindal
- Lovisenberg Diaconal University College, Oslo, Norway
- Faculty of Health Studies, VID Specialized University, Oslo, Norway
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Yang R, Ganeshan S, Thompson A, McAllister S, Mourad M. Impact of a resident and student-led video visitation navigation program. BMC MEDICAL EDUCATION 2022; 22:110. [PMID: 35183182 PMCID: PMC8857532 DOI: 10.1186/s12909-022-03172-6] [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: 10/24/2021] [Accepted: 02/07/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Many institutions implemented telehealth initiatives to provide social support for patients during the SARS-CoV-2 (COVID-19) pandemic. Little is known about the impact of these programs on patient support persons and the trainees who facilitated them. OBJECTIVE To assess perceptions of a resident physician and medical student-driven video visit program. METHODS We designed and implemented a trainee-led video visit navigation program across three affiliated urban hospitals to facilitate video visits between patients and their support persons. We used descriptive statistics to understand the patient population served by the program and employed surveys for support persons and trainees to assess attitudes on the program. RESULTS From April to June 2020, a total of 443 video visits were completed. Surveys were conducted for 101 out of 184 (54.9%) support persons and 39 out of 65 (60.0%) of medical trainees. Surveys demonstrated that video visits helped alleviate the stress and anxiety of support persons having a hospitalized loved one they could not visit. For trainees, facilitating these connections helped mitigate stress and provided a mechanism to contribute to the pandemic response. CONCLUSION Telehealth navigation programs provide high levels of connection for patients and their support persons during the COVID-19 pandemic and potentially beyond. Residents and medical students involved in these initiatives mobilized telehealth modalities to improve experiences with care delivery.
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Affiliation(s)
- Rachel Yang
- School of Medicine, University of California San Francisco, San Francisco, CA, USA.
| | - Smitha Ganeshan
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Avery Thompson
- School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Sophie McAllister
- School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Michelle Mourad
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
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Commiskey P, Armstrong AW, Coker TR, Dorsey ER, Fortney JC, Gaines KJ, Gibbons BM, Nguyen HQ, Singla DR, Szigethy E, Krupinski EA. A Blueprint for the Conduct of Large, Multisite Trials in Telemedicine. J Med Internet Res 2021; 23:e29511. [PMID: 34542417 PMCID: PMC8491114 DOI: 10.2196/29511] [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: 04/09/2021] [Revised: 06/25/2021] [Accepted: 07/27/2021] [Indexed: 11/13/2022] Open
Abstract
Recent literature supports the efficacy and efficiency of telemedicine in improving various health outcomes despite the wide variability in results. Understanding site-specific issues in the implementation of telemedicine trials for broader replication and generalizability of results is needed. Lessons can be learned from existing trials, and a blueprint can guide researchers to conduct these challenging studies using telemedicine more efficiently and effectively. This viewpoint presents relevant challenges and solutions for conducting multisite telemedicine trials using 7 ongoing and completed studies funded by the Patient-Centered Outcomes Research Institute portfolio of large multisite trials to highlight the challenges in implementing telemedicine trials. Critical issues of ensuring leadership and buy-in, appropriate funding, and diverse and representative trials are identified and described, as well as challenges related to clinical, informatics, regulatory, legal, quality, and billing. The lessons learned from these studies were used to create a blueprint of key aspects to consider for the design and implementation of multisite telemedicine trials.
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Affiliation(s)
- Patricia Commiskey
- Division of Stroke, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, United States
| | - April W Armstrong
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Tumaini R Coker
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, United States
- Seattle Children's Research Institute, Seattle, WA, United States
| | - Earl Ray Dorsey
- Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, United States
| | - John C Fortney
- Division of Population Health, Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA, United States
- Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research and Development, Department of Veteran's Affairs, Seattle, WA, United States
| | - Kenneth J Gaines
- Division of Stroke, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Brittany M Gibbons
- Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Huong Q Nguyen
- Division of Health Services Research & Implementation Science, Kaiser Permanente Southern California, Pasadena, CA, United States
| | - Daisy R Singla
- Center of Addiction and Mental Health, Toronto, ON, Canada
- Lunenfeld Tanenbaum Research Institute, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Eva Szigethy
- Center for High Value Health Care, UPMC Insurances Division, Department of Psychiatry, Medicine, and Pediatrics, University of Pittsburgh, Pittsburgh, PA, United States
| | - Elizabeth A Krupinski
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, United States
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