Video consultations in palliative care: A systematic integrative review

BACKGROUND

There is extensive need for palliative care worldwide, but access to care remains inadequate, especially for non-cancer patients. Video consultations are a promising tool in the provision of home-based palliative care, but an overview of evidence solely on video consultations in palliative care is lacking.

AIM

To review and synthesize current evidence regarding the use of video consultations in general and specialized palliative care to various patient groups.

DESIGN

A systematic integrative review with a narrative synthesis was undertaken in accordance with PRISMA (2009) guidelines. PROSPERO #: CRD42018095383.

DATA SOURCES

PubMed, Embase, CINAHL, and PsychINFO were searched for primary research articles published between 2005 and 2018. In addition, reference lists of included articles were hand searched.

RESULTS

The search resulted in 813 articles; 39 articles were included in the review, consisting of mixed methods (n = 14), qualitative (n = 10), quantitative (n = 10), and case studies (n = 5). The studies mainly focused on specialized palliative care to adult patients with cancer in high income countries. Through data analysis, six themes addressing advantages/disadvantages and facilitators/barriers were identified: (1) Redesign of care, (2) Communication, (3) User perceptions, (4) Technology, (5) Privacy issues, and (6) Economic implications.

CONCLUSION

Using video technology in palliative care has both advantages and disadvantages. However, evidence beyond the focus on specialized palliative care and patients with cancer is limited. Future research should focus on how and when video consultations might replace in-person specialized palliative care and video consultations in general palliative care, in low and middle income countries; and involve patients with a non-cancer diagnosis.

Bridging the dichotomous gap between expectations and perceptions in quantifying hospice care quality

This study uses a fuzzy logic and neural network to ascertain how service quality dimensions of the SERVQUAL model (reliability, assurance, empathy, responsiveness, and tangibility) affect overall customer satisfaction. Using a threshold logic unit to produce observation outcomes, the algorithm indicated that while reliability was the crux of the service outcome, peripheral variables (e.g., assurance, empathy, responsiveness, and tangibility) integrated emotions and feelings into the hospice service process which equated to an increased quality of life, a positive disconfirmation of expectations (service expectations were met or exceeded) and a good death experience equating to a positive perception of quality.

Interprofessional team approach to infertility treatment in Japan

Purpose

At present, a team approach involving gynecologists, nurses, embryologists, and the other professionals is considered necessary to provide successful infertility treatment. First, we documented which professionals were in charge during various phases of infertility treatment. Second, clinical staff and patients were surveyed regarding their expectations regarding which of these professionals should contribute during examination, during treatment and after treatment for infertility.

Methods

We surveyed the actual situation perceived by staff as well as the desired situation for staff and patients in relation to 21 procedures related to infertility treatment. We distributed 781 questionnaires to staff and patients at 86 facilities. Of 380 returned by mail, we analyzed 128 responses from staff who worked with four types of professionals or specialists, i.e., medical doctors, nurses, embryologists, and medical clerks, and 46 from patients who consulted these professionals during their treatment.

Results

Most staff recognized 5 of 15 procedures before and after treatment as being conducted by medical doctors alone. However, explanation and consultation regarding the methods and schedule were mainly performed with an interprofessional team approach. Expectations regarding professionals in charge differed between staff and patients. A team approach including infertility counselors and medical clerks was utilized and considered desirable during counseling.

Conclusions

An effective team approach should be established for each step of infertility treatment.