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Wiederhold BK. Bridging Tradition and Technology: Soft Skills Training for the Modern Day "House Call". CYBERPSYCHOLOGY, BEHAVIOR AND SOCIAL NETWORKING 2024; 27:357-358. [PMID: 38856154 DOI: 10.1089/cyber.2024.28593.editorial] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
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2
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Acezat Oliva J, Alarcón Belmonte I, Paredes Costa EJ, Albiol Perarnau M, Goussens A, Vidal-Alaball J. [Teleconsultation: finding its place in primary care]. Aten Primaria 2024; 56:102927. [PMID: 38608402 PMCID: PMC11019093 DOI: 10.1016/j.aprim.2024.102927] [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: 01/03/2024] [Accepted: 01/12/2024] [Indexed: 04/14/2024] Open
Abstract
Teleconsultation is a remote health consultation using information and communication technologies. There are different modalities and specific practical and communication skills are required. Notwithstanding its prominence in Spain, there is little evidence on teleconsultation. This article explores the applicability, barriers, facilitators and future challenges of teleconsultation. While it has the potential to improve access to healthcare, as well as save time and costs for both patients and healthcare professionals, it faces a number of challenges such as the digital divide and resistance to change. To address new challenges and overcome obstacles, it is crucial to gain the trust of patients and professionals. Improving training in the skills required to optimize their use is also essential. Future research should aim to provide robust evidence regarding safety and cost-effectiveness to ensure successful implementation.
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Affiliation(s)
- Jordi Acezat Oliva
- Grup de Salut Digital CAMFIC, Barcelona, España; Servei d'Atenció Primària Dreta i Muntanya, Gerència Territorial Barcelona ciutat, Institut Català de la Salut, Barcelona, España
| | - Iris Alarcón Belmonte
- Grup de Salut Digital CAMFIC, Barcelona, España; Servei d'Atenció Primària Dreta i Muntanya, Gerència Territorial Barcelona ciutat, Institut Català de la Salut, Barcelona, España
| | - Eugeni Joan Paredes Costa
- Grup de Salut Digital CAMFIC, Barcelona, España; Equip d'Atenció Primària Onze de Setembre, Lleida-7 Direcció d'Atenció Primària Lleida. Institut Català de la Salut, Lleida, España; Facultat de Medicina. Universitat de Lleida, Lleida, España.
| | - Marc Albiol Perarnau
- Grup de Salut Digital CAMFIC, Barcelona, España; Centre d'Atenció Primària Cornellà de Llobregat. Servei d'Atenció Primària Baix Llobregat, Metropolitana Sud. Institut Català de la Salut, Barcelona, España
| | - Alyson Goussens
- Grup de Salut Digital CAMFIC, Barcelona, España; CAP Ernest Lluch. Figueres. Servei d'Atenció Primària Girona Nord. Atenció Primària Girona Institut Català de la Salut, Girona, España
| | - Josep Vidal-Alaball
- Grup de Salut Digital CAMFIC, Barcelona, España; Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Sant Fruitós de Bages, Barcelona, España; Grup de Recerca Promoció de la Salut en l'Àmbit Rural, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Barcelona, España; Facultat de Medicina, Universitat de Vic-Universitat Central de Catalunya, Vic, Barcelona, España
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3
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Mehta S, Gardner K, Hall J, Rosenfield D, Tse S, Ho K, Grant K, Bradbury-Squires DJ, Lang E, Chartier L. Virtual urgent care is here to stay: driving toward safe, equitable, and sustainable integration within emergency medicine. CAN J EMERG MED 2024; 26:305-311. [PMID: 38334940 DOI: 10.1007/s43678-024-00658-8] [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] [Received: 01/03/2024] [Accepted: 01/24/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND Virtual care in Canada rapidly expanded during the COVID-19 pandemic in a low-rules environment in response to pressing needs for ongoing access to care amid public health restrictions. Emergency medicine specialists now face the challenge of advising on which virtual urgent care services ought to remain as part of comprehensive emergency care. Consideration must be given to safe, quality, and appropriate care as well as issues of equitable access, public demand, and sustainability (financial and otherwise). The aim of this project was to summarize current literature and expert opinion and formulate recommendations on the path forward for virtual care in emergency medicine. METHODS We formed a working group of emergency medicine physicians from across Canada working in a variety of practice settings. The virtual care working group conducted a scoping review of the literature and met monthly to discuss themes and develop recommendations. The final recommendations were circulated to stakeholders for input and subsequently presented at the 2023 Canadian Association of Emergency Physicians (CAEP) Academic Symposium for discussion, feedback, and refinement. RESULTS The working group developed and reached unanimity on nine recommendations addressing the themes of system design, equity and accessibility, quality and patient safety, education and curriculum, financial models, and sustainability of virtual urgent care services in Canada. CONCLUSION Virtual urgent care has become an established service in the Canadian health care system. Emergency medicine specialists are uniquely suited to provide leadership and guidance on the optimal delivery of these services to enhance and complement emergency care in Canada.
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Affiliation(s)
- S Mehta
- Unity Health Toronto, Toronto, ON, Canada
- North York General Hospital, North York, ON, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - K Gardner
- IWK Health, Halifax, NS, Canada.
- Department of Emergency Medicine, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada.
| | - J Hall
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Sunnybrook Research Institute, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - D Rosenfield
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Paediatric Emergency Medicine, The Hospital for Sick Children (SickKids), Toronto, ON, Canada
| | - S Tse
- Department of Pediatrics and Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
- Children's Hospital of Eastern Ontario, CHEO Research Institute, Ottawa, ON, Canada
| | - K Ho
- Faculty of Medicine, Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
| | - K Grant
- Faculty of Medicine, Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
| | - D J Bradbury-Squires
- Faculty of Medicine, Disciplines of Family Medicine and Emergency Medicine, Memorial University of Newfoundland, Newfoundland Regional Health Centre, Grand Falls-Windsor, NL, Canada
| | - E Lang
- Department of Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - L Chartier
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- University Health Network, Toronto, ON, Canada
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4
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Gately ME, Trudeau SA. An Online Learning Experience Simulating Video Telehealth with Older Adults: Student Perceptions. JOURNAL OF TECHNOLOGY IN BEHAVIORAL SCIENCE 2023; 9:154-163. [PMID: 38586236 PMCID: PMC10996448 DOI: 10.1007/s41347-023-00363-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 10/30/2023] [Accepted: 11/02/2023] [Indexed: 04/09/2024]
Abstract
Older adults are an underserved population with a broad-spectrum of care needs due to multi-morbidity, including increasing rates of mental health conditions. Though a prime target for tele-behavioral health due to access barriers, older adults face a persistent digital divide that necessitates clinician training and education to ensure interprofessional tele-behavioral health is tailored to their needs. This paper presents findings from a simulation learning program designed to teach students about the role of video telehealth with populations with diverse needs. Occupational therapy (OT) students enrolled in a Master's program between 2017 and 2018 conducted a simulated video telehealth session geared for an older adult. Sessions were recorded and annotated by students, who then provided feedback on their experience of the simulation via reflective essays (N = 27). Essays were analyzed using conventional content analysis with themes revealing the benefits of simulation in providing students with an opportunity to experience the often unpredictable nature of video telehealth. Themes also revealed perceived limitations of video and the negative impact of age-related conditions and age itself on older adults' ability to engage in video, reflecting ageist stereotyping and bias as potential barriers to novice practitioners' integration of video telehealth with older adults. Simulation provides students an opportunity to engage in active learning and problem-solving in the moment, fostering students' development of clinical reasoning while promoting reflective practice. Findings reveal the importance of supporting students' recognition of biased attitudes to ensure equitable application of tele-behavioral health care, especially to populations with complex needs.
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Affiliation(s)
- Megan E. Gately
- Geriatric Research Education and Clinical Center, VA; Bedford Health Care System, Bedford, MA, USA
- Department of Occupational Therapy, Tufts University, Medford, MA, USA
| | - Scott A. Trudeau
- Geriatric Research Education and Clinical Center, VA; Bedford Health Care System, Bedford, MA, USA
- Department of Occupational Therapy, Tufts University, Medford, MA, USA
- American Occupational Therapy Association, Bethesda, MD, USA
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5
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Mikesell L, Rea S, Cuddihy C, Perry M, Allison B. Exploring the Connectivity Paradox: How the Sociophysical Environment of Telehealth Shapes Adolescent Patients' and Parents' Perceptions of the Patient-Clinician Relationship. HEALTH COMMUNICATION 2023; 38:2854-2864. [PMID: 36102361 DOI: 10.1080/10410236.2022.2124056] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Even before the widespread transition to telehealth as a result of COVID-19, there was a considerable amount of research exploring its value and impact. However, telehealth research with adolescent patients is somewhat limited, with most work focusing on access, feasibility, and acceptability but reporting far less frequently on relationship building and rapport. This study examines qualitative interviews with adolescent patients (n = 14) and parents (n = 20) from a larger convergent parallel mixed methods study to explore how they understand telehealth to have altered the sociophysical environment of primary care clinic encounters and whether they perceive these changes to influence adolescents' relationships with clinicians. We show that participants perceived the sociophysical environment of telehealth to be both less institutional (e.g. more relaxed and less rushed) and more instrumental (e.g. more focused on the chief complaint), which shaped interactions with clinicians in ways that were experienced as paradoxically less personal (e.g. lacking social connection) and more person-centered (e.g. more attentive to the individual patient). We discuss theoretical and practical implications of these findings and what they mean for defining person-centered communication for adolescent care.
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Affiliation(s)
| | - Samantha Rea
- Transitional Year Residency Program, Henry Ford Health System
| | | | - Martha Perry
- Department of Pediatrics, University of North Carolina at Chapel Hill
| | - Bianca Allison
- Department of Pediatrics, University of North Carolina at Chapel Hill
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6
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Chandrasekaran R, Bapat P, Jeripity Venkata P, Moustakas E. Do Patients Assess Physicians Differently in Video Visits as Compared with In-Person Visits? Insights from Text-Mining Online Physician Reviews. Telemed J E Health 2023; 29:1557-1565. [PMID: 36847352 DOI: 10.1089/tmj.2022.0507] [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: 03/01/2023] Open
Abstract
Introduction: Use of both in-person and video visits have become a common norm in health care delivery, especially after the COVID-19 pandemic. It is imperative to understand how patients feel about their providers and their experiences during in-person and video visits. This study examines the important factors that patients use in their reviews and differences in the relative importance. Methods: We performed sentiment analysis and topic modeling on online physician reviews from April 2020 to April 2022. Our dataset comprised 34,824 reviews posted by patients after completing in-person or video visits. Results: Sentiment analysis yielded 27,507 (92.69%) positive and 2,168 (7.31%) negative reviews for in-person visits, and 4,610 (89.53%) positive and 539 (10.47%) negative reviews for video visits. Topic modeling identified seven factors patients used in their reviews: Bedside manners, Medical Expertise, Communication, Visit Environment, Scheduling and Follow-up, Wait times, and Costs and insurance. Patients who gave positive reviews after in-person consultations more frequently mentioned communication, office environment and staff, and bedside manners. Those who gave negative reviews after in-person visits mentioned longer wait times, providers' office and staff, medical expertise, and costs and insurance problems. Patients with positive reviews after video visits emphasized communication, bedside manners, and medical expertise. However, patients posting negative reviews after video visits frequently mentioned problems with appointment scheduling and follow-up, medical expertise, wait times, costs and insurance, and technical problems in video visits. Conclusions: This study identified key factors that influence patients' assessment of their providers in in-person and video visits. Paying attention to these factors can help improve the overall patient experience.
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Affiliation(s)
- Ranganathan Chandrasekaran
- Department of Information and Decision Sciences, University of Illinois at Chicago, Chicago, Illinois, USA
- Department of Biomedical and Health Information Systems, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Prathamesh Bapat
- Department of Information and Decision Sciences, University of Illinois at Chicago, Chicago, Illinois, USA
| | | | - Evangelos Moustakas
- Center for Innovation and Entrepreneurship, Middlesex University at Dubai, Dubai, United Arab Emirates
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7
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Minuz P, Albini FL, Imbalzano E, Izzo R, Masi S, Pengo MF, Pucci G, Scalise F, Salvetti M, Tocci G, Cicero A, Iaccarino G, Savoia C, Sechi L, Parati G, Borghi C, Volpe M, Ferri C, Grassi G, Muiesan ML. Telemedicine and Digital Medicine in the Clinical Management of Hypertension and Hypertension-Related Cardiovascular Diseases: A Position Paper of the Italian Society of Arterial Hypertension (SIIA). High Blood Press Cardiovasc Prev 2023; 30:387-399. [PMID: 37594686 PMCID: PMC10600275 DOI: 10.1007/s40292-023-00595-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 07/25/2023] [Indexed: 08/19/2023] Open
Abstract
High blood pressure is the leading cause of death and disability globally and an important treatable risk factor for cardiovascular, cerebrovascular and chronic kidney diseases. Digital technology, including mobile health solutions and digital therapy, is expanding rapidly in clinical medicine and has the potential to improve the quality of care and effectiveness of drug treatment by making medical interventions timely, tailored to hypertensive patients' needs and by improving treatment adherence. Thus, the systematic application of digital technologies could support diagnosis and awareness of hypertension and its complications, ultimately leading to improved BP control at the population level. The progressive implementation of digital medicine in the national health systems must be accompanied by the supervision and guidance of health authorities and scientific societies to ensure the correct use of these new technologies with consequent maximization of the potential benefits. The role of scientific societies in relation to the rapid adoption of digital technologies, therefore, should encompass the entire spectrum of activities pertaining to their institutional role: information, training, promotion of research, scientific collaboration and advice, evaluation and validation of technological tools, and collaboration with regulatory and health authorities.
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Affiliation(s)
- Pietro Minuz
- Department of Medicine, University of Verona, Medicina Generale C, Policlinico GB Rossi, Piazzale LA Scuro 10, 37134, Verona, Italy.
| | | | - Egidio Imbalzano
- Hypertension Unit, Division of Internal Medicine, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Raffaele Izzo
- Department of Advanced Biomedical Sciences, "Federico II" University, Naples, Italy
| | - Stefano Masi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Institute of Cardiovascular Science, University College London, London, UK
| | - Martino F Pengo
- Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Ospedale San Luca, Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Giacomo Pucci
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
- Unit of Internal Medicine, "Santa Maria" Terni Hospital, Terni, Italy
| | - Filippo Scalise
- Center for the Study of Hypertension and Vascular Diseases-Clinical Institute Verano Brianza, Policlinico di Monza, Monza, Italy
| | - Massimo Salvetti
- Department of Clinical and Experimental Sciences, University of Brescia and Emergency Medicine ASST Spedali Civili di Brescia, Brescia, Italy
| | - Giuliano Tocci
- Division of Cardiology, Department of Clinical and Molecular Medicine, Sapienza University of Rome, Azienda Ospedaliero-Universitaria Sant'Andrea, Rome, Italy
| | - Arrigo Cicero
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Guido Iaccarino
- Center for Research on Hypertension and Related Conditions, Federico II University of Naples, Naples, Italy
| | - Carmine Savoia
- Clinical and Molecular Medicine, University of Rome Sapienza and IRCCS San Raffaele Roma, Rome, Italy
| | - Leonardo Sechi
- Department of Life, Health, and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Gianfranco Parati
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- IRCCS, Istituto Auxologico Italiano, San Luca Hospital, Milan, Italy
| | - Claudio Borghi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Massimo Volpe
- Clinical and Molecular Medicine, University of Rome Sapienza and IRCCS San Raffaele Roma, Rome, Italy
| | - Claudio Ferri
- Department of Life, Health, and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Guido Grassi
- Clinica Medica, University of Milano-Bicocca, Milan, Italy
| | - Maria Lorenza Muiesan
- Department of Clinical and Experimental Sciences, University of Brescia and Emergency Medicine ASST Spedali Civili di Brescia, Brescia, Italy
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Teles S, Crudo V, Sangrar R, Langlois S. Enabling Patients as Partners on Virtual Teams: A Scoping Review. J Patient Exp 2023; 10:23743735231177205. [PMID: 37283697 PMCID: PMC10240866 DOI: 10.1177/23743735231177205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Abstract
Developing partnerships among patients and healthcare providers improves quality of virtual care. Successful patient engagement is influenced by digital literacy. Although adults (35-64) with chronic health challenges may be motivated to use virtual services, they may not have the required skills or orientation to effectively participate on their virtual team. This scoping review aimed to identify resources available to enable adults with chronic health challenges to participate as partners on their virtual teams. Peer-reviewed and grey literature data from 2011 to 2022 were searched. A total of 432 peer-reviewed and 357 grey literature sources were retrieved and screened, and 14 and 84 sources, respectively, met the inclusion criteria. Relevant information from the sources was extracted and analyzed in duplicate and synthesized qualitatively. Key findings include (1) virtual workflow processes/frameworks, (2) 'webside manner' guidelines which emphasize "the how" as opposed to "the what" of facilitating team interactions, and (3) virtual patient support personnel. Overall, analyses suggest there are persisting gaps to be addressed in synchronous virtual care resources for adults with chronic health challenges.
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Affiliation(s)
- Sabrina Teles
- Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Vanessa Crudo
- Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Ruheena Sangrar
- Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Sylvia Langlois
- Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Centre for Advancing Collaborative Healthcare and Education, University Health Network and University of Toronto, Toronto, Canada
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Wiener AA, Neuman HB. Improving shared decision making in virtual breast cancer surgery consultations. Am J Surg 2023; 225:645-649. [PMID: 38577977 PMCID: PMC9579141 DOI: 10.1016/j.amjsurg.2022.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 10/06/2022] [Accepted: 10/11/2022] [Indexed: 11/06/2022]
Abstract
With the COVID19 pandemic, use of telehealth has expanded rapidly in subspecialties with limited prior telehealth experience. While telehealth offers many opportunities to improve patient convenience, access, and comfort, the virtual platform poses unique challenges for shared decision making. In this review article, we describe what occurs within a standard in-person breast surgery consult and propose a model for an ideal virtual breast surgery consult, including strategies to foster patient engagement and shared decision making. Our model incorporates pre-visit preparation, deliberate pauses, and targeted engagement as ways to encourage patients to integrate information and actively participate in treatment decisions. Intentional strategies such as these must be adopted to improve shared decision making on the virtual platform.
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Affiliation(s)
- Alyssa A Wiener
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Heather B Neuman
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; University of Wisconsin Carbone Cancer Center, Madison, WI, USA.
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10
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Hall JN, Costello LL. Training Residents for the Future: A Virtual Care Rotation for Emergency Medicine. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2023; 10:23821205231165183. [PMID: 37153849 PMCID: PMC10159239 DOI: 10.1177/23821205231165183] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 03/04/2023] [Indexed: 05/10/2023]
Abstract
OBJECTIVES Virtual care (VC) is increasingly becoming a part of emergency medicine (EM) physician workflows, yet no formal digital health curricula exist within Canadian EM training programs. The objective was to design and pilot a VC elective rotation for EM residents to help address this gap and better prepare them for future VC practice. METHODS The current work describes the design and implementation of a 4-week VC elective rotation for EM residents. The rotation consisted of VC shifts, medical transport shifts, one-on-one discussions with various stakeholders, weekly thematic articles, and a final project deliverable. RESULTS The rotation was well received by all stakeholders, and the quality of feedback and one-on-one teaching were highlighted as strengths. Future work will consider the optimal delivery timing of this type of curricula, whether all EM residents should receive basic training in VC, and how our current findings may be generalizable to other VC sites. CONCLUSION A formal digital health curriculum for EM residents supports competency development for delivering VC as part of future EM practice.
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Affiliation(s)
- Justin N Hall
- Department of Emergency Services, Sunnybrook Health Sciences Centre, Toronto, Canada
- Division of Emergency Medicine, Department of
Medicine, Temerty Faculty of Medicine, University of
Toronto, Toronto, Canada
| | - Lorne L Costello
- Department of Emergency Services, Sunnybrook Health Sciences Centre, Toronto, Canada
- Division of Emergency Medicine, Department of
Medicine, Temerty Faculty of Medicine, University of
Toronto, Toronto, Canada
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11
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The Tao of Integrative Nursing Assessment (TINA). Holist Nurs Pract 2023; 37:E1-E13. [DOI: 10.1097/hnp.0000000000000562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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12
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Virtanen L, Kaihlanen AM, Kainiemi E, Saukkonen P, Heponiemi T. Patterns of acceptance and use of digital health services among the persistent frequent attenders of outpatient care: A qualitatively driven multimethod analysis. Digit Health 2023; 9:20552076231178422. [PMID: 37256014 PMCID: PMC10226178 DOI: 10.1177/20552076231178422] [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: 09/21/2022] [Accepted: 05/10/2023] [Indexed: 06/01/2023] Open
Abstract
Objective Utilising digital health services in the treatment of patients who frequently attend outpatient care could be beneficial for patients' health and the sustainability of health systems but carries the risk of digital exclusion. This study aimed to explore the patterns of acceptance and use of digital health services among frequent attenders (FAs), which may help in the assessment of patients' digital suitability. Methods Persistent FAs (N = 30) were recruited by random sampling from one Finnish municipality. The semistructured interviews were conducted in February-May 2021. We analysed the data with qualitative content analysis using the Unified Theory of Acceptance and Use of Technology (UTAUT) model. Additionally, we quantified the data for two-step cluster analyses to create separate cluster models that grouped FAs based on acceptance and use of (a) digital services for self-management of health and (b) telemedicine services. Results Based on digital self-management, FAs were defined as Self-Managers, Supported Self-Managers, and Non-Self-Managers. Based on telemedicine use, they were grouped into Telemedicine Users, Doubtful Telemedicine Users, and Telemedicine Refusers. The clusters described different opportunities, awareness, and interest in using digital health services. Referral from professionals seemed to promote digital service use. For some, digital services were not accessible. Conclusions Our findings emphasise the importance of assessing the suitability of FAs to digital health services, as their readiness to use may vary. Professionals should recommend digital services that support individual health to suitable patients. More accessible digital services could promote digital suitability despite functional limitations.
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Affiliation(s)
- Lotta Virtanen
- Welfare State Research and Reform Unit, Finnish Institute for Health and
Welfare (THL), Helsinki, Finland
| | - Anu-Marja Kaihlanen
- Welfare State Research and Reform Unit, Finnish Institute for Health and
Welfare (THL), Helsinki, Finland
| | - Emma Kainiemi
- Welfare State Research and Reform Unit, Finnish Institute for Health and
Welfare (THL), Helsinki, Finland
| | - Petra Saukkonen
- Welfare State Research and Reform Unit, Finnish Institute for Health and
Welfare (THL), Helsinki, Finland
| | - Tarja Heponiemi
- Welfare State Research and Reform Unit, Finnish Institute for Health and
Welfare (THL), Helsinki, Finland
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13
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Vincent D, Peixoto C, Quinn KL, Kyeremanteng K, Lalumiere G, Kurahashi AM, Gilbert N, Isenberg SR. Virtual home-based palliative care during COVID-19: A qualitative exploration of the patient, caregiver, and healthcare provider experience. Palliat Med 2022; 36:1374-1388. [PMID: 36071621 PMCID: PMC9596681 DOI: 10.1177/02692163221116251] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Due to the COVID-19 pandemic, many community palliative healthcare providers shifted from providing care in a patient's home to providing almost exclusively virtual palliative care, or a combination of in-person and virtual care. Research on virtual palliative care is thus needed to provide evidence-based recommendations aiming to enhance the delivery of palliative care during and beyond the pandemic. AIM To explore the experiences and perceptions of community palliative care providers, patients and caregivers who delivered or received virtual palliative care as a component of home-based palliative care during the COVID-19 pandemic. DESIGN Qualitative study using phone and video-based semi-structured interviews. Data were analyzed using thematic analysis. SETTING/PARTICIPANTS A total of 37 participants, including community palliative care patients/caregivers (n = 19) and healthcare providers (n = 18) recruited from sites in Ottawa and Toronto, Ontario, Canada. RESULTS Overall, participants preferred in-person palliative care compared to virtual care, but suggested virtual care could be a useful supplement to in-person care. The findings are presented in three main themes: (1) Impact of COVID-19 pandemic on community palliative care services; (2) Factors influencing transition from exclusively virtual model of care back to a blended model of care; and (3) Recommended uses and implementation of virtual palliative care. CONCLUSIONS Incorporating virtual palliative care into healthcare provider practice models (blended care models) may be the ideal model of care and standard practice moving forward beyond the COVID-19 pandemic, which has important implications toward organization and delivery of community palliative care services and funding of healthcare providers.
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Affiliation(s)
- Daniel Vincent
- Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute (OHRI), Ottawa, ON, Canada
| | | | - Kieran L Quinn
- Department of Medicine, University of Toronto, Toronto, ON, Canada.,Temmy Latner Centre for Palliative Care, Sinai Health System, Toronto, ON, Canada
| | | | - Genevieve Lalumiere
- Regional Palliative Consultation Team, Elizabeth Bruyère Hospital, Ottawa, ON, Canada
| | - Allison M Kurahashi
- Temmy Latner Centre for Palliative Care, Sinai Health System, Toronto, ON, Canada
| | - Nathalie Gilbert
- Home and Community Care Support Services Champlain, Ottawa, ON, Canada
| | - Sarina R Isenberg
- Bruyère Research Institute, Ottawa, ON, Canada.,Department of Medicine, University of Ottawa, Ottawa, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
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14
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Noronha C, Lo MC, Nikiforova T, Jones D, Nandiwada DR, Leung TI, Smith JE, Lee WW. Telehealth Competencies in Medical Education: New Frontiers in Faculty Development and Learner Assessments. J Gen Intern Med 2022; 37:3168-3173. [PMID: 35474505 PMCID: PMC9040701 DOI: 10.1007/s11606-022-07564-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 03/30/2022] [Indexed: 11/25/2022]
Abstract
Telehealth visits have become an integral model of healthcare delivery since the COVID-19 pandemic. This rapid expansion of telehealthcare delivery has forced faculty development and trainee education in telehealth to occur simultaneously. In response, academic medical institutions have quickly implemented clinical training to teach digital health skills to providers across the medical education continuum. Yet, learners of all levels must still receive continual assessment and feedback on their skills to align with the telehealth competencies and milestones set forth by the Association of American Medical Colleges (AAMC) and the Accreditation Council for Graduate Medical Education (ACGME). This paper discusses key educational needs and emerging areas for faculty development in telehealth teaching and assessment of telehealth competencies. It proposes strategies for the successful integration of the AAMC telehealth competencies and ACGME milestones into medical education, including skills in communication, data gathering, and patient safety with appropriate telehealth use. Direct observation tools in the paper offer educators novel instruments to assess telehealth competencies in medical students, residents, and peer faculty. The integration of AAMC and ACGME telehealth competencies and the new assessment tools in this paper provide a unique perspective to advance clinical practice and teaching skills in telehealthcare delivery.
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Affiliation(s)
- Craig Noronha
- Section of General Internal Medicine, Boston University School of Medicine/Boston Medical Center, Boston, MA, USA
| | - Margaret C Lo
- Division of General Internal Medicine, Department of Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - Tanya Nikiforova
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Danielle Jones
- Division of General Internal Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Deepa Rani Nandiwada
- Division of General Internal Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Tiffany I Leung
- Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Janeen E Smith
- San Francisco VA Health Care System, San Francisco, CA, USA.,Department of Medicine, University of California, San Francisco, CA, USA
| | - Wei Wei Lee
- Section of General Internal Medicine, University of Chicago Medical Center, Chicago, IL, USA.
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15
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Virtual management of hypertension: lessons from the COVID-19 pandemic-International Society of Hypertension position paper endorsed by World Hypertension League and European Society of Hypertension. J Hypertens 2022; 40:1435-1448. [PMID: 35579481 DOI: 10.1097/hjh.0000000000003205] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The coronavirus disease 2019 pandemic caused an unprecedented shift from in person care to delivering healthcare remotely. To limit infectious spread, patients and providers rapidly adopted distant evaluation with online or telephone-based diagnosis and management of hypertension. It is likely that virtual care of chronic diseases including hypertension will continue in some form into the future. The purpose of the International Society of Hypertension's (ISH) position paper is to provide practical guidance on the virtual management of hypertension to improve its diagnosis and blood pressure control based on the currently available evidence and international experts' opinion for nonpregnant adults. Virtual care represents the provision of healthcare services at a distance with communication conducted between healthcare providers, healthcare users and their circle of care. This statement provides consensus guidance on: selecting blood pressure monitoring devices, accurate home blood pressure assessments, delivering patient education virtually, health behavior modification, medication adjustment and long-term virtual monitoring. We further provide recommendations on modalities for the virtual assessment and management of hypertension across the spectrum of resource availability and patient ability.
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16
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Telehealth cancer care consultations during the COVID-19 pandemic: a qualitative study of the experiences of Australians affected by cancer. Support Care Cancer 2022; 30:6659-6668. [PMID: 35503140 PMCID: PMC9062284 DOI: 10.1007/s00520-022-07021-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 03/29/2022] [Indexed: 10/27/2022]
Abstract
BACKGROUND In response to the onset of the COVID-19 pandemic, telehealth was rapidly rolled out in health services across Australia including those delivering cancer care. This study aimed to understand people with cancer and carers' experiences with telehealth for cancer care during the COVID-19 pandemic and associated restrictions. METHOD Semi-structured interviews conducted with people with cancer and carers via telephone or online video link between December 2020 and May 2021. Participants were recruited through cancer networks and social media. Interviews were transcribed and thematic analysis undertaken. RESULTS Twenty-three patients and 5 carers were interviewed. Telephone-based appointments were most common. Responses to telehealth were influenced by existing relationships with doctors, treatment/cancer stage and type of appointment. Four themes were derived: (i) benefits, (ii) quality of care concerns, (iii) involving carers, and (iv) optimising use of telehealth. Benefits included efficiency and reduced travel. Quality of care concerns identified subthemes: transactional feel to appointments; difficulties for rapport; suitability for appointment type and adequacy for monitoring. Both patients and carers noted a lack of opportunity for carers to participate in telephone-based appointments. Aligning appointment mode (i.e. telehealth or in person) with appointment purpose and ensuring telehealth was the patient's choice were seen as essential for its ongoing use. DISCUSSION AND CONCLUSIONS While telehealth has benefits, its potential to reduce the quality of interactions with clinicians made it less attractive for cancer patients. Patient-centred guidelines that ensure patient choice, quality communication, and alignment with appointment purpose may help to increase telehealth's utility for people affected by cancer.
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17
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Balestra AM, Chalk K, Spies C, Denke C, Krampe H, Tafelski S. Living with Chronic Pain During the COVID-19 Pandemic: A Qualitative Analysis. J Pain Res 2022; 15:969-981. [PMID: 35411185 PMCID: PMC8994632 DOI: 10.2147/jpr.s351846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 02/18/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose COVID-19 pandemic containment measures have led to changes in various areas of life, including restrictions on health care. Patients with chronic pain may have faced an increased burden during pandemic and the resources of this vulnerable population are unknown. Therefore, a qualitative study was conducted to understand how people with chronic pain have experienced the course of the pandemic. Patients and Methods Twenty semi-structured telephone interviews were conducted six months after the initial lockdown in Germany. The participants were patients with chronic pain who exhibited varying changes in their pain during the first German lockdown, recruited from a German outpatient pain clinic at a Department of Anesthesiology and Intensive Care. The semi-structured interview guidelines were designed to explore how patients with chronic pain experienced their pain during the pandemic, how they coped, and how they experienced pain management during this time. The interview recordings were transcribed verbatim and coded using the qualitative content analysis method. Results Four themes emerged from the results: differential impact on pain experience, difficulty coping with pain, supportive pain management, and endurance. Conclusion During this uncertain time, it was particularly important to maintain pain treatment in order to establish a sense of safety and stability. This underscores the special role of maintaining therapeutic contact during a pandemic and the potentially special role of telemedicine.
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Affiliation(s)
- Anna Marie Balestra
- Department of Anesthesiology and Intensive Care Medicine, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Correspondence: Anna Marie Balestra, Department of Anesthesiology and Intensive Care Medicine, Charité – Universitätsmedizin Berlin, Berlin, Germany, Tel +49 30 450 631 014, Fax +49 30 450 531 904, Email
| | - Katharina Chalk
- Department of Anesthesiology and Intensive Care Medicine, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Claudia Spies
- Department of Anesthesiology and Intensive Care Medicine, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Claudia Denke
- Department of Anesthesiology and Intensive Care Medicine, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Henning Krampe
- Department of Anesthesiology and Intensive Care Medicine, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Sascha Tafelski
- Department of Anesthesiology and Intensive Care Medicine, Charité – Universitätsmedizin Berlin, Berlin, Germany
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18
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Stosic MD, Duane JN, Durieux BN, Sando M, Robicheaux E, Podolski M, Sanders JJ, Ericson JD, Blanch-Hartigan D. Patient Preference for Telehealth Background Shapes Impressions of Physicians and Information Recall: A Randomized Experiment. Telemed J E Health 2022; 28:1541-1546. [PMID: 35271378 DOI: 10.1089/tmj.2021.0545] [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: 11/12/2022] Open
Abstract
Introduction: Telehealth is increasing rapidly as a health care delivery platform, but we lack empirical evidence regarding how telehealth environments can affect patient experiences. The present research determined how physician's telehealth backgrounds affect various patient outcomes. Methods: Participants viewed a 30-s video of a physician with one of six different virtual backgrounds and reported various socioemotional and cognitive responses to the mock telehealth experience. Results: Although the telehealth background manipulation did not impact participants' socioemotional or cognitive responses, participants' subjective perceptions of the telehealth backgrounds were related to important clinical outcomes, such as their ability to remember critical information from the appointment and overall satisfaction with the experience. Discussion: Telehealth environments may result in tradeoffs between patient experience, subjective impressions of clinicians, and information recall. Conclusions: A physician's telehealth background can have measurable impact on patients' telehealth experiences, suggesting a need for careful background selection and design.
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Affiliation(s)
- Morgan D Stosic
- Department of Psychology, University of Maine, Orono, Maine, USA
| | - Ja-Nae Duane
- Department of Information and Process Management, Bentley University, Waltham, Massachusetts, USA
| | - Brigitte N Durieux
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Madelyn Sando
- Department of Information Design & Corporate Communication, Bentley University, Waltham, Massachusetts, USA
| | | | - Maxim Podolski
- Department of Economics, Bentley University, Waltham, Massachusetts, USA
| | - Justin J Sanders
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Family Medicine, Palliative Care, McGill University, Montreal, Québec, Canada
| | - Jonathan D Ericson
- Department of Information Design & Corporate Communication, Bentley University, Waltham, Massachusetts, USA
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19
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Abstract
The accelerating integration of telehealth technologies in neurology practice has transformed traditional interactions between neurologists and patients, allied clinicians and society. Despite the immense promise of these technologies to improve systems of neurological care, the infusion of telehealth technologies into neurology practice introduces a host of unique ethical challenges. Proactive consideration of the ethical dimensions of teleneurology and of the impact of these innovations on the field of neurology more generally can help to ensure responsible development and deployment across stages of implementation. Toward these ends, this article explores key ethical dimensions of teleneurology practice and policy, presents a normative framework for their consideration, and calls attention to underexplored questions ripe for further study at this evolving nexus of teleneurology and neuroethics. To promote successful and ethically resilient development of teleneurology across diverse contexts, clinicians, organizational leaders, and information technology specialists should work closely with neuroethicists with the common goal of identifying and rigorously assessing the trajectories and potential limits of teleneurology systems.
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Affiliation(s)
- Michael J Young
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
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20
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Lesley GC, Tahmasebi H, Meti N, Wright FC, Thawer A, Cheung M, Singh S. Cancer Treatment During COVID-19: A Qualitative Analysis of Patient-Perceived Risks and Experiences with Virtual Care. J Patient Exp 2021; 8:23743735211039328. [PMID: 34485693 PMCID: PMC8411616 DOI: 10.1177/23743735211039328] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
During the COVID-19 pandemic, most cancer centers shifted from in-person to virtual cancer care to curb community spread and ensure care continuity. This qualitative descriptive study aimed to understand cancer patient-perceived risks related to COVID-19 and cancer treatment, as well as the patient-perceived and experienced value of virtual care. From June to August 2020, focus groups were conducted with patients under active management or observation for a diagnosed malignancy in Toronto, Canada. A thematic analysis of six focus groups found that most participants worried more about treatment delays than they did about COVID-19 infection. Despite some concern about COVID-19 exposure in the hospital, care delays contributed to increased anxiety among participants who already subscribed to strict safety measures in their everyday lives. Most participants accepted virtual care for some appointment types; however, preference for in-person care was found to sustain the humanistic and therapeutic aspects of cancer care that many participants valued. Nuances in the appropriateness and adequacy of virtual cancer care still need exploration. Preserving the humanistic aspects of care is of paramount importance.
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Affiliation(s)
- Gotlib Conn Lesley
- Evaluative Clinical Sciences, Sunnybrook Research
Institute, Toronto, Canada
| | - Houman Tahmasebi
- Evaluative Clinical Sciences, Sunnybrook Research
Institute, Toronto, Canada
| | - Nicholas Meti
- Odette Cancer Center, Sunnybrook Health Sciences Center, Toronto, Canada
| | - Frances C. Wright
- Odette Cancer Center, Sunnybrook Health Sciences Center, Toronto, Canada
| | - Alia Thawer
- Department of Pharmacy, Sunnybrook Health Sciences
Center, Toronto, Canada
| | - Matthew Cheung
- Evaluative Clinical Sciences, Sunnybrook Research
Institute, Toronto, Canada
- Odette Cancer Center, Sunnybrook Health Sciences Center, Toronto, Canada
| | - Simron Singh
- Evaluative Clinical Sciences, Sunnybrook Research
Institute, Toronto, Canada
- Odette Cancer Center, Sunnybrook Health Sciences Center, Toronto, Canada
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21
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Alcocer Alkureishi M, Lenti G, Choo ZY, Castaneda J, Weyer G, Oyler J, Lee WW. Teaching Telemedicine: The Next Frontier for Medical Educators. JMIR MEDICAL EDUCATION 2021; 7:e29099. [PMID: 33878011 PMCID: PMC8086780 DOI: 10.2196/29099] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 04/14/2021] [Accepted: 04/15/2021] [Indexed: 05/04/2023]
Abstract
The COVID-19 pandemic has pushed telemedicine to the forefront of health care delivery, and for many clinicians, virtual visits are the new normal. Although telemedicine has allowed clinicians to safely care for patients from a distance during the current pandemic, its rapid adoption has outpaced clinician training and development of best practices. Additionally, telemedicine has pulled trainees into a new virtual education environment that finds them oftentimes physically separated from their preceptors. Medical educators are challenged with figuring out how to integrate learners into virtual workflows while teaching and providing patient-centered virtual care. In this viewpoint, we review principles of patient-centered care in the in-person setting, explore the concept of patient-centered virtual care, and advocate for the development and implementation of patient-centered telemedicine competencies. We also recommend strategies for teaching patient-centered virtual care, integrating trainees into virtual workflows, and developing telemedicine curricula for graduate medical education trainees by using our TELEMEDS framework as a model.
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Affiliation(s)
| | - Gena Lenti
- Pritzker School of Medicine, University of Chicago, Chicago, IL, United States
| | - Zi-Yi Choo
- Pritzker School of Medicine, University of Chicago, Chicago, IL, United States
| | - Jason Castaneda
- Pritzker School of Medicine, University of Chicago, Chicago, IL, United States
| | - George Weyer
- Department of Medicine, University of Chicago, Chicago, IL, United States
| | - Julie Oyler
- Department of Medicine, University of Chicago, Chicago, IL, United States
| | - Wei Wei Lee
- Department of Medicine, University of Chicago, Chicago, IL, United States
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