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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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Schröder J, Riiser K, Holmen H. The needs of healthcare personnel who provide home-based pediatric palliative care: a mixed method systematic review. BMC Health Serv Res 2024; 24:45. [PMID: 38195519 PMCID: PMC10777650 DOI: 10.1186/s12913-023-10495-7] [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: 05/10/2023] [Accepted: 12/19/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND Families with children who have life-limiting or life-threatening illnesses often prefer to receive care at home to maintain a sense of normalcy. However, caring for children at home is different from caring for them in a hospital, and we do not know enough about the needs of healthcare personnel who provide home-based pediatric palliative care. AIM The aim of this review was to systematically summarize, appraise and synthesize available quantitative, qualitative, and mixed methods research to identify the needs of healthcare personnel in home-based pediatric palliative care. METHODS We used the Joanna Briggs Institute methodology for mixed method systematic reviews and searched systematically in Medline, Embase, PsycINFO, CINAHL, Web of Science, AMED, and the Cochrane Library. Quantitative, qualitative and mixed methods studies from 2012 to 2021 reporting on healthcare personnel's needs, experiences, perspectives, coping strategies, and/or challenges related to home-based pediatric palliative care were eligible for inclusion. The screening was conducted independently in pairs. The quantitative data were transformed into qualitative data and analyzed using thematic synthesis. RESULTS Overall, 9285 citations were identified, and 21 studies were eligible for review. Most of the studies were qualitative and interview-based. Few studies included healthcare personnel other than doctors and nurses. Three analytical themes were developed: (1) being connected and engaged with the child and family, (2) being part of a dedicated team, and (3) ensuring the quality of home-based pediatric palliative care services. Healthcare personnel strived to deliver high-quality, home-based pediatric palliative care. Establishing a relationship with the child and their parents, collaborating within a committed team, and having sufficient resources were identified as important needs influencing healthcare personnel when providing home-based pediatric palliative care. CONCLUSION The findings underscore the importance of building trusting relationships among healthcare personnel, children, and families. It also emphasizes the significance of interdisciplinary collaboration that is effective, along with the presence of enough skilled personnel to ensure high-quality home-based pediatric palliative care. Further research is necessary to include healthcare personnel beyond doctors and nurses, as palliative care requires a team of professionals from various disciplines. Addressing the needs of healthcare personnel can ensure safe and professional palliative care for children at home.
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Affiliation(s)
- Judith Schröder
- Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo Metropolitan University, P.O. Box 4, Oslo, NO-0130, Norway.
| | - Kirsti Riiser
- Faculty of Health Sciences, Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, Oslo, Norway
| | - Heidi Holmen
- Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo Metropolitan University, P.O. Box 4, Oslo, NO-0130, Norway
- Division of Technology and Innovation, Intervention Centre, Oslo University Hospital, Oslo, Norway
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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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Jones E, Cross-Barnet C. Telehealth as a Tool to Transform Pediatric Care: Views from Stakeholders. Telemed J E Health 2023; 29:1843-1852. [PMID: 37252789 DOI: 10.1089/tmj.2022.0496] [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: 06/01/2023] Open
Abstract
Background and Objectives: The 2020 COVID-19 pandemic generated rapid telehealth expansion. Most prior telehealth studies focus on a single program or health condition, leaving a knowledge gap regarding the most appropriate and effective means of allocating telehealth services and funding. This research seeks to evaluate a wide range of perspectives to inform pediatric telehealth policy and practice. Methods: In 2017, the Center for Medicare & Medicaid Services, Center for Medicare and Medicaid Innovation (Innovation Center) issued a Request for Information to inform the Integrated Care for Kids model. Researchers identified 55 of 186 responses that addressed telehealth and analyzed them based on grounded theory principles overlaid with a constructivist approach to contextualize Medicaid policies, respondent characteristics, and implications for specific populations. Results: Respondents noted several health equity issues that telehealth could help to remedy, including timely care access, specialist shortages, transportation and distance barriers, provider-to-provider communication, and patient and family engagement. Implementation barriers reported by commenters included reimbursement restrictions, licensure issues, and costs of initial infrastructure. Respondents raised savings, care integration, accountability, and increased access to care as potential benefits. Discussion and Conclusions: The pandemic demonstrated that the health system can implement telehealth rapidly, although telehealth cannot be used to provide every aspect of pediatric care such as vaccinations. Respondents highlighted the promise of telehealth, which is heightened if telehealth supports health care transformation rather than replicating how in-office care is currently provided. Telehealth also offers the potential to increase health equity for some populations of pediatric patients.
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Affiliation(s)
- Emily Jones
- Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, Department of Health and Human Services, Baltimore, Maryland, USA
| | - Caitlin Cross-Barnet
- Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, Department of Health and Human Services, Baltimore, Maryland, USA
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Thomas R, Pesut B, Siden H, Treschow M, Puurveen G. Developing competencies for volunteer navigators to support caregivers of children living with medical complexity: a mixed-method e-Delphi study. Palliat Care Soc Pract 2023; 17:26323524231209060. [PMID: 37954463 PMCID: PMC10634257 DOI: 10.1177/26323524231209060] [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] [Received: 06/12/2023] [Accepted: 10/04/2023] [Indexed: 11/14/2023] Open
Abstract
Background Providing specially trained volunteer navigators is one promising strategy for supporting the increasing number of family caregivers who are caring for children living with medical complexity. Objective The objective of this study was to develop consensus on the role and competencies required for volunteer navigators who support caregivers of children living with medical complexity. Design This was a mixed-method study using modified e-Delphi and focus group methods. In phase 1, a modified e-Delphi survey with 20 family caregivers and a focus group with 4 family caregivers were conducted to develop consensus on their unmet needs and the potential roles of a volunteer to meet those needs. In phase 2, a modified e-Delphi survey was conducted with experts to develop consensus on the volunteer competencies required to meet the roles identified by family caregivers in phase 1. Results Findings from phase 1 resulted in 36 need-related items over 8 domains: communication, daily life and chores, emotional support, information and knowledge, respite, support with decision-making, and sharing the caregiving experience. Concerns about the volunteer role included the potential lack of commitment in the absence of remuneration, the complexity of the child's condition that was beyond the role of a volunteer, and a preference for support from individuals they knew. Findings from the phase 2 Delphi survey with professionals resulted in 22 competencies, derived from the roles identified in phase 1, that would be required of volunteers who wished to support these family caregivers. Conclusion This study provides insight into a role for volunteers in meeting the needs of family caregivers of children living with medical complexity. A volunteer with lived experience and adequate preparation can assist with meeting some of these important needs. Further research is required to better understand the feasibility and acceptability of such a role.
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Affiliation(s)
- Robyn Thomas
- The University of British Columbia Okanagan, Kelowna, BC, Canada
| | - Barbara Pesut
- The University of British Columbia Okanagan, 1147 Research Way, Kelowna, BC V1V 1V7, Canada
| | - Hal Siden
- The University of British Columbia, Canuck Place Children’s Hospice and BC Children’s Hospital, Vancouver, BC, Canada
| | - Michael Treschow
- The University of British Columbia Okanagan, Kelowna, BC, Canada
| | - Gloria Puurveen
- The University of British Columbia Okanagan, Kelowna, BC, Canada
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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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Araújo MDSD, Albuquerque ACD, Felisberto E, Samico I, Rodrigues ÁS. [Assessment of the implementation of an care teleregulation project in a Brazilian capital city]. CAD SAUDE PUBLICA 2023; 39:e00009623. [PMID: 37466552 PMCID: PMC10494686 DOI: 10.1590/0102-311xpt009623] [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: 01/27/2023] [Revised: 04/26/2023] [Accepted: 05/04/2023] [Indexed: 07/20/2023] Open
Abstract
This study evaluates the degree of implementation (DI) of the Regulates+ Brazil project and analyzes to what extent the variations in implementation influence the results observed in access to specialized appointments in Recife, Pernambuco, Brazil. This is an evaluative research of implementation analysis. A logic model and an analysis and judgment matrix with indicators for evaluating the degree of implementation and the results of the Project were developed and submitted to expert consensus. The data collection was conducted via a semi-structured questionnaire applied to key informants and secondary data extracted from the official documents from Regulates+ Brazil and Brazilian National Regulation System (SISREG), referring to the period from May/2020 to May/2021, which were consolidated and compared with values defined in the matrix. The degree of implementation of the Regulates+ Brazil project in Recife was considered to be implemented (83.7%), as well as the Structure (81.7%) and Methods (84.6%) dimensions. However, most effect indicators underperformed, which, when confronted, were consistent with bottlenecks observed in some components and subcomponents of the Project, such as the performance of professionals in basic health units, which was indicated as incipient, especially regarding follow-up of returned requests. The results suggest that any intervention in Telehealth requires, for its proper implementation, the adequacy of teams and work processes, practices of Continuing Education, as well as a continuous evaluation process, to achieve the expected results, or else it will become another bureaucratization and barrier to access.
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Affiliation(s)
| | | | | | - Isabella Samico
- Instituto de Medicina Integral Professor Fernando Figueira, Recife, Brasil
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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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Haffner DN, Bauer Huang SL. Using Telemedicine to Overcome Barriers to Neurodevelopmental Care from the Neonatal Intensive Care Unit to School Entry. Clin Perinatol 2023; 50:253-268. [PMID: 36868709 DOI: 10.1016/j.clp.2022.10.006] [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: 03/05/2023]
Abstract
Dedicated Neonatal Intensive Care Unit (NICU) follow-up programs are recommended for ongoing surveillance for infants at high-risk for future neurodevelopmental impairment (NDI). Systemic, socioeconomic, and psychosocial barriers remain for referrals and the continued neurodevelopmental follow-up of high-risk infants. Telemedicine can help overcome these barriers. Telemedicine allows standardization of evaluations, increased referral rates, and reduced time to follow-up as well as increased therapy engagement. Telemedicine can expand neurodevelopmental surveillance and support all NICU graduates, facilitating the early identification of NDI. However, with the recent expansion of telemedicine during the COVID-19 pandemic, new barriers related to access and technological support have arisen.
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Affiliation(s)
- Darrah N Haffner
- Division of Pediatric Neurology, Department of Pediatrics, Nationwide Children's Hospital and the Ohio State University, 700 Children's Dr, Columbus, OH 43205, USA.
| | - Sarah L Bauer Huang
- Department of Pediatric and Developmental Neurology, Department of Neurology, Washington University in Saint Louis School of Medicine, 660 S. Euclid Avenue, St. Louis, MO 63110, USA
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Calò P, Leblond P, Girodet M, Gauchet A, Anota A, Christophe V, Bertrand A. Health Workers' Perception and Emotions Surrounding Teleconsultation in Pediatric Cancer Care During the COVID-19 Pandemic. J Pediatr Hematol Oncol 2023; 45:e222-e227. [PMID: 35129149 DOI: 10.1097/mph.0000000000002425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 01/10/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND AIMS During the first lockdown of the coronavirus disease 2019 (COVID-19) pandemic, we developed a teleconsultation model and conducted a survey-based study with the aim to evaluate satisfaction and emotions of health workers (HWs), to assess the feasibility of teleconsultations, and to evaluate technical issues. MATERIALS AND METHODS This is a prospective monocentric exploratory study based on synchronous, video consultations between HWs and pediatric patients treated for blood or solid malignancies or blood benign diseases. Every HW completed an online survey which covered technical aspects, data concerning satisfaction, quality of the interaction with the patient, and emotions felt after the teleconsultation. A score was calculated for each aspect. RESULTS Eleven specialists participated in the study, and we selected 84 questionnaires. With a satisfaction rate of 74%, HWs felt mostly calm (80%), relaxed (70%), stress-free (69%), and relieved (65%). We calculated the following median scores: an overall satisfaction score of 6.67 (0 to 10), a global feeling score of 8.79 (3.33 to 10.00), and a quality score of 7.34 (2.50 to 10.00). A strong correlation between the quality of teleconsultation and the satisfaction of the HWs has been highlighted ( r =0.588). CONCLUSION Our series is an encouragingly positive experience from the perspective of the HWs, their feelings, and perceptions.
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Affiliation(s)
| | | | | | | | - Amélie Anota
- Departments of Human and Social Sciences
- Clinical Research and Innovation, Leon Berard Center
- French National Platform Quality of Life and Cancer
| | - Veronique Christophe
- Departments of Human and Social Sciences
- University of Lille, UMR CNRS 9193-SCALab-Affective and Cognitive Sciences, Lille, France
| | - Amandine Bertrand
- Pediatric Hematology and Oncology Institute (IHOPe)
- Departments of Human and Social Sciences
- Research on Healthcare Performance (RESHAPE), Lyon
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Gundry A, Elvidge N, Donovan L, Bunker K, Herbert A, Bradford N. Parent and Provider Perspectives of a Hospital-Based Bereavement Support Program in Pediatric Palliative Care. J Pain Symptom Manage 2023; 65:388-399.e9. [PMID: 36775110 DOI: 10.1016/j.jpainsymman.2023.02.002] [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] [Received: 12/09/2022] [Revised: 01/26/2023] [Accepted: 02/02/2023] [Indexed: 02/12/2023]
Abstract
CONTEXT Bereavement is an individuated, nuanced experience, and its expression is different for each parent who has cared for a dying child. Evidence highlights support is valuable to navigate this loss. OBJECTIVES To evaluate a Bereavement Support Program from the perspectives of both families and service providers. METHODS A cross-sectional study design explored the experiences and perspectives of the benefits of various program components. Respondents were asked about accessing program components, their expectations, and parents were asked to rate the impact of program components on their grief on a scale from one, (no impact) to 100 (positive impact). Space for free text was provided throughout for additional feedback. SETTING/ PARTICIPANTS The survey was distributed through mailing lists of parents known to the service, referring service providers, and advertised in the program newsletter. RESULTS One hundred two respondents completed the survey and provided detailed comments about their experiences. Most interactions and program components were reported helpful by both parents and service providers. Parents (N = 60) reported a positive impact on grief across all program components (median impact on grief range 81-98, Interquartile range 68.5-99). There were, however, a considerable number of respondents who were unaware of some components. CONCLUSION Bereavement care to navigate the devastating loss of a child is of paramount importance and can offer significant and beneficial resources for families. Findings have supported service development in a major tertiary paediatric hospital facilitating improved access for families, particularly for those in regional and rural locations.
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Affiliation(s)
- Alyson Gundry
- Paediatric Palliative Care Service, Oncology Services Group (A.G., L.D., A.H.), Children's Health Queensland Hospital and Health Service, South Brisbane, Australia; School of Nursing (N.E., N.B.), Queensland University of Technology, Kelvin Grove, Australia; Cancer and Palliative Care Outcomes Centre at Centre for Children's Health Research (A.H., N.B.), Queensland University of Technology, South Brisbane, Australia.
| | - Norah Elvidge
- Paediatric Palliative Care Service, Oncology Services Group (A.G., L.D., A.H.), Children's Health Queensland Hospital and Health Service, South Brisbane, Australia; School of Nursing (N.E., N.B.), Queensland University of Technology, Kelvin Grove, Australia; Cancer and Palliative Care Outcomes Centre at Centre for Children's Health Research (A.H., N.B.), Queensland University of Technology, South Brisbane, Australia
| | - Leigh Donovan
- Paediatric Palliative Care Service, Oncology Services Group (A.G., L.D., A.H.), Children's Health Queensland Hospital and Health Service, South Brisbane, Australia; School of Nursing (N.E., N.B.), Queensland University of Technology, Kelvin Grove, Australia; Cancer and Palliative Care Outcomes Centre at Centre for Children's Health Research (A.H., N.B.), Queensland University of Technology, South Brisbane, Australia
| | - Kristy Bunker
- Paediatric Palliative Care Service, Oncology Services Group (A.G., L.D., A.H.), Children's Health Queensland Hospital and Health Service, South Brisbane, Australia; School of Nursing (N.E., N.B.), Queensland University of Technology, Kelvin Grove, Australia; Cancer and Palliative Care Outcomes Centre at Centre for Children's Health Research (A.H., N.B.), Queensland University of Technology, South Brisbane, Australia
| | - Anthony Herbert
- Paediatric Palliative Care Service, Oncology Services Group (A.G., L.D., A.H.), Children's Health Queensland Hospital and Health Service, South Brisbane, Australia; School of Nursing (N.E., N.B.), Queensland University of Technology, Kelvin Grove, Australia; Cancer and Palliative Care Outcomes Centre at Centre for Children's Health Research (A.H., N.B.), Queensland University of Technology, South Brisbane, Australia
| | - Natalie Bradford
- Paediatric Palliative Care Service, Oncology Services Group (A.G., L.D., A.H.), Children's Health Queensland Hospital and Health Service, South Brisbane, Australia; School of Nursing (N.E., N.B.), Queensland University of Technology, Kelvin Grove, Australia; Cancer and Palliative Care Outcomes Centre at Centre for Children's Health Research (A.H., N.B.), Queensland University of Technology, South Brisbane, Australia
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12
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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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13
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Haynes SC, Marcin JP. Pediatric Telemedicine: Lessons Learned During the Coronavirus Disease 2019 Pandemic and Opportunities for Growth. Adv Pediatr 2022; 69:1-11. [PMID: 35985702 PMCID: PMC8979775 DOI: 10.1016/j.yapd.2022.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The accelerated uptake of telemedicine during the coronavirus disease 2019 pandemic has resulted in valuable experience and evidence on the delivery of telemedicine for pediatric patients. The pandemic has also highlighted inequities and opportunities for improvement. This review discusses lessons learned during the pandemic, focusing on provider-to-patient virtual encounters. Recent evidence on education and training, developing and adapting clinical workflows, patient assessment and treatment, and family-centered care is reviewed. Opportunities for future research in pediatric telemedicine are discussed, specifically with regard to engaging pediatric patients, improving and measuring access to care, addressing health equity, and expanding the evidence base.
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Affiliation(s)
- Sarah C Haynes
- Department of Pediatrics, UC Davis School of Medicine, UC Davis Center for Health and Technology, 4610 X Street, Suite 2300, Sacramento, CA 95817, USA.
| | - James P Marcin
- Department of Pediatrics, UC Davis School of Medicine, UC Davis Center for Health and Technology, 4610 X Street, Suite 2300, Sacramento, CA 95817, USA
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14
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Ekberg S, Bowers A, Bradford N, Ekberg K, Rolfe M, Elvidge N, Cook R, Roberts SJ, Howard C, Agar M, Deleuil R, Fleming S, Hynson J, Jolly A, Heywood M, Waring S, Rice T, Vickery A. Enhancing paediatric palliative care: A rapid review to inform continued development of care for children with life-limiting conditions. J Paediatr Child Health 2022; 58:232-237. [PMID: 34904760 DOI: 10.1111/jpc.15851] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 10/19/2021] [Accepted: 11/24/2021] [Indexed: 11/27/2022]
Abstract
AIM Following the establishment of paediatric palliative care services over recent decades, this study sought to identify information to inform future policy and practice. METHODS A rapid review using thematic synthesis was conducted to synthesise existing information about improving paediatric palliative care. Information was extracted in relation to key areas for investment and change: quality, access, advance care planning, skills, research, collaboration and community awareness. RESULTS A total of 2228 literature sources were screened, with 369 included. Synthesised information identified clear ways to improve quality of care, access to care, advance care planning, and research and data collection. The synthesis identified knowledge gaps in understanding how to improve skills in paediatric palliative care, collaboration across Australian jurisdictions and community awareness. CONCLUSIONS The findings of this review bring together information from a vast range of sources to provide action-oriented information to target investment and change in paediatric palliative care over the coming decades.
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Affiliation(s)
- Stuart Ekberg
- Cancer and Palliative Care Outcomes Centre, Centre for Healthcare Transformation, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Alison Bowers
- Cancer and Palliative Care Outcomes Centre, Centre for Healthcare Transformation, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Natalie Bradford
- Cancer and Palliative Care Outcomes Centre, Centre for Healthcare Transformation, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Katie Ekberg
- School of Early Childhood and Inclusive Education, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Melanie Rolfe
- Cancer and Palliative Care Outcomes Centre, Centre for Healthcare Transformation, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Norah Elvidge
- Cancer and Palliative Care Outcomes Centre, Centre for Healthcare Transformation, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Rebecca Cook
- Cancer and Palliative Care Outcomes Centre, Centre for Healthcare Transformation, Queensland University of Technology, Kelvin Grove, Queensland, Australia.,Queensland Paediatric Rehabilitation Service, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Sara-Jane Roberts
- Cancer and Palliative Care Outcomes Centre, Centre for Healthcare Transformation, Queensland University of Technology, Kelvin Grove, Queensland, Australia.,IMPACCT (Improving Palliative Aged and Chronic Care through Clinical Research and Translation) Centre, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Christine Howard
- Cancer and Palliative Care Outcomes Centre, Centre for Healthcare Transformation, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Meera Agar
- IMPACCT (Improving Palliative Aged and Chronic Care through Clinical Research and Translation) Centre, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Renee Deleuil
- WA Paediatric Palliative Care Service, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Sara Fleming
- Paediatric Palliative Care Service, Women's and Children's Health Network, North Adelaide, South Australia, Australia
| | - Jenny Hynson
- Victorian Paediatric Palliative Care Program, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Ashka Jolly
- Paediatric Palliative Care Service, Centenary Hospital for Women and Children, Garran, Australian Capital Territory, Australia
| | - Melissa Heywood
- Victorian Paediatric Palliative Care Program, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Simon Waring
- Palliative Care Australia, Griffith, Australian Capital Territory, Australia
| | - Toni Rice
- Palliative Care Australia, Griffith, Australian Capital Territory, Australia
| | - Annette Vickery
- Palliative Care Australia, Griffith, Australian Capital Territory, Australia
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15
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Archer S, Cheung NH, Williams I, Darzi A. The impact of digital health interventions on the psychological outcomes of patients and families receiving paediatric palliative care: A systematic review and narrative synthesis. Palliat Med 2021; 35:2017-2023. [PMID: 34159851 PMCID: PMC8641035 DOI: 10.1177/02692163211026523] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Digital health interventions are becoming increasingly important and may be particularly relevant for paediatric palliative care. In line with the aims of palliative care, digital health interventions should aim to maintain, if not improve, psychological wellbeing. However, the extent to which the psychological outcomes of digital health interventions are assessed is currently unknown. AIM To identify and synthesise the literature exploring the impact of all digital health interventions on the psychological outcomes of patients and families receiving paediatric palliative care. DESIGN Systematic review and narrative synthesis. DATA SOURCES MEDLINE, EMBASE, Health Management Information Consortium, PsycINFO, Cumulative Index to Nursing and Allied Health Literature and the Midwives Information & Resource Service were searched on the 27th July 2020, in addition to the first five pages of Google Scholar. To be included in the review, papers must have contained: quantitative or qualitative data on psychosocial outcomes, data from patients aged 0-18 receiving palliative care or their families, a digital health intervention, and been written in English. RESULTS Three studies were included in the review. All looked at the psychological impact of telehealth interventions. Papers demonstrated fair or good quality reporting but had small sample sizes and varied designs. CONCLUSIONS Despite the design and development of digital health interventions that span the technological landscape, little research has assessed their psychosocial impact in the paediatric palliative care community. Whilst the evidence base around the role of these interventions continues to grow, their impact on children and their families must not be overlooked.
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Affiliation(s)
- Stephanie Archer
- Department of Surgery and Cancer, Imperial College London, St Mary’s Hospital, London, UK
| | | | - Ivor Williams
- Helix Centre, Imperial College London, St Mary’s Hospital, London, UK
| | - Ara Darzi
- Department of Surgery and Cancer, Imperial College London, St Mary’s Hospital, London, UK
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16
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Dolan H, Eggett C, Holliday L, Delves S, Parkes D, Sutherland K. Virtual care in end of life and palliative care: A rapid evidence check. J Telemed Telecare 2021; 27:631-637. [PMID: 34726997 DOI: 10.1177/1357633x211046118] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The purpose of this rapid evidence check was to identify virtual care modalities that are safe and effective in the delivery of end of life and palliative care. Thirty-three peer reviewed articles which were either review articles or interventional/evaluative studies presenting comparative data were identified through PubMed, Google, and Google Scholar searches. Extracted data was synthesized narratively and outcomes were categorised separately for patients, healthcare providers, caregivers and health system. Included studies reported on a wide range of virtual care modalities, including video consultation, mobile apps, videos, websites, telephone support, email and alert messages. Generally, studies reported similar or favourable quality of life outcomes to face-to-face palliative care, especially when virtual care was used as a supplement rather than a substitute for face-to-face care. Positive attitudes for perceived usefulness and helpfulness were reported by patients, caregivers and healthcare providers. Challenges identified related to technology limitations, trust, ethical concerns, administrative burden and evidence gaps. Overall, most studies found virtual care modalities to be safe and effective in end of life and palliative care with no detrimental adverse outcomes, when used as a supplement to face-to-face care.
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Affiliation(s)
- Hankiz Dolan
- NSW 144952Agency for Clinical Innovation, Sydney, NSW, Australia
| | - Catherine Eggett
- NSW 144952Agency for Clinical Innovation, Sydney, NSW, Australia
| | - Laura Holliday
- NSW 144952Agency for Clinical Innovation, Sydney, NSW, Australia
| | - Shane Delves
- NSW 144952Agency for Clinical Innovation, Sydney, NSW, Australia
| | - Donna Parkes
- NSW 144952Agency for Clinical Innovation, Sydney, NSW, Australia
| | - Kim Sutherland
- NSW 144952Agency for Clinical Innovation, Sydney, NSW, Australia
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17
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Haydon HM, Snoswell CL, Thomas EE, Broadbent A, Caffery LJ, Brydon JA, Smith AC. Enhancing a community palliative care service with telehealth leads to efficiency gains and improves job satisfaction. J Telemed Telecare 2021; 27:625-630. [PMID: 34726990 DOI: 10.1177/1357633x211048952] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Telepalliative care services enable clinicians to provide essential palliation services to people with a life-limiting illness in or closer to home. This study aims to explore the costs, service activity and staff experiences resulting from the introduction of telehealth in a community palliative care service in Queensland, Australia. Pre- and post-activity and cost data from the 2016-2017 and 2019-2020 financial years were examined and staff members interviewed. Accounting for inflation and standard wage increases, the labour costs before and after the addition of telehealth were approximately equal. There were small variations in non-labour costs, but these were not directly attributable to the expansion of the telehealth services. Overall, the service activity increased by 189% for standard doctor and nurse consultations, due to the increased efficiency of telehealth compared to the previous outreach (travel) model. Thematic analysis of the staff interview data generated an overarching theme of Increased Job Satisfaction which staff attributed to the patient-centred nature of the telepalliative care service, the increased peer support and increased professional development. Compared with the traditional in-person service, the new telehealth-supported model resulted in equivalent costs, greater efficiency by allowing palliative care to reach more patients and improved staff job satisfaction.
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Affiliation(s)
- Helen M Haydon
- Centre for Online Health, 1974The University of Queensland, Australia
- Centre for Health Services Research, 1974The University of Queensland, Australia
| | - Centaine L Snoswell
- Centre for Online Health, 1974The University of Queensland, Australia
- Centre for Health Services Research, 1974The University of Queensland, Australia
| | - Emma E Thomas
- Centre for Online Health, 1974The University of Queensland, Australia
- Centre for Health Services Research, 1974The University of Queensland, Australia
| | - Andrew Broadbent
- 3556Gold Coast Specialist and Supportive Palliative Care Service, Gold Coast Hospital, Australia
| | - Liam J Caffery
- Centre for Online Health, 1974The University of Queensland, Australia
- Centre for Health Services Research, 1974The University of Queensland, Australia
| | - Julie-Ann Brydon
- 3556Gold Coast Specialist and Supportive Palliative Care Service, Gold Coast Hospital, Australia
| | - Anthony C Smith
- Centre for Online Health, 1974The University of Queensland, Australia
- Centre for Health Services Research, 1974The University of Queensland, Australia
- Centre for Innovative Medical Technology, University of Southern Denmark, Denmark
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18
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Lundereng ED, Nes AAG, Holmen H, Winger A, Thygesen H, Jøranson N, Borge CR, Chen W, Dajani O, Mariussen KL, Steindal SA. Health Care Professionals' Experiences and Perspectives on Using Telehealth for Home-Based Palliative Care: Protocol for a Scoping Review. JMIR Res Protoc 2021; 10:e33305. [PMID: 34714254 PMCID: PMC8590185 DOI: 10.2196/33305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 09/22/2021] [Accepted: 09/28/2021] [Indexed: 12/29/2022] Open
Abstract
Background Telehealth seems feasible for use in home-based palliative care. However, acceptance among health care professionals (HCPs) is essential for the successful delivery of telehealth in practice. No scoping review has mapped the experiences and perspectives of HCPs on the use of telehealth for home-based palliative care. Objective The aim of this review is to systematically map published studies on HCPs’ experiences and perspectives on the use of telehealth in home-based palliative care. Methods The proposed scoping review will employ the methodology of Arksey and O’Malley. This protocol is guided by the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocol (PRISMA-P). A systematic search will be performed in MEDLINE, PsycINFO, EMBASE, CINAHL, Allied and Complementary Medicine (AMED), and Web of Science for studies published between January 2000 and July 5, 2021. We will also hand search the reference lists of included papers to identify additional studies of relevance. The search will be updated in 2022. Pairs of authors will independently assess the eligibility of studies and extract data. The first 2 stages of thematic synthesis will be used to thematically organize the data. Because the scoping review methodology consists of reviewing and collecting data from publicly available materials, this study does not require ethics approval. Results The database searches; testing of eligibility criteria; and screening of titles, abstracts, and full-text papers will be performed by fall 2021. The results from this scoping review will be presented as a descriptive summary of the results from all included papers, and will be inductively organized into descriptive themes. A frequency table illustrating which papers were included in which descriptive themes will be made. Results are anticipated by the fall of 2022. Conclusions A mapping of studies could identify research gaps regarding HCPs’ experiences and perspectives on the use of telehealth in home-based palliative care and may determine the value and feasibility of conducting a full systematic review. International Registered Report Identifier (IRRID) PRR1-10.2196/33305
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Affiliation(s)
- Elias David Lundereng
- Section for Palliative Treatment, 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
| | - 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
| | - Chrstine Råheim Borge
- Lovisenberg Diaconal Hospital, Oslo, Norway.,Department of Interdisciplinary Health Sciences, University of Oslo, Oslo, Norway
| | - Weiqin Chen
- Department of Computer Science, Oslo Metropolitan University, Oslo, Norway
| | - Olav Dajani
- Section for Gastrointestinal Oncology, 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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19
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Schmitt S, Ebby C, Doshi A, Bower K, Marc-Aurele K. Retrospective Pediatric Telepalliative Care Experience. J Palliat Med 2021; 25:274-281. [PMID: 34550796 DOI: 10.1089/jpm.2021.0173] [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: 10/20/2022] Open
Abstract
Background: Rady Children's Hospital (RCH) offers an outpatient pediatric palliative clinic that began offering telepalliative care in 2016. Objectives: This study describes demographics of parents receiving pediatric telepalliative care, patient/family satisfaction with telepalliative care, and patient/family perspectives. Design: Retrospective electronic medical record chart review (2016-2020) of telepalliative patients at RCH (San Diego, USA), including satisfaction surveys. Documented quotes from telepalliative care consultations were analyzed thematically. Results: Fifty-six patients were seen through 181 telepalliative visits. Demographics: Forty-three percent were female and 32% were Hispanic/Latino. Ages ranged from 3 months to 25 years. Average Palliative Performance Scale was 47%. Seventy-nine percent used gastrostomy tubes for nutrition, but only 29% used home ventilation. Eighty-two percent completed a Physician Order for Life-Sustaining Treatment. Goals for 84% of patients were for life prolongation and attempt resuscitation. Visits averaged 86 minutes. Twenty-five surveys were returned: 92% felt very satisfied and 96% said the video visit was the same, better, or much better than an in-person visit. Sixty-four percent said the video visit was more convenient and 68% felt the video visit was safer. Identified themes from telepalliative consultations included advocacy for their child, challenges surrounding care for children with complex medical needs, medical team communication, caregiver support, facing uncertainty, and decision making. Conclusions and Implications: Pediatric patients receiving telepalliative care varied in demographics, functional status, and goals of care. Telepalliative care can provide good quality of care and patient satisfaction. In a telepalliative setting, parents were able to communicate challenging aspects of care including navigating uncertainty, finding support, and decision making.
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Affiliation(s)
- Stephanie Schmitt
- Department of Pediatrics, University of California San Diego and Rady Children's Hospital, San Diego, California, USA
| | - Cris Ebby
- Department of Pediatrics, University of California San Diego and Rady Children's Hospital, San Diego, California, USA
| | - Ami Doshi
- Department of Pediatrics, University of California San Diego and Rady Children's Hospital, San Diego, California, USA.,Division of Pediatric Hospital Medicine, University of California San Diego and Rady Children's Hospital, San Diego, California, USA.,Division of Pediatric Palliative Medicine, University of California San Diego and Rady Children's Hospital, San Diego, California, USA
| | - Kimberly Bower
- Department of Pediatrics, University of California San Diego and Rady Children's Hospital, San Diego, California, USA.,Division of Pediatric Palliative Medicine, University of California San Diego and Rady Children's Hospital, San Diego, California, USA
| | - Krishelle Marc-Aurele
- Department of Pediatrics, University of California San Diego and Rady Children's Hospital, San Diego, California, USA.,Division of Pediatric Palliative Medicine, University of California San Diego and Rady Children's Hospital, San Diego, California, USA
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20
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Miller KA, Baird J, Lira J, Herrera Eguizabal J, Fei S, Kysh L, Lotstein D. The Use of Telemedicine for Home-Based Palliative Care for Children With Serious Illness: A Scoping Review. J Pain Symptom Manage 2021; 62:619-636.e6. [PMID: 33348029 DOI: 10.1016/j.jpainsymman.2020.12.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 12/06/2020] [Accepted: 12/08/2020] [Indexed: 10/22/2022]
Abstract
CONTEXT There is potential value to home-based palliative care for children with serious illness delivered via telemedicine (TM HBPC). Evidence to guide optimal design and delivery of TM HBPC is urgently needed. OBJECTIVES To explore the existing literature to identify research on pediatric TM HBPC. METHODS Systematic scoping review conducted following preferred reporting items for systematic reviews and meta-analysis for scoping reviews guidelines. PubMed, Embase, Cochrane CENTRAL, CINAHL, Web of Science, PsycINFO, and ERIC were searched (January-April 2020) using keywords and controlled vocabulary. The Reach, Effectiveness, Adoption, Implementation, Maintenance framework was used to identify components in the literature that facilitate or limit dissemination of TM HBPC interventions. RESULTS Seventeen articles were included. Most of the literature comprised small descriptive studies, such as case reports, and feasibility trials. Many studies focused on acceptability, and the TM HBPC model was generally acceptable to both clinicians and families. Few studies measured patient access to care, patient, and family centered health or quality of life outcomes. While included studies addressed multiple criteria for each of the Reach, Effectiveness, Adoption, Implementation, Maintenance dimensions, much of the information was qualitative and subjective. CONCLUSION TM HBPC is a promising strategy to increase access to palliative care for children with serious illness. However, the current review found a need for more robust information describing implementation and effectiveness of TM HBPC models, adaptation across care settings, and maintenance over time to guide and facilitate broader dissemination.
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Affiliation(s)
- Kimberly A Miller
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA; Department of Dermatology, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Jennifer Baird
- Institute for Nursing and Interprofessional Research, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Jessica Lira
- Institute for Nursing and Interprofessional Research, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Josseline Herrera Eguizabal
- Department of Anesthesia Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Shangnon Fei
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Lynn Kysh
- Institute for Nursing and Interprofessional Research, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Debra Lotstein
- Department of Anesthesia Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, California, USA; Department of Pediatrics, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA.
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21
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Steindal SA, Nes AAG, Godskesen TE, Lind S, Dhle A, Winger A, Österlind J, Pettersen FS, Holmen H, Klarare A. Advantages and Challenges in Using Telehealth for Home-Based Palliative Care: Protocol for a Systematic Mixed Studies Review. JMIR Res Protoc 2021; 10:e22626. [PMID: 34018964 PMCID: PMC8178736 DOI: 10.2196/22626] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 10/14/2020] [Accepted: 04/19/2021] [Indexed: 01/03/2023] Open
Abstract
Background Given the increasing number of people in need of palliative care services and the current health care professional workforce strain, providing equitable, quality palliative care has become a challenge. Telehealth could be an innovative approach to palliative care delivery, enabling patients to spend more time or even remain at home, if they wish, throughout the illness trajectory. However, no previous systematic mixed studies reviews have synthesized evidence on patients’ experiences of the advantages and challenges of telehealth for home-based palliative care. Objective The aim of this systematic mixed studies review is to critically appraise and synthesize findings from studies that investigated patients’ use of telehealth in home-based palliative care with a focus on the advantages and challenges experienced by the patients. Methods This article describes the protocol for a systematic mixed studies review with a convergent design. The reporting will be guided by the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. A systematic search was performed in eight databases for studies published from January 2010 to June 2020. The search will be updated in 2021. Pairs of authors will independently assess eligibility, extract data, and assess methodological quality. The data will then be analyzed using thematic synthesis. Results We describe the rationale and design of a systematic mixed studies review. The database searches were performed on June 25, 2020. Assessment of eligibility and further steps have not yet been performed. Results are anticipated by August 2021. Conclusions Following the ethos of patient-centered palliative care, this systematic mixed studies review could lead to recommendations for practice and policy, enabling the development and implementation of telehealth applications and services that align with patients’ preferences and needs at home. International Registered Report Identifier (IRRID) PRR1-10.2196/22626
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Affiliation(s)
| | | | - Tove E Godskesen
- Department of Health Care Sciences, Ersta Sköndal Bräcke University College, Stockholm, Sweden.,Centre for Research Ethics & Bioethics, Uppsala University, Uppsala, Sweden
| | - Susanne Lind
- Department of Health Care Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden
| | - Alfhild Dhle
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 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, Ersta Sköndal Bräcke University College, Stockholm, Sweden
| | | | - Heidi Holmen
- 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, Ersta Sköndal Bräcke University College, Stockholm, Sweden.,Clinical Psychology in Healthcare, Department for Women's and Children's Health, Uppsala University, Uppsala, Sweden
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22
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Finucane AM, O'Donnell H, Lugton J, Gibson-Watt T, Swenson C, Pagliari C. Digital health interventions in palliative care: a systematic meta-review. NPJ Digit Med 2021; 4:64. [PMID: 33824407 PMCID: PMC8024379 DOI: 10.1038/s41746-021-00430-7] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 02/25/2021] [Indexed: 02/07/2023] Open
Abstract
Digital health interventions (DHIs) have the potential to improve the accessibility and effectiveness of palliative care but heterogeneity amongst existing systematic reviews presents a challenge for evidence synthesis. This meta-review applied a structured search of ten databases from 2006 to 2020, revealing 21 relevant systematic reviews, encompassing 332 publications. Interventions delivered via videoconferencing (17%), electronic healthcare records (16%) and phone (13%) were most frequently described in studies within reviews. DHIs were typically used in palliative care for education (20%), symptom management (15%), decision-making (13%), information provision or management (13%) and communication (9%). Across all reviews, mostly positive impacts were reported on education, information sharing, decision-making, communication and costs. Impacts on quality of life and physical and psychological symptoms were inconclusive. Applying AMSTAR 2 criteria, most reviews were judged as low quality as they lacked a protocol or did not consider risk of bias, so findings need to be interpreted with caution.
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Affiliation(s)
- Anne M Finucane
- Clinical Psychology, School of Health in Social Science, University of Edinburgh, Edinburgh, Scotland, UK. .,Marie Curie Hospice Edinburgh, Edinburgh, Scotland, UK.
| | - Hannah O'Donnell
- The Usher Institute, University of Edinburgh, Edinburgh, Scotland, UK
| | - Jean Lugton
- Marie Curie Hospice Edinburgh, Edinburgh, Scotland, UK
| | - Tilly Gibson-Watt
- Edinburgh Medical School, University of Edinburgh, Edinburgh, Scotland, UK
| | | | - Claudia Pagliari
- The Usher Institute, University of Edinburgh, Edinburgh, Scotland, UK
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23
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Weaver MS, Shostrom VK, Neumann ML, Robinson JE, Hinds PS. Homestead together: Pediatric palliative care telehealth support for rural children with cancer during home-based end-of-life care. Pediatr Blood Cancer 2021; 68:e28921. [PMID: 33522720 DOI: 10.1002/pbc.28921] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 12/14/2020] [Accepted: 01/08/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Children with terminal cancer and their families describe a preference for home-based end-of-life care. Inadequate support outside of the hospital is a limiting factor in home location feasibility, particularly in rural regions lacking pediatric-trained hospice providers. METHODS The purpose of this longitudinal palliative telehealth support pilot study was to explore physical and emotional symptom burden and family impact assessments for children with terminal cancer receiving home based-hospice care. Each child received standard of care home-based hospice care from an adult-trained rural hospice team with the inclusion of telehealth pediatric palliative care visits at a scheduled minimum of every 14 days. RESULTS Eleven children (mean age 11.9 years) received pediatric palliative telehealth visits a minimum of every 14 days, with an average of 4.8 additional telehealth visits initiated by the family. Average time from enrollment to death was 21.6 days (range 4-95). Children self-reported higher physical symptom prevalence than parents or hospice nurses perceived the child was experiencing at time of hospice enrollment with underrecognition of the child's emotional burden. At the time of hospice enrollment, family impact was reported by family caregivers as 46.4/100 (SD 18.7), with noted trend of improved family function while receiving home hospice care with telehealth support. All children remained at home for end-of-life care. CONCLUSION Pediatric palliative care telehealth combined with adult-trained rural hospice providers may be utilized to support pediatric oncology patients and their family caregivers as part of longitudinal home-based hospice care.
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Affiliation(s)
- Meaghann S Weaver
- Department of Pediatrics, Division of Pediatric Palliative Care, Children's Hospital and Medical Center, Omaha, Nebraska
| | - Valerie K Shostrom
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, Nebraska
| | - Marie L Neumann
- Department of Pediatrics, Division of Pediatric Palliative Care, Children's Hospital and Medical Center, Omaha, Nebraska
| | - Jacob E Robinson
- Department of Pediatrics, Division of Pediatric Palliative Care, Children's Hospital and Medical Center, Omaha, Nebraska
| | - Pamela S Hinds
- Department of Nursing Science, Professional Practice and Quality, Children's National Health System, Washington, District of Columbia.,Department of Pediatrics, George Washington University, Washington, District of Columbia
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24
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James HSE, Smith AC, Thomas EE, Snoswell CL, Caffery LJ, Haydon HM. Exploring paramedics’ intention to use a specialist palliative care telehealth service. PROGRESS IN PALLIATIVE CARE 2021. [DOI: 10.1080/09699260.2020.1852657] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
| | - A. C. Smith
- Centre for Online Health, The University of Queensland, Princess Alexandra Hospital, Ground Floor, Building 33, Woolloongabba, QLD 4102, Australia
- Centre for Health Services Research, The University of Queensland, Princess Alexandra Hospital, Ground Floor, Building 33, Woolloongabba, QLD 4102, Australia
| | - E. E. Thomas
- Centre for Online Health, The University of Queensland, Princess Alexandra Hospital, Ground Floor, Building 33, Woolloongabba, QLD 4102, Australia
- Centre for Health Services Research, The University of Queensland, Princess Alexandra Hospital, Ground Floor, Building 33, Woolloongabba, QLD 4102, Australia
| | - C. L. Snoswell
- Centre for Online Health, The University of Queensland, Princess Alexandra Hospital, Ground Floor, Building 33, Woolloongabba, QLD 4102, Australia
- Centre for Health Services Research, The University of Queensland, Princess Alexandra Hospital, Ground Floor, Building 33, Woolloongabba, QLD 4102, Australia
| | - L. J. Caffery
- Centre for Online Health, The University of Queensland, Princess Alexandra Hospital, Ground Floor, Building 33, Woolloongabba, QLD 4102, Australia
- Centre for Health Services Research, The University of Queensland, Princess Alexandra Hospital, Ground Floor, Building 33, Woolloongabba, QLD 4102, Australia
| | - H. M. Haydon
- Centre for Online Health, The University of Queensland, Princess Alexandra Hospital, Ground Floor, Building 33, Woolloongabba, QLD 4102, Australia
- Centre for Health Services Research, The University of Queensland, Princess Alexandra Hospital, Ground Floor, Building 33, Woolloongabba, QLD 4102, Australia
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25
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Ovares JEP. Los cuidados paliativos domiciliares reducen las consultas a urgencias y muertes en centros de salud a un menor costo. REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2021. [DOI: 10.1590/1981-22562021024.210112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumen Objetivos Comparar los tipos de asistencia domiciliar geriátrica y paliativa para determinar cuál obtiene mejores resultados en los pacientes con demencia avanzada. Métodos El presente es un estudio de cohorte retrospectiva. Se incluyeron pacientes con demencia avanzada ingresados al programa de Atención Comunitaria Geriátrica de un hospital geriátrico público de Costa Rica en el periodo entre enero de 2018 y junio de 2019. Ellos se dividieron en dos grupos dependiendo del equipo especializado que realizó la atención domiciliaria y se analizaron sus características sociodemográficas y clínicas. Posteriormente, se analizaron los datos generados de los registros médicos sobre consultas de emergencia, hospitalización, lugar de defunción y costo de la visita generados por cada paciente entre junio de 2018 y diciembre de 2019. Se compararon 192 pacientes con demencia avanzada Global Dementia Scale 7 visitados por el equipo geriátricos especializado domiciliar con 19 de visitados por el equipo de cuidados paliativos especializado domiciliar del Hospital Geriátrico Nacional. Resultados Se analizaron 226 datos generados (192 por el programa de geriatría y 34 por el de paliativos). Los que recibían atención domiciliaria por un equipo paliativo tenían menos probabilidades de acudir a la sala de emergencias y morir en un centro de salud en comparación con aquellos que reciben atención domiciliaria por un equipo geriátrico, con un costo menor. Conclusiones El programa de cuidado paliativo especializado domiciliar reduce las consultas de emergencia, la muerte en el domicilio y los costos de atención en pacientes con demencia avanzada en comparación con el programa geriátrico.
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Scherr JF, Albright C, de los Reyes E. Utilizing telehealth to create a clinical model of care for patients with Batten disease and other rare diseases. THERAPEUTIC ADVANCES IN RARE DISEASE 2021; 2:26330040211038564. [PMID: 37181116 PMCID: PMC10032454 DOI: 10.1177/26330040211038564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 07/22/2021] [Indexed: 05/16/2023]
Abstract
The COVID-19 pandemic transformed the delivery of healthcare across the world. Telehealth has emerged as the primary method for providing healthcare early in the pandemic. Patient and healthcare provider views of the effectiveness of telehealth services are encouraging and support the long-term use of telehealth services in clinical practice. Telehealth may provide a strategy that has far-reaching benefits for diverse patient populations, such as patients with Batten disease and other rare diseases, who face additional barriers to accessing subspecialty healthcare services. The aims of this paper, through the experience of a single Batten Disease Center of Excellence, are to (1) review the benefits and barriers involved in the delivery of telehealth services to patients with rare diseases; (2) discuss components of a model for clinical care that utilizes telehealth services for patients with Batten disease; (3) discuss limitations and future directions of using telehealth in patients with rare diseases. Healthcare systems should consider building clinical models that utilize telehealth services to provide multidisciplinary services to patients with rare diseases. There are numerous benefits in using telehealth that can enhance and expand service delivery between the patient and clinician. Telehealth services can also improve provider-to-provider communication and collaboration when providing clinical care to individuals with rare diseases. Although there are many benefits to utilizing telehealth services in provision of care to patients with rare diseases, it is important to consider factors that may limit or add additional barriers prior to implementing telehealth services. There is a need for future collaborative research to examine and compare the effectiveness and outcomes of telehealth services with standard of care services that are provided in-person. Future research should also examine how to reduce the challenges and barriers associated with the implementation of telehealth services. Plain language summary What is telehealth? Telehealth is defined by the US Department of Health Resources and Services Administrations1 as the "use of electronic information and telecommunication technologies to support long-distance clinical healthcare, patient and professional health-related education, public health, and health administration. Technologies include video conference, the internet, store-and-forward imaging, streaming media, and terrestrial and wireless communication." What was the aim of this review? This review was conducted to guide a clinical model using telehealth services for patients with Batten disease and other rare diseases based on the experiences of a single Batten Disease Center of Excellence. Why is this important? Individuals with rare diseases may face multiple barriers to accessing clinical services. Local doctors and treatment providers, such as speech therapists, occupational therapists, physical therapists, and psychologists, may not have knowledge of rare diseases or how to manage symptoms and disease progression, or how to guide treatment services. Other barriers may also include:• Lack of local resources;• Increased caregiver stress;• Difficulty obtaining a correct diagnosis.There are numerous benefits to using telehealth services for both patients with rare diseases, such as:• Convenience;• Cost savings;• Improved access to care;• Ability to see multiple providers that can help with symptom monitoring, assessment, and treatment services. Where do we go from here? It is important to consider limitations when creating a model for clinical care for patients with rare diseases. Some limitations to think about are:• Clinician and organization familiarity with telehealth;• Reimbursement and coverage from insurance companies for telehealth;• Security and privacy of patient information;• Training of telehealth providers;• Logistical factors, including use of equipment, internet/connectivity, and technical troubleshooting.Future directions should involve collaborative research that studies the effectiveness, feasibility, and perceptions of families of rare diseases and providers that use telehealth for clinical healthcare services. Research should also further study and consider ways to improve barriers and challenges associated with implementing telehealth systems into existing healthcare systems.
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Affiliation(s)
- Jessica F. Scherr
- Nationwide Children’s Hospital, Child
Development Center, Columbus, OH 43205, USA
| | - Charles Albright
- Nationwide Children’s Hospital, Child
Development Center, Columbus, OH, USA
| | - Emily de los Reyes
- Nationwide Children’s Hospital, Department of
Neurology, Columbus, OH, USA, The Ohio State University Department of
Pediatrics and Neurology, Columbus, OH, USA
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27
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Weaver MS, Rosenberg AR, Fry A, Shostrom V, Wiener L. Impact of the Coronavirus Pandemic on Pediatric Palliative Care Team Structures, Services, and Care Delivery. J Palliat Med 2020; 24:1213-1220. [PMID: 33350874 DOI: 10.1089/jpm.2020.0589] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objectives: Define the impact of the coronavirus pandemic on pediatric palliative care team structures, communication, and workflow; and describe the roles, responsibilities, and reflections of interdisciplinary team members. Methods: Cross-sectional online surveys were posted on seven professional Listservs from May 2020 to June 2020. Data were summarized descriptively and with semantic content analyses. Results: N = 207 surveys were completed by pediatric palliative program representatives from 80 cities, inclusive of physicians, nurses, child life, social workers, chaplains, and psychologists. Teams consulted on <20% of potential or presumed COVID-19 cases in their centers. Sixty percent of personnel were deemed "essential" during the pandemic. One-third of personnel remained in their usual work locale, with some shifting to support adult palliative services and others working remotely. Over 60% reported a sense of team "distance" compared with "close" team cohesion, associated with physical location of team members (p < 0.01) and frequency of team counseling, education, or support meetings (p < 0.02). All programs adopted a form of telehealth for patient care, although 41% did not receive telehealth training and 73% perceived unequal care quality with virtual care. Absence of pediatric patients' family members due to visitation policies, missing human presence and physical touch, concern for personal and colleague health, and fear of financial sustainability for programs were notable stressors. Conclusions: While the number of children diagnosed with COVID-19 receiving hands-on care from pediatric palliative care teams was reportedly low, the coronavirus pandemic vastly impacted pediatric palliative care team structure, daily services, and communication models warranting attentiveness to lessons learned and future direction.
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Affiliation(s)
- Meaghann S Weaver
- Division of Pediatric Palliative Care - Hand in Hand, Children's Hospital and Medical Center, Omaha, Nebraska, USA
| | - Abby R Rosenberg
- Division of Hematology/Oncology, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA.,Palliative Care and Resilience Lab, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Abigail Fry
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, Maryland, USA
| | - Valerie Shostrom
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Lori Wiener
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, Maryland, USA
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COVID-19 Pandemic Restrictions and the Use of Technology for Pediatric Palliative Care in the Acute Care Setting. J Hosp Palliat Nurs 2020; 22:432-434. [PMID: 32925490 DOI: 10.1097/njh.0000000000000694] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The COVID-19 pandemic has caused health care facilities to restrict visitors for patients in all care settings. Most pediatric care facilities have restricted visitation to one parent at a time, unfortunately even if the child is in critical condition or is terminally ill. These situations have necessitated the use of technology such as the Zoom platform to have difficult conversations concerning complex medical decision-making and goals of care. In cases where the child is deemed at immediate end of life, many facilities will allow both parents to be at the bedside, but no other family or friends that may be integral support to the parents or child. These situations have compelled the use of FaceTime, Zoom, or Skype technology to facilitate real-time support at end of life for these young patients and their caregivers. This article presents a case where technologies such as these were utilized to assist a family in goals-of-care discussions and at end of life for an infant in the intensive care unit at a large urban pediatric care facility during the COVID-19 pandemic.
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29
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Weaver MS, Neumann ML, Navaneethan H, Robinson JE, Hinds PS. Human Touch via Touchscreen: Rural Nurses' Experiential Perspectives on Telehealth Use in Pediatric Hospice Care. J Pain Symptom Manage 2020; 60:1027-1033. [PMID: 32525081 PMCID: PMC7276120 DOI: 10.1016/j.jpainsymman.2020.06.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 05/29/2020] [Accepted: 06/01/2020] [Indexed: 11/04/2022]
Abstract
CONTEXT Telemedicine has the potential to extend care reach and access to home-based hospice services for children. Few studies have explored nurse perspectives regarding this communication modality for rural pediatric cohorts. OBJECTIVES The objective of this qualitative study was to learn from the experiences of rural hospice nurses caring for children at the end of life using telehealth modalities to inform palliative communication. METHODS Voice-recorded qualitative interviews with rural hospice nurse telehealth users inquiring on nurse experiences with telehealth. Semantic content analysis was used. RESULTS About 15 hospice nurses representing nine rural hospice agencies were interviewed. Nurses participated in an average of eight telehealth visits in the three months prior. Nurses were female with a mean age of 38 years and an average of seven years of hospice nursing experience. Five themes about telehealth emerged: accessible support, participant inclusion, timely communication, informed and trusted planning, and familiarity fostered. Each theme had both benefits and cautions associated as well as telehealth suggestions. Nurses recommended individualizing communication, pacing content, fostering human connection, and developing relationships even with technology use. CONCLUSION The experiences of nurses who use telehealth in their care for children receiving end-of-life care in rural regions may enable palliative care teams to understand both the benefits and challenges of telehealth use. Nurse insights on telehealth may help palliative care teams better honor the communication needs of patients and families while striving to improve care access.
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Affiliation(s)
- Meaghann S Weaver
- Division of Pediatric Palliative Care, Department of Pediatrics, Children's Hospital and Medical Center, Omaha, Nebraska, USA.
| | - Marie L Neumann
- Division of Pediatric Palliative Care, Department of Pediatrics, Children's Hospital and Medical Center, Omaha, Nebraska, USA
| | - Hema Navaneethan
- Division of Pediatric Palliative Care, Department of Pediatrics, Children's Hospital and Medical Center, Omaha, Nebraska, USA
| | - Jacob E Robinson
- Division of Pediatric Palliative Care, Department of Pediatrics, Children's Hospital and Medical Center, Omaha, Nebraska, USA
| | - Pamela S Hinds
- Department of Nursing Science, Professional Practice & Quality, Children's National Health System, the George Washington University, Washington, District of Columbia, USA; Department of Pediatrics, the George Washington University, Washington, District of Columbia, USA
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30
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Winger A, Kvarme LG, Løyland B, Kristiansen C, Helseth S, Ravn IH. Family experiences with palliative care for children at home: a systematic literature review. BMC Palliat Care 2020; 19:165. [PMID: 33099303 PMCID: PMC7585197 DOI: 10.1186/s12904-020-00672-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 10/15/2020] [Indexed: 01/29/2023] Open
Abstract
Background The main goal of pediatric palliative care (PPC) is to improve or maintain the best possible quality of life (QoL) for the child and their family. PPC can be provided in community health centres, within the specialist health care service and/or in the child’s home. Home is often the preferred place for families, and recommendations state that, whenever possible, the family home should be the centre of care for the child. The aim of this study is to systematically review the experiences and needs of families with children receiving palliative care at home. Methods We conducted a systematic review and searched the peer-reviewed databases CINAHL, Embase, PsycInfo and MEDLINE for articles published between January 2000 and October 2019. We included 23 studies emphasising the experience of family members when their child (0–18 years) received palliative care at home. We used a thematic analysis to identify relevant themes in the literature, and synthesised the findings from the different studies. Results The review represents the experiences of the families of almost 300 children with life-limiting (LL) and life-threatening (LT) conditions receiving palliative care at home. In general, the children’s mothers are interviewed, and seldom the sick children themselves or their siblings. Most families preferred staying at home since it made it easier to maintain a normal family life, was less stressful for the sick child, and meant that siblings could still attend school and be with friends. Families experienced a range of challenges due to the coordination of care, including a lack of support and adequately skilled staff with appropriate experience. Respite care was needed in order to cope with everyday life. Some studies were not specific concerning the place of care, and some relevant papers may have been omitted. Conclusions Families receiving PPC need organised, individualised support from a skilled PPC team. Respite care is necessary in order to manage a demanding home-care situation and parents need support for siblings. Privacy to be a family is a need, and many families need financial support. Future studies should focus on PPC at home in the perspectives of sick children and their siblings.
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Affiliation(s)
- Anette Winger
- Oslo Metropolitan University (OsloMet), P.O. Box 4 St. Olavs plass, NO-0130, Oslo, Norway.
| | - Lisbeth Gravdal Kvarme
- Oslo Metropolitan University (OsloMet), P.O. Box 4 St. Olavs plass, NO-0130, Oslo, Norway
| | - Borghild Løyland
- Oslo Metropolitan University (OsloMet), P.O. Box 4 St. Olavs plass, NO-0130, Oslo, Norway
| | | | - Sølvi Helseth
- Oslo Metropolitan University (OsloMet), P.O. Box 4 St. Olavs plass, NO-0130, Oslo, Norway
| | - Ingrid H Ravn
- Oslo Metropolitan University (OsloMet), P.O. Box 4 St. Olavs plass, NO-0130, Oslo, Norway
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31
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Nguyen M, Fujioka J, Wentlandt K, Onabajo N, Wong I, Bhatia RS, Bhattacharyya O, Stamenova V. Using the technology acceptance model to explore health provider and administrator perceptions of the usefulness and ease of using technology in palliative care. BMC Palliat Care 2020; 19:138. [PMID: 32895060 PMCID: PMC7476427 DOI: 10.1186/s12904-020-00644-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 08/30/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Studies have shown that telehealth applications in palliative care are feasible, can improve quality of care, and reduce costs but few studies have focused on user acceptance of current technology applications in palliative care. Furthermore, the perspectives of health administrators have not been explored in palliative care and yet they are often heavily involved, alongside providers, in the coordination and use of health technologies. The study aim was to explore both health care provider and administrator perceptions regarding the usefulness and ease of using technology in palliative care. METHODS The Technology Acceptance Model (TAM) was used as the guiding theoretical framework to provide insight into two key determinants that influence user acceptance of technology (perceived usefulness and ease of use). Semi-structured interviews (n = 18) with health providers and administrators with experience coordinating or using technology in palliative care explored the usefulness of technologies in palliative care and recommendations to support adoption. Interview data were analyzed using inductive thematic analysis to identify common, meaningful themes. RESULTS Four themes were identified; themes related to perceived usefulness were: enabling remote connection and information-sharing platform. Themes surrounding ease of use included: integration with existing IT systems and user-friendly with ready access to technical support. Telehealth can enable remote connection between patients and providers to help address insufficiencies in the current palliative care environment. Telehealth, as an information sharing platform, could support the coordination and collaboration of interdisciplinary providers caring for patients with palliative needs. However, health technologies need to passively integrate with existing IT systems to enhance providers' workflow and productivity. User-friendliness with ready access to technical support was considered especially important in palliative care as patients often experience diminished function. CONCLUSION Participants' perspectives of technology acceptance in palliative care were largely dependent on their potential to help address major challenges in the field without imposing significant burden on providers and patients.
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Affiliation(s)
- M Nguyen
- Women's College Hospital Institute for Health System Solutions and Virtual Care, 76 Grenville Street, 6th Floor, Toronto, Ontaro, M5S 1B2, Canada.
| | - J Fujioka
- Women's College Hospital Institute for Health System Solutions and Virtual Care, 76 Grenville Street, 6th Floor, Toronto, Ontaro, M5S 1B2, Canada
| | - K Wentlandt
- Women's College Hospital Institute for Health System Solutions and Virtual Care, 76 Grenville Street, 6th Floor, Toronto, Ontaro, M5S 1B2, Canada
| | - N Onabajo
- Women's College Hospital Institute for Health System Solutions and Virtual Care, 76 Grenville Street, 6th Floor, Toronto, Ontaro, M5S 1B2, Canada
| | - I Wong
- Women's College Hospital Institute for Health System Solutions and Virtual Care, 76 Grenville Street, 6th Floor, Toronto, Ontaro, M5S 1B2, Canada
| | - R S Bhatia
- Women's College Hospital Institute for Health System Solutions and Virtual Care, 76 Grenville Street, 6th Floor, Toronto, Ontaro, M5S 1B2, Canada
| | - O Bhattacharyya
- Women's College Hospital Institute for Health System Solutions and Virtual Care, 76 Grenville Street, 6th Floor, Toronto, Ontaro, M5S 1B2, Canada
| | - V Stamenova
- Women's College Hospital Institute for Health System Solutions and Virtual Care, 76 Grenville Street, 6th Floor, Toronto, Ontaro, M5S 1B2, Canada
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Steindal SA, Nes AAG, Godskesen TE, Dihle A, Lind S, Winger A, Klarare A. Patients' Experiences of Telehealth in Palliative Home Care: Scoping Review. J Med Internet Res 2020; 22:e16218. [PMID: 32369037 PMCID: PMC7238080 DOI: 10.2196/16218] [Citation(s) in RCA: 104] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 01/18/2020] [Accepted: 02/10/2020] [Indexed: 01/20/2023] Open
Abstract
Background Telehealth is increasingly being used in home care and could be one measure to support the needs of home-based patients receiving palliative care. However, no previous scoping review has mapped existing studies on the use of telehealth for patients in palliative home care. Objective The aim of this study was to map and assess published studies on the use of telehealth for patients in palliative home care. Methods A scoping review was conducted using the methodological framework of Arksey and O’Malley. Reporting was guided by Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. A systematic and comprehensive search of Medical Literature Analysis and Retrieval System Online, EMBASE, PsycINFO, and Cumulative Index to Nursing and Allied Health was performed for studies published between January 2000 and October 2018. Two authors independently assessed eligibility and extracted data. Results The review included 22 papers from 19 studies. Four thematic groupings were identified among the included papers: easy and effortless use of telehealth regardless of the current health condition, visual features that enhance communication and care via telehealth, symptom management and self-management promotion by telehealth, and perceptions of improved palliative care at home. Conclusions The use of telehealth in palliative home care seems to be feasible, improving access to health care professionals at home and enhancing feelings of security and safety. The visual features of telehealth seem to allow a genuine relationship with health care professionals. However, there are contradicting results on whether the use of telehealth improves burdensome symptoms and quality of life. Future research should investigate the experiences of using telehealth among patients with life-limiting illness other than cancer and patients aged 85 years or older. More research is needed to increase the body of knowledge regarding the effectiveness of telehealth on symptoms and quality of life.
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Affiliation(s)
| | | | - Tove E Godskesen
- Palliative Research Centre, Department of Health Care Sciences, Ersta Sköndal Bräcke University College, Stockholm, Sweden.,Centre for Research Ethics & Bioethics, Uppsala University, Uppsala, Sweden
| | | | - Susanne Lind
- Palliative Research Centre, Department of Health Care Sciences, Ersta Sköndal Bräcke University College, Stockholm, Sweden
| | | | - Anna Klarare
- Palliative Research Centre, Department of Health Care Sciences, Ersta Sköndal Bräcke University College, Stockholm, Sweden.,Clinical Psychology in Healthcare, Department for Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Weaver MS, Robinson JE, Shostrom VK, Hinds PS. Telehealth Acceptability for Children, Family, and Adult Hospice Nurses When Integrating the Pediatric Palliative Inpatient Provider during Sequential Rural Home Hospice Visits. J Palliat Med 2020; 23:641-649. [DOI: 10.1089/jpm.2019.0450] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Meaghann S. Weaver
- Division of Pediatric Palliative Care, Department of Pediatrics, Children's Hospital and Medical Center, Omaha, Nebraska, USA
| | - Jacob E. Robinson
- Division of Pediatric Palliative Care, Department of Pediatrics, Children's Hospital and Medical Center, Omaha, Nebraska, USA
| | - Valerie K. Shostrom
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Pamela S. Hinds
- Department of Nursing Science, Professional Practice and Quality, Children's National Health System, Washington, DC, USA
- Department of Pediatrics, The George Washington University, Washington, DC, USA
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Ferrell BR, Chung V, Koczywas M, Smith TJ. Dissemination and Implementation of Palliative Care in Oncology. J Clin Oncol 2020; 38:995-1001. [PMID: 32023151 PMCID: PMC7082157 DOI: 10.1200/jco.18.01766] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2019] [Indexed: 12/24/2022] Open
Abstract
Palliative care began in academic centers with specialty consultation services, and its value to patients, families, and health systems has been evident. The demand for palliative care to be integrated throughout the cancer trajectory, combined with a limited palliative care workforce, means that new models of care are needed. This review discusses evidence regarding the need for integration of palliative care into routine oncology care and describes best practices recognized for dissemination of palliative care. The available evidence suggests that palliative care be widely adopted by clinicians in all oncology settings to benefit patients with cancer and their families. Efforts are needed to adapt and integrate palliative care into community practice. Limitations of these models are discussed, as are future directions to continue implementation efforts. The benefits of palliative care can only be realized through effective dissemination of these principles of care, with more primary palliative care delivered by oncology clinicians.
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Affiliation(s)
| | | | | | - Thomas J. Smith
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Medicine, Baltimore, MD
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Holmen H, Riiser K, Winger A. Home-Based Pediatric Palliative Care and Electronic Health: Systematic Mixed Methods Review. J Med Internet Res 2020; 22:e16248. [PMID: 32130127 PMCID: PMC7070344 DOI: 10.2196/16248] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 11/05/2019] [Accepted: 12/14/2019] [Indexed: 01/23/2023] Open
Abstract
Background Children and families in pediatric palliative care depend on close contact with health care personnel, and electronic health (eHealth) is suggested to support care at home by facilitating their remote interactions. Objective This study aimed to identify and review the use of eHealth to communicate and support home-based pediatric palliative care and appraise the methodological quality of the published research. Methods We conducted a convergent, systematic mixed methods review and searched Medical Literature Analysis and Retrieval System Online (Medline), EMBASE, PsycINFO, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, and Scopus for eligible papers. Studies evaluating 2-way communication technology for palliative care for children aged ≤18 years and applying quantitative, qualitative, or mixed methods from 2012 to 2018 were eligible for inclusion. Quantitative and qualitative studies were equally valued during the search, screening, extraction, and analysis. Quantitative data were transformed into qualitative data and analyzed using a thematic analysis. Overall, 2 independent researchers methodologically appraised all included studies. Results We identified 1277 citations. Only 7 papers were eligible for review. Evaluating eHealth interventions in pediatric palliative care poses specific methodological and ethical challenges. eHealth to facilitate remote pediatric palliative care was acknowledged both as an intrusion and as a support at home. Reluctance toward eHealth was mainly identified among professionals. Conclusions The strengths of the conclusions are limited by the studies’ methodological challenges. Despite the limitless possibilities held by new technologies, research on eHealth in home-based pediatric palliative care is scarce. The affected children and families appeared to hold positive attitudes toward eHealth, although their views were less apparent compared with those of the professionals. Trial Registration PROSPERO CRD42018119051; https://tinyurl.com/rtsw5ky
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Abstract
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.
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Affiliation(s)
- Mia Jess
- 1 REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital and University of Southern Denmark, Nyborg, Denmark
| | - Helle Timm
- 1 REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital and University of Southern Denmark, Nyborg, Denmark
| | - Karin B Dieperink
- 1 REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital and University of Southern Denmark, Nyborg, Denmark.,2 Department of Oncology, Odense University Hospital, Odense, Denmark
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Yu JA, Schenker Y, Maurer SH, Cook SC, Kavlieratos D, Houtrow A. Pediatric palliative care in the medical neighborhood for children with medical complexity. FAMILIES, SYSTEMS & HEALTH : THE JOURNAL OF COLLABORATIVE FAMILY HEALTHCARE 2019; 37:107-119. [PMID: 31045385 PMCID: PMC6657525 DOI: 10.1037/fsh0000414] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Children with medical complexity (CMC) are a medically fragile pediatric population that experience severe chronic illnesses resulting in significant health care needs, functional limitations, and health care utilization, and are at the highest risk for morbidity and mortality among all children. Furthermore, families and parents of CMC experience significant caregiver hardships and diminished quality of life. The field of pediatric palliative care has grown in recent years, in part to address the physical and psychosocial issues inherent to the care of these chronically ill children. However, as the prevalence and long-term survival of CMC increases with medical advancements, the demand for pediatric palliative care will likely exceed the capacity of current and future pediatric palliative care specialists. Therefore, alternative strategies to ensure access to essential aspects of palliative care must be considered. This article focuses on why and how high-quality palliative care should be integrated into the patient- and family-centered medical home, the ideal care delivery model for CMC and their families. We first discuss how palliative care principles naturally align with and complement the goals of the CMC medical home. Next, we detail what actions pediatric palliative care specialists can take to best support the CMC medical home as "medical neighbors." Lastly, we describe the fundamental aspects of pediatric palliative care that all clinicians caring for CMC should be able to provide, referred to as "primary pediatric palliative care." (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
- Justin A Yu
- Section of Palliative Care and Medical Ethics
| | | | - Scott H Maurer
- Division of Pediatric Hematology/Oncology and Blood and Marrow Transplantation, Department of Pediatrics, The University of Pittsburgh School of Medicine
| | - Stacey C Cook
- Department of Pediatrics, The University of Pittsburgh School of Medicine
| | | | - Amy Houtrow
- Division of Pediatric Rehabilitation Medicine, Department of Physical Medicine and Rehabilitation, The University of Pittsburgh School of Medicine
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Tasneem S, Kim A, Bagheri A, Lebret J. Telemedicine Video Visits for patients receiving palliative care: A qualitative study. Am J Hosp Palliat Care 2019; 36:789-794. [DOI: 10.1177/1049909119846843] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
In this needs assessment, gathered patient perceptions on how telemedicine video visits might influence their care. Patients in this study (n = 13) were all diagnosed with end-stage cancer and were receiving palliative care at an urban academic medical center. Interview themes addressed: 1. impact on patient's health management, 2. user experience, 3. technical issues and 4. cost and time. Ultimately, despite concerns over truncated physical exams and prescription limits, the majority of patients favored having the opportunity for telemedicine video visits, felt that the doctor-patient relationship would not suffer, had confidence in their or their surrogate's technical abilities to navigate the video visit, had privacy concerns on par with other technologies, had few cost concerns, and believed a video alternative to an in-person visit might increase access, save time as well as increase comfort and safety by avoiding a trip to the office. These results suggest potential for acceptance of video-based telemedicine by an urban population of oncology patients receiving palliative care.
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Affiliation(s)
- Sumaiya Tasneem
- Department of Population Health, NYU Langone Health, New York, NY, USA
| | - Arum Kim
- Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
| | - Ashley Bagheri
- Department of Population Health, NYU Langone Health, New York, NY, USA
| | - James Lebret
- Department of Medicine, NYU Langone Health, New York, NY, USA
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Read Paul L, Salmon C, Sinnarajah A, Spice R. Web-based videoconferencing for rural palliative care consultation with elderly patients at home. Support Care Cancer 2019; 27:3321-3330. [PMID: 30613908 DOI: 10.1007/s00520-018-4580-8] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 11/27/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE Providing specialized palliative care support to elderly patients in rural areas can be challenging. The purpose of this study was to gain a preliminary understanding of the experience of using mobile web-based videoconferencing (WBVC) for conducting in-home palliative care consults with elderly rural patients with life-limiting illness. METHODS This was a descriptive, exploratory, proof-of-concept study with a convenience sample of 10 WBVC visits. A palliative care clinical nurse specialist (PC-CNS), in the home with the patient/family and home care nurse (HC-N), used a laptop computer with webcam and speakerphone to connect to a distant palliative care physician consultant (PC-MD) over a secure Internet connection. Data was collected using questionnaires, interviews, and focus groups. RESULTS Analysis of qualitative data revealed four themes: communication, logistics, technical issues, and trust. Participants reported they were comfortable discussing concerns by WBVC and felt it was an acceptable and convenient way to address needs. Audiovisual quality was not ideal but was adequate for communication. Use of WBVC improved access and saved time and travel. Fears were expressed about lack of security of information transmitted over the Internet. CONCLUSIONS Using WBVC for in-home palliative care consults could be an acceptable, effective, feasible, and efficient way to provide timely support to elderly rural patients and their families. Having a health care provider in the home during the WBVC is beneficial. WBVC visits have advantages over telephone calls, but limitations compared to in-person visits, suggesting they be an alternative but not replacement for in-person consultations.
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Affiliation(s)
- Linda Read Paul
- Palliative Care Consult Service - Rural, Calgary Zone, Alberta Health Services, 11 Cimarron Common, Okotoks, Alberta, T1S 2E9, Canada.
| | - Charleen Salmon
- University of Calgary, TRW Building, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada
| | - Aynharan Sinnarajah
- Palliative / End of Life Care, Calgary Zone, Alberta Health Services, 710 South Tower, Foothills Medical Centre, 1403 - 29th Street NW, Calgary, Alberta, T2N 2T8, Canada
| | - Ron Spice
- Palliative Care Consult Service - Rural, Calgary Zone, Alberta Health Services, 11 Cimarron Common, Okotoks, Alberta, T1S 2E9, Canada
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Ahluwalia SC, Chen C, Raaen L, Motala A, Walling AM, Chamberlin M, O'Hanlon C, Larkin J, Lorenz K, Akinniranye O, Hempel S. A Systematic Review in Support of the National Consensus Project Clinical Practice Guidelines for Quality Palliative Care, Fourth Edition. J Pain Symptom Manage 2018; 56:831-870. [PMID: 30391049 DOI: 10.1016/j.jpainsymman.2018.09.008] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 09/07/2018] [Indexed: 12/25/2022]
Abstract
CONTEXT Palliative care continues to be a rapidly growing field aimed at improving quality of life for patients and their caregivers. OBJECTIVES The purpose of this review was to provide a synthesis of the evidence in palliative care to inform the fourth edition of the National Consensus Project Clinical Practice Guidelines for Quality Palliative Care. METHODS Ten key review questions addressing eight content domains guided a systematic review focused on palliative care interventions. We searched eight databases in February 2018 for systematic reviews published in English from 2013, after the last edition of National Consensus Project guidelines was published, to present. Experienced literature reviewers screened, abstracted, and appraised data per a detailed protocol registered in PROSPERO. The quality of evidence was evaluated using the Grading of Recommendations, Assessment, Development and Evaluations criteria. The review was supported by a technical expert panel. RESULTS We identified 139 systematic reviews meeting inclusion criteria. Reviews addressed the structure and process of care (interdisciplinary team care, 13 reviews; care coordination, 18 reviews); physical aspects (48 reviews); psychological aspects (26 reviews); social aspects (two reviews); spiritual, religious, and existential aspects (11 reviews); cultural aspects (three reviews); care of the patient nearing the end of life (grief/bereavement programs, six reviews; final days of life, two reviews); ethical and legal aspects (36 reviews). CONCLUSION A substantial body of evidence exists to support clinical practice guidelines for quality palliative care, but the quality of evidence is limited.
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Affiliation(s)
- Sangeeta C Ahluwalia
- RAND Health, Santa Monica, California, USA; UCLA Fielding School of Public Health, Los Angeles, California, USA.
| | - Christine Chen
- Pardee RAND Graduate School, Santa Monica, California, USA
| | | | - Aneesa Motala
- Evidence based Practice Center, RAND Corp., Santa Monica, California, USA
| | - Anne M Walling
- RAND Health, Santa Monica, California, USA; Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at University of California, Los Angeles, California, USA; Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles, California, USA
| | | | | | - Jody Larkin
- Evidence based Practice Center, RAND Corp., Santa Monica, California, USA
| | - Karl Lorenz
- RAND Health, Santa Monica, California, USA; VA Palo Alto Health Care System, Center for Innovation to Implementation, Menlo Park, California, USA; Stanford University School of Medicine, Stanford, California, USA
| | | | - Susanne Hempel
- Evidence based Practice Center, RAND Corp., Santa Monica, California, USA
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Boyden JY, Curley MAQ, Deatrick JA, Ersek M. Factors Associated With the Use of U.S. Community-Based Palliative Care for Children With Life-Limiting or Life-Threatening Illnesses and Their Families: An Integrative Review. J Pain Symptom Manage 2018; 55:117-131. [PMID: 28807702 DOI: 10.1016/j.jpainsymman.2017.04.017] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 03/07/2017] [Accepted: 04/11/2017] [Indexed: 11/17/2022]
Abstract
CONTEXT As children with life-limiting illnesses (LLIs) and life-threatening illnesses (LTIs) live longer, challenges to meeting their complex health care needs arise in homes and communities, as well as in hospitals. Integrated knowledge regarding community-based pediatric palliative care (CBPPC) is needed to strategically plan for a seamless continuum of care for children and their families. OBJECTIVES The purpose of this integrative review article is to explore factors that are associated with the use of CBPPC for U.S. children with LLIs and LTIs and their families. METHODS A literature search of PubMed, CINAHL, Scopus, Google Scholar, and an ancestry search was performed to identify empirical studies and program evaluations published between 2000 and 2016. The methodological protocol included an evaluation of empirical quality and explicit data collection of synthesis procedures. RESULTS Forty peer-reviewed quantitative and qualitative methodological interdisciplinary articles were included in the final sample. Patient characteristics such as older age and a solid tumor cancer diagnosis and interpersonal factors such as family support were associated with higher CBPPC use. Organizational features were the most frequently discussed factors that increased CBPPC, including the importance of interprofessional hospice services and interorganizational care coordination for supporting the child and family at home. Finally, geography, concurrent care and hospice eligibility regulations, and funding and reimbursement mechanisms were associated with CBPPC use on a community and systemic level. CONCLUSION Multilevel factors are associated with increased CBPPC use for children with LLIs or LTIs and their families in the U.S.
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Affiliation(s)
- Jackelyn Y Boyden
- University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania.
| | - Martha A Q Curley
- University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania; University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Janet A Deatrick
- University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania
| | - Mary Ersek
- University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania; Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania
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Stuckey R, Domingues-Montanari S. Telemedicine is helping the parents of children with neurodevelopmental disorders living in remote and deprived areas. Paediatr Int Child Health 2017; 37:155-157. [PMID: 28498062 DOI: 10.1080/20469047.2017.1315914] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Telecommunication technologies are advancing rapidly with huge investment to improve infrastructure in rural areas. Telemedicine brings the benefits of telecommunication to healthcare, especially in resource-limited and remote communities. The recent literature on telemedicine in paediatrics will be reviewed, with particular focus on its application to help children with neurodevelopmental disorders and their families living in remote regions and/or low-income countries, and gaps identified for future research. Studies show that telemedicine can enable a family's access to appropriately qualified help that physically may only be available hundreds of miles away, helping to overcome geographic barriers. Telemedicine can also train parents and equip them with the knowledge and skills to better care for their children. Despite some technological barriers to implementation, telemedicine can help transform all stages of autism treatment. However, more studies are required in low- and middle-income countries to fully elucidate the benefits offered by telemedicine to autistic children and their families.
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Jeffs L, Jain AK, Man RH, Onabajo N, Desveaux L, Shaw J, Hensel J, Agarwal P, Saragosa M, Jamieson T, Wong I, Maione M, Bhatia RS. Exploring the utility and scalability of a telehomecare intervention for patients with chronic kidney disease undergoing peritoneal dialysis-a study protocol. BMC Nephrol 2017; 18:155. [PMID: 28486991 PMCID: PMC5424340 DOI: 10.1186/s12882-017-0557-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 04/16/2017] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Chronic Kidney Disease (CKD) is a pressing global health concern that is placing increased strain on health care resources. CKD patients regularly receive peritoneal dialysis as a common CKD treatment. An emerging technological solution is telehomecare as way to support patients receiving PD in their homes. This study protocol outlines a mixed methods evaluation exploring a telehomecare developed to enhance CKD patients' outcomes and experiences. The study aims to assess the usability, acceptability and scalability of this virtual care application. METHODS A realist evaluation using an embedded case study design will be used to understand the usability, acceptability and scalability of a telehomecare application for patients with CKD undergoing PD. The realist evaluation that is further described in this paper is part of a larger evaluation of the eQ Connect™ intervention that includes a randomized, parallel-arm control trial aimed at determining if utilizing eQ Connect improves selected clinical outcomes for PD patients (CONNECT Trial). DISCUSSION Potential implications of this study include elucidating which components of the intervention are most effective and under what conditions with a focus on the contextual influences. Collectively, our multi-method design will yield knowledge around how best to implement, sustain and spread the telehomecare application that will be useful to guide the development, implementation and evaluation of future virtual care applications aimed at improving the quality of care outcomes and experiences of patients. TRIAL REGISTRATION NCT02670512 . Registered: January 18, 2016.
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Affiliation(s)
- Lianne Jeffs
- Keenan Research Centre, Li Ka Shing Knowledge Institute St Michaels Hospital, 209 Victoria St, Toronto, ON, M5B 1T8, Canada.
| | - Arsh Kumar Jain
- London Health Sciences Centre, 800 Commissioners Rd E, London, ON, N6A 5W9, Canada
| | - Rachel HiuTung Man
- London Health Sciences Centre, 800 Commissioners Rd E, London, ON, N6A 5W9, Canada
| | - Nike Onabajo
- Women's College Hospital, 76 Grenville St, Toronto, ON, M5S 1B2, Canada
| | - Laura Desveaux
- Women's College Hospital, 76 Grenville St, Toronto, ON, M5S 1B2, Canada
| | - James Shaw
- Women's College Hospital, 76 Grenville St, Toronto, ON, M5S 1B2, Canada
| | - Jennifer Hensel
- Women's College Hospital, 76 Grenville St, Toronto, ON, M5S 1B2, Canada
| | - Payal Agarwal
- Women's College Hospital, 76 Grenville St, Toronto, ON, M5S 1B2, Canada
| | - Marianne Saragosa
- Women's College Hospital, 76 Grenville St, Toronto, ON, M5S 1B2, Canada
| | - Trevor Jamieson
- Keenan Research Centre, Li Ka Shing Knowledge Institute St Michaels Hospital, 209 Victoria St, Toronto, ON, M5B 1T8, Canada.,Women's College Hospital, 76 Grenville St, Toronto, ON, M5S 1B2, Canada
| | - Ivy Wong
- Women's College Hospital, 76 Grenville St, Toronto, ON, M5S 1B2, Canada
| | - Maria Maione
- Keenan Research Centre, Li Ka Shing Knowledge Institute St Michaels Hospital, 209 Victoria St, Toronto, ON, M5B 1T8, Canada
| | - R Sacha Bhatia
- Women's College Hospital, 76 Grenville St, Toronto, ON, M5S 1B2, Canada
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Tieman JJ, Swetenham K, Morgan DD, To TH, Currow DC. Using telehealth to support end of life care in the community: a feasibility study. BMC Palliat Care 2016; 15:94. [PMID: 27855681 PMCID: PMC5114812 DOI: 10.1186/s12904-016-0167-7] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Accepted: 11/09/2016] [Indexed: 11/25/2022] Open
Abstract
Background Telehealth is being used increasingly in providing care to patients in the community setting. Telehealth enhanced service delivery could offer new ways of managing load and care prioritisation for palliative care patients living in the community. The study assesses the feasibility of a telehealth-based model of service provision for community based palliative care patients, carers and clinicians. Methods This study was a prospective cohort study of a telehealth-based intervention for community based patients of a specialist palliative care service living in Southern Adelaide, South Australia. Participants were 43 community living patients enrolled in the Southern Adelaide Palliative Service. To be eligible patients needed to be over 18 years and have an Australian modified Karnofksy Performance Score > 40. Exclusion criteria included a demonstrated inability to manage the hardware or technology (unless living with a carer who could manage the technology) or non-English speaking without a suitable carer/proxy. Participants received video-based conferences between service staff and the patient/carer; virtual case conferences with the patient/carer, service staff and patient’s general practitioner (GP); self-report assessment tools for patient and carer; and remote activity monitoring (ACTRN12613000733774). Results The average age of patients was 71.6 years (range: 49 to 91 years). All 43 patients managed to enter data using the telehealth system. Self-reported data entered by patients and carers did identify changes in performance status leading to changes in care. Over 4000 alerts were generated. Staff reported that videocalls were similar (22.3%) or better/much better (65.2%) than phone calls and similar (63.1%) or better/much better (27.1%) than face-to-face. Issues with the volume of alerts generated, technical support required and the impact of service change were identified. Conclusions The trial showed that patients and carers could manage the technology and provide data that would otherwise not have been available to the palliative care service. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12613000733774 registered on 02/07/2013.
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Affiliation(s)
- Jennifer J Tieman
- Palliative and Supportive Services, Flinders University, Bedford Park, South Australia, Australia.
| | - Kate Swetenham
- Southern Adelaide Palliative Services, Repatriation General Hospital, Daw Park, South Australia, Australia
| | - Deidre D Morgan
- Palliative and Supportive Services, Flinders University, Bedford Park, South Australia, Australia
| | - Timothy H To
- Southern Adelaide Palliative Services, Repatriation General Hospital, Daw Park, South Australia, Australia
| | - David C Currow
- Palliative and Supportive Services, Flinders University, Bedford Park, South Australia, Australia
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Arnold K, Scheibe M, Müller O, Schmitt J. Grundsätze für die Evaluation telemedizinischer Anwendungen – Ergebnisse eines systematischen Reviews und Konsens-Verfahrens. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2016; 117:9-19. [DOI: 10.1016/j.zefq.2016.04.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 04/25/2016] [Accepted: 04/25/2016] [Indexed: 11/24/2022]
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Duregger K, Hayn D, Morak J, Ladenstein R, Schreier G. An mHealth system for toxicity monitoring of paediatric oncological patients using Near Field Communication technology. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2016; 2015:6848-51. [PMID: 26737866 DOI: 10.1109/embc.2015.7319966] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Home-based monitoring might be useful to reduce the burden of long-lasting oncological treatment for children. Current telemonitoring applications focus on chronic diseases or elderly people. Based on the workflow for different stakeholders and the identification of parameters important in paediatric oncology, we developed a prototype of a smartphone-based telehealth system using Near Field Communication technology for monitoring paediatric neuroblastoma patients at home. The parameters blood pressure, heart rate, temperature, body weight, C-reactive protein, white blood cell count, wellbeing, pain level, nausea level and skin alterations could be monitored using a smartphone, a designated app, point-of-care measurement devices and a smart-poster containing RFID tags. The system has been designed to increase the quality of life for paediatric cancer patients. As a future step, a clinical trial is currently being planned to evaluate the system in clinical setting.
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Wade VA, Taylor AD, Kidd MR, Carati C. Transitioning a home telehealth project into a sustainable, large-scale service: a qualitative study. BMC Health Serv Res 2016; 16:183. [PMID: 27185041 PMCID: PMC4869378 DOI: 10.1186/s12913-016-1436-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 05/12/2016] [Indexed: 11/23/2022] Open
Abstract
Background This study was a component of the Flinders Telehealth in the Home project, which tested adding home telehealth to existing rehabilitation, palliative care and geriatric outreach services. Due to the known difficulty of transitioning telehealth projects services, a qualitative study was conducted to produce a preferred implementation approach for sustainable and large-scale operations, and a process model that offers practical advice for achieving this goal. Methods Initially, semi-structured interviews were conducted with senior clinicians, health service managers and policy makers, and a thematic analysis of the interview transcripts was undertaken to identify the range of options for ongoing operations, plus the factors affecting sustainability. Subsequently, the interviewees and other decision makers attended a deliberative forum in which participants were asked to select a preferred model for future implementation. Finally, all data from the study was synthesised by the researchers to produce a process model. Results 19 interviews with senior clinicians, managers, and service development staff were conducted, finding strong support for home telehealth but a wide diversity of views on governance, models of clinical care, technical infrastructure operations, and data management. The deliberative forum worked through these options and recommended a collaborative consortium approach for large-scale implementation. The process model proposes that the key factor for large-scale implementation is leadership support, which is enabled by 1) showing solutions to the problems of service demand, budgetary pressure and the relationship between hospital and primary care, 2) demonstrating how home telehealth aligns with health service policies, and 3) achieving clinician acceptance through providing evidence of benefit and developing new models of clinical care. Two key actions to enable change were marketing telehealth to patients, clinicians and policy-makers, and building a community of practice. Conclusions The implementation of home telehealth services is still in an early stage. Change agents and a community of practice can contribute by marketing telehealth, demonstrating policy alignment and providing potential solutions for difficult health services problems. This should assist health leaders to move from trials to large-scale services.
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Affiliation(s)
- Victoria A Wade
- Discipline of General Practice, The University of Adelaide, North Tce., Adelaide, 5005, Australia.
| | - Alan D Taylor
- Faculty of Medicine, Nursing and Health Sciences, Flinders University, Adelaide, 5042, Australia
| | - Michael R Kidd
- Faculty of Medicine, Nursing and Health Sciences, Flinders University, Adelaide, 5042, Australia
| | - Colin Carati
- Faculty of Medicine, Nursing and Health Sciences, Flinders University, Adelaide, 5042, Australia
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Downing J, Powell RA, Marston J, Huwa C, Chandra L, Garchakova A, Harding R. Children's palliative care in low- and middle-income countries. Arch Dis Child 2016; 101:85-90. [PMID: 26369576 DOI: 10.1136/archdischild-2015-308307] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 08/27/2015] [Indexed: 11/03/2022]
Abstract
One-third of the global population is aged under 20 years. For children with life-limiting conditions, palliative care services are required. However, despite 80% of global need occurring in low- and middle-income countries (LMICs), the majority of children's palliative care (CPC) is provided in high-income countries. This paper reviews the status of CPC services in LMICs--highlighting examples of best practice among service models in Malawi, Indonesia and Belarus--before reviewing the status of the extant research in this field. It concludes that while much has been achieved in palliative care for adults, less attention has been devoted to the education, clinical practice, funding and research needed to ensure children and young people receive the palliative care they need.
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Affiliation(s)
- Julia Downing
- International Children's Palliative Care Network, London, UK Makerere University, Kampala, Uganda
| | | | - Joan Marston
- International Children's Palliative Care Network, Bloemfontein, South Africa
| | - Cornelius Huwa
- Palliative Care Support Trust, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | | | | | - Richard Harding
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, UK
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Dussel V, Orellana L, Soto N, Chen K, Ullrich C, Kang TI, Geyer JR, Feudtner C, Wolfe J. Feasibility of Conducting a Palliative Care Randomized Controlled Trial in Children With Advanced Cancer: Assessment of the PediQUEST Study. J Pain Symptom Manage 2015; 49:1059-69. [PMID: 25640275 PMCID: PMC4530789 DOI: 10.1016/j.jpainsymman.2014.12.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 12/16/2014] [Accepted: 12/23/2014] [Indexed: 11/29/2022]
Abstract
CONTEXT Pediatric palliative care randomized controlled trials (PPC-RCTs) are uncommon. OBJECTIVES To evaluate the feasibility of conducting a PPC-RCT in pediatric cancer patients. METHODS This was a cohort study embedded in the Pediatric Quality of Life and Evaluation of Symptoms Technology Study (NCT01838564). This multicenter PPC-RCT evaluated an electronic patient-reported outcomes system. Children aged two years and older, with advanced cancer, and potentially eligible for the study were included. Outcomes included: pre-inclusion attrition (patients not approached, refusals); post-inclusion attrition (drop-out, elimination, death, and intermittent attrition (IA; missing surveys) over nine months of follow-up); child/teenager self-report rates; and, reasons to enroll/participate. RESULTS Over five years, of the 339 identified patients, 231 were eligible (in 22, we could not verify eligibility); 84 eligible patients were not approached and 43 declined participation. Patients not approached were more likely to die or have brain tumors. We enrolled 104 patients. Average enrollment rate was one patient per site per month; shortening follow-up from nine to three months (with optional re-enrollment) increased recruitment by 20%. A total of 87 patients completed the study (24 died) and 17 dropped out. Median IA was 41% in the first 20 weeks of follow-up and more than 60% in the eight weeks preceding death. Child/teenager self-report was 94%. Helping others, low burden procedures, incentives, and staff attitude were frequent reasons to enroll/participate. CONCLUSION A PPC-RCT in children with advanced cancer was feasible, post-inclusion retention adequate; many families participated for altruistic reasons. Strategies that may further PPC-RCT feasibility include: increasing target population through large multicenter studies, approaching sicker patients, preventing exclusion of certain patient groups, and improving data collection at end of life.
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Affiliation(s)
- Veronica Dussel
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Liliana Orellana
- Biostatistics Unit Faculty of Health, Deakin University, Victoria, Australia
| | - Natalie Soto
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Kun Chen
- Center for Outcomes and Policy Research, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Christina Ullrich
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Center for Outcomes and Policy Research, Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Department of Medicine, Boston Children's Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
| | - Tammy I Kang
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jeffrey R Geyer
- Division of Pediatric Hematology/Oncology, Seattle Children's Hospital, Seattle, Washington, USA; Fred Hutchinson Cancer Research Center, Seattle, Washington, USA; University of Washington, Seattle, Washington, USA
| | - Chris Feudtner
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Joanne Wolfe
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Center for Outcomes and Policy Research, Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Department of Medicine, Boston Children's Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA.
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Bradford NK, Armfield NR, Young J, Herbert A, Mott C, Smith AC. Principles of a paediatric palliative care consultation can be achieved with home telemedicine. J Telemed Telecare 2014; 20:360-4. [DOI: 10.1177/1357633x14552370] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We compared the records of paediatric palliative consultations undertaken face-to-face, with telemedicine consultations undertaken in patients’ homes. A convenience sample of consecutive paediatric palliative care patients was identified from the hospital's palliative care database. A total of 100 consultations was reviewed (50 telemedicine consultations during home visits and 50 face-to-face consultations) according to 14 established principles and components of a paediatric palliative care consultation. In the telemedicine group there was a higher proportion of patients in a stable condition (58% vs 7%), and a lower proportion of patients in terminal phase (2% vs 17%). Discussion about pain and anorexia were significantly more common in the telemedicine group. Discussion about follow up was significantly more common in the telemedicine group (86% vs 56%), whilst resuscitation planning was more common in deteriorating patients receiving inpatient care. All other components and principles of a palliative care consultation were documented equally regardless of method of consultation. The findings confirm that palliative consultations via telemedicine are just as effective as face-to-face consultations in terms of the documented components of the consultation.
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Affiliation(s)
- Natalie K Bradford
- Centre for Online Health, University of Queensland, Brisbane, Australia
- Queensland Children’s Medical Research Institute, Royal Children’s Hospital, Brisbane, Queensland, Australia
| | - Nigel R Armfield
- Centre for Online Health, University of Queensland, Brisbane, Australia
- Queensland Children’s Medical Research Institute, Royal Children’s Hospital, Brisbane, Queensland, Australia
| | - Jeanine Young
- School of Nursing and Midwifery, University of the Sunshine Coast, Sippy Downs, Queensland, Australia
| | - Anthony Herbert
- Paediatric Palliative Care Service, Royal Children’s Hospital, Brisbane, Queensland, Australia
- Discipline of Paediatrics and Child Health, School of Medicine, University of Queensland, Brisbane, Australia
| | - Christine Mott
- Paediatric Palliative Care Service, Royal Children’s Hospital, Brisbane, Queensland, Australia
| | - Anthony C Smith
- Centre for Online Health, University of Queensland, Brisbane, Australia
- Queensland Children’s Medical Research Institute, Royal Children’s Hospital, Brisbane, Queensland, Australia
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