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May S, Gehlhaar A, Stahlhut K, Kamp MA, Heinze M, Allsop M, Muehlensiepen F. "Let's put it this way: you can't really live without it" - digital technologies in routine palliative care delivery: an explorative qualitative study with patients and their family caregivers in Germany. BMC Health Serv Res 2024; 24:702. [PMID: 38831314 PMCID: PMC11149286 DOI: 10.1186/s12913-024-11150-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 05/27/2024] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND Despite ongoing efforts to integrate palliative care into the German healthcare system, challenges persist, particularly in areas where infrastructure does not fully support digital technologies (DT). The increasing importance of digital technology (DT) in palliative care delivery presents both opportunities and challenges. OBJECTIVE This study aimed to explore the perspectives and preferences of palliative care patients and their family caregivers regarding the use of DT in care delivery. METHODS An exploratory qualitative study was conducted using semi-structured interviews with palliative care patients and their family caregivers across various settings. Participants were selected through gatekeeper-supported purposive sampling. Interviews were analysed using structured qualitative content analysis. RESULTS Nineteen interviews were conducted.Three themes emerged: (1) Application of DTs in palliative care; (2) Potential of DTs; (3) Barriers to the use of DTs. Key findings highlighted the preference for real-time communication using DTs that participants are familiar with. Participants reported limited perceived value for digital transformation in the presence of in-person care. The study identified requirements for DT development and use in palliative care, including the need for direct and immediate functionality, efficiency in healthcare professional (HCP) work, and continuous access to services. CONCLUSION The findings highlight a demonstrate the importance of familiarity with DTs and real-time access for patients and their families. While DT can enhance palliative care efficiency and accessibility, its integration must complement, not replace, in-person interaction in palliative care. As DTs continue to grow in scope and use in palliative care, maintaining continued user engagement is essential to optimise their adoption and ensure they benefit patients and their caregivers.
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Affiliation(s)
- Susann May
- Center for Health Services Research, Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Seebad 82/83, 15562, Rüdersdorf, Brandenburg, Germany
| | - Anne Gehlhaar
- Center for Health Services Research, Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Seebad 82/83, 15562, Rüdersdorf, Brandenburg, Germany
| | - Kerstin Stahlhut
- Department of Oncology and Palliative Medicine, Brandenburg Medical School, Immanuel Klinik Rüdersdorf, 15562, Rüdersdorf, Brandenburg, Germany
| | - Marcel-Alexander Kamp
- Department of Oncology and Palliative Medicine, Brandenburg Medical School, Immanuel Klinik Rüdersdorf, 15562, Rüdersdorf, Brandenburg, Germany
| | - Martin Heinze
- Center for Health Services Research, Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Seebad 82/83, 15562, Rüdersdorf, Brandenburg, Germany
- Department of Psychiatry and Psychotherapy, Brandenburg Medical School, Immanuel Klinik Rüdersdorf, 15562, Rüdersdorf, Germany
| | - Matthew Allsop
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, LS2 9JT, UK
| | - Felix Muehlensiepen
- Center for Health Services Research, Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Seebad 82/83, 15562, Rüdersdorf, Brandenburg, Germany.
- AGEIS, Université Grenoble-Alpes, Grenoble, 38000, France.
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Bernhardt F, Bückmann A, Krüger J, Bauer B, Hofmeister U, Juhra C, Eveslage M, Fischhuber K, Storck M, Brix TJ, Lenz P. Telemedicine Plus Standard Care Versus Standard Care Only in Specialized Outpatient Palliative Care: A Randomized Controlled Noninferiority Trial. Telemed J E Health 2024; 30:1459-1469. [PMID: 38294865 DOI: 10.1089/tmj.2023.0621] [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: 02/01/2024] Open
Abstract
Background: Patients suffering from incurable diseases are more likely to die in the hospital than at home. Specialized outpatient palliative care (PC) may be able to counteract this tendency. Similarly, potential benefits of telemedicine in health care were scientifically reported. The aim of this research was to compare patients receiving specialized outpatient PC plus telemedicine with those receiving standard specialized outpatient PC only. In this study, telemedicine is assumed to decrease the number of home visits and therefore should not be considered a mere add-on. Methods: This is a randomized controlled noninferiority trial. Recruitment lasted between January 2020 and October 2021. Quality of care was evaluated using the Integrated Palliative Care Outcome Scale (IPOS) at day 0, 7, and 14 after randomization. Change from day 0 to 7 was defined as the primary outcome (noninferiority margin = 4 points). This study was conducted in an urban setting in collaboration with a university hospital and a local specialized outpatient PC service. Results: A total of 196 patients were screened with 34 patients included (18 telemedicine/16 standard care). The mean change in the total score of the IPOS from day 0 to 7 amounted to -1.8 ± 3.9 (telemedicine) versus 1.2 ± 5.7 (standard care). The telemedicine group was statistically not relevantly inferior to the standard care group (t-test for noninferiority, p = 0.005). Conclusions: Although, due to COVID-19, the sample size remained rather small, our findings indicate that telemedical approaches offer a promising and equally effective option to provide specialized outpatient PC. Clinical Trial Registration Number: NCT06054048.
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Affiliation(s)
- Florian Bernhardt
- Department of Palliative Care, University Hospital Muenster, Muenster, Germany
- West German Cancer Center Consortium, Network Partner Muenster, University Hospital Muenster, Muenster, Germany
| | - Andreas Bückmann
- Department of Palliative Care, University Hospital Muenster, Muenster, Germany
- West German Cancer Center Consortium, Network Partner Muenster, University Hospital Muenster, Muenster, Germany
| | - Janina Krüger
- Specialized Outpatient Palliative Care Service Muenster, Palliativnetz Muenster gGmbH, Muenster, Germany
| | - Birgit Bauer
- Specialized Outpatient Palliative Care Service Muenster, Palliativnetz Muenster gGmbH, Muenster, Germany
| | - Ulrike Hofmeister
- Specialized Outpatient Palliative Care Service Muenster, Palliativnetz Muenster gGmbH, Muenster, Germany
| | - Christian Juhra
- Office for eHealth, University Hospital Muenster, Muenster, Germany
| | - Maria Eveslage
- Institute of Biostatistics and Clinical Research, University of Muenster, Muenster, Germany
| | - Karen Fischhuber
- Institute of Biostatistics and Clinical Research, University of Muenster, Muenster, Germany
| | - Michael Storck
- Institute of Medical Informatics, University of Muenster, Muenster, Germany
| | - Tobias J Brix
- Institute of Medical Informatics, University of Muenster, Muenster, Germany
| | - Philipp Lenz
- Department of Palliative Care, University Hospital Muenster, Muenster, Germany
- West German Cancer Center Consortium, Network Partner Muenster, University Hospital Muenster, Muenster, Germany
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Weihermann GA, Bernhardt F, Brix TJ, Baumeister SE, Lenz P. Role and relevance of dentists in a multiprofessional palliative care team: results of a cross-sectional survey study. Support Care Cancer 2024; 32:159. [PMID: 38361035 PMCID: PMC10869371 DOI: 10.1007/s00520-024-08356-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 02/05/2024] [Indexed: 02/17/2024]
Abstract
PURPOSE Despite the multiprofessional concept surrounding palliative care patients (PCPs) and their high prevalence of oral issues, licensed dentists (LDs) are often not included in their treatment team. This study aimed to examine the current state of cooperation and to determine whether and how LDs should be included in the care for PCPs. METHODS This single-centre cross-sectional study was conducted at the University Hospital Muenster, Germany. We surveyed three participant groups: PCPs, LDs, and healthcare professionals (HCPs). Questionnaires were tailored for each group, with some questions common for comparison. RESULTS The study encompassed the results of 48 questionnaires from LDs, 50 from PCPs along with 50 from HCPs. Consensus was reached among all parties (LDs: 73% (n = 35/48); HCPs: 94%, n = 47/50; PCPs: 60%, n = 30/50) that involving LDs in the treatment concept is favourable. On the other hand, a significant discrepancy emerged in the perception of the dental treatment effort required by PCPs. While LDs (81%; n = 39/48) and HCPs (64%; n = 32/50) were convinced of increased effort, PCPs (34%; n = 17/50) largely did not share this perspective. To enhance patient care and formulate appropriate treatment plans, LDs consider both training (58%; n = 28/48) and guidebooks (71%; n = 34/48) to be valuable and would attend or use such resources. CONCLUSION This study sheds light on the current gaps in including LDs in palliative care teams and emphasizes the importance of multidisciplinary collaboration to address oral health needs effectively. Development of continuing education options and collaborative models between LDs and HCPs needs to be further expanded in future.
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Affiliation(s)
| | - Florian Bernhardt
- Department of Palliative Care, University Hospital Muenster, 48149, Muenster, Germany
| | - Tobias J Brix
- Institute of Medical Informatics, University of Muenster, 48149, Muenster, Germany
| | | | - Philipp Lenz
- Department of Palliative Care, University Hospital Muenster, 48149, Muenster, Germany.
- Department of Palliative Care, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building W 30, D-48149, Muenster, Germany.
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Lantheaume S, Doublet L, Mory JE, Durand T, Lebosse W, Heudel PE. A qualitative study of teleconsultation practices among French oncologists in a post-COVID-19 period. Digit Health 2023; 9:20552076231215906. [PMID: 38033511 PMCID: PMC10685777 DOI: 10.1177/20552076231215906] [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: 07/31/2023] [Accepted: 11/06/2023] [Indexed: 12/02/2023] Open
Abstract
Background The Covid-19 pandemic has prompted healthcare professionals to adapt and implement new tools to ensure continuity of patient care. Teleconsultation became the only option for some practitioners who had never used it previously and boosted its use for others who already used it. Several studies have reviewed the use of teleconsultation in oncology during the epidemic, but few have addressed its continued use and how practitioners view it in a post-epidemic period. The aim of this survey was to conduct a qualitative exploration of how oncologists use teleconsultation in their daily practice in a post-COVID 19 period. Materials and Methods For this qualitative study, semi-structured interviews were conducted with oncologists in France who utilized teleconsultation in the field of oncology during the COVID-19 period. The interview guide included questions on the interests and limitations of using teleconsultation in oncology, on reluctance to use it among oncologists, and invited participants to formulate proposals for more optimal use. Results Fourteen oncologists participated in the survey. Currently, 12% of the consultations of the surveyed practitioners are conducted via teleconsultation. Seven themes were identified in the analysis of the interviews: (a) The oncologist and teleconsultation; (b) Clinical motivations for using teleconsultation; (c) Comparison between teleconsultation and in-person consultation; (d) Advantages and disadvantages of teleconsultation; (e) Technical modalities of teleconsultation; (f) Role of Covid and confinement in the use of teleconsultation; (h) Epistemic judgments about teleconsultation. Optimal teleconsultation occurs when seamlessly incorporated into patient care, offering reduced patient inconvenience, and providing economic and environmental benefits. Although there's a lack of unified agreement in research literature regarding time efficiency, teleconsultation facilitates more customized patient monitoring and addresses the challenge of "medical deserts" nationally. Considering patient preferences is crucial when contemplating the use of teleconsultation. Predominantly, technical issues stand as the principal barriers to teleconsultation implementation. Conclusion Even after the end of the health crisis, teleconsultation is still used in clinical practice. Recommendations for effective use are suggested.
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Affiliation(s)
- Sophie Lantheaume
- Ramsay Santé Hôpital Privé Drôme Ardèche, 07500 Guilherand-Granges, France
- Univ. Grenoble Alpes, Univ. Savoie Mont Blanc, LIP/PC2S, 38000 Grenoble, France
| | - Louis Doublet
- Ramsay Santé Hôpital Privé Drôme Ardèche, 07500 Guilherand-Granges, France
| | - Jean-Eudes Mory
- Ramsay Santé Hôpital Privé Drôme Ardèche, 07500 Guilherand-Granges, France
- Centre de Coordination de Cancérologie Drôme Ardèche, 26000 Valence, France
| | - Thierry Durand
- Direction des systèmes d’information, centre Léon Bérard, 69008 Lyon, France
| | - William Lebosse
- Centre de Coordination de Cancérologie Rhodanien, Centre Léon Bérard, 69008 Lyon, France
| | - Pierre-Etienne Heudel
- Centre de Coordination de Cancérologie Rhodanien, Centre Léon Bérard, 69008 Lyon, France
- Département d’Oncologie Médicale, Centre Léon Bérard, 69008 Lyon, France
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