1
|
Fernando J, Revuelta I, Palou E, Scandurra R, Bayés B, Escarrabill J. Impact of pandemic mobility restrictions on kidney transplant patients' experience: lessons on quality of care. J Nephrol 2024; 37:707-722. [PMID: 38735001 DOI: 10.1007/s40620-024-01905-y] [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: 10/19/2023] [Accepted: 01/15/2024] [Indexed: 05/13/2024]
Abstract
BACKGROUND Patient perspectives on their post-operative health are acknowledged as valuable healthcare outcomes and should be scrupulously considered when designing interventions for patient-centered healthcare. Yet, following the COVID-19 lockdown and in the absence of standardized guidelines on how to best provide virtual chronic care to kidney transplant recipients, little is known about how this unique population coped and managed to comply with public health indications during confinement. METHODS This study addresses this shortcoming by examining the experiences of patients from a tertiary hospital in Spain during the initial weeks of the lockdown decreed by the national government. Specifically, we focus our attention on the perceptions and experiences of these patients by retrieving robust qualitative and quantitative data: the former based on a thematic analysis of focus group transcripts, the latter obtained from a large-scale survey. RESULTS Our findings identify opportunities for improvement in the quality of care and point to the provisions that might be made when facing future pandemics or lockdown-requiring situations. CONCLUSIONS As healthcare services navigate evolving landscapes, our findings on the experience of kidney transplant recipients should enable hospital services to improve the quality of care they are able to provide to such patients during periods of restricted mobility, especially those associated with future disease emergencies, and considering that home confinement is often part of the natural course of post-operative care of these patients.
Collapse
Affiliation(s)
- Joan Fernando
- Patient Experience Observatory, Hospital Clínic Barcelona, Barcelona, Spain.
| | - Ignacio Revuelta
- Department of Nephrology and Renal Transplantation, Hospital Clínic Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Clinical Institute of Nephrology and Urology (LENIT), Barcelona, Spain
- Department of Medicine, University of Barcelona, Barcelona, Spain
- Red de Investigación Renal (REDINREN), Madrid, Spain
| | - Eva Palou
- Patient Experience Observatory, Hospital Clínic Barcelona, Barcelona, Spain
| | - Rosario Scandurra
- Department of Sociology and GEPS, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Beatriu Bayés
- Department of Nephrology and Renal Transplantation, Hospital Clínic Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Clinical Institute of Nephrology and Urology (LENIT), Barcelona, Spain
- Department of Medicine, University of Barcelona, Barcelona, Spain
- Red de Investigación Renal (REDINREN), Madrid, Spain
| | - Joan Escarrabill
- Patient Experience Observatory, Hospital Clínic Barcelona, Barcelona, Spain
| |
Collapse
|
2
|
Jain N, Bernacki RE, Lee KA, Siegel JH, Yenulevich EG, Lally KM. Adaptations within Palliative Care Delivery Models Due to the COVID-19 Pandemic at a Tertiary Care Hospital. J Palliat Med 2023; 26:544-547. [PMID: 36719991 DOI: 10.1089/jpm.2022.0398] [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: 02/02/2023] Open
Abstract
Background: Since the onset of the COVID-19 pandemic, all facets of palliative care provision for patients with serious illness have faced unparalleled challenges. Methods: We describe our palliative care program's response to the increased clinical volume associated with the pandemic by adapting workflows for inpatient and outpatient palliative care teams caring for oncology and nononcology populations. Results: During the initial surge, the demand for palliative care consultation for patients affected by SARS-CoV-2 was high, accounting for 75% of all inpatient palliative care referral requests for oncology and nononcology patients. Furthermore, our ambulatory clinic experienced a 40% increase in visits for complex oncology patients between February and December of 2020. Discussion: This article highlights transformations in palliative care delivery implemented in response to the pandemic and reflects on how these transformations have shaped our current care delivery models. We further delineate our intentional reliance on key population health principles to drive ongoing innovation in palliative care provision across our clinical teams.
Collapse
Affiliation(s)
- Nelia Jain
- Department of Psychosocial Oncology and Palliative Care and Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Division of Palliative Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Rachelle E Bernacki
- Department of Psychosocial Oncology and Palliative Care and Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Division of Palliative Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Kathleen A Lee
- Harvard Medical School, Boston, Massachusetts, USA.,Section of Palliative Care, Division of General Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Jocelyn H Siegel
- Department of Psychosocial Oncology and Palliative Care and Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Eric G Yenulevich
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Kate M Lally
- Department of Psychosocial Oncology and Palliative Care and Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Division of Palliative Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
3
|
Gonella S, Di Giulio P, Berchialla P, Bo M, Cotogni P, Macchi G, Campagna S, Dimonte V. The Impact of Health and Social Care Professionals' Education on the Quality of Serious Illness Conversations in Nursing Homes: Study Protocol of a Quality Improvement Project. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:725. [PMID: 36613049 PMCID: PMC9819581 DOI: 10.3390/ijerph20010725] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 12/23/2022] [Accepted: 12/26/2022] [Indexed: 06/17/2023]
Abstract
Health and social care professionals (HCPs) who work in nursing homes (NHs) are increasingly required to sustain serious illness conversations about care goals and preferences. Although these conversations may also be challenging for experienced HCPs and the literature recognizes high-quality communication as key to providing patient-centered care, so far, no specific educational program has been developed for the NH setting to improve HCPs' communication skills. Our study aims to test the feasibility and potential effectiveness of an innovative, blended communication skills training program (Teach-to-Communicate) targeting the HCPs who work in NHs. This program includes classroom-based theory, experiential learning, and e-learning, and relies on interdisciplinary contexts and several didactic methods. The study consists of two phases: phase I is the development of written resources that employ focus group discussion involving field experts and external feedback from key stakeholders. Phase II consists of a multicenter, pilot, pre-post study with nested qualitative study. The Teach-to-Communicate training program is expected to enhance the quality of communication in NH and HCPs' confidence in sustaining serious illness conversations, reduce family carers' psycho-emotional burden and improve their satisfaction with the care received, and increase advance care planning documentation. Our protocol will provide insight for future researchers, healthcare providers, and policymakers and pave the way for blended educational approaches in the field of communication skills training.
Collapse
Affiliation(s)
- Silvia Gonella
- Direction of Health Professions, City of Health and Science University Hospital of Torino, Corso Bramante 88-90, 10126 Turin, Italy
- Department of Public Health and Pediatrics, University of Torino, via Santena 5 bis, 10126 Turin, Italy
| | - Paola Di Giulio
- Department of Public Health and Pediatrics, University of Torino, via Santena 5 bis, 10126 Turin, Italy
| | - Paola Berchialla
- Department of Clinical and Biological Sciences, University of Torino, via Santena 5 bis, 10126 Torino, Italy
| | - Mario Bo
- Section of Geriatrics, Department of Medical Sciences, University of Torino, City of Health and Science University Hospital of Turin, Corso Bramante 88-90, 10126 Turin, Italy
| | - Paolo Cotogni
- Pain Management and Palliative Care, Department of Anesthesia, Intensive Care and Emergency, University of Torino, City of Health and Science University Hospital of Turin, Corso Bramante 88-90, 10126 Turin, Italy
| | - Giorgia Macchi
- Pain Management and Palliative Care, Department of Anesthesia, Intensive Care and Emergency, University of Torino, City of Health and Science University Hospital of Turin, Corso Bramante 88-90, 10126 Turin, Italy
| | - Sara Campagna
- Department of Public Health and Pediatrics, University of Torino, via Santena 5 bis, 10126 Turin, Italy
| | - Valerio Dimonte
- Direction of Health Professions, City of Health and Science University Hospital of Torino, Corso Bramante 88-90, 10126 Turin, Italy
- Department of Public Health and Pediatrics, University of Torino, via Santena 5 bis, 10126 Turin, Italy
| |
Collapse
|
4
|
Abstract
Hospice and palliative care is a framework of care focused on the palliation of a patient's pain and symptoms while attending to the emotional and spiritual needs of the client caregiver. Telehospice and telepalliative care is the use of telehealth services for delivering hospice and palliative care to patients remotely through videoconferencing, telephonic communication, or remote symptom monitoring and can address the needs of both patients and clients. Telehealth-based interventions can provide hospice and palliative care providers the ability to assess and address patient care needs including the delivery of effective pain and symptom management, timelier assessments and medical interventions, increased compliance, and additional teaching opportunities for clients.
Collapse
|
5
|
Teece K, Oeding K, Nelson P. Adults With Hearing Loss Demonstrate Resilience During COVID-19 Pandemic: Applications for Postpandemic Services. Am J Audiol 2022; 31:392-402. [PMID: 35503964 DOI: 10.1044/2022_aja-21-00234] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has produced unique challenges for persons with hearing loss. There is a unique concern that adults with hearing loss may be more susceptible to isolation than adults with normal hearing. PURPOSE This study explored the impact of the COVID-19 pandemic on the well-being of older adults with and without hearing loss. RESEARCH DESIGN This was a longitudinal study with pre-COVID-19 and six mid-COVID-19 interviews, spanning from March 1, 2020, to October 31, 2020. STUDY SAMPLE The study enrolled 12 participants with hearing aids and 12 with cochlear implants aged 55-80 years that were compared to 18 age-matched adults with hearing within normal limits. DATA COLLECTION AND ANALYSIS Surveys were completed to evaluate the impact of time alone and loneliness, social contact, depression, and the impact of masks on hearing. A mixed-effects statistical model was used to analyze each question. RESULTS Participants commonly reported stress and anxiety during monthly video calls. Adults with varying degrees of hearing loss reported decreased social interaction and increased stress during the pandemic, similar to the rates observed by participants with healthy hearing. Face coverings were commonly reported to affect the intelligibility of conversational speech. Participants with hearing loss found satisfactory methods for maintaining social connection during the pandemic that they hope will continue once restrictions ease fully. CONCLUSIONS Participants from the hearing loss groups in this study were frustrated by challenges posed by facial masks and were resilient in their ability to cope with COVID-19 and found the use of technology to be helpful. Audiologists are encouraged to use these successful electronic means of connecting with their patients even after restrictions are fully lifted.
Collapse
Affiliation(s)
- Katherine Teece
- Department of Speech-Language-Hearing Sciences, University of Minnesota, Minneapolis, Twin Cities
| | - Kristi Oeding
- Department of Speech-Language-Hearing Sciences, University of Minnesota, Minneapolis, Twin Cities
| | - Peggy Nelson
- Department of Speech-Language-Hearing Sciences, University of Minnesota, Minneapolis, Twin Cities
- Center for Applied and Translational Sensory Science, University of Minneapolis, Twin Cities
| |
Collapse
|
6
|
Riccò B, Fiorani C, Ferrara L, Potenza L, Saviola A, Malavasi N, Acquaviva G, Carboni C, Scarabelli L, Dominici M, Luppi M, Longo G. Survey on the effectiveness of telephone-based communication with relatives of hospitalized cancer patients in COVID-19 era in Italy. Support Care Cancer 2022; 30:6007-6012. [PMID: 35399104 PMCID: PMC8995134 DOI: 10.1007/s00520-022-07042-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 04/04/2022] [Indexed: 11/26/2022]
Abstract
Objective Methods Results Conclusion
Collapse
Affiliation(s)
- Beatrice Riccò
- Division of Oncology, Department of Oncology and Hematology, University Hospital of Modena, Via del Pozzo 71, 41125, Modena, Italy.
| | - Claudia Fiorani
- Division of Oncology, Department of Oncology and Hematology, University Hospital of Modena, Via del Pozzo 71, 41125, Modena, Italy
| | - Leonardo Ferrara
- Division of Oncology, Department of Oncology and Hematology, University Hospital of Modena, Via del Pozzo 71, 41125, Modena, Italy
| | - Leonardo Potenza
- Division of Oncology, Department of Oncology and Hematology, University Hospital of Modena, Via del Pozzo 71, 41125, Modena, Italy
| | - Alessia Saviola
- Division of Oncology, Department of Oncology and Hematology, University Hospital of Modena, Via del Pozzo 71, 41125, Modena, Italy
| | - Norma Malavasi
- Division of Oncology, Department of Oncology and Hematology, University Hospital of Modena, Via del Pozzo 71, 41125, Modena, Italy
| | - Gloria Acquaviva
- Division of Oncology, Department of Oncology and Hematology, University Hospital of Modena, Via del Pozzo 71, 41125, Modena, Italy
| | - Chiara Carboni
- Division of Oncology, Department of Oncology and Hematology, University Hospital of Modena, Via del Pozzo 71, 41125, Modena, Italy
| | - Laura Scarabelli
- Division of Oncology, Department of Oncology and Hematology, University Hospital of Modena, Via del Pozzo 71, 41125, Modena, Italy
| | - Massimo Dominici
- Division of Oncology, Department of Oncology and Hematology, University Hospital of Modena, Via del Pozzo 71, 41125, Modena, Italy
| | - Mario Luppi
- Division of Oncology, Department of Oncology and Hematology, University Hospital of Modena, Via del Pozzo 71, 41125, Modena, Italy
| | - Giuseppe Longo
- Division of Oncology, Department of Oncology and Hematology, University Hospital of Modena, Via del Pozzo 71, 41125, Modena, Italy
| |
Collapse
|
7
|
Adánez-Martínez MG, Jiménez-Ruiz I, Carrillo-García C, Díaz-Agea JL, Ramos-Morcillo AJ, Molina-Rodríguez A, Ruzafa-Martínez M, Leal-Costa C. Telephone-Based Structured Communication Simulation Program for the Follow-Up of COVID-19 Cases and Contacts in Primary Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:3915. [PMID: 35409597 PMCID: PMC8997775 DOI: 10.3390/ijerph19073915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/17/2022] [Accepted: 03/22/2022] [Indexed: 11/16/2022]
Abstract
(1) The COVID-19 pandemic has had many consequences on health systems worldwide. In the Spanish health system, telephone-based consultations were coupled to in-person consultations. This type of consultation was mainly a challenge for the primary care teams, who had to assume the greatest load of care provision. The objective of the present study was to discover the satisfaction and perception of health professionals related to a training program on efficient communication based on high-fidelity simulation. (2) Methods: A cross-sectional descriptive study based on a convergent and parallel mixed method. The satisfaction and perception of 275 health professionals associated with COVID-19 training based on the structured communication model CERCAR© was analyzed. (3) Results: The assessment of the satisfaction with the training and methodology was high. With respect to the transfer of information, the participants gave a high score to the categories of consolidation of learning, applicability to their work, and benefits for the institution. The qualitative results supported these findings. (4) Conclusions: The training program and its virtual modality were well received, and had a high degree of transference. The application of active, online learning methodologies is a relevant format for continuous education.
Collapse
Affiliation(s)
| | - Ismael Jiménez-Ruiz
- Faculty of Nursing, University of Murcia, El Palmar, 30120 Murcia, Spain; (C.C.-G.); (A.J.R.-M.); (A.M.-R.); (M.R.-M.)
| | - César Carrillo-García
- Faculty of Nursing, University of Murcia, El Palmar, 30120 Murcia, Spain; (C.C.-G.); (A.J.R.-M.); (A.M.-R.); (M.R.-M.)
- Professional Development Unit, General Directorate of Human Resources, Murcian Health Service, 30003 Murcia, Spain
| | - José Luis Díaz-Agea
- Faculty of Nursing, Catholic University of Murcia, Guadalupe, 30107 Murcia, Spain;
| | - Antonio Jesús Ramos-Morcillo
- Faculty of Nursing, University of Murcia, El Palmar, 30120 Murcia, Spain; (C.C.-G.); (A.J.R.-M.); (A.M.-R.); (M.R.-M.)
| | - Alonso Molina-Rodríguez
- Faculty of Nursing, University of Murcia, El Palmar, 30120 Murcia, Spain; (C.C.-G.); (A.J.R.-M.); (A.M.-R.); (M.R.-M.)
| | - María Ruzafa-Martínez
- Faculty of Nursing, University of Murcia, El Palmar, 30120 Murcia, Spain; (C.C.-G.); (A.J.R.-M.); (A.M.-R.); (M.R.-M.)
| | - César Leal-Costa
- Faculty of Nursing, University of Murcia, El Palmar, 30120 Murcia, Spain; (C.C.-G.); (A.J.R.-M.); (A.M.-R.); (M.R.-M.)
| |
Collapse
|
8
|
Kuo YS, Lu CH, Chiu PW, Chang HC, Lin YY, Huang SP, Wang PY, Chen CJ, Lin IC, Tang JS, Chang YH, Chang RH, Lin CH. Challenges of Using Instant Communication Technology in the Emergency Department during the COVID-19 Pandemic: A Focus Group Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312463. [PMID: 34886188 PMCID: PMC8656867 DOI: 10.3390/ijerph182312463] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 11/21/2021] [Accepted: 11/23/2021] [Indexed: 11/16/2022]
Abstract
A record outbreak of community-spread COVID-19 started on 10 May 2021, in Taiwan. In response to the COVID-19 pandemic, care facilities have adopted various protocols using instant communication technology (ICT) to provide remote yet timely healthcare while ensuring staff safety. The challenges of patient evaluation in the emergency department (ED) using ICT are seldom discussed in the literature. The objective of this study was to investigate the factors influencing the utility of ICT for patient assessment in emergency settings during the pandemic. The patient flow protocol and the ED layout were modified and regionalized into different areas according to the patient’s risk of COVID-19 infection. Nine iPads were stationed in different zones to aid in virtual patient assessment and communication between medical personnel. A focus group study was performed to assess and analyze the utility of the ICT module in the ED. Eight emergency physicians participated in the study. Of them, four (50%) had been directly involved in the development of the ICT module in the study hospital. Three main themes that influenced the application of the ICT module were identified: setting, hardware, and software. The setting theme included six factors: patient evaluation, subspecialty consultation, patient privacy and comfortableness, sanitation, cost, and patient acceptability. The hardware theme included six factors: internet connection, power, quality of image and voice, public or personal mode, portable or fixed mode, and maintenance. The software theme included six factors: platform choices, security, ICT accounts, interview modes, video/voice recording, and time limitation. Future studies should focus on quantifying module feasibility, user satisfaction, and protocol adjustment for different settings.
Collapse
Affiliation(s)
- Yuh-Shin Kuo
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan; (Y.-S.K.); (C.-H.L.); (P.-W.C.); (H.-C.C.); (Y.-Y.L.); (S.-P.H.); (P.-Y.W.); (C.-J.C.); (I.-C.L.); (Y.-H.C.)
| | - Chien-Hsin Lu
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan; (Y.-S.K.); (C.-H.L.); (P.-W.C.); (H.-C.C.); (Y.-Y.L.); (S.-P.H.); (P.-Y.W.); (C.-J.C.); (I.-C.L.); (Y.-H.C.)
| | - Po-Wei Chiu
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan; (Y.-S.K.); (C.-H.L.); (P.-W.C.); (H.-C.C.); (Y.-Y.L.); (S.-P.H.); (P.-Y.W.); (C.-J.C.); (I.-C.L.); (Y.-H.C.)
| | - Hung-Chieh Chang
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan; (Y.-S.K.); (C.-H.L.); (P.-W.C.); (H.-C.C.); (Y.-Y.L.); (S.-P.H.); (P.-Y.W.); (C.-J.C.); (I.-C.L.); (Y.-H.C.)
| | - Yu-Yuan Lin
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan; (Y.-S.K.); (C.-H.L.); (P.-W.C.); (H.-C.C.); (Y.-Y.L.); (S.-P.H.); (P.-Y.W.); (C.-J.C.); (I.-C.L.); (Y.-H.C.)
| | - Shao-Peng Huang
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan; (Y.-S.K.); (C.-H.L.); (P.-W.C.); (H.-C.C.); (Y.-Y.L.); (S.-P.H.); (P.-Y.W.); (C.-J.C.); (I.-C.L.); (Y.-H.C.)
| | - Pei-Yu Wang
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan; (Y.-S.K.); (C.-H.L.); (P.-W.C.); (H.-C.C.); (Y.-Y.L.); (S.-P.H.); (P.-Y.W.); (C.-J.C.); (I.-C.L.); (Y.-H.C.)
| | - Cheng-Jen Chen
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan; (Y.-S.K.); (C.-H.L.); (P.-W.C.); (H.-C.C.); (Y.-Y.L.); (S.-P.H.); (P.-Y.W.); (C.-J.C.); (I.-C.L.); (Y.-H.C.)
| | - I-Chen Lin
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan; (Y.-S.K.); (C.-H.L.); (P.-W.C.); (H.-C.C.); (Y.-Y.L.); (S.-P.H.); (P.-Y.W.); (C.-J.C.); (I.-C.L.); (Y.-H.C.)
| | - Jing-Shia Tang
- Department of Nursing, Chung Hwa University of Medical Technology, Tainan 71703, Taiwan;
- International Doctoral Program in Nursing, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan
| | - Ying-Hsin Chang
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan; (Y.-S.K.); (C.-H.L.); (P.-W.C.); (H.-C.C.); (Y.-Y.L.); (S.-P.H.); (P.-Y.W.); (C.-J.C.); (I.-C.L.); (Y.-H.C.)
| | - Ray Hsienho Chang
- Department of Security and Emergency Services, Embry-Riddle Aeronautical University-Worldwide, Daytona Beach, FL 32114, USA
- Correspondence: (R.H.C.); (C.-H.L.)
| | - Chih-Hao Lin
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan; (Y.-S.K.); (C.-H.L.); (P.-W.C.); (H.-C.C.); (Y.-Y.L.); (S.-P.H.); (P.-Y.W.); (C.-J.C.); (I.-C.L.); (Y.-H.C.)
- Correspondence: (R.H.C.); (C.-H.L.)
| |
Collapse
|
9
|
Klop HT, Nasori M, Klinge TW, Hoopman R, de Vos MA, du Perron C, van Zuylen L, Steegers M, Ten Tusscher BL, Abbink FCH, Onwuteaka-Philipsen BD, Pasman HRW. Family support on intensive care units during the COVID-19 pandemic: a qualitative evaluation study into experiences of relatives. BMC Health Serv Res 2021; 21:1060. [PMID: 34615524 PMCID: PMC8494165 DOI: 10.1186/s12913-021-07095-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 09/22/2021] [Indexed: 12/13/2022] Open
Abstract
Background During the first peak of the COVID-19 pandemic in the Netherlands, relatives of patients with COVID-19 admitted to Intensive Care Units (ICUs) were severely restricted in visiting their relatives and in communicating with treating physicians. Family communication is a core element of critical care, however, this pandemic forced medical ICU staff to arrange alternative family support for instance by Family Support Teams (FSTs), consisting of non-ICU affiliated staff who telephonically contacted relatives. This study aims to examine relatives’ experiences with FSTs on two ICUs of a Dutch university medical centre, and to evaluate its working strategies. . Methods In a semi-structured interview study, relatives of patients with COVID-19 admitted to ICU’s, who had been supported by the FSTs, were sampled purposively. Twenty-one interviews were conducted telephonically by three researchers. All interviews were topic list guided and audio-recorded. Data was analysed thematically. Results All participants indicated they went through a rough time. Almost all evaluated the FSTs positively. Four major themes were identified. First, three important pillars of the FSTs were providing relatives with transparency about the patients’ situation, providing attention to relatives’ well-being, and providing predictability and certainty by calling on a daily basis in a period characterised by insecurity. Second, relatives appeared to fulfil their information needs by calls of the FSTs, but also by calling the attending ICU nurse. Information provided by the FSTs was associated with details and reliability, information provided by nurses was associated with the patient’s daily care. Third, being a primary family contact was generally experienced as both valuable and as an emotional burden. Last, participants missed proper aftercare. Family support often stopped directly after the patient died or had left the ICU. Relatives expressed a need for extended support after that moment since they had strong emotions after discharge or death of the patient. Conclusions Family support in times of the extreme COVID-19 situation is important, as relatives are restricted in communication and have a strong need for information and support. Relatives feel encouraged by structure, frequency, support and understanding by FSTs. However, remote family support should be tailored to the needs of relatives. A fixed contact person on de ICU and video calling might be good extra options for family support, also in future post COVID-19 care, but cannot replace physical visits.
Collapse
Affiliation(s)
- Hanna T Klop
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute (APH), De Boelelaan, 1117, Amsterdam, Netherlands. .,Expertise Center for Palliative Care Amsterdam UMC, Amsterdam, Netherlands.
| | - Mana Nasori
- Department of General Practice, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands
| | - Tjitske W Klinge
- Department of Human Genetics, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands
| | - Rianne Hoopman
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute (APH), De Boelelaan, 1117, Amsterdam, Netherlands.,Expertise Center for Palliative Care Amsterdam UMC, Amsterdam, Netherlands
| | - Mirjam A de Vos
- Department of Paediatrics, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands
| | - Chantal du Perron
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute (APH), De Boelelaan, 1117, Amsterdam, Netherlands
| | - Lia van Zuylen
- Expertise Center for Palliative Care Amsterdam UMC, Amsterdam, Netherlands.,Department of Medical Oncology, Amsterdam UMC, VU Medical Center, De Boelelaan, 1117, Amsterdam, Netherlands
| | - Monique Steegers
- Expertise Center for Palliative Care Amsterdam UMC, Amsterdam, Netherlands.,Department of Anaesthesiology, Amsterdam UMC, VU Medical Center, De Boelelaan, 1117, Amsterdam, Netherlands
| | - Birkitt L Ten Tusscher
- Department of Intensive Care Medicine, Amsterdam UMC, VU Medical Center, De Boelelaan, 1117, Amsterdam, Netherlands
| | - Floor C H Abbink
- Department of Paediatrics, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands
| | - Bregje D Onwuteaka-Philipsen
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute (APH), De Boelelaan, 1117, Amsterdam, Netherlands.,Expertise Center for Palliative Care Amsterdam UMC, Amsterdam, Netherlands
| | - H Roeline W Pasman
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute (APH), De Boelelaan, 1117, Amsterdam, Netherlands.,Expertise Center for Palliative Care Amsterdam UMC, Amsterdam, Netherlands
| |
Collapse
|
10
|
Voices From the Pandemic: A Qualitative Study of Family Experiences and Suggestions Regarding the Care of Critically Ill Patients. Ann Am Thorac Soc 2021; 19:614-624. [PMID: 34436977 PMCID: PMC8996268 DOI: 10.1513/annalsats.202105-629oc] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Rationale Intensive care unit (ICU) visitation restrictions during the coronavirus disease (COVID-19) pandemic have drastically reduced family-engaged care. Understanding the impact of physical distancing on family members of ICU patients is needed to inform future policies. Objectives To understand the experiences of family members of critically ill patients with COVID-19 when physically distanced from their loved ones and to explore ways clinicians may support them. Methods This qualitative study of an observational cohort study reports data from 74 family members of ICU patients with COVID-19 at 10 United States hospitals in four states, chosen based on geographic and demographic diversity. Adult family members of patients admitted to the ICU with COVID-19 during the early phase of the pandemic (February–June 2020) were invited to participate in a phone interview. Interviews followed a semistructured guide to assess four constructs: illness narrative, stress experiences, communication experiences, and satisfaction with care. Interviews were transcribed verbatim and analyzed using an inductive approach to thematic analysis. Results Among 74 interviewees, the mean age was 53.0 years, 55% were white, and 76% were female. Physical distancing contributed to substantial stress and harms (nine themes). Participants described profound suffering and psychological illness, unfavorable perceptions of care, and weakened therapeutic relationship between family members and clinicians. Three communication principles emerged as those most valued by family members: contact, consistency, and compassion (the 3Cs). Family members offered suggestions to guide clinicians faced with communicating with physically distanced families. Conclusions Visitation restrictions impose substantial psychological harms upon family members of critically ill patients. Derived from the voics of family members, our findings warrant strong consideration when implementing visitation restrictions in the ICU and advocate for investment in infrastructure (including staffing and videoconferencing) to support communication. This study offers family-derived recommendations to operationalize the 3Cs to guide and improve communication in times of physical distancing during the COVID-19 pandemic and beyond.
Collapse
|
11
|
Calton BA. Communication Strategies for Providing Palliative Care via Telemedicine #406. J Palliat Med 2021; 24:135-136. [PMID: 33393890 DOI: 10.1089/jpm.2020.0582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
12
|
Menéndez-Colino R, Argentina F, de Miguel AM, Barcons Marqués M, Chaparro Jiménez B, Figueroa Poblete C, Alarcón T, Martínez Peromingo FJ, González-Montalvo JI. [Liaison geriatrics with nursing homes in COVID time. A new coordination model arrived to stay]. Rev Esp Geriatr Gerontol 2021; 56:157-165. [PMID: 33642134 PMCID: PMC7836697 DOI: 10.1016/j.regg.2021.01.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 12/22/2020] [Accepted: 01/07/2021] [Indexed: 01/15/2023]
Abstract
Older people living in nursing homes fulfil the criteria to be considered as geriatric patients, but they often do not have met their health care needs. Current deficits appeared as a result of COVID-19 pandemic. The need to improve the coordination between hospitals and nursing homes emerged, and in Madrid it materialized with the implantation of Liaison Geriatrics teams or units at public hospitals. The Sociedad Española de Geriatría y Gerontología has defined the role of the geriatricians in the COVID-19 pandemic and they have given guidelines about prevention, early detection, isolation and sectorization, training, care homes classification, patient referral coordination, and the role of the different care settings, among others. These units and teams also must undertake other care activities that have a shortfall currently, like nursing homes-hospital coordination, geriatricians visits to the homes, telemedicine sessions, geriatric assessment in emergency rooms, and primary care and public health services coordination. This paper describes the concept of Liaison Geriatrics and its implementation at the Autonomous Community of Madrid hospitals as a result of COVID-19 pandemic. Activity data from a unit at a hospital with a huge number of nursing homes in its catchment area are reported. The objective is to understand the need of this activity in order to avoid the current fragmentation of care between hospitals and nursing homes. This activity should be consolidated in the future.
Collapse
Affiliation(s)
- Rocío Menéndez-Colino
- Servicio de Geriatría. Hospital Universitario La Paz, Madrid, España; Facultad de Medicina. Universidad Autónoma de Madrid, Madrid, España; Instituto de Investigación IdiPAZ, Hospital Universitario La Paz, Madrid, España; Unidad de Geriatría de Enlace, Servicio de Geriatría, Hospital Universitario La Paz, Madrid, España.
| | - Francesca Argentina
- Servicio de Geriatría. Hospital Universitario La Paz, Madrid, España; Unidad de Geriatría de Enlace, Servicio de Geriatría, Hospital Universitario La Paz, Madrid, España
| | - Ana Merello de Miguel
- Servicio de Geriatría. Hospital Universitario La Paz, Madrid, España; Unidad de Geriatría de Enlace, Servicio de Geriatría, Hospital Universitario La Paz, Madrid, España
| | - Montserrat Barcons Marqués
- Servicio de Geriatría. Hospital Universitario La Paz, Madrid, España; Unidad de Geriatría de Enlace, Servicio de Geriatría, Hospital Universitario La Paz, Madrid, España
| | - Blanca Chaparro Jiménez
- Servicio de Geriatría. Hospital Universitario La Paz, Madrid, España; Unidad de Geriatría de Enlace, Servicio de Geriatría, Hospital Universitario La Paz, Madrid, España
| | - Carolina Figueroa Poblete
- Servicio de Geriatría. Hospital Universitario La Paz, Madrid, España; Unidad de Geriatría de Enlace, Servicio de Geriatría, Hospital Universitario La Paz, Madrid, España
| | - Teresa Alarcón
- Servicio de Geriatría. Hospital Universitario La Paz, Madrid, España; Facultad de Medicina. Universidad Autónoma de Madrid, Madrid, España; Instituto de Investigación IdiPAZ, Hospital Universitario La Paz, Madrid, España; Unidad de Geriatría de Enlace, Servicio de Geriatría, Hospital Universitario La Paz, Madrid, España
| | | | - Juan Ignacio González-Montalvo
- Servicio de Geriatría. Hospital Universitario La Paz, Madrid, España; Facultad de Medicina. Universidad Autónoma de Madrid, Madrid, España; Instituto de Investigación IdiPAZ, Hospital Universitario La Paz, Madrid, España; Unidad de Geriatría de Enlace, Servicio de Geriatría, Hospital Universitario La Paz, Madrid, España
| |
Collapse
|
13
|
Maaskant JM, Jongerden IP, Bik J, Joosten M, Musters S, Storm-Versloot MN, Wielenga J, Eskes AM. Strict isolation requires a different approach to the family of hospitalised patients with COVID-19: A rapid qualitative study. Int J Nurs Stud 2021; 117:103858. [PMID: 33621720 PMCID: PMC7834466 DOI: 10.1016/j.ijnurstu.2020.103858] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 12/12/2020] [Accepted: 12/16/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND The outbreak of the COVID-19 pandemic influenced family-centred care dramatically due to restricting visiting policies. In this new situation, nurses were challenged to develop new approaches to involve family members in patient care. A better understanding of these changes and the experiences of nurses is essential to make an adaptation of procedures, and to secure a family-centred approach in care as much as possible. OBJECTIVES The aim of this study was to investigate how family involvement had taken place, and to explore the experiences of nurses with family involvement during the COVID-19 outbreak. In addition, we aimed to formulate recommendations for the involvement of family. METHODS We conducted a qualitative study using patient record review and focus-group interviews between April and July 2020. We reviewed records of patients with confirmed COVID-19, who were admitted to the COVID-19 wards at two affiliated university hospitals in the Netherlands. All records were searched for notations referring to family involvement. In two focus-groups, nurses who worked at the COVID-19 wards were invited to share their experiences. The Rigorous and Accelerated Data Reduction (RADaR) method was used to collect, reduce and analyse the data. RESULTS In total, 189 patient records were reviewed and nine nurses participated in the focus-group meetings. Patient records revealed infrequent and often unstructured communication with focus on physical condition. Nurses confirmed that communication with family was far less than before and that the physical condition of the patient was predominant. The involvement of family in care was limited to practicalities, although more involvement was described in end-of-life situations. Nurses experienced moral distress due to the visiting restrictions, though some acknowledged that they had experienced the direct patient care so intense and burdensome, that family contact simply felt too much. CONCLUSION The communication with and involvement of family in hospital care changed enormously during the COVID-19 outbreak. Based on the identified themes, we formulated recommendations that may be helpful for family-centered care in hospitals during periods of restricted visiting policy.
Collapse
Affiliation(s)
- J M Maaskant
- Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
| | - I P Jongerden
- Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam UMC, VU University, Amsterdam, the Netherlands
| | - J Bik
- Department of Internal Medicine, Amsterdam UMC, VU University, Amsterdam, the Netherlands
| | - M Joosten
- Department of Internal Medicine, Amsterdam UMC, VU University, Amsterdam, the Netherlands
| | - S Musters
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - M N Storm-Versloot
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - J Wielenga
- Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - A M Eskes
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Menzies Health Institute Queensland and School of Nursing and Midwifery, Griffith University, Gold Coast, Australia
| |
Collapse
|
14
|
Saraiva MD, Apolinario D, Avelino-Silva TJ, de Assis Moura Tavares C, Gattás-Vernaglia IF, Marques Fernandes C, Rabelo LM, Tavares Fernandes Yamaguti S, Karnakis T, Kalil-Filho R, Jacob-Filho W, Romero Aliberti MJ. The Impact of Frailty on the Relationship between Life-Space Mobility and Quality of Life in Older Adults during the COVID-19 Pandemic. J Nutr Health Aging 2021; 25:440-447. [PMID: 33786560 PMCID: PMC7678592 DOI: 10.1007/s12603-020-1532-z] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 10/20/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND The COVID-19 pandemic has led to abrupt restrictions of life-space mobility. The impact of shelter-in-place orders on older adults' health and well-being is still unclear. OBJECTIVE To investigate the relationship between life-space mobility and quality of life (QoL) in older adults with and without frailty during the COVID-19 pandemic. DESIGN Multicenter prospective cohort study based on structured telephone interviews. SETTING Four geriatric outpatient clinics in the metropolitan area of Sao Paulo, Brazil. PARTICIPANTS 557 community-dwelling adults aged 60 years and older. MEASUREMENTS The Life-Space Assessment was used to measure community mobility before and during the COVID-19 pandemic, and a previously validated decrease of ≥ 5 points defined restricted life-space mobility. Frailty was assessed through the FRAIL (fatigue, resistance, ambulation, illnesses, and loss of weight) scale. The impact of shelter-in-place orders on QoL was evaluated with the question «How is the COVID-19 pandemic affecting your QoL?», to which participants could respond «not at all», «to some extent», or «to a great extent». We used ordinal logistic regressions to investigate the relationship between restricted life-space mobility and impact on QoL, adjusting our analyses for demographics, frailty, comorbidities, cognition, functionality, loneliness, depression, and anxiety. We explored whether frailty modified the association between life-space mobility and impact on QoL. RESULTS Participants were on average 80±8 years old, 65% were women, and 33% were frail. The COVID-19 quarantine led to a restriction of community mobility in 79% of participants and affected the QoL for 77% of participants. We found that restricted life-space mobility was associated with impact on QoL in older adults during the pandemic, although frailty modified the magnitude of the association (P-value for interaction=0.03). Frail participants who experienced restricted life-space mobility had twice the odds of reporting an impact on QoL when compared with non-frail individuals, with respective adjusted odds ratios of 4.20 (95% CI=2.36-7.50) and 2.18 (95% CI=1.33-3.58). CONCLUSION Older adults experienced substantial decreases in life-space mobility during the COVID-19 pandemic, and this unexpected change impacted their QoL. Providers should be particularly watchful for the consequences of abrupt life-space restrictions on frail individuals.
Collapse
Affiliation(s)
- M D Saraiva
- Márlon Juliano Romero Aliberti, Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo. Av. Dr. Eneas de Carvalho Aguiar 155, 8º andar, Clinica Medica, LIM-66, Cerqueira Cesar, Sao Paulo - SP, 05403-000, Brazil. Tel.: +55-11-26618116. E-mail address:
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Calton B, Shibley WP, Cohen E, Pantilat SZ, Rabow MW, O'Riordan DL, Bischoff KE. Patient and Caregiver Experience with Outpatient Palliative Care Telemedicine Visits. Palliat Med Rep 2020; 1:339-346. [PMID: 34223495 PMCID: PMC8241370 DOI: 10.1089/pmr.2020.0075] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2020] [Indexed: 01/21/2023] Open
Abstract
Background: Telemedicine visits reduce the physical and financial burdens associated with in-person appointments, especially for patients with serious illness. Little is known about patient and caregiver preferences regarding telemedicine visit timing and the discussion of sensitive topics by telemedicine. Objective: To characterize the experience of patients with serious illness and their caregivers receiving palliative care (PC) by telemedicine. Design: Mixed-methods telephone survey. Setting/Subjects: Patients and family caregivers who had at least one telemedicine visit with the outpatient PC team at our urban academic medical center. Results: A total of 35 patients and 15 caregivers were surveyed. Patient mean age was 61 years, 49% had cancer, and 86% were Caucasian. Caregiver mean age was 62 years. Mean satisfaction with PC telemedicine visits was 8.9 out of 10 for patients; 8.8 for caregivers. Patients (97%) and caregivers (100%) felt comfortable discussing sensitive topics over video. Participants felt telemedicine was an acceptable format to discuss most sensitive topics but 53% of caregivers preferred to receive bad news in person. Participants valued the convenience of telemedicine; they had concerns about rapport building and desired a more user-friendly telemedicine platform. Conclusions: Patients with serious illness and their caregivers rated telemedicine visits highly and felt comfortable discussing sensitive topics by video. Concerns included rapport building and telemedicine platform setup and quality. The rapid growth of telemedicine during coronavirus disease 2019 creates an imperative for research to understand the impact on the quality of care and mitigate any negative effects of telemedicine within a diverse population of patients.
Collapse
Affiliation(s)
- Brook Calton
- Division of Palliative Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | | | - Eve Cohen
- Division of Palliative Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Steven Z Pantilat
- Division of Palliative Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Michael W Rabow
- Division of Palliative Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - David L O'Riordan
- Division of Palliative Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Kara E Bischoff
- Division of Palliative Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| |
Collapse
|
16
|
Krishnaswami A, Beavers C, Dorsch MP, Dodson JA, Masterson Creber R, Kitsiou S, Goyal P, Maurer MS, Wenger NK, Croy DS, Alexander KP, Batsis JA, Turakhia MP, Forman DE, Bernacki GM, Kirkpatrick JN, Orr NM, Peterson ED, Rich MW, Freeman AM, Bhavnani SP. Gerotechnology for Older Adults With Cardiovascular Diseases: JACC State-of-the-Art Review. J Am Coll Cardiol 2020; 76:2650-2670. [PMID: 33243384 PMCID: PMC10436190 DOI: 10.1016/j.jacc.2020.09.606] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 08/18/2020] [Accepted: 09/21/2020] [Indexed: 12/19/2022]
Abstract
The growing population of older adults (age ≥65 years) is expected to lead to higher rates of cardiovascular disease. The expansion of digital health (encompassing telehealth, telemedicine, mobile health, and remote patient monitoring), Internet access, and cellular technologies provides an opportunity to enhance patient care and improve health outcomes-opportunities that are particularly relevant during the current coronavirus disease-2019 pandemic. Insufficient dexterity, visual impairment, and cognitive dysfunction, found commonly in older adults should be taken into consideration in the development and utilization of existing technologies. If not implemented strategically and appropriately, these can lead to inequities propagating digital divides among older adults, across disease severities and socioeconomic distributions. A systematic approach, therefore, is needed to study and implement digital health strategies in older adults. This review will focus on current knowledge of the benefits, barriers, and use of digital health in older adults for cardiovascular disease management.
Collapse
Affiliation(s)
- Ashok Krishnaswami
- Division of Cardiology, Kaiser Permanente Medical Center, San Jose, California.
| | - Craig Beavers
- Division of Pharmacy, University of Kentucky, Lexington, Kentucky
| | - Michael P Dorsch
- College of Pharmacy, University of Michigan, Ann Arbor, Michigan
| | - John A Dodson
- NYU Langone Health, NYU Grossman School of Medicine, New York, New York
| | - Ruth Masterson Creber
- Weill Cornell Medicine, Department of Population Health Sciences, Division of Health Informatics, New York, New York
| | - Spyros Kitsiou
- Department of Biomedical and Health Information Sciences, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, Illinois
| | - Parag Goyal
- Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Mathew S Maurer
- Division of Cardiology, Columbia University Medical Center, New York, New York
| | - Nanette K Wenger
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | | | - Karen P Alexander
- Division of Cardiology, Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
| | - John A Batsis
- Department of Medicine, Geisel School of Medicine and The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College and Dartmouth-Hitchcock, Lebanon, New Hampshire; Division of Geriatric Medicine, School of Medicine, Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill. Chapel Hill, North Carolina
| | - Mintu P Turakhia
- Center for Digital Health, Stanford University, Stanford, California; Palo Alto Veterans Administration Health Care System, Palo Alto, California
| | - Daniel E Forman
- Division of Geriatric Cardiology, University of Pittsburgh, Geriatric Research, Education and Clinical Center; VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Gwen M Bernacki
- Cardiovascular Division, Department of Medicine, Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington
| | - James N Kirkpatrick
- Cardiovascular Division, Department of Medicine, Department of Bioethics and Humanities, University of Washington, Seattle, Washington
| | - Nicole M Orr
- Post-Acute Cardiology Care, LCC, Darien, Connecticut; Division of Cardiology, Tufts Medical Center, Boston, Massachusetts
| | - Eric D Peterson
- Division of Cardiology, Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
| | - Michael W Rich
- Cardiovascular Division, Washington University, St. Louis, Missouri
| | - Andrew M Freeman
- Division of Cardiology, Department of Medicine, National Jewish Health, Denver, Colorado
| | - Sanjeev P Bhavnani
- Prebys Cardiovascular Institute, Scripps Clinic & Research Foundation, San Diego, California
| |
Collapse
|
17
|
Jumreornvong O, Yang E, Race J, Appel J. Telemedicine and Medical Education in the Age of COVID-19. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2020; 95:1838-1843. [PMID: 32889946 PMCID: PMC7489227 DOI: 10.1097/acm.0000000000003711] [Citation(s) in RCA: 119] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
The COVID-19 pandemic has offered medical schools an opportunity to incorporate telemedicine training into the curricula in a timely and practical manner. Telemedicine has grown exponentially in the United States, and the shift toward remote care to align with social distancing guidelines is fueling this growth. Training medical students to deliver high-quality, secure, and personalized health care through telemedicine will prepare the next generation of physicians to conscientiously use these technologies and meet a growing need for telehealth services. Telemedicine-specific educational goals can be incorporated into curricula and integrated with existing clinical experiences to provide students with core telemedicine and clinical skills to prepare them for current and future pandemics. Medical educators could explore 5 major telemedicine domains: (1) access to care, (2) cost, (3) cost-effectiveness, (4) patient experience, and (5) clinician experience. Schools could use the following learning vehicles to help medical students explore these domains: (1) asynchronous lectures covering telehealth history; (2) discussions on applications, ethics, safety, etiquette, and patient considerations; (3) faculty-supervised standardized patient telehealth encounters; and (4) hands-on diagnostic or therapeutic procedures using telehealth equipment. Incorporating telemedicine into the medical school curriculum exposes students to the application of telemedicine across specialties as well as its limitations.
Collapse
Affiliation(s)
- Oranicha Jumreornvong
- O. Jumreornvong is a third-year student, Icahn School of Medicine at Mount Sinai, New York, New York; ORCID: https://orcid.org/0000-0001-7327-9514
| | - Emmy Yang
- E. Yang is a fourth-year student, Icahn School of Medicine at Mount Sinai, New York, New York; ORCID: https://orcid.org/0000-0001-8966-9971
| | - Jasmine Race
- J. Race is a fourth-year student, Icahn School of Medicine at Mount Sinai, New York, New York; ORCID: https://orcid.org/0000-0001-9077-5085
| | - Jacob Appel
- J. Appel is assistant professor, Departments of Psychiatry and Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York; ORCID: https://orcid.org/0000-0003-3523-9145
| |
Collapse
|
18
|
Ritchey KC, Foy A, McArdel E, Gruenewald DA. Reinventing Palliative Care Delivery in the Era of COVID-19: How Telemedicine Can Support End of Life Care. Am J Hosp Palliat Care 2020; 37:992-997. [PMID: 32762477 PMCID: PMC7488822 DOI: 10.1177/1049909120948235] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Telemedicine technology has become essential to healthcare delivery in the COVID-19 era, but concerns remain regarding whether the intimacy and communication that is central to high-quality palliative care will be compromised by the use of this technology. We employed a business model approach to identify the need for system innovation in palliative care, and a quality improvement approach to structure the project. Products from this project included a standard operating procedure for safe use of tablet computers for inpatient palliative care consultations and family visitations; tablet procurement with installation of video telehealth software; and training and education for clinical staff and other stakeholders. We describe a case illustrating the successful use of palliative care telehealth in the care of a COVID-19-positive patient at the end of life. Successful use of video telehealth for palliative care involved overcoming inertia to the development of telehealth infrastructure and learning clinical video telehealth skills; and engaging front-line care staff and family members who were open to a trial of telehealth for communication. Information gleaned from family about the patient as a person helped bedside staff to tailor care toward aspects meaningful to the patient and family and informed best practices to incorporate intimacy into future palliative video consultations and family visit.
Collapse
Affiliation(s)
- Katherine C. Ritchey
- Palliative Care and Hospice Service, Geriatrics and Extended Care Service, Veterans Affairs Puget Sound Healthcare System, Seattle, WA, USA
- Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Alice Foy
- Palliative Care and Hospice Service, Geriatrics and Extended Care Service, Veterans Affairs Puget Sound Healthcare System, Seattle, WA, USA
| | - Erin McArdel
- Chaplain Service, Palliative Care and Hospice Service, Veterans Affairs Puget Sound Healthcare System, Seattle, WA, USA
| | - David A. Gruenewald
- Palliative Care and Hospice Service, Geriatrics and Extended Care Service, Veterans Affairs Puget Sound Healthcare System, Seattle, WA, USA
- Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| |
Collapse
|