Breaking Access and Distance Barriers: Using Innovative Modalities of Tele-Palliative Care (TH364) (original) (raw)
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Best Practices for Providing Patient-Centered Tele-Palliative Care to Cancer Patients
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Cancer patients receiving palliative care may face significant challenges in attending outpatient appointments. Patients on controlled substances such as opioids require frequent visits and often rely on assistive devices and/or a caregiver to accompany them to these visits. In addition, pain, fatigue, and shortness of breath may magnify the challenges associated with in-person visits. The rapid adoption of telemedicine in response to the COVID-19 pandemic has proven to be highly beneficial for advanced cancer patients and caregivers. The hurried COVID-19-related implementation of telemedicine is now evolving into a permanent platform for providing palliative care. This review will focus on the best practices and recommendations to deliver high-quality, interdisciplinary tele-palliative care.
Telemedicine for palliative care: Current and future challenges
Annals Academy of Medicine Singapore, 2021
Telemedicine for palliative care: Current and future challenges LETTER TO THE EDITOR Dear Editor, We read with interest the article published in the June 2021 issue of the Annals titled "Use of telemedicine in healthcare during COVID-19 in Pakistan: Lessons, legislation challenges and future perspective". 1 We would like to share our perspectives on using telemedicine to deliver palliative care during the COVID-19 pandemic. On 23 January 2020, Singapore reported its first confirmed case of COVID-19 and between 7 April 2020 and 1 June 2020, a "circuit breaker" was implemented. During this period, non-essential medical services and procedures were deferred and encouraged to be delivered remotely if possible. 2 At the same time, buildings were converted to care facilities, and professionals were redeployed away from their primary roles to meet the demands of curbing COVID-19 cases. Therefore, our palliative care team adjusted the delivery of its services to adapt to the changes brought about by the pandemic. 3 Currently, Singapore is one of the countries in Asia with guidelines to regulate telemedicine, which has resulted in a thriving ecosystem of digital health providers in Singapore. Studies conducted across Europe have found that using telemedicine to provide palliative care improved patients' access to healthcare professionals from home, enhanced their sense of security and safety, and allowed a close connectedness with their healthcare providers. 4 However, patients in Singapore may have different levels of technological and health literacy compared to Western patients. Furthermore, providing palliative care remotely is relatively new, and few studies have been conducted in Singapore to explore its acceptability. Therefore, our team designed a study to pilot the acceptability of providing palliative care via telemedicine to advanced cancer patients in Singapore. This programme was overseen by a palliative care consultant (at 0.1 full-time equivalent [FTE]) and a palliative care nurse (at 0.6 FTE). Upon referral from oncologists, patients were screened for recruitment into the study. The telemedicine service provided as part of the study consisted of an initial video consult with a palliative care nurse and consultant, targeting patients' reported symptoms and problems (Week 1). For the subsequent 11 weeks (Week 2-12), patients were monitored weekly through the Integrated Palliative
PloS one, 2015
The problems and needs of advanced cancer patients and proxies normally increase as the disease progresses. Home-based advanced cancer patients and their proxies benefit from collaborations between primary care physicians and hospital-based palliative care specialists when confronted with complex problems in the last phase of life. Telemedicine might facilitate direct, patient-centered communication between patients and proxies, primary care physicians, and specialist palliative care teams (SPCTs). This study focuses on the impact of teleconsultation technologies on the relationships between home-based palliative care patients and hospital-based palliative care specialists. This work consists of a qualitative study among patients, family members, and caregivers that utilizes long-term direct observations, semi-structured interviews, and open interviews following the observations. The analysis of the empirical data resulted in three key concepts that describe the impact of teleconsul...
The Joint Commission Journal on Quality and Patient Safety
Palliative Care Facts and Stats Ò Approximately 90 million Americans are living with serious illness, and this number is expected to more than double over the next 25 years with the aging of the baby boomers. Ò Approximately 6,000,000 people in the United States could benefit from palliative care. Ò Palliative care is the medical specialty focused on improving quality of life for people facing serious illness. Ò Palliative care provides relief from the symptoms and stress of a serious illness. Ò The goal is to improve quality of life for both the patient and their family. Ò Palliative care is provided by an interdisciplinary team of palliative care specialists, including doctors, nurses, social workers and others who work with a patient's other doctors to provide an extra layer of support. Ò Palliative care is appropriate at any age and at any stage in a serious illness, and it can be provided together with curative treatment. To learn more about CAPC and palliative care, please contact us.
F1000 - Post-publication peer review of the biomedical literature
The problems and needs of advanced cancer patients and proxies normally increase as the disease progresses. Home-based advanced cancer patients and their proxies benefit from collaborations between primary care physicians and hospital-based palliative care specialists when confronted with complex problems in the last phase of life. Telemedicine might facilitate direct, patient-centered communication between patients and proxies, primary care physicians, and specialist palliative care teams (SPCTs). This study focuses on the impact of teleconsultation technologies on the relationships between home-based palliative care patients and hospital-based palliative care specialists. Methods This work consists of a qualitative study among patients, family members, and caregivers that utilizes long-term direct observations, semi-structured interviews, and open interviews following the observations. Results The analysis of the empirical data resulted in three key concepts that describe the impact of teleconsultation on the patient-professional relationship in palliative homecare: transcending the institutional walls of home and hospital; transparency of teleconsultation technology; and technologized, intimate patient-professional relationships. Teleconsultation offers (1) condensed encounters between home-based palliative care patients and distant professionals, (2) a unique insight into the patients' daily lives for palliative care specialists, and (3) long-term interaction that results in trustful relationships and experiences of intimacy and relief.
BMC Palliative Care, 2011
Background: Due to the growing number of elderly with advanced chronic conditions, healthcare services will come under increasing pressure. Teleconsultation is an innovative approach to deliver quality of care for palliative patients at home. Quantitative studies assessing the effect of teleconsultation on clinical outcomes are scarce. The aim of this present study is to investigate the effectiveness of teleconsultation in complex palliative homecare. Methods/Design: During a 2-year recruitment period, GPs are invited to participate in this cluster randomized controlled trial. When a GP refers an eligible patient for the study, the GP is randomized to the intervention group or the control group. Patients in the intervention group have a weekly teleconsultation with a nurse practitioner and/or a physician of the palliative consultation team. The nurse practitioner, in cooperation with the palliative care specialist of the palliative consultation team, advises the GP on treatment policy of the patient. The primary outcome of patient symptom burden is assessed at baseline and weekly using the Edmonton Symptom Assessment Scale (ESAS) and at baseline and every four weeks using the Hospital Anxiety and Depression Scale (HADS). Secondary outcomes are self-perceived burden from informal care (EDIZ), patient experienced continuity of medical care (NCQ), patient and caregiver satisfaction with the teleconsultation (PSQ), the experienced problems and needs in palliative care (PNPC-sv) and the number of hospital admissions.
Psychosocial challenges in palliative care: Bridging the gaps using digital health
2020
Psychosocial health is a major palliative care concern globally. Patients and caregivers engaged in palliative care may experience deteriorated mental and social health conditions. Global evidence informs a high burden of depression, anxiety, psychological distress, and other mental health problems among the palliative care populations. Those challenges aggravate the preexisting palliative care issues, such as lack of access and suboptimal quality of care. Palliative caregiving, both in the institutional and community settings, should be strengthened, incorporating psychosocial support for the patients and their caregivers. The recent advancements in digital health technologies have shown promising impacts in facilitating health communication, decision-making, and delivering psychosocial interventions using digital devices and platforms. Adopting evidence-based interventions can help the users to access mental health resources and communicate with each other to promote shared decisi...
Understanding and Accessing Palliative Care Services for Patients with Progressive Illness
Osteopathic Family Physician, 2014
As our country’s population ages, there are more patients with advanced chronic illness and increasingly complex care needs. Our rapidly changing healthcare environment now recognizes the importance of improving care quality to achieve better health outcomes while lowering cost and improving patient satisfaction. This focus solidified the emergence of Palliative Care as an essential specialty to provide the comprehensive care that these patients with advanced chronic illness require. Palliative Care assists patients and families with difficult decision-making, addresses pain and other distressing symptoms, helps prolong life, controls costs, and most importantly, improves patient and family satisfaction. To maximize the benefits of palliative care, practicing Family Physicians need to develop primary palliative care knowledge and skills while recognizing when specialty level palliative care is required. Prognostication is an essential skill as it allows patients and families to esta...
Journal of Palliative Medicine
Introduction: Early palliative care (PC) integrated with oncology care improves quality of life (QOL), depression symptoms, illness understanding, and end-of-life (EOL) care for patients with advanced lung cancer. The aims of this trial are to compare the effect of delivering early integrated PC through telehealth versus in-person on patient and caregiver outcomes. We hypothesize that both modalities for delivering early PC would be equivalent for improving patient QOL, communication about EOL care preferences with their oncologist, and length of stay in hospice. Methods: For this comparative effectiveness trial, we will enroll and randomize 1250 adult patients with advanced nonsmall cell lung cancer (NSCLC), who are not being treated with curative intent, to receive either early integrated telehealth or in-person PC at 20 cancer centers throughout the United States. Patients may also invite a family caregiver to participate in the study. Patients and their caregivers in both study groups meet at least every four weeks with a PC clinician from within 12 weeks of patient diagnosis of advanced NSCLC until death. Participants complete measures of QOL, mood, and quality of communication with oncologists at baseline before randomization and at 12, 24, 36, and 48 weeks. Information on health care utilization, including length of stay in hospice, will be collected from patients' health records. To test equivalence in outcomes between study groups, we will compute analysis of covariance and mixed linear models, controlling for baseline scores and study site. Study Implementation and Stakeholder Engagement: To ensure that this comparative effectiveness trial and findings are as patient centered and meaningful as possible, we have incorporated a robust patient and stakeholder engagement plan. Our stakeholder partners include (1) patients/families, (2) PC clinicians, (3) telehealth experts and clinician users, (4) representatives from health care systems and medical insurance providers, and (5) health care policy makers and advocates. These stakeholders will inform and provide feedback about every phase of study implementation.