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Telehealth in palliative care in the UK: A review of the evidence
Abstract and Figures
We reviewed telehealth applications which were being used in palliative care settings in the UK. Electronic database searches (Medline, CINAHL, PsychInfo and Embase), searches of the grey literature and cited author searches were conducted. In total, 111 papers were identified and 21 documents were included in the review. Telehealth was being used by a range of health professionals in oncology care settings that included specialist palliative care, hospices, primary care settings, nursing homes and hospitals as well as patients and carers. The most common applications were: out-of-hours telephone support, advice services for palliative care patients, carers and health professionals, videoconferencing for interactive case discussions, consultations and assessments, and training and education of palliative care and other health-care staff. The review suggests that current technology is usable and acceptable to patients and health professionals in palliative care settings. However, there are several challenges in integrating telehealth into routine practice.
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... Several systematic reviews have examined home-based telehealth in palliative care settings and have reported improved quality of life or symptom management (Steindal et al. 2020). Kidd et al. (2010) found that telehealth applications, including the use of videoconferencing in consultations, symptom assessments, and providing advice for patients, relatives, and health care professionals, were deemed usable and acceptable for patients and health care professionals. ...
The wake of the novel coronavirus (COVID-19) pandemic had caused substantial disruptions to the usual delivery of healthcare services. This is because of restrictive orders that were put in place to curb the spread of the infection. Palliative care services in Brunei also face challenges to deliver effective services during this period. However, the impact of advanced illnesses on patients' health and end-of-life care are issues that cannot be planned, postponed or cancelled. Hence, the palliative care team needs to continue to deliver effective palliative care services. As Brunei faced its second pandemic wave in August 2021, crucial adaptations were made to ensure palliative care service was not disrupted. This reflective case study aims to discuss the adaptations made in providing palliative care during this era of disruptions.
... Telehealth and telemedicine offer digital solutions to treat patients remotely. Applications include out-of-hours telephone services, videoconferencing case discussions and virtual clinics (Kidd et al, 2010;Gilbert et al, 2020). During the pandemic, telehealth facilitated continuity of care by allowing people to communicate with health providers (Andrews et al, 2020). ...
Digital technology is becoming increasingly common in routine nursing practice. The adoption of digital technologies such as video calling, and other digital communication, has been hastened by the recent COVID-19 pandemic. Use of these technologies has the potential to revolutionise nursing practice, leading to potentially more accurate patient assessment, monitoring processes and improved safety in clinical areas. This article outlines key concepts related to the digitalisation of health care and the implications for nursing practice. The aim of this article is to encourage nurses to consider the implications, opportunities and challenges associated with the move towards digitalisation and advances in technology. Specifically, this means understanding key digital developments and innovations associated with healthcare provision and appreciating the implications of digitalisation for the future of nursing practice.
... Previously there was mixed views on the delivery of psychological support online, with some suggesting that face-to-face interventions are better for psychological concerns. 51 However, staff in our study were comfortable discussing psychological issues and felt safe to share their views and experiences in online group session. A recent review showed that online Acceptance and Commitment Therapy improves mental health outcomes including anxiety, depression and psychological flexibility in a range of contexts, especially with therapist guidance. ...
Background:
Acceptance and Commitment Therapy is a form of Cognitive Behavioural Therapy which uses behavioural psychology, values, acceptance and mindfulness techniques to improve mental health and wellbeing. Acceptance and Commitment Therapy is efficacious in treating stress, anxiety and depression in a broad range of settings including occupational contexts where emotional labour is high. This approach could help palliative care staff to manage work-related stress and promote wellbeing.
Aim:
To develop, and feasibility test, an online Acceptance and Commitment Therapy intervention to improve wellbeing of palliative care staff.
Design:
A single-arm feasibility trial of an 8-week Acceptance and Commitment Therapy based intervention for staff, consisting of three online facilitated group workshops and five online individual self-directed learning modules. Data was collected via online questionnaire at four time-points and online focus groups at follow-up.
Setting/participants:
Participants were recruited from Marie Curie hospice and nursing services in Scotland.
Results:
Twenty five staff commenced and 23 completed the intervention (93%). Fifteen participated in focus groups. Twelve (48%) completed questionnaires at follow-up. Participants found the intervention enjoyable, informative and beneficial. There was preliminary evidence for improvements in psychological flexibility (Cohen's d = 0.7) and mental wellbeing (Cohen's d = 0.49) between baseline and follow-up, but minimal change in perceived stress, burnout or compassion satisfaction.
Conclusion:
Online Acceptance and Commitment Therapy for wellbeing is acceptable to palliative care staff and feasible to implement using Microsoft Teams in a palliative care setting. Incorporating ways to promote long-term maintenance of behaviour changes, and strategies to optimise data collection at follow-up are key considerations for future intervention refinement and evaluation.
... (2) Smart device app follow-up: An Austrian study used an app on a tablet to conduct videoconferencing follow-up of cancer patients at home [82][83]. Using video conferencing allows for a physical assessment of the patient, which facilitates individualized management and care of the patient while also enabling an application to be used to record patient vital signs as well as ongoing treatment and other parameters (e.g., pain level, nutrition, body mass) and provide graphical data for the visualization of medical staff [84]. It also provides information modules related to symptom management, treatment counseling, and nursing skills training for patients and their caregivers to learn. ...
With the continuous improvement and development of modern network information technology and the continuous improvement of people's demand for healthcare, the traditional healthcare model has evolved, giving birth to a new telemedicine healthcare model. Telemedicine refers to the comprehensive application of information technology for medical information transmission and long-distance communication between different places. It integrates medicine, computer technology, and communication technology, including remote monitoring, remote diagnosis, remote consultation, remote case discussion, remote teaching, remote surgery, and a series of medical activities. With the continuous development of communication technology, telemedicine is also constantly changing. As a relatively novel technology, telemedicine has been sought after by major hospitals. With the advancement of Internet technology, digitization and informationalization have been gradually applied in telemedicine, but due to various factors, telemedicine still has great limitations. This paper summarises the development status of telemedicine; discusses in detail the development of telemedicine at home and abroad; the application of telemedicine as well as the feasibility and limitations of its promotion and development; and puts forward an outlook for the future development of telemedicine.
... 86,87 Data from the United Kingdom suggest its benefit for providing continuity of care (eg, off-hours telephonic support) in addition to the previously noted applications. 88 Research evaluating outcomes of telehealth as a strategy to expand access or the equitability of access in palliative care is limited and further study is crucial to the field. 86,87 Hospice care has an evidence base supporting the generally high acceptability of the incorporation of telehealth for patients and caregivers; data on implementation beyond gauging acceptability have not been reported. ...
Telehealth programs existed in many subspecialities before the COVID-19 pandemic, and the public health event motivated many subspecialties to reflect on how current technologies could be leveraged to benefit patient outcomes and increase health-care access. This article reviews the history and current state of telehealth access in many areas of subspecialty care. Primary care physicians (PCPs) may be unaware of the telehealth services and options local subspecialists offer. To best serve patients, PCPs could partner with subspecialists to develop processes to link patients to the right subspecialist at the right time and in the right visit type.
Palliative care consultation (PCC) has been shown to improve quality of life and reduce costs for various chronic life-threatening diseases. Despite PCC incorporation into modern pancreatic cancer care guidelines, limited data regarding its specific utilization and impact on resource use is available.
The 2016–2020 Nationwide Readmissions Database was used to identify all adult hospitalizations entailing pancreatic cancer. Only patients with at least one readmission within 90 days were included to account for uncaptured out-of-hospital mortality. Multivariable regression models were used to ascertain the relationship between inpatient PCC during initial hospitalization and index as well as cumulative costs, overall length of stay (LOS), readmission rate, and number of repeat hospitalizations.
Of an estimated 175,805 patients with pancreatic cancer, 11.1% had inpatient PCC during the index admission. PCC utilization significantly increased from 10.5% in 2016 to 11.6% in 2020 (nptrend < 0.001). After adjustment, PCC was associated with reduced index hospitalization costs [β: − $1100; 95% confidence interval (CI) − 1500, − 800; P < 0.001] and cumulative 90-day costs (β: − $11,700; 95% CI − 12,700, − 10,000; P < 0.001). PCC was associated with longer index LOS (β: + 1.12 days, 95% CI 0.92–1.31, P < 0.001) but significantly reduced cumulative LOS (β: − 3.16 days; 95% CI − 3.67, − 2.65; P < 0.001). Finally, PCC was linked with decreased odds of 30-day nonelective readmission (AOR: 0.48, 95% CI 0.45–0.50, P < 0.001).
PCC was associated with decreased costs, readmission rates, and number of hospitalizations among patients with pancreatic cancer. Directed strategies to increase utilization and reduce barriers to consultation should be implemented to encourage practitioners to maximize inpatient PCC referral rates.
Telehealth looks to be a viable tool to meet patients’ expectations and requirements during home treatment; however, there are obstacles to overcome. Palliative care has been described as ‘high touch’ rather than ‘high tech’, which may restrict healthcare workers’ enthusiasm in integrating technological advances into the development and refinement of interventions. As a result, the goal of this integrative review was to map and evaluate existing research on the use of telemedicine and telehealth in palliative care patients during the COVID-19 outbreak. This review was guided using the PRISMA Model and CASP guidelines. A total of 17 articles on the use of telehealth in palliative care satisfied the inclusion and exclusion criteria of the review. This integrative review provided more evidence for the function and application of telehealth in palliative care. It demonstrated the resiliency of individuals in swiftly adjusting to a new system or application and the adaptability of healthcare systems and providers in establishing an alternate means of providing treatment to patients during a crisis.
Teleoncology is increasingly being used to provide specialized consultation services for remote cancer populations. This article out lines typical requirements for such systems and describes one that has been organized in northwestern Ontario. The article reviews potential pros and cons of teleoncology and presents the results of a survey of user physician satisfaction. Possible solutions to a number of perceived problems with teleoncology services are explored. Additional training for physicians using tele oncology may help them improve skills for communicating in this medium. Many oppor tunities exist for better research in this rapidly expanding area. while the challenge of providing standardized oncology services to residents of geographically distant areas is not confined to canada, only australia and certain remote areas in asia have populations as physically dispersed as ours.
Background: Readiness is an integral and preliminary step in the successful implementation of telehealth services into existing health systems within rural communities. Methods and Materials: This paper details and critiques published international peer-reviewed studies that have focused on assessing telehealth readiness for rural and remote health. Background specific to readiness and change theories is provided, followed by a critique of identified telehealth readiness models, including a commentary on their readiness assessment tools. Results: Four current readiness models resulted from the search process. The four models varied across settings, such as rural outpatient practices, hospice programs, rural communities, as well as government agencies, national associations, and organizations. All models provided frameworks for readiness tools. Two specifically provided a mechanism by which communities could be categorized by their level of telehealth readiness. Discussion: Common themes across models included: an appreciation of practice context, strong leadership, and a perceived need to improve practice. Broad dissemination of these telehealth readiness models and tools is necessary to promote awareness and assessment of readiness. This will significantly aid organizations to facilitate the implementation of telehealth.
This study examined the criterion validity of computer-based screening tools (Distress Thermometer [DT], Brief Symptom Inventory-18 [BSI-18], and General Health Questionnaire-12 [GHQ-12]) in detecting any form of psychological distress in palliative care patients, compared with a semistructured psychiatric interview, Schedules for Clinical Assessment in Neuropsychiatry (SCAN). Patients aged 18 years or older referred to specialist palliative care services in Leeds completed the computer-based screening tools before SCAN interview by psychiatrists who were blind to screening results. SCAN interviews generated International Classification of Diseases, Tenth Revision (ICD-10) psychiatric diagnoses. Receiver operating characteristic (ROC) analysis compared the performance of screening tools with SCAN interview in identifying cases of distress. Sensitivity, specificity, positive and negative predictive values, and area under the curve (AUC) were calculated. Of the 226 eligible patients during the study period, 174 consented and 150 completed the study. Fifty-one (34%) patients satisfied ICD-10 criteria for a psychiatric diagnosis, adjustment disorder being the most common one (22%). On ROC analysis, DT, BSI-18, and GHQ-12 showed an AUC of 0.729, 0.729, and 0.755, respectively. At optimum cutoff values, sensitivity and specificity were 0.77 and 0.59 for DT, 0.78 and 0.62 for BSI-18, and 0.77 and 0.61 for GHQ-12, respectively. These data indicate that more than one-third of palliative care patients experience psychological distress. The three touch screen-based screening tools performed equally well in identifying distress compared with a psychiatric interview. The single-item DT is as good as longer screening tools, with an optimum cutoff of 5 in this population. Depressive disorders may be rarer in this population than commonly thought, in comparison to adjustment disorders.
• Recent restructuring of cancer services in the United Kingdom and advances in cancer chemotherapy have resulted in the majority of chemotherapy being delivered on an outpatient basis.
• Patients receiving chemotherapy are at risk of developing multiple problems and increased anxiety levels and are now more likely to encounter these problems outside the hospital setting. Therefore, providing all the necessary information at chemotherapy sessions is crucial to self‐care activities and coping.
• A study was carried out to investigate the information needs of patients at various stages of chemotherapy treatment and this article reports these needs at the beginning of treatment.
• Most patients wanted to receive all possible information about their condition and reported satisfaction with the information provided.
• The overwhelming finding was lack of information given to patients regarding family relationships. Whilst almost all patients wanted this information, more than half reported that it had not been given.
The term palliative care refers to the care for patients with terminal conditions. Traditionally, much of this end-of-life care has been provided by hospices or acute care centres. As healthcare systems face aging patient demographics and struggle with the need to deliver quality services with fewer resources, we must find new approaches to healthcare delivery. Some of the more established areas of healthcare such as cardiac care or administration are rather advanced in terms of the application of information technologies such as clinical knowledge bases and computer-integrated service delivery models. In palliative care, partly due to its relatively recent emergence as a discipline, informatics has played only a minor role to date. In this paper, we argue that we can achieve cost reduction and increased quality of service by adopting network-enabled information systems (IS) and telematics to advance the boundaries of traditional palliative care towards the patient homes. This vision, called e-Hospice in this article, is not meant to replace but to augment the traditional brick and mortar hospices. We discuss our model of an e-Hospice along with the challenges and opportunities involved in realising it. Our experiences are based on our ongoing tight collaboration with a local hospice as well as our studies of prototype technology infrastructures we have developed in our laboratories. We present a concrete application scenario in this paper, along with a description of the underlying architecture and technologies that underlie the infrastructures developed.
Palcall is an out-of-hours telephone service providing support and advice to palliative care patients, their carers and health professionals. Each patient who is registered with the scheme consents to named friends or relatives having access to the dedicated Palcall number. Telephone calls to the service are taken by the most senior palliative care nurse on duty in the hospice. The nurse has ready access to details of the medical condition and current medications of every patient who is registered. If required, the nurse can contact a more senior nursing colleague or the on-call hospice GP. The day following the telephone call, the Palcall administrator forwards written details to the patient's GP and any healthcare professional involved in the care of the patient. Quality control measures are in place to continually enhance the service.
This article presents a framework for the practical implementation of a 24-hour specialist palliative care advice line, illustrated by two case examples from the authors' experience. In the UK, National Institute for Health and Clinical Excellence guidance requires provision of 24-hour access to specialist palliative care advice for healthcare professionals and carers regardless of a patient's location. Effective implementation of a telephone advice line for specialist advice is one approach to addressing the current variability in palliative care service provision, both in the UK and elsewhere. The authors were unable to identify a model with documentation for ensuring adequate clinical governance of an advice line in the literature and so present their own. The accompanying case examples demonstrate the difference between 'evolution of services by demand' and taking a systemic approach to service design. Key recommendations for practice are outlined for an effective advice line service which incorporates training and education into the clinical governance structures of the host organization.
Telehealth is defined in this study as remote telemonitoring in the patient's home using a device to capture vital signs and related healthcare information, which is transmitted over the phone line. Telehealth, used to support home visits, is one solution to position home health agencies for success in the pay-for-performance model. Staff readiness to implement remote monitoring impacts device implementation and success of the telehealth program. The authors of this study evaluated nurse readiness for telehealth implementation within the home health agencies of one health system providing insight into the implementation plan.