Hostname: page-component-669899f699-qzcqf Total loading time: 0 Render date: 2025-04-27T12:25:57.906Z Has data issue: false hasContentIssue false
  • English
  • Français

Early integration of palliative care in a long-term care home: A telemedicine feasibility pilot study

Published online by Cambridge University Press:  18 February 2020

Giulia-Anna Perri Open the ORCID record for Giulia-Anna Perri [Opens in a new window] ,
Nada Abdel-Malek ,
Aysha Bandali ,
Haddas Grosbein  and
Sandra Gardner
Giulia-Anna Perri*
Affiliation:
Department of Family and Community Medicine, Division of Palliative Care, University of Toronto, Toronto, Ontario, Canada Baycrest Health Sciences, University of Toronto, Toronto, Ontario, Canada
Nada Abdel-Malek
Affiliation:
Baycrest Health Sciences, University of Toronto, Toronto, Ontario, Canada Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
Aysha Bandali
Affiliation:
Baycrest Health Sciences, University of Toronto, Toronto, Ontario, Canada
Haddas Grosbein
Affiliation:
Baycrest Health Sciences, University of Toronto, Toronto, Ontario, Canada
Sandra Gardner
Affiliation:
Baycrest Health Sciences, University of Toronto, Toronto, Ontario, Canada Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
*
Author for correspondence: Giulia-Anna Perri, Baycrest Health Sciences, 3560 Bathurst Street, North York, Ontario, CanadaM6A 2E1. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective

Palliative care plays an essential role in enhancing the quality of life and quality of death for residents in long-term care homes (LTCHs). Access to palliative care specialists is one barrier to providing palliative care to LTCHs. This project focused on palliative telemedicine, specifically evaluating whether integration of early palliative care specialist consultation into an LTCH would be feasible through the implementation of videoconferencing during routine interdisciplinary care conferences.

Method

This was a mixed-methods evaluation of a pilot program implementation over 6 months, to integrate early palliative care into an LTCH. There were two pilot communities with a total of 61 residents. Resident demographics were collected by a chart review, and palliative telemedicine feasibility was evaluated using staff and family member surveys.

Results

For the 61 residents, the average age of the residents was 87 years, with 61% being female and 69% having dementia as the primary diagnosis. The mean CHESS (Change in Health, End-Stage Disease, Signs, and Symptoms) and ADL (Activities of Daily Living) scores were 0.8 and 4.0, respectively, with 54% having a Palliative Performance Scale score of 40. Seventeen clinical staff surveys on palliative teleconferences were completed with the majority rating their experience as high. Ten out of the 20 family members completed the palliative teleconference surveys, and the majority were generally satisfied with the experience and were willing to use it again. Clinical staff confidence in delivering palliative care through telemedicine significantly increased (P = 0.0021).

Significance of results

The results support the feasibility of videoconferencing as a means of palliative care provision. Despite technical issues, most clinical staff and families were satisfied with the videoconference and were willing to use it again. Early integration of palliative care specialist services into an LTCH through videoconferencing also led to improved self-rated confidence in the palliative approach to care by clinical staff.

Keywords

Long-term carePalliative CareTelemedicine
Type
Original Article
Information
Palliative & Supportive Care , Volume 18 , Special Issue 4: Palliative and Supportive Care During The COVID-19 Pandemic , August 2020 , pp. 460 - 467
Check for updates
Copyright
Copyright © Cambridge University Press 2020

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

AlDossary, S, Martin-Khan, MG, Bradford, NK and Smith, AC (2017) A systematic review of the methodologies used to evaluate telemedicine service initiatives in hospital facilities. International Journal of Medical Informatics 97, 171–194.CrossRefGoogle ScholarPubMed
Aldridge, MD, Hasselaar, J, Garralda, E, van der Eerden, M, Stevenson, D, McKendrick, K, Centeno, C and Meier, DE (2016) Education, implementation, and policy barriers to greater integration of palliative care: A literature review. Palliative Medicine 3, 224–239.CrossRefGoogle Scholar
Cable-Williams, B and Wilson, DM (2017) Dying and death within the culture of long-term care facilities in Canada. International Journal of Older People Nursing 12, 1.CrossRefGoogle ScholarPubMed
Collier, A, Morgan, DD, Swetenham, K, To, TH, Currow, DC and Tieman, JJ (2016) Implementation of a pilot telehealth programme in community palliative care: A qualitative study of clinicians’ perspectives. Palliative Medicine 30(4), 409–417.CrossRefGoogle ScholarPubMed
De Gendt, C, Bilsen, J, Stichele, RV and Deliens, L (2013) Advance care planning and dying in nursing homes in Flanders, Belgium: A nationwide survey. Journal of Pain and Symptom Management 45, 223–234.CrossRefGoogle ScholarPubMed
Froggatt, K, Hockley, J, Parker, D and Brazil, K (2011) A system lifeworld perspective on dying in long term care settings for older people: Contested states in contested places. Health & Place 17, 263–268.CrossRefGoogle ScholarPubMed
Gold Standards Framework (2006) Prognostic indicator guidance: to aid identification of adult patients with advanced disease, in the last months/years of life, who need supportive and palliative care. Version 2.25. Available at: http://www.goldstandardsframework.nhs.uk/ (accessed December 2018).Google Scholar
Goodman, C, Sharpe, R, Russell, C, Meyer, J, Gordon, AL, Dening, T, Corazzini, K, Lynch, J and Bunn, F (2017) Care home readiness: a rapid review and consensus workshops on how organizational context affects care home engagement with health care innovation. Available at: https://uhra.herts.ac.uk/handle/2299/18200Google Scholar
Greenhalgh, T, Vijayaraghavan, S, Wherton, J, Shaw, S, Byrne, E, Campbell-Richards, D, Bhattacharya, S, Hanson, P, Ramoutar, S, Gutteridge, C, Hodkinson, I, Collard, A and Morris, J (2016) Virtual online consultations: Advantages and limitations (VOCAL) study. BMJ Open 6(1), e009388. doi: 10.1136/bmjopen-2015-009388.CrossRefGoogle ScholarPubMed
Hall, S, Kolliakou, A, Petkova, H, Froggatt, K and Higginson, IJ (2011) Interventions for improving palliative care for older people living in nursing care homes. Cochrane Database of Systematic Reviews 3, CD007132.Google Scholar
Kinley, J, Froggatt, K and Bennett, MI (2013) The effect of policy on end-of-life care practice within nursing care homes: A systematic review. Palliative Medicine 27, 209–220.CrossRefGoogle ScholarPubMed
Long-Term Care Homes Act (2007) https://www.ontario.ca/laws/statute/07l08 (accessed November 2019).Google Scholar
Pulsford, D, Jackson, G, O'Brien, T, Yates, S and Duxbury, J (2013) Classroom-based and distance learning education and training courses in end-of-life care for health and social care staff: A systematic review. Palliative Medicine 27, 221–235.CrossRefGoogle ScholarPubMed
Read Paul, L, Salmon, C, Sinnarajah, A and Spice, R (2019) Web-based videoconferencing for rural palliative care consultation with elderly patients at home. Supportive Care in Cancer 27(9), 3321–3330.CrossRefGoogle ScholarPubMed
Smets, T, Onwuteaka-Philipsen, BBD, Miranda, R, Pivodic, L, Tanghe, M, van Hout, H, Pasman, RHRW, Oosterveld-Vlug, M, Piers, R, Van Den Noortgate, N, Wichmann, AB, Engels, Y, Vernooij-Dassen, M, Hockley, J, Froggatt, K, Payne, S, Szczerbińska, K, Kylänen, M, Leppäaho, S, Barańska, I, Gambassi, G, Pautex, S, Bassal, C, Deliens, L, Van den Block, L and PACE, trial group (2018) Integrating palliative care in long-term care facilities across Europe (PACE): Protocol of a cluster randomized controlled trial of the ‘PACE Steps to Success’ intervention in seven countries. BMC Palliative Care 17(1), 47.CrossRefGoogle ScholarPubMed
Sommerbakk, R, Haugen, DF, Tjora, A, Kaasa, S and Hjermstad, MJ (2016) Barriers to and facilitators for implementing quality improvements in palliative care — Results from a qualitative interview study in Norway. BMC Palliative Care 15(15), 61.CrossRefGoogle ScholarPubMed
Tanuseputro, P, Wodchis, WP, Fowler, R, Walker, P, Bai, YQ, Bronskill, SE and Manuel, D (2015) The health care cost of dying: A population-based retrospective cohort study of the last year of life in Ontario, Canada. PLoS ONE 10, 1–11.CrossRefGoogle ScholarPubMed
Tieman, JJ, Swetenham, K, Morgan, DD, To, TH and Currow, DC (2016) Using telehealth to support end of life care in the community: A feasibility study. BMC Palliative Care 15, 94. doi:10.1186/s12904-016-0167-7CrossRefGoogle ScholarPubMed
Wanzer, MB, Booth-Butterfield, M and Gruber, K (2004) Perceptions of health care providers’ communication: Relationships between patient-centered communication and satisfaction. Health Communication 16, 363–384.CrossRefGoogle ScholarPubMed
World Health Organization (WHO) (2013) WHO definition of palliative care. Available at: http://www.who.int.myaccess.library.utoronto.ca/cancer/palliative/definition/en/ (accessed 23 April 2019).Google Scholar
Zimmermann, C, Swami, N, Krzyzanowska, M, Hannon, B, Leigh, N, Oza, A, Moore, M, Rydall, A, Rodin, G, Tannock, I, Donner, A and Lo, C (2014) Early palliative care for patients with advanced cancer: A cluster-randomized controlled trial. The Lancet 17, 1721–1730.CrossRefGoogle Scholar