ABSTRACT
BACKGROUND: Developments in digital health have the potential to transform the delivery of health and social care to help citizens manage their health. Currently, there is a lack of consensus about digital health research priorities in palliative care and a lack of theories about how these technologies might improve care outcomes. Therefore, it is important for health care leaders to identify innovations to ensure that an increasingly frail population has appropriate access to palliative care services. Consequently, it is important to articulate research priorities as the first step in determining how finite resources should be allocated to a field saturated with rapidly developing innovation. OBJECTIVE: The aim of this study is to identify research priority areas for digital health in palliative care. METHODS: We selected digital health trends, most relevant to palliative care, from a list of emerging trends reported by a leading institute of quantitative futurists. We conducted 2 rounds of the Delphi questionnaire, followed by a consensus meeting and public engagement workshop to establish a final consensus on research priorities for digital technology in palliative care. We used the views of public representatives to gain their perspectives on the agreed priorities. RESULTS: A total of 103 experts (representing 11 countries) participated in the first Delphi round. Of the 103 experts, 55 (53.3%) participated in the second round. The final consensus meetings were attended by 10.7% (11/103) of the experts. We identified 16 priority areas, which involved many applications of technologies, including care for patients and caregivers, self-management and reporting of diseases, education and training, communication, care coordination, and research methodology. We summarized the priority areas into eight topics: big data, mobile devices, telehealth and telemedicine, virtual reality, artificial intelligence, smart home, biotechnology, and digital legacy. CONCLUSIONS: The priorities identified in this study represent a wide range of important emerging areas in the fields of digital health, personalized medicine, and data science. Human-centered design and robust governance systems should be considered in future research. It is important that the risks of using these technologies in palliative care are properly addressed to ensure that these tools are used meaningfully, wisely, and safely and do not cause unintentional harm.
ABSTRACT
BACKGROUND: Providing care for our patients during the COVID-19 pandemic required a rapid shift to video consultations (VCs). A service evaluation was performed to capture hospice professionals' (HPs) and patients' experiences of VC. METHODS: Online or postal surveys were sent to HPs and patients, who had participated in VC between March and July 2020, focusing on their experience and satisfaction with the service. RESULTS: 31 responses from HPs were received. 19 (61.3%) rated their experience of VC as good, despite 29 (93.5%) having no prior VC experience. One-third of HPs had undertaken potentially sensitive consultations, including resuscitation discussions. 23 (74.2%) undertook a VC that included a family member and 18 (58.1%) had included an external healthcare professional. 25 (80.6%) wanted to offer VC as an option going forward. Well-being staff successfully provided multiple group support sessions via video. 26 responses from patients (23) and carers (3) were received. 22 (84.6%) had access to a smartphone. 8 (30.8%) included a family member in their consultation. All patients/carers reported satisfaction with their VC, although 10 (38.5%) expressed a preference for face-to-face consultations. 22 (84.6%) patients would be happy to receive care via VC going forward and 21 (80.8%) stated they would recommend the use of VC to others. CONCLUSION: Patients reported VC to be an acceptable way to receive support from a hospice service and HPs would like to continue to offer VC in the future. VC can be offered as an alternative to face-to-face consultations with the potential to continue and improve access to a wide range of hospice services.
ABSTRACT
IntroductionDuring the Covid-19 pandemic, our hospice services had to rapidly move to consulting using video-conferencing technology. A service evaluation captured our patients‘ experiences of video consultations provided by a range of hospice professionals.MethodsAn online or postal survey was sent to a convenience sample of patients, who had participated in video consultations between March and June 2020, focussing on their experience and overall satisfaction with the service.ResultsWe received 26 responses from patients (23) and family members/carers (3), 12 of whom were over the age of 70. Patients had consulted with our doctors (2), nurses (14), physiotherapists (5), occupational therapist (1), social worker (1), complementary therapist (4) and Wellbeing team (17). 25 respondents stated that they used the internet daily, 22 had access to a smartphone, and 23 used videoconferencing for reasons other than healthcare. However, 22 had never used this technology for healthcare prior to the pandemic. 32% included a family member in their consultation and this was viewed as beneficial. 88.4% experienced being able to talk in the same way as if they were face-to-face. All respondents reported overall satisfaction with consulting via video, although 41.7% still stated a preference for face-to-face consultations where possible. 91.7% said they would be happy to use video to consult with hospice professionals in the future, and 87.5% stated that they would recommend this service video to others.ConclusionsPatients and carers reported video consultations to be an acceptable way to receive support from a range of hospice professionals. The majority had access to, and familiarity with their own technology. Video consultations should be offered as an alternative to face-to-face consultations with the potential to improve access for more patients and carers to a range of hospice services in the future.
ABSTRACT
IntroductionProviding care for our patients, carers and families during the coronavirus pandemic required a rapid shift to remote consultations, using videoconferencing technology. A service evaluation was performed to capture hospice professionals’ experience.MethodsAn online survey exploring experience and satisfaction was sent to a convenience sample of hospice professionals who had participated in video consultations between March and June 2020.Results35 hospice professionals responded, and both quantitative and qualitative data was analysed. 62.5% rated their video consultations as good, despite 94.1% having no prior video consultation experience. A third of respondents had undertaken potentially sensitive consultations, including advance care planning and resuscitation. Although 50% of respondents had undertaken first assessments remotely, they consistently found this more challenging when the patient was not known to them previously. The results helpfully captured specific scenarios, when video consultations were less appropriate. 75% of respondents had undertaken a video consultation with a family member participating and 52.9% had included an external health professional. Wellbeing staff had also successfully provided multiple group support sessions via video for both patients and carers. The respondents thought video consultations were efficient and convenient for hospice professionals (80.6%) and patients (67.7%). As a consequence of the rapid shift to video consultations, our results highlighted that 78% of respondents had received no formal training, and in addition, 39% reported some technical difficulties. Overall 80.7% wanted to offer video consultations as an option in the future.ConclusionHospice professionals have quickly adapted to video consultations and are keen to continue to offer this service in the future but need appropriate training and reliable videoconferencing technology in order to do this effectively. Videoconferencing can be used in creative ways to expand access for patients and family caregivers to a range of palliative care services and enhance multi-professional team-working.
ABSTRACT
While the additional value from adding the option of virtual visits is not in question, numerous issues are raised around how to decide between face-to-face and virtual visits in individual cases and how best to set up such provision within an organisation. With only limited palliative care-specific literature and no time to set up and evaluate pilots, we had to get on and set up a prototype 'virtual visits' model, retro-fitting guidance and a supporting ethical framework. We looked at the issues spanning clinical, ethical and logistics domains; identifying areas of benefit as well as drawbacks, some specific to the rushed implementation because of COVID-19's infective risks and the 'rules' of lockdown, but many are generic areas to help guide longer term service design. Unsurprisingly, it appears clear that a 'one-size-fits-all' mentality is a poor fit for the individualised needs of the heterogeneous palliative care population. Virtual visits have great potential even if they are not a panacea.