RESUMO
La ecografía clínica se emplea cada vez por más profesionales sanitarios de diversas disciplinas asistenciales. En cuidados paliativos existen iniciativas que han puesto de manifiesto la utilidad de sus múltiples aplicaciones, permitiendo ofrecer respuestas a cuestiones diversas, tanto en el hospital como en el domicilio. No debe suponer una perturbación del confort del paciente contribuyendo a evitar la percepción por parte de pacientes y familiares de abandono tecnológico en las fases más avanzadas de la enfermedad. El avance tecnológico de estos dispositivos permite disponer de opciones que aúnan precio, portabilidad, sencillez de manejo y calidad de imagen suficiente para satisfacer los requisitos para su empleo en las necesidades asistenciales más habituales en cuidados paliativos. La curva de aprendizaje en su manejo es relativamente rápida, esperando que esta serie de publicaciones con material teórico-práctico en la revista Medicina Paliativa contribuyan a establecer una base de conocimiento para los profesionales interesados en este tema, pudiendo continuarse más adelante con un sistema para una adecuada acreditación de competencias. (AU)
Clinical ultrasound is being increasingly used by health professionals from various healthcare disciplines. In Palliative Care some initiatives have revealed the usefulness of its multiple applications, allowing to answer various questions both in the hospital and at home. It should not imply a disturbance of patient wellbeing, and helps avoid the perception, both by patients and relatives, of technological abandonment in the most advanced phases of disease. The technological advance of these devices allows having options that combine price, portability, ease of use, and sufficient image quality to satisfy the requirements of use in the most common care settings in Palliative Care. The learning curve in its operation is relatively fast, and we hope that this series of publications with theoretical-practical material in the Palliative Medicine journal will contribute to establishing a knowledge base for professionals interested in this topic, which might be later expanded by providing a system for adequate accreditation of competencies. (AU)
Assuntos
Humanos , Ultrassonografia/métodos , Cuidados Paliativos , Medicina Paliativa , Bases de Conhecimento , Desenvolvimento TecnológicoRESUMO
BACKGROUND: Due to the complexities of advanced illnesses and their treatments, it can be difficult for patients in palliative care to maintain their quality of life. Telemedicine interventions in chronic disease management engage patients in their care, provide continuous follow-up by their health care providers, identify symptoms earlier, and allow a quick response to illness-related decline. OBJECTIVE: We aimed to detail and reflect on the design of an app and evaluate its feasibility to monitor the clinical situation of patients with advanced illnesses. METHODS: This study used a mixed methods design using qualitative methods to inform app development and design and quantitative methods for data collection and analysis of patient evaluations. Palliative care units in 2 Spanish university hospitals (Nuestra Señora de la Candelaria in Santa Cruz de Tenerife and University Hospital Complex of Ferrol in A Coruña) carried out a literature review, designed the study protocol, and obtained approval from the Ethics Committee from June to December 2020. In addition, focus group meetings were held, and the design and technical development of the app were elaborated on and subsequently presented in the participating palliative care units. From January to March 2021, the app was made public on the App Store and Play Store, and a pilot study with patients was carried out in April to September 2021. RESULTS: Six focus group meetings were held that included doctors, nurses, app developers, technology consultants, and sponsors. In addition, the technology consultants presented their results 3 times in the participating palliative care units to obtain feedback. After the app's final design, it was possible to publish it on the usual servers and begin its evaluation in patients (n=60, median age 72 years). Sixty percent (n=36) of the participants were women and 40% (n=24) were men. The most prevalent advanced pathology was cancer (n=46, 76%), followed by other diseases (n=7, 12%) and amyotrophic lateral sclerosis (n=5, 8%). Seventy percent (n=42) of the patients were already in follow-up prior to the start of the study, while 30% (n=18) were included at the start of their follow-up. The information in the app was collected and entered by relatives or caregivers in 60% (n=36) of the cases. The median follow-up was 52 (IQR 14-104) days. In all, 69% (n=41) had a follow-up >30 days (10 were deceased and 9 were missing data). The use of the different sections of the app ranged from 37% (n=22) for the glycemic record to 90% (n=54) for the constipation scale). Patients and caregivers were delighted with its ease of use and usefulness. CONCLUSIONS: Incorporating an intelligent remote patient monitoring system in clinical practice for patients in palliative care can improve access to health services and provide more information to professionals.
RESUMO
Antecedentes: Las iniciativas de telemedicina involucran a los pacientes en sus cuidados, favorecen la adherencia a los tratamientos y ayudan a centrar las valoraciones presenciales en los problemas más importantes, mejorando en general la atención.Objetivo: Diseño y evaluación de la factibilidad de una app dirigida a monitorizar la situación clínica en pacientes con enfermedades avanzadas.Material y métodos: Tipo de estudio: cualitativo (Diseño app) - cuantitativo (Evaluación en pacientes). Ubicación: Unidades de Cuidados Paliativos del Complejo Hospital Universitario Ntra. Sra. de Candelaria (CHUNSC) en Tenerife y Complejo Hospital Universitario de Ferrol (CHUF). Intervención: diseño app entre profesionales expertos en enfermedades avanzadas y un equipo de desarrollo de app sanitarias. Evaluación: análisis del uso de app por parte de pacientes y profesionales, aportación al seguimiento diario, y satisfacción con su uso. (AU)
Background: Telemedicine initiatives involve patients in their care, promote adherence to treatment, and help focus face-to-face assessments on the most important problems, improving care in general.Objective: Design and evaluation of the feasibility of an app aimed at monitoring clinical status in patients with advanced diseases.Material and methods: Type of study: qualitative (app design)-quantitative (evaluation in patients). Location: Palliative Care Units at the Ntra. Sra. de Candelaria University Hospital Complex (CHUNSC) in Tenerife, and Ferrol University Hospital Complex (CHUF). Intervention: app development by experts in advanced diseases and a health app development team. Evaluation: analysis of the use of the app by patients and professionals, contribution to daily monitoring, and satisfaction with its use. (AU)
