Audio-Visual Communication and Its Use in Palliative Care

Abstract

The technology of telemedicine has been used for over 20 years, involving different areas of medicine, providing medical care for the geographically isolated patients, and uniting geographically isolated clinicians. Today audio-visual technology may be useful in palliative care for the patients lacking access to medical services due to the medical condition rather than geographic isolation. We report results of a three-month trial of using audio-visual communications as a complementary tool in care for a complex palliative care patient. Benefits of this system to the patient included 1) a daily limited physical examination, 2) screening for a need for a clinical visit or admission, 3) lip reading by the deaf patient, 4) satisfaction by the patient and the caregivers with this form of communication as a complement to telephone communication. A brief overview of the historical prospective on telemedicine and a listing of applied telemedicine programs are provided.

Preliminary Report of a Pilot Tele-Health Palliative Care and Bioethics Program for Residents in Skilled Nursing Facilities

“…Most studies assessing potential effectiveness of telemedicine modalities in end-of-life care have been underpowered. 13,14 Rationale for this project For immobile SNF residents the incorporation of video conferencing into the delivery of some core end-oflife services, such as pain management and bioethical consultation, could avoid potentially several hours of painful and expensive ambulance trips to hospital clinics or emergency rooms. Hospital based specialists are often unable to serve SNF patients because of the time involved in inter-institutional travel.…”

“…To Palliative Care clinicians and community care providers of long-term care facilities video-conferencing may facilitate group learning opportunities that otherwise would not be available due to geographical distance. [13][14][15] This modality has been used and for individual clinical disciplines such as nursing. [15][16][17] Recent technical advances and reduced costs have enhanced the utility of video conferencing in healthcare.…”

Pain management in the home

“…Communication, monitoring, and support of patients with chronic pain and their families: the use of the telephone, telemonitoring, e-mails, and algorithms The use of the telephone is an important aspect of monitoring and managing pain on an outpatient basis [77,78]. In addition, it makes expert resources available to communities in which this may not otherwise be the case.…”

Telephone versus Face to Face Palliative Care Consults during Referral

“…2 There is need to quantify the adequacy of this mode of communication compared to the traditional face to face model as its use is more applicable in palliative care due to the fact that mobility for these patients sometimes is limited. 3 There is lack of information about the use and adequacy of telephony communication for palliative care referral and the general outcome on their use. This is particularly urgent given the great and accelerating penetration of information technologies, especially mobile phone and Internet connections in developing countries, which is creating large numbers of potential users that could benefit from well-designed systems to support health in general and palliative care in particular.…”

“…3 This should be based on the patient's clinical and other circumstances; and the patient's reasonably known wishes and beliefs. The "attending health care practitioner" should make clear to the patient and/or to his/her authorized health care decision maker that decisions concerning options rest with the patient and/or his/her decision maker.…”