Findings and lessons learnt from early termination of a pragmatic comparative effectiveness trial of video consultations in home-based palliative care

Nguyen, Huong Q.; McMullen, Carmit K.; Haupt, Eric C.; Wang, Susan E; Werch, Henry; Edwards, Paula E; Andres, Gina M; Reinke, Lynn F.; Mittman, Brian; Shen, Ernest; Mularski, Richard A.

doi:10.1136/bmjspcare-2020-002553

Cited by 14 publications

(30 citation statements)

References 30 publications

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“…A frequency table illustrating which papers were included in which descriptive themes was made (Table 1). [66], Scofano et al [67], and Weck et al [68] Easy to use but technological issues undermine confidence 18 Bonsignore et al [69], Collier et al [60], Funderskov et al [49] Hackett et al [70], Helleman et al [71], Oelschlägel et al [62], Read Paul et al [59], Shulver et al [57], Harding et al [52], Whitten et al [56], Hochstenbach et al [50], Lind et al [51], Nguyen et al [48], van Gurp et al [72], Stern et al [55], Haydon et al [66], Scofano et al [67], and Weck et al [68] Adds value but personal and organizational barriers challenge adoption 23 Collier et al [60], Hackett et al [70], Harding et al [52], Hochstenbach et al [50], Lind et al [51], McCall et al [61], Adam et al [54], Funderskov et al [49], Read Paul et al [59], Whitten et al [53], Miyazaki et al [58], Tieman et al [73], van Gurp et al [74], Nguyen et al [48], Whitten et al [56], Oelschlägel et al [62], Shulver et al [57], Alodhayani et al [75], Bhargava et al...…”

Section: Data Synthesismentioning

confidence: 99%

Health Care Professionals’ Experiences and Perspectives on Using Telehealth for Home-based Palliative Care: Scoping Review

Lundereng¹,

Nes²,

Holmen³

et al. 2023

J Med Internet Res

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Background Telehealth seems feasible for use in home-based palliative care (HBPC). It may improve access to health care professionals (HCPs) at patients’ homes, reduce hospital admissions, enhance patients’ feelings of security and safety, and increase the time spent at home for patients in HBPC. HBPC requires the involvement of various HCPs such as nurses, physicians, allied health professionals, dietitians, psychologists, religious counselors, and social workers. Acceptance of the use of technology among HCPs is essential for the successful delivery of telehealth in practice. No scoping review has mapped the experiences and perspectives of HCPs regarding the use of telehealth in HBPC. Objective The aim of this review was to systematically map published studies on HCPs’ experiences and perspectives on the use of telehealth in HBPC. Methods A scoping review was conducted using the methodology of Arksey and O’Malley. The review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews. A systematic search was performed in AMED, CINAHL, Embase, MEDLINE, PsycINFO, and Web of Science for studies published in peer-reviewed journals between January 1, 2000, and August 23, 2022. The reference lists of the included papers were hand searched to identify additional studies. The inclusion criteria were (1) studies using qualitative, quantitative, or mixed methods; (2) studies including HCPs using telehealth with patients in HBPC; (3) studies on HCPs’ experiences and perspectives on the use of telehealth in HBPC; (4) studies published between January 1, 2000, and August 23, 2022; and (5) studies published in English, Portuguese, Norwegian, Danish, Swedish, or Spanish. Pairs of authors independently included studies and extracted data. The first 2 stages of thematic synthesis were used to thematically organize the data. Results This scoping review included 29 papers from 28 studies. Four descriptive themes were identified: (1) easy to use but technological issues undermine confidence, (2) adds value but personal and organizational barriers challenge adoption, (3) potential to provide useful and meaningful patient-reported data, and (4) mutual trust as a prerequisite for interpersonal relationships. Conclusions Telehealth in HBPC seems to be easy to use and may improve the coordination of care, time efficiency, clinical assessments, and help build and enhance personal and professional relationships. However, the introduction of technology in HBPC is complex, as it may not align well with the overall aim of palliative care from HCPs’ point of view. Further, changes in practice and requirements for HCPs may reduce motivation for the use of telehealth in HBPC. HCPs consider themselves to have central roles in implementing telehealth, and a lack of acceptance and motivation is a key barrier to telehealth adoption. Policy makers and telehealth developers should be aware of this potential barrier when developing or implementing new technology for use in HBPC. International Registered Report Identifier (IRRID) RR2-10.2196/33305

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Section: Data Synthesismentioning

confidence: 99%

Health Care Professionals’ Experiences and Perspectives on Using Telehealth for Home-based Palliative Care: Scoping Review

Lundereng¹,

Nes²,

Holmen³

et al. 2023

J Med Internet Res

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“…Data for this prospective cohort study were drawn from a pragmatic, non-inferiority cluster randomised trial to compare two models of HomePal, where patients either received only home visits from all care team members versus a combination of home and video visits with a physician who was facilitated by a nurse in the patient’s home 13 14. Patient and family caregiver dyads were recruited from 14 sites across two Kaiser Permanente regions (Southern California (KPSC) and Oregon/Washington (KPNW)).…”

Section: Methodsmentioning

confidence: 99%

Hospital utilisation in home palliative care: caregiver health, preparedness and burden associations

Nguyen

Haupt

Duan

et al. 2022

BMJ Support Palliat Care

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BackgroundPrior studies show that family caregiver factors influence patient outcomes. The purpose of this analysis was to determine the association between family caregiver self-rated health, perception of preparedness and burden at the time of patient admission to home palliative care (HomePal) with downstream patient hospital utilisation and time to hospice enrolment and death.MethodsData for this cohort study (n=441) were drawn from a trial testing two models of HomePal. Caregiver self-rated health, preparedness (Preparedness for Caregiving Scale, CPS) and burden (Zarit-12) were measured at admission to HomePal. Caregivers were categorised as having good/very good/excellent or fair/poor health, scoring above or below the CPS median score (23), or having no/mild (0–10), moderate (11-20) or high (>20) burden. Proportional hazard competing risk models assessed the association between caregiver factors with hospital utilisation (emergency department visits, observation and inpatient stays).ResultsPatients whose caregivers reported poor health and low preparedness received more visits by home health aides and social workers, respectively (both, p<0.05). Adjusted models showed that worse caregiver health (HR: 0.69 (95% CI 0.52 to 0.92), p=0.01), low preparedness (HR: 0.73 (95% CI 0.57 to 0.94), p=0.01) and high burden (HR: 0.77 (95% CI 0.56 to 1.06), p=0.10) were associated with lower risk for hospital utilisation. There were no significant associations between caregiver factors with time to patient enrolment in hospice or death in adjusted models (both, p>0.05).ConclusionProspective studies are needed to understand how greater in-home supports for family caregivers with poor health could help achieve quality palliative care that aligns with families’ priorities.Trial registration numberNCT03694431; ClinicalTrials.gov.

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“…This study was a secondary analysis of data drawn from a noninferiority cluster randomized trial to compare two models of HBPC, a standard and tech-supported approach that leveraged remote physician video consultations. 21,22 Patients and family caregivers were recruited from fourteen sites across two Kaiser Permanente regions (Southern California [KPSC] and Oregon/ Washington [KPNW]). The study was approved by the KPSC (#11633) and KPNW (#834) Institutional Review Boards.…”

Section: Designmentioning

confidence: 99%

Association Between Financial Distress with Patient and Caregiver Outcomes in Home-Based Palliative Care: A Secondary Analysis of a Clinical Trial

et al. 2022

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Background Serious illness often causes financial hardship for patients and families. Home-based palliative care (HBPC) may partly address this. Objective Describe the prevalence and characteristics of patients and family caregivers with high financial distress at HBPC admission and examine the relationship between financial distress and patient and caregiver outcomes. Design, Settings, and Participants Data for this cohort study were drawn from a pragmatic comparative-effectiveness trial testing two models of HBPC in Kaiser Permanente. We included 779 patients and 438 caregivers from January 2019 to January 2020. Measurements Financial distress at admission to HBPC was measured using a global question (0–10-point scale: none=0; mild=1–5; moderate/severe=6+). Patient- (Edmonton Symptom Assessment Scale, distress thermometer, PROMIS-10) and caregiver (Preparedness for Caregiving, Zarit-12 Burden, PROMIS-10)-reported outcomes were measured at baseline and 1 month. Hospital utilization was captured using electronic medical records and claims. Mixed-effects adjusted models assessed survey measures and a proportional hazard competing risk model assessed hospital utilization. Results Half of the patients reported some level of financial distress with younger patients more likely to have moderate/severe financial distress. Patients with moderate/severe financial distress at HBPC admission reported worse symptoms, general distress, and quality of life (QoL), and caregivers reported worse preparedness, burden, and QoL (all, p <.001). Compared to patients with no financial distress, moderate/severe financial distress patients had more social work contacts, improved symptom burden at 1 month (ESAS total score: −4.39; 95% CI: −7.61, −1.17; p <.01), and no increase in hospital-based utilization (adjusted hazard ratio: 1.11; 95% CI: 0.87–1.40; p =.41); their caregivers had improved PROMIS-10 mental scores (+2.68; 95% CI: 0.20, 5.16; p =.03). No other group differences were evident in the caregiver preparedness, burden, and physical QoL change scores. Conclusion These findings highlight the importance and need for routine assessments of financial distress and for provision of social supports required to help families receiving palliative care services.

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Findings and lessons learnt from early termination of a pragmatic comparative effectiveness trial of video consultations in home-based palliative care

Cited by 14 publications

References 30 publications

Health Care Professionals’ Experiences and Perspectives on Using Telehealth for Home-based Palliative Care: Scoping Review

Health Care Professionals’ Experiences and Perspectives on Using Telehealth for Home-based Palliative Care: Scoping Review

Hospital utilisation in home palliative care: caregiver health, preparedness and burden associations

Association Between Financial Distress with Patient and Caregiver Outcomes in Home-Based Palliative Care: A Secondary Analysis of a Clinical Trial

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