Home telehealth and paediatric palliative care: clinician perceptions of what is stopping us?

Abstract

BackgroundAdvances in technology have made the use of telehealth in the home setting a feasible option for palliative care clinicians to provide clinical care and support. However, despite being widely available and accessible, telehealth has still not been widely adopted either in Australia or internationally. The study aim was to investigate the barriers, enablers and perceived usefulness for an established home telehealth program in paediatric palliative care from the perspective of clinicians.MethodsSemi-structured interviews (n = 10) were undertaken with palliative care clinicians in a tertiary paediatric hospital to identify attitudes to, satisfaction with, and perceived benefits and limitations of, home telehealth in palliative care. Iterative analysis was used to thematically analyse data and identify themes and core concepts from interviews.ResultsFour themes are reported: managing relationships; expectations of clinicians; co-ordination, and the telehealth compromise. Core concepts that emerged from the data were the perceived ability to control clinical encounters in a virtual environment and the need to trust technology. These concepts help explain the telehealth compromise and low utilisation of the home telehealth program.ConclusionsEffective communication between caregivers and clinicians is recognised as a core value of palliative care. Home telehealth has the potential to provide a solution to inequity of access to care, facilitate peer support and maintain continuity of care with families. However, significant limitations and challenges may impede its use. The virtual space creates additional challenges for communication, which clinicians and families may not intuitively understand. For home telehealth to be integrated into routine care, greater understanding of the nature of communication in the virtual space is required.

Biomedical approaches to care and their influence on point of care nurses: a scoping review

“…In fact, through a collaborative approach and integration of multiple perspectives, a patient's plan of care becomes individualized and a reductionist approach is avoided. [4,13,19] Empowered caring illuminates that without empirical knowing, depth, and breadth of knowledge, critical thinking and advanced skills would not be possible. Technology and equipment are just tools that assist nurses in their work.…”

“…[9][10][11] This further hinders a nurse's ability to establish a therapeutic relationship, resulting in nurses distancing themselves, losing physical proximity [12] and nurse presence. [4,13] A biomedical model continues to influence patient care because emphasis is placed on evidence-based practice with measurable outcomes; ultimately, resembling an audit culture with the undertone of a business model. [14][15][16] Nurses should never be reluctant to integrate a biomedical model or technology into practice because this affords nurses the opportunity to expand critical thinking and problem-solving abilities.…”

“…A biomedical model and technology can never fully capture the lived experience of what it means to be ill [19] because technology can never replace the closeness and empathy of the human touch. [4,13,19,20] Therefore, to fully understand and integrate wholistic care nurses need to incorporate diverse [3] paradigms as part of their knowledge and decision-making to enhance a therapeutic nurse-patient relationship and nurse presence.…”

Tele-monitoring of ventilator-dependent patients: a European Respiratory Society Statement

“…Tele-hospice was able to decrease spiritual and medical burden, improving quality of life and symptom management for veterans and families coping with end of life [114]. Home tele-health consultations are a feasible and acceptable means of facilitating a palliative care consultation reducing the burden on families also in paediatric patients [115,116].…”

Trust Me, I’m a Doctor: Understanding Clinician’s Experiences of Service Separation and Trust Formation in Telehealth

“…For example, in health care, online consultations have been studied to understand how a customer's lack of trust decreases their potential to engage in "…exchanges that require divulging sensitive information, such as health issues" (Gummerus, Liljander, Pura and van Riel, 2004, p. 175). A recent quantitative study by Russell, Gillespie, Hartley, Theodoros, Hill and Gray (2015) found that trust in telehealth was the strongest predictor of customer uptake of telehealth in the home for aged patients and is salient to providers' telehealth use (Bradford, Caffery and Smith, 2015;Bradford, Young, Armfield, Herbert, and Smith (2014). Radhakrishnan, Jacelon and Roche (2014) found in interviews with 40 nurses that trust in technology equipment accuracy drove acceptance.…”