Study protocol: optimization of complex palliative care at home via telemedicine. A cluster randomized controlled trial

Abstract

BackgroundDue to the growing number of elderly with advanced chronic conditions, healthcare services will come under increasing pressure. Teleconsultation is an innovative approach to deliver quality of care for palliative patients at home. Quantitative studies assessing the effect of teleconsultation on clinical outcomes are scarce. The aim of this present study is to investigate the effectiveness of teleconsultation in complex palliative homecare.Methods/DesignDuring a 2-year recruitment period, GPs are invited to participate in this cluster randomized controlled trial. When a GP refers an eligible patient for the study, the GP is randomized to the intervention group or the control group. Patients in the intervention group have a weekly teleconsultation with a nurse practitioner and/or a physician of the palliative consultation team. The nurse practitioner, in cooperation with the palliative care specialist of the palliative consultation team, advises the GP on treatment policy of the patient. The primary outcome of patient symptom burden is assessed at baseline and weekly using the Edmonton Symptom Assessment Scale (ESAS) and at baseline and every four weeks using the Hospital Anxiety and Depression Scale (HADS). Secondary outcomes are self-perceived burden from informal care (EDIZ), patient experienced continuity of medical care (NCQ), patient and caregiver satisfaction with the teleconsultation (PSQ), the experienced problems and needs in palliative care (PNPC-sv) and the number of hospital admissions.DiscussionThis is one of the first randomized controlled trials in palliative telecare. Our data will verify whether telemedicine positively affects palliative homecare.Trial registrationThe Netherlands National Trial Register NTR2817

Challenges in defining ‘palliative care’ for the purposes of clinical trials

“…We identified 15 studies and two study protocols [14,15] evaluating palliative care as an intervention in four randomized controlled trials (RCTs) [14,16,17], two nonrandomized controlled studies [18,19], two before and after studies [20,21], three cohort studies [22][23][24] …”

“…Duursma et al [14] tested this in form of a teleconsultation between a nurse and the patient. Duursma et al [14] tested this in form of a teleconsultation between a nurse and the patient.…”

“…Frequency of palliative care contacts differed from weekly [14] to 3 weeks within enrolment and at least monthly thereafter [17], or 4-6 weeks after initial consultation [19]. Other authors adjusted the frequency to patients' needs [18].…”

“…Palliative care was provided in various settings such as home [14,15,18,20,21], outpatient clinic [17,19,20,25 & ,26,27], inpatient palliative care unit [20], other hospital wards [24] including intensive care [22,23,28] and cardiology [29], or a place of patient's choice [16].…”

Qualitative Study for the Development of a Telemedicine System in Palliative Care

“…Palliative care involves the prevention and relief of suffering, such as the treatment of pain, optimizing physical, psychosocial, and depending on spiritual situations. 4,5 In high income countries, there is a great knowledgeabout palliative care, which was initially carried out in an institutionalized way, either through general hospitals or specially structured hospitals (hospices). 2 Progressively, these services have been decentralized and created specialized teams and services that support home management, which can be more comfortable, efficient and humane.…”