Video consultations in palliative care: A systematic integrative review

Abstract

Background: There is extensive need for palliative care worldwide, but access to care remains inadequate, especially for non-cancer patients. Video consultations are a promising tool in the provision of home-based palliative care, but an overview of evidence solely on video consultations in palliative care is lacking. Aim: To review and synthesize current evidence regarding the use of video consultations in general and specialized palliative care to various patient groups. Design: A systematic integrative review with a narrative synthesis was undertaken in accordance with PRISMA (2009) guidelines. PROSPERO #: CRD42018095383 Data sources: PubMed, Embase, CINAHL, and PsychINFO were searched for primary research articles published between 2005 and 2018. In addition, reference lists of included articles were hand searched. Results: The search resulted in 813 articles; 39 articles were included in the review, consisting of mixed methods ( n = 14), qualitative ( n = 10), quantitative ( n = 10), and case studies ( n = 5). The studies mainly focused on specialized palliative care to adult patients with cancer in high income countries. Through data analysis, six themes addressing advantages/disadvantages and facilitators/barriers were identified: (1) Redesign of care, (2) Communication, (3) User perceptions, (4) Technology, (5) Privacy issues, and (6) Economic implications. Conclusion: Using video technology in palliative care has both advantages and disadvantages. However, evidence beyond the focus on specialized palliative care and patients with cancer is limited. Future research should focus on how and when video consultations might replace in-person specialized palliative care and video consultations in general palliative care, in low and middle income countries; and involve patients with a non-cancer diagnosis.

Early Integrated Telehealth versus In-Person Palliative Care for Patients with Advanced Lung Cancer: A Study Protocol

“…In this review, several themes emerged with respect to the advantages and disadvantages of using videoconferencing in PC including the redesign of care; communication among patients, family members, and the clinicians; users' perceptions of video consultations; technology issues; privacy concerns; and economic considerations. 14 As our study progresses, other potential challenges may include how PC clinicians address sensitive topics with patients and families through telehealth, including discussions about preferences for EOL care and advance care planning. Although some research is beginning to take place on telephonic discussions of advance care planning, 31 further study is needed to discern the best practices for such conversations using videoconferencing to ensure patients and families have accurate understanding of their illness and sufficient support to communicate their goals and wishes.…”

“…10 Studies show that telehealth not only increases access to health care services, especially where the availability of specialty clinicians is limited, but also is equivalent to in-person services for mental health, rehabilitation, and dermatology. 11,12 Although researchers are beginning to study the use of videoconferencing to conduct virtual home visits in the context of providing PC, 13,14 prior studies have demonstrated that telephone-based psychoeducational interventions, delivered by PC-trained advanced practice nurses, improve QOL and lower depression symptoms among patients with newly diagnosed advanced cancers as well as decrease depression symptoms in their caregivers. 15,16 Telehealth may be especially helpful for caregivers by improving access to PC for patients' loved ones, enhancing communication between multiple family members and the care team, and reducing the burden of attending in-person clinic visits.…”

“…15,16 Telehealth may be especially helpful for caregivers by improving access to PC for patients' loved ones, enhancing communication between multiple family members and the care team, and reducing the burden of attending in-person clinic visits. 14 In this study, we will adapt the evidence-based early integrated in-person PC model to a telehealth platform using secure videoconferencing, thereby enabling PC clinicians to provide virtual home visits and increase access to specialty services in a patient-centered manner. If the proposed study demonstrates that telehealth is as effective as (or superior to) in-person PC, such findings would address a major evidence gap between the data supporting early integrated in-person PC and lack of data regarding how to disseminate this care model most efficiently, equitably, and effectively.…”

Palliative Patients’ and Relatives’ Views on Using Telemedicine in Palliative Care – A Pilot Study from Southern Denmark

“…Recent reviews have indicated that telemedicine can be useful within palliative care. Most users are positive about the use of technology in palliative care [9,10]. Telemedicine might provide a feeling of security and contribute to building trust between patients, relatives and healthcare providers [9,10].…”

“…Most users are positive about the use of technology in palliative care [9,10]. Telemedicine might provide a feeling of security and contribute to building trust between patients, relatives and healthcare providers [9,10]. The provision of specialized palliative care at home is both desired and needed and may contribute to avoiding unwanted hospitalization at the end of life.…”