Building a telepalliative care strategy in nursing homes: a qualitative study with mobile palliative care teams

Cormi, Clément; Petit, Marie Sophie; Auclair, J.; Bagaragaza, Emmanuel; Colombet, Isabelle; Sanchez, Stéphane

doi:10.1186/s12904-021-00864-6

Cited by 11 publications

(15 citation statements)

References 36 publications

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“…This argument is premised on the basis that service provider had difficulties in conducting assessments and diagnosis via tele-consultation platforms. Similar challenges of using teleconsultation in PC service delivery has been reported in a qualitative study by Cormi et al (2021). This finding underscores the need for tertiary hospitals in Ghana to prioritize service providers' technological development through continuous professional development and implementation of emergency response strategies.…”

Section: Discussionsupporting

confidence: 78%

Covid-19 Front-Liners: Experiences of Palliative Care Providers in a Tertiary Hospital

2022

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Introduction In “normal” times, palliative care (PC) service delivery is confronted with many challenges thereby making access to care difficult. Now, we are in the era of COVID-19 where the healthcare ecology is radically changed. During this process of radical transformation, there are some ramification of COVID-19 on PC service delivery. Yet, there is a paucity of empirical evidence to support this claim. Objective We explored PC providers’ perspectives on delivering PC services in the era of COVID-19. Methods Using an exploratory descriptive qualitative approach, we conducted face-to-face and telephone interviews with seven PC service providers at Korle Bu Teaching Hospital, Ghana. Haase's adaptation of Colaizzi's method was employed as the analysis strategy. Results Two main themes emerged: ramifications and adaptations. The ramifications of COVID-19 on PC service delivery included changes in care relationship, perceived increased responsibilities, psychological distress, shortage of medicines, and treatment delays. In an attempt to mitigate the challenges posed by COVID-19 on PC service delivery, the following mechanisms adaptations were made: halting of service provision, resorting to tele-consultation, adopting shift system and reducing number of appointments, and adoption of infection prevention and control strategies. Conclusions Our results indicate that COVID-19 has substantial ramification of PC service delivery. In conclusion, priority should be given to the training of healthcare workers on emergency preparedness for future pandemics. Also, continuous professional development would be needed in order build PC service providers’ skills and capacity to effectively utilize tele-consultation in PC service delivery.

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Section: Discussionsupporting

confidence: 78%

Covid-19 Front-Liners: Experiences of Palliative Care Providers in a Tertiary Hospital

2022

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“…These authors also identified technology as, essentially, a third party in the remote care equation—an additional relationship to be managed by the palliative specialist. Our study, alongside others citing high levels of patient satisfaction, suggests that certain components of this concept of telepresence come easily to palliative specialists [ 11–13 , 21 ]—such as connection, trust, being supportive, and collaboration—but that this secondary human-technological interface can be a barrier as much as it is a boon [ 7 , 22 ]. Concerns cited in earlier studies, such as potential overemphasis upon and/or neglect of symptoms [ 2 , 18 ], privacy concerns [ 23 , 24 ], injury to the patient-clinician relationship [ 25 ], and even lack of substantive benefit [ 26 ], suggest that these patient experiences were not born out of the COVID-19 pandemic.…”

Section: Discussionmentioning

confidence: 53%

“…Telepalliative care has also been well received in the few evaluations of inpatient studies performed to date [ 13 ], despite reservations expressed by clinicians [ 21 ], particularly regarding the negative impact of remote interactions upon relationship-building. Our findings reinforce some of these misgivings while diminishing others: multiple respondents in our study cited the paradoxical dilemma of having more time for their patients while also having less access to them.…”

Section: Discussionmentioning

confidence: 99%

“Doing palliative care with my hands tied behind my back”: telepalliative care delivery for oncology inpatients during a COVID-19 surge

Rosa

Lynch

Hadler

et al. 2022

Translational Behavioral Medicine

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New York City was a “global COVID-19 hotspot” in spring 2020. Many health teams rapidly transitioned to telehealth platforms. Little is known about the experiences of inpatient palliative care services who delivered telehealth services during the pandemic. This study was aimed to explore the experiences of an interdisciplinary palliative care team in meeting the holistic needs of oncology inpatients via telehealth over a 10-week period during the first COVID-19 surge. A targeted sample of interdisciplinary palliative specialists at an urban comprehensive cancer center participated in in-depth interviews that explored participants’ experiences delivering physical, psychosocial, and spiritual care via telehealth. An interdisciplinary coding team followed a rigorous thematic text analysis approach and met regularly to reach consensus on emerging themes. Eleven palliative specialists from six disciplines (chaplaincy, medicine, nursing, pharmacy, physician assistant, and social work) participated. Seventy-three percent reported not receiving telehealth training prior to COVID-19 and 64% were “not at all” or “somewhat comfortable” delivering telepalliative care. Several themes were identified, including the barriers related to telehealth, the impact of telehealth on the quality of relationships with patients, their families, and coworkers, and the changes in perceived self-efficacy of fulfilling job responsibilities. Telehealth use has increased significantly during COVID-19, requiring further evaluation of its utility. Participants reported both positive and negative inpatient telepalliative care experiences associated with various domains of professional functioning, such as communication, relationships with key stakeholders, and self-efficacy. Enhanced telehealth training and support must be improved to sustain the palliative workforce and promote high-quality patient and family care in the future.

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“…This prehospital evaluation also could be helpful to avoid overburdening of healthcare systems during a pandemic. Technologies such as telemedicine also could be helpful, specifically in cases of infectious diseases and entry restrictions in nursing homes [23][24][25]. Interestingly, the majority of referrals of COVID-19 patients to our OPC team came from general practitioners (75.0%).…”

Section: Discussionmentioning

confidence: 99%

Outpatient palliative care during the COVID-19 pandemic: a retrospective single centre analysis in Germany

et al. 2022

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Background The coronavirus disease 2019 (COVID-19) pandemic has challenged health care systems worldwide. In Germany, patients in a palliative care setting have the opportunity to receive treatment by a specialised mobile outpatient palliative care team (OPC). The given retrospective single centre analysis describes the use of OPC structures for terminally ill COVID-19 patients during the height of the pandemic in Germany and aims to characterise this exceptional OPC patient collective. Methods First, death certificates were analysed in order to collect data about the place of death of all deceased COVID-19 patients (n = 471) within our local governance district. Second, we investigated whether advance care planning structures were established in local nursing homes (n = 30) during the height of the COVID-19 pandemic in 2020. Third, we examined patient characteristics of COVID-19 negative (n = 1579) and COVID-19 positive (n = 28) patients treated by our tertiary care centre guided OPC service. Results The analysis of death certificates in our local district revealed that only 2.1% of all deceased COVID-19 patients had succumbed at their home address (n = 10/471). In contrast, 34.0% of COVID-19 patients died in nursing homes (n = 160/471), whereas 63.5% died in an inpatient hospital setting (n = 299/471). A large proportion of these hospitalised patients died on non-intensive care unit wards (38.8%). Approximately 33.0% of surveyed nursing homes had a palliative care council service and 40.0% of them offered advance care planning (ACP) structures for their nursing home residents. In our two OPC collectives we observed significant differences concerning clinical characteristics such as the Index of Eastern Cooperative Oncology Group [ECOG] (p = 0.014), oncologic comorbidity (p = 0.004), as well as referrer and primary patient location (p = 0.001, p = 0.033). Conclusions Most COVID-19 patients in our governance district died in an inpatient setting. However, the highest number of COVID-19 patients in our governance district who died in an outpatient setting passed away in nursing homes where palliative care structures should be further expanded. COVID-19 patients who died under the care of our OPC service had considerably fewer oncologic comorbidities. Finally, to relieve conventional health care structures, we propose the expansion of established OPC structures for treating terminally ill COVID-19 patients.

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Building a telepalliative care strategy in nursing homes: a qualitative study with mobile palliative care teams

Cited by 11 publications

References 36 publications

Covid-19 Front-Liners: Experiences of Palliative Care Providers in a Tertiary Hospital

Covid-19 Front-Liners: Experiences of Palliative Care Providers in a Tertiary Hospital

“Doing palliative care with my hands tied behind my back”: telepalliative care delivery for oncology inpatients during a COVID-19 surge

Outpatient palliative care during the COVID-19 pandemic: a retrospective single centre analysis in Germany

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