mPalliative Care Link: Examination of a Mobile Solution to Palliative Care Coordination Among Tanzanian Patients With Cancer

Ngoma, Mamsau; Mushi, Beatrice; Morse, Robert S.; Ngoma, Twalib; Mahuna, Habiba; Lambden, Kaley; Quinn, Erin; Sagan, Sarah B; Ho, Yun Xian; Lucas, F. Lee; Mmari, Joshua; Miesfeldt, Susan

doi:10.1200/go.21.00122

Cited by 11 publications

(18 citation statements)

References 20 publications

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“…For example, in Sub-Saharan African, digital health is not as established as in other high-income regions [ 115 ]. Consequently, Sub-Saharan African stakeholders describe digital health as part of a wider vision in this region to potentially improve data development and support the development of health care services [ 116 , 117 ]. Palliative care is a growing discipline in the Asia Pacific region, and current research describing digital priorities is limited, although it is acknowledged that digital health can play an important role in supporting education and training [ 118 ].…”

Section: Discussionmentioning

confidence: 99%

Identification of Digital Health Priorities for Palliative Care Research: Modified Delphi Study

Nwosu¹,

McGlinchey²,

Sanders³

et al. 2022

JMIR Aging

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Background Developments in digital health have the potential to transform the delivery of health and social care to help citizens manage their health. Currently, there is a lack of consensus about digital health research priorities in palliative care and a lack of theories about how these technologies might improve care outcomes. Therefore, it is important for health care leaders to identify innovations to ensure that an increasingly frail population has appropriate access to palliative care services. Consequently, it is important to articulate research priorities as the first step in determining how finite resources should be allocated to a field saturated with rapidly developing innovation. Objective The aim of this study is to identify research priority areas for digital health in palliative care. Methods We selected digital health trends, most relevant to palliative care, from a list of emerging trends reported by a leading institute of quantitative futurists. We conducted 2 rounds of the Delphi questionnaire, followed by a consensus meeting and public engagement workshop to establish a final consensus on research priorities for digital technology in palliative care. We used the views of public representatives to gain their perspectives on the agreed priorities. Results A total of 103 experts (representing 11 countries) participated in the first Delphi round. Of the 103 experts, 55 (53.3%) participated in the second round. The final consensus meetings were attended by 10.7% (11/103) of the experts. We identified 16 priority areas, which involved many applications of technologies, including care for patients and caregivers, self-management and reporting of diseases, education and training, communication, care coordination, and research methodology. We summarized the priority areas into eight topics: big data, mobile devices, telehealth and telemedicine, virtual reality, artificial intelligence, smart home, biotechnology, and digital legacy. Conclusions The priorities identified in this study represent a wide range of important emerging areas in the fields of digital health, personalized medicine, and data science. Human-centered design and robust governance systems should be considered in future research. It is important that the risks of using these technologies in palliative care are properly addressed to ensure that these tools are used meaningfully, wisely, and safely and do not cause unintentional harm.

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Section: Discussionmentioning

confidence: 99%

Identification of Digital Health Priorities for Palliative Care Research: Modified Delphi Study

Nwosu¹,

McGlinchey²,

Sanders³

et al. 2022

JMIR Aging

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“…Diagnoses were not described in 3 (8%) of the studies. Overall, 25% (n=10) of studies were qualitative studies [ 42 - 52 ]; 8% (n=3) were quantitative randomized trials [ 53 - 55 ]; 30% (n=12) of studies were quantitative nonrandomized trials [ 56 - 67 ]; 10% (n=4) of studies were quantitative descriptive studies [ 68 - 71 ]; and 28% (n=11) were mixed methods or multimethod studies [ 72 - 82 ]. Furthermore, 18% (n=7) of studies described the theoretical framework for telehealth applications [ 49 , 50 , 57 , 59 , 62 , 74 , 76 ].…”

Section: Resultsmentioning

confidence: 99%

Advantages and Challenges of Using Telehealth for Home-Based Palliative Care: Systematic Mixed Studies Review

Steindal¹,

Nes²,

Godskesen³

et al. 2023

J Med Internet Res

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Background Owing to the increasing number of people with palliative care needs and the current shortage of health care professionals (HCPs), providing quality palliative care has become challenging. Telehealth could enable patients to spend as much time as possible at home. However, no previous systematic mixed studies reviews have synthesized evidence on patients’ experiences of the advantages and challenges of telehealth in home-based palliative care. Objective In this systematic mixed studies review, we aimed to critically appraise and synthesize the findings from studies that investigated patients’ use of telehealth in home-based palliative care, focusing on the advantages and challenges experienced by patients. Methods This is a systematic mixed studies review with a convergent design. The review is reported according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. A systematic search was performed in the following databases: Allied and Complementary Medicine Database, CINAHL, Cochrane Central Register of Controlled Trials, Embase, Latin American and Caribbean Health Sciences Literature, MEDLINE, PsycInfo, and Web of Science. The inclusion criteria were as follows: studies using quantitative, qualitative, or mixed methods; studies that investigated the experience of using telehealth with follow-up from HCPs of home-based patients aged ≥18; studies published between January 2010 and June 2022; and studies published in Norwegian, Danish, Swedish, English, Portuguese, or Spanish in peer-reviewed journals. Five pairs of authors independently assessed eligibility of the studies, appraised methodological quality, and extracted data. The data were synthesized using thematic synthesis. Results This systematic mixed studies review included 41 reports from 40 studies. The following 4 analytical themes were synthesized: potential for a support system and self-governance at home; visibility supports interpersonal relationships and a joint understanding of care needs; optimized information flow facilitates tailoring of remote caring practices; and technology, relationships, and complexity as perpetual obstacles in telehealth. Conclusions The advantages of telehealth were that patients experience a potential support system that could enable them to remain at home, and the visual features of telehealth enable them to build interpersonal relationships with HCPs over time. Self-reporting provides HCPs with information about symptoms and circumstances that facilitates tailoring care to specific patients. Challenges with the use of telehealth were related to barriers to technology use and inflexible reporting of complex and fluctuating symptoms and circumstances using electronic questionnaires. Few studies have included the self-reporting of existential or spiritual concerns, emotions, and well-being. Some patients perceived telehealth as intrusive and a threat to their privacy at home. To optimize the advantages and minimize the challenges with the use of telehealth in home-based palliative care, future research should include users in the design and development process.

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“…This highlights the role of the palliative care team in ensuring appropriate access to opioids at the end-of-life. However, patients who had not received an opioid prescription were less likely to receive palliative care ( Craigs et al, 2018 ) and in many jurisdictions, access to opioids and palliative care services is limited ( Herce et al, 2014 ; Nambiar et al, 2021 ; Ngoma et al, 2021 ).…”

Section: Discussionmentioning

confidence: 99%

Opioid Use at End-Of-Life Among Nova Scotia Patients With Cancer

et al. 2022

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Purpose: To determine the factors associated with opioid analgesic prescriptions as measured by community pharmacy dispensations to all Nova Scotia (NS) patients with cancer at end-of-life from 2005 to 2009.Methods: The NS Cancer Registry and the NS Prescription Monitoring Program (NSPMP) were used to link Nova Scotians who had a cancer diagnosis and received a prescription for opioids in their last year of life (n = 6,186) from 2005 to 2009. The association of factors with opioid dispensations at end-of-life were determined (e.g., patient demographics, type of prescriber, type of cancer, and opioid type, formulation, and dose).Results: Almost 54% (n = 6,186) of the end-of-life study population with cancer (n = 11,498) was linked to the NSPMP and therefore dispensed opioids. Most prescriptions were written by general practitioners (89%) and were for strong opioids (81%). Immediate-release formulations were more common than modified-release formulations. Although the annual average parenteral morphine equivalents (MEQ) did not change during the study period, the number of opioid prescriptions per patient per year increased from 5.9 in 2006 to 7.0 in 2009 (p < 0.0001). Patients age 80 and over received the fewest prescriptions (mean 3.9/year) and the lowest opioid doses (17.0 MEQ) while patients aged 40–49 received the most prescriptions (mean 14.5/year) and the highest doses of opioid (80.2 MEQ).Conclusion: Our study examined opioid analgesic use at end-of-life in patients with cancer for a large real-world population and determined factors, trends and patterns associated with type and dose of opioid dispensed. We provide information regarding how general practitioners prescribe opioid therapy to patients at end-of-life. Our data suggest that at the time of this study, there may have been under-prescribing of opioids to patients with cancer at end-of-life. This information can be used to increase awareness among general practitioners, and to inform recommendations from professional regulatory bodies, to aid in managing pain for cancer patients at end-of-life. Future work could address how opioid prescribing has changed over time, and whether efforts to reduce opioid prescribing in response to the opioid crisis have affected patients with cancer at end-of-life in Nova Scotia.

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mPalliative Care Link: Examination of a Mobile Solution to Palliative Care Coordination Among Tanzanian Patients With Cancer

Cited by 11 publications

References 20 publications

Identification of Digital Health Priorities for Palliative Care Research: Modified Delphi Study

Identification of Digital Health Priorities for Palliative Care Research: Modified Delphi Study

Advantages and Challenges of Using Telehealth for Home-Based Palliative Care: Systematic Mixed Studies Review

Opioid Use at End-Of-Life Among Nova Scotia Patients With Cancer

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