Protocol for a Noninferiority Comparative Effectiveness Trial of Home-Based Palliative Care (HomePal)

Nguyen, Huong Q.; Mularski, Richard A.; Edwards, Paula E; Lynn, Joanne; Machado, Mary T; McBurnie, Mary Ann; McMullen, Carmit K.; Mittman, Brian; Reinke, Lynn; Shen, Ernest; Wang, Susan E; Werch, Henry

doi:10.1089/jpm.2019.0116

Cited by 14 publications

(7 citation statements)

References 43 publications

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“…The survey was approved by our institutional review board as part of the main study. 11 All HBPC clinicians (physicians, n = 83; full-and part-time registered nurse case managers, n = 105) were invited to participate in the survey through e-mail and participation was strictly voluntary. Respondents completed web (REDCap) or paper surveys.…”

Section: Methodsmentioning

confidence: 99%

“…This report is a substudy of a larger comparative effectiveness trial (HomePal) that compared a standard HBPC model with a tech-supported model that included use of nurse to physician video consultation. 11 Standard HBPC typically included separate home visits by physicians and nurses. The tech-supported model relied on the nurse who was in the patient's home to facilitate a synchronous video consultation between the patient and family with the remote physician; this approach to video visit use was intended to minimize disparities in access to technology by patients and families.…”

Section: Introductionmentioning

confidence: 99%

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Clinician Perspectives on Implementing Video Visits in Home-Based Palliative Care

Osuji

Macias

McMullen

et al. 2020

Palliative Medicine Reports

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Background: Despite the increasing use and acceptance of technology in health care, there is limited evidence on the usefulness and appropriate use of telehealth in home-based palliative care (HBPC). As part of the process evaluation of a pragmatic trial of video visits in HBPC, we assessed clinician experience with video visit implementation. Methods: We assessed clinicians' experiences with and perception of the usefulness and appropriateness of video visits using anonymous surveys and brief qualitative interviews with a subset of survey participants. Qualitative analyses were guided by sociotechnical frameworks that emphasize technology's ''value proposition'' for its end users as being key to adoption. Results: Clinicians (36 physicians and 48 registered nurses) generally had favorable attitudes toward video visits and telehealth. Respondents felt confident in the skills needed to make their role in video visits successful. Clinicians were neutral on whether video visits were useful for their practice or enhanced the patient-caregiver experience. Clinicians found video visits to be most appropriate for follow-up care (as opposed to start of care). The interviews yielded two themes that complemented the survey findings: (1) factors enhancing the value proposition (positive responses from patients and families and convenience) and (2) factors diminishing the value proposition (issues related to the technology and scheduling). Discussion: Our findings provide insights into clinicians' experiences with implementing remote video physician consultations, facilitated by a nurse in the patient's home in the pre-COVID-19 era. Clinician views about video visits may have shifted with the pandemic, which occurred after our data collection was complete. Clinical Trials Registration No. NCT#03694431.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Clinician Perspectives on Implementing Video Visits in Home-Based Palliative Care

Osuji

Macias

McMullen

et al. 2020

Palliative Medicine Reports

Self Cite

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“…A number of protocols are used to improve home palliative care and to stimulate and promote the use of multidisciplinary teams to cover better the needs of the palliative patients and their families. Some of them are specially designed to cover specific problems, diseases or symptoms in palliative patients and their relatives (33)(34)(35).…”

Section: Discussionmentioning

confidence: 99%

Narrative review of home care for palliative patients in general practice

Despotova-Toleva

Toleva-Nowak

2021

Ann Palliat Med

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The need of palliative care is constantly growing worldwide and the spectrum of patients and diseases, leading to the need of palliative care is very broad (1). According to recently published data in the "Letter for National Palliative Care Advocates to send to government lead on Universal Health coverage, and UN negotiations" (2) by 2060, an estimated 48 million people (47% of all deaths globally) will die each year with serious health-related suffering, and 83% of these deaths will occur in low-income and middleincome countries.Due to the phenomenon of the so-called "silver tsunami" (the increasing number of elderly, and those of them with severe, incurable, life-limiting and life-threatening diseases) the problem escalates dramatically. Thus, significant and urgent changes should be made in some basic documents, including "Suggested language changes to zero draft 'Political Declaration of the High-level Meeting on

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“…This study was a secondary analysis of data drawn from a noninferiority cluster randomized trial to compare two models of HBPC, a standard and tech-supported approach that leveraged remote physician video consultations. 21,22 Patients and family caregivers were recruited from fourteen sites across two Kaiser Permanente regions (Southern California [KPSC] and Oregon/ Washington [KPNW]). The study was approved by the KPSC (#11633) and KPNW (#834) Institutional Review Boards.…”

Section: Designmentioning

confidence: 99%

Association Between Financial Distress with Patient and Caregiver Outcomes in Home-Based Palliative Care: A Secondary Analysis of a Clinical Trial

et al. 2022

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Background Serious illness often causes financial hardship for patients and families. Home-based palliative care (HBPC) may partly address this. Objective Describe the prevalence and characteristics of patients and family caregivers with high financial distress at HBPC admission and examine the relationship between financial distress and patient and caregiver outcomes. Design, Settings, and Participants Data for this cohort study were drawn from a pragmatic comparative-effectiveness trial testing two models of HBPC in Kaiser Permanente. We included 779 patients and 438 caregivers from January 2019 to January 2020. Measurements Financial distress at admission to HBPC was measured using a global question (0–10-point scale: none=0; mild=1–5; moderate/severe=6+). Patient- (Edmonton Symptom Assessment Scale, distress thermometer, PROMIS-10) and caregiver (Preparedness for Caregiving, Zarit-12 Burden, PROMIS-10)-reported outcomes were measured at baseline and 1 month. Hospital utilization was captured using electronic medical records and claims. Mixed-effects adjusted models assessed survey measures and a proportional hazard competing risk model assessed hospital utilization. Results Half of the patients reported some level of financial distress with younger patients more likely to have moderate/severe financial distress. Patients with moderate/severe financial distress at HBPC admission reported worse symptoms, general distress, and quality of life (QoL), and caregivers reported worse preparedness, burden, and QoL (all, p <.001). Compared to patients with no financial distress, moderate/severe financial distress patients had more social work contacts, improved symptom burden at 1 month (ESAS total score: −4.39; 95% CI: −7.61, −1.17; p <.01), and no increase in hospital-based utilization (adjusted hazard ratio: 1.11; 95% CI: 0.87–1.40; p =.41); their caregivers had improved PROMIS-10 mental scores (+2.68; 95% CI: 0.20, 5.16; p =.03). No other group differences were evident in the caregiver preparedness, burden, and physical QoL change scores. Conclusion These findings highlight the importance and need for routine assessments of financial distress and for provision of social supports required to help families receiving palliative care services.

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Protocol for a Noninferiority Comparative Effectiveness Trial of Home-Based Palliative Care (HomePal)

Cited by 14 publications

References 43 publications

Clinician Perspectives on Implementing Video Visits in Home-Based Palliative Care

Clinician Perspectives on Implementing Video Visits in Home-Based Palliative Care

Narrative review of home care for palliative patients in general practice

Association Between Financial Distress with Patient and Caregiver Outcomes in Home-Based Palliative Care: A Secondary Analysis of a Clinical Trial

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