Telehealth in palliative care is being described but not evaluated: a systematic review

Abstract

BackgroundTelehealth is growing and its application in palliative care is seen as a solution to pressures on palliative care services. A 2010 UK review reported growing awareness of telehealth in palliative care but a lack of evidence-based research to support its use. The primary aim of this review was to describe the current use of telehealth in palliative care in the UK and evaluate telehealth initiatives against a digital service standard. The secondary aim was to explore whether telehealth results in a reduction in emergency care access.MethodsSystematic review of the literature with thematic synthesis. Records were screened and data extracted by two reviewers. EMBASE, MEDLINE, CINAHL, Psychinfo and Cochrane central register for controlled trials were searched using pre-defined terms. Hand searching of conference literature, thesis databases and citation tracking was also conducted. The protocol for this systematic review was registered with PROSPERO and can be found at http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42017080038.ResultsThe search identified 3807 titles and 30 studies were included in the review. Telehealth was used to support patients and carers, electronic record keeping and professional education. Notably, the number of home telemonitoring initiatives for patients had increased from the 2010 review. Despite this variety, many studies were small scale, descriptive and provided little evidence of evaluation of the service. Ten papers were sufficiently detailed to allow appraisal against the digital service standard and only one of these met all of the criteria to some extent. Seven studies made reference to emergency care access.ConclusionsAlthough there is growth of telehealth services, there remains a lack of evaluation and robust study design meaning conclusions regarding the clinical application of telehealth in palliative care cannot be drawn. There is insufficient evidence to appreciate any benefit of telehealth on access to emergency care. Future work is needed to evaluate the use of telehealth in palliative care and improve telehealth design in line with digital service standards.

Digital Health Interventions in Palliative Care: A Systematic Meta-Review and Evidence Synthesis

“…Three reviews focused on cancer, [21][22][23] others did not limit their inclusion criteria a specific disease. The reviews were carried out by research teams based in the following countries: USA (9), 17,[24][25][26][27][28][29][30][31] UK (6), 16,23,[32][33][34][35] Australia (2), 14,36 Canada (1) 22 Chile (1), 15 Denmark (1) 37 and Brazil (1) 38 .…”

“…Eleven reviews assessed the quality of evidence. 14,17,24,25,[29][30][31][34][35][36][37] Four used the Cochrane risk of bias tool. 25,30,31,36 One used the Critical Appraisal Skills (CASP) programme tool.…”

“…14,17,24 Eight reviews reported evidence of low to moderate quality. 25,[29][30][31][34][35][36][37] This was due to small sample size, insufficient detail on study design, unclear or high risk of bias, non-blinding of participants and outcomes, and poorly defined comparison groups.…”

“…Eight reviews identified DHIs for education, of which most focused on describing interventions rather than evaluating their outcomes. 15,16,24,25,29,33,34,38 Educational interventions were delivered via online learning for professionals, 15,25,30,38 videoconferencing for professionals, 16,34,40 videos for professionals, 19,25,28 online symptom reporting for caregivers, 24 simulation based learning experiences (SBLEs) for professionals; 29 and mobile phones/text messaging for education and training of providers and patients. 33 Two reviews reported that online learning was a feasible alternative to in-person training, though quality of evidence was not assessed.…”

“…Thirteen reviews referenced the role of DHIs in monitoring, assessing, and managing physical and psychological symptoms. [14][15][16][17][22][23][24][25]27,30,31,34,37 EHRs were used to record symptoms 27,34 while telephone and videoconferencing were frequently used to monitor, assess and treat symptoms. 15,22,23,25,30,37,39 Some reviews described positive impacts of DHIs on symptom management, while most reviews identified inconsistent evidence or noted that evaluation of impact in many studies was lacking.…”