Skip to main navigation menu Skip to main content Skip to site footer

Review article: Biomedical intelligence

Vol. 152 No. 0910 (2022)

Feasibility, acceptability and needs in telemedicine for palliative care: A pre-implementation phase scoping review

  • Andreas S.  Ebneter
  • Thomas C.  Sauter
  • Andri Christen
  • Steffen Eychmueller
DOI
https://doi.org/10.4414/SMW.2022.w30148
Cite this as:
Swiss Med Wkly. 2022;152:w30148
Published
09.03.2022

Summary

BACKGROUND: Telemedicine in palliative care was initially developed in countries where geography or resources limit access to care services. Recently, largely owing to the COVID-19 pandemic, this technology is being increasingly used in highly urbanised countries such as Switzerland. However, there is still scepticism regarding whether these tools can be used effectively in palliative care, a relationship-based speciality that is generally highly dependent on compassion, communication and direct human interaction. The objective of this review was to analyse the needs, elements of feasibility, and reasons for acceptance or possible barriers before the implementation of a telemedicine intervention in Switzerland.

METHODS: The method used was a scoping review, following the PRISMA-ScR reporting guidelines. We searched the PubMed, Ovid SP, Medline, Cochrane and Scopus databases for relevant reports. Charting and analyses of the data were done by a single researcher. A total of 520 records were screened and assessed for eligibility. Finally, 27 studies and 4 registry entries were included. Main reasons for exclusion were wrong population and intervention.

RESULTS: The prevailing study type was the single-arm intervention study. Most studies originated from countries with geographic barriers to access. Feasibility was good in 69% of all studies. Good acceptability (84.1–100%) was confirmed in the majority of the studies. The needs of the patients or the healthcare professionals were directly addressed in only five (16%) studies. Three needs were consistently reported: communication, coordination and technical reliability

CONCLUSION: Despite a broad range of studies on telemedicine in palliative care, patients’ needs are rarely addressed. Therefore, especially in countries such as Switzerland, a needs assessment is recommended before the implementation of a new telemedicine intervention, to guarantee high feasibility and acceptability.

References

  1. WHO. WHO | Classification of digital health interventions v1.0. Available from: http://www.who.int/reproductivehealth/publications/mhealth/classification-digital-health-interventions/en/
  2. Coyle N, Khojainova N, Francavilla JM, Gonzales GR. Audio-visual communication and its use in palliative care. J Pain Symptom Manage. 2002 Feb;23(2):171–5. https://doi.org/10.1016/s0885-3924(01)00402-x https://doi.org/10.1016/S0885-3924(01)00402-X
  3. Finucane AM, O'Donnell H, Lugton J, Gibson-Watt T, Swenson C, Pagliari C. Digital health interventions in palliative care: a systematic meta-review. NPJ Digit Med. 2021;4(1):64. Epub 2021/04/08. doi: https://doi.org/10.1038/s41746-021-00430-7. PubMed PMID: 33824407; PubMed Central PMCID: PMCPMC8024379.
  4. Hurst EJ. Evolutions in Telemedicine: From Smoke Signals to Mobile Health Solutions. J Hosp Librariansh. 2016;16(2):174–85. https://doi.org/10.1080/15323269.2016.1150750
  5. Ritchey KC, Foy A, McArdel E, Gruenewald DA. Reinventing Palliative Care Delivery in the Era of COVID-19: How Telemedicine Can Support End of Life Care. Am J Hosp Palliat Care. 2020;37(11):992-7. Epub 2020/08/09. doi: https://doi.org/10.1177/1049909120948235. PubMed PMID: 32762477; PubMed Central PMCID: PMCPMC7488822.
  6. Schwamm LH, Erskine A, Licurse A. A digital embrace to blunt the curve of COVID19 pandemic. NPJ Digit Med. 2020;3:64. Epub 2020/05/08. doi: https://doi.org/10.1038/s41746-020-0279-6. PubMed PMID: 32377575; PubMed Central PMCID: PMCPMC7198549.
  7. Shigekawa E, Fix M, Corbett G, Roby DH, Coffman J. The Current State Of Telehealth Evidence: A Rapid Review. Health Aff (Millwood). 2018 Dec;37(12):1975–82. https://doi.org/10.1377/hlthaff.2018.05132
  8. Bashshur RL, Howell JD, Krupinski EA, Harms KM, Bashshur N, Doarn CR. The Empirical Foundations of Telemedicine Interventions in Primary Care. Telemed J E Health. 2016;22(5):342-75. Epub 2016/04/30. doi: https://doi.org/10.1089/tmj.2016.0045. PubMed PMID: 27128779; PubMed Central PMCID: PMCPMC4860623.
  9. Allen Watts K, Malone E, Dionne-Odom JN, McCammon S, Currie E, Hicks J, et al. Can you hear me now?: Improving palliative care access through telehealth. Res Nurs Health. 2021;44(1):226-37. Epub 2021/01/05. doi: https://doi.org/10.1002/nur.22105. PubMed PMID: 33393704; PubMed Central PMCID: PMCPMC7958991.
  10. Gordon B, Mason B, Smith SL. Leveraging Telehealth for Delivery of Palliative Care to Remote Communities: A Rapid Review. J Palliat Care. 2021 Mar;8258597211001184:8258597211001184. https://doi.org/10.1177/08258597211001184
  11. Higginson IJ, Evans CJ, Grande G, Preston N, Morgan M, McCrone P, et al. Evaluating complex interventions in end of life care: the MORECare statement on good practice generated by a synthesis of transparent expert consultations and systematic reviews. BMC Med. 2013;11(1):111. Epub 2013/04/27. doi: https://doi.org/10.1186/1741-7015-11-111. PubMed PMID: 23618406; PubMed Central PMCID: PMCPMC3635872.
  12. Munn Z, Peters MDJ, Stern C, Tufanaru C, McArthur A, Aromataris E. Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach. BMC Med Res Methodol. 2018;18(1):143. Epub 2018/11/21. doi: https://doi.org/10.1186/s12874-018-0611-x. PubMed PMID: 30453902; PubMed Central PMCID: PMCPMC6245623.
  13. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. Epub 2021/03/31. doi: https://doi.org/10.1136/bmj.n71. PubMed PMID: 33782057; PubMed Central PMCID: PMCPMC8005924.
  14. Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D, et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): checklist and Explanation. Ann Intern Med. 2018 Oct;169(7):467–73. https://doi.org/10.7326/M18-0850
  15. Page MJ, Moher D, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews. BMJ. 2021 Mar;372(160):n160. https://doi.org/10.1136/bmj.n160
  16. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021 Mar;372(71):n71. https://doi.org/10.1136/bmj.n71
  17. Bentley B, O'Connor M, Williams A, Breen LJ. Dignity therapy online: Piloting an online psychosocial intervention for people with terminal illness. Digit Health. 2020;6:2055207620958527. Epub 2020/10/06. doi: https://doi.org/10.1177/2055207620958527. PubMed PMID: 33014409; PubMed Central PMCID: PMCPMC7509717.
  18. Bonsignore L, Bloom N, Steinhauser K, Nichols R, Allen T, Twaddle M, et al. Evaluating the Feasibility and Acceptability of a Telehealth Program in a Rural Palliative Care Population: TapCloud for Palliative Care. J Pain Symptom Manage. 2018 Jul;56(1):7–14. https://doi.org/10.1016/j.jpainsymman.2018.03.013
  19. Elk R, Emanuel L, Hauser J, Bakitas M, Levkoff S. Developing and Testing the Feasibility of a Culturally Based Tele-Palliative Care Consult Based on the Cultural Values and Preferences of Southern, Rural African American and White Community Members: A Program by and for the Community. Health Equity. 2020;4(1):52-83. Epub 2020/04/08. doi: https://doi.org/10.1089/heq.2019.0120. PubMed PMID: 32258958; PubMed Central PMCID: PMCPMC7104898.
  20. Kuntz JG, Kavalieratos D, Esper GJ, Ogbu N, Jr., Mitchell J, Ellis CM, et al. Feasibility and Acceptability of Inpatient Palliative Care E-Family Meetings During COVID-19 Pandemic. J Pain Symptom Manage. 2020;60(3):e28-e32. Epub 2020/06/09. doi: https://doi.org/10.1016/j.jpainsymman.2020.06.001. PubMed PMID: 32505643; PubMed Central PMCID: PMCPMC7272163.
  21. Moore SL, Portz JD, Santodomingo M, Elsbernd K, McHale M, Massone J. Using Telehealth for Hospice Reauthorization Visits: Results of a Quality Improvement Analysis. J Pain Symptom Manage. 2020;60(3):e22-e7. Epub 2020/06/12. doi: https://doi.org/10.1016/j.jpainsymman.2020.06.002. PubMed PMID: 32525082; PubMed Central PMCID: PMCPMC7276118.
  22. Schoppee TM, Dyal BW, Scarton L, Ezenwa MO, Singh P, Yao Y, et al. Patients and Caregivers Rate the PAINReportIt Wireless Internet-Enabled Tablet as a Method for Reporting Pain During End-of-Life Cancer Care. Cancer Nurs. 2020;43(5):419-24. Epub 2019/09/14. doi: https://doi.org/10.1097/NCC.0000000000000743. PubMed PMID: 31517649; PubMed Central PMCID: PMCPMC7098847.
  23. Slavin-Stewart C, Phillips A, Horton R. A Feasibility Study of Home-Based Palliative Care Telemedicine in Rural Nova Scotia. J Palliat Med. 2020 Apr;23(4):548–51. https://doi.org/10.1089/jpm.2019.0173
  24. Tieman JJ, Swetenham K, Morgan DD, To TH, Currow DC. Using telehealth to support end of life care in the community: a feasibility study. BMC Palliat Care. 2016;15(1):94. Epub 2016/11/20. doi: https://doi.org/10.1186/s12904-016-0167-7. PubMed PMID: 27855681; PubMed Central PMCID: PMCPMC5114812.
  25. Weck CE, Lex KM, Lorenzl S. Telemedicine in Palliative Care: Implementation of New Technologies to Overcome Structural Challenges in the Care of Neurological Patients. Front Neurol. 2019;10:510. Epub 2019/06/11. doi: https://doi.org/10.3389/fneur.2019.00510. PubMed PMID: 31178815; PubMed Central PMCID: PMCPMC6542948.
  26. Jess M, Timm H, Dieperink KB. Video consultations in palliative care: A systematic integrative review. Palliat Med. 2019 Sep;33(8):942–58. https://doi.org/10.1177/0269216319854938
  27. Steindal SA, Nes AAG, Godskesen TE, Dihle A, Lind S, Winger A, et al. Patients' Experiences of Telehealth in Palliative Home Care: Scoping Review. J Med Internet Res. 2020;22(5):e16218. Epub 2020/05/06. doi: https://doi.org/10.2196/16218. PubMed PMID: 32369037; PubMed Central PMCID: PMCPMC7238080.
  28. Sutherland AE, Stickland J, Wee B. Can video consultations replace face-to-face interviews? Palliative medicine and the Covid-19 pandemic: rapid review. BMJ Support Palliat Care. 2020;10(3):271-5. Epub 2020/05/28. doi: https://doi.org/10.1136/bmjspcare-2020-002326. PubMed PMID: 32457086; PubMed Central PMCID: PMCPMC7295858.
  29. Widberg C, Wiklund B, Klarare A. Patients' experiences of eHealth in palliative care: an integrative review. BMC Palliat Care. 2020;19(1):158. Epub 2020/10/16. doi: https://doi.org/10.1186/s12904-020-00667-1. PubMed PMID: 33054746; PubMed Central PMCID: PMCPMC7560207.
  30. Zheng Y, Head BA, Schapmire TJ. A Systematic Review of Telehealth in Palliative Care: caregiver Outcomes. Telemed J E Health. 2016 Apr;22(4):288–94. https://doi.org/10.1089/tmj.2015.0090
  31. Funderskov KF, Boe Danbjørg D, Jess M, Munk L, Olsen Zwisler AD, Dieperink KB. Telemedicine in specialised palliative care: healthcare professionals’ and their perspectives on video consultations-A qualitative study. J Clin Nurs. 2019 Nov;28(21-22):3966–76. https://doi.org/10.1111/jocn.15004
  32. Portz JD, Ford KL, Doyon K, Bekelman DB, Boxer RS, Kutner JS, et al. Using Grounded Theory to Inform the Human-Centered Design of Digital Health in Geriatric Palliative Care. J Pain Symptom Manage. 2020;60(6):1181-92 e1. Epub 2020/07/03. doi: https://doi.org/10.1016/j.jpainsymman.2020.06.027. PubMed PMID: 32615298; PubMed Central PMCID: PMCPMC7323666.
  33. Read Paul L, Salmon C, Sinnarajah A, Spice R. Web-based videoconferencing for rural palliative care consultation with elderly patients at home. Support Care Cancer. 2019 Sep;27(9):3321–30. https://doi.org/10.1007/s00520-018-4580-8
  34. Tasneem S, Kim A, Bagheri A, Lebret J. Telemedicine Video Visits for patients receiving palliative care: A qualitative study. Am J Hosp Palliat Care. 2019 Sep;36(9):789–94. https://doi.org/10.1177/1049909119846843
  35. Calton BA, Rabow MW, Branagan L, Dionne-Odom JN, Parker Oliver D, Bakitas MA, et al. Top Ten Tips Palliative Care Clinicians Should Know About Telepalliative Care. J Palliat Med. 2019 Aug;22(8):981–5. https://doi.org/10.1089/jpm.2019.0278
  36. Chavarri-Guerra Y, Ramos-Lopez WA, Covarrubias-Gomez A, Sanchez-Roman S, Quiroz-Friedman P, Alcocer-Castillejos N, et al. Providing Supportive and Palliative Care Using Telemedicine for Patients with Advanced Cancer During the COVID-19 Pandemic in Mexico. Oncologist. 2021;26(3):e512-e5. Epub 2020/10/24. doi: https://doi.org/10.1002/onco.13568. PubMed PMID: 33094533; PubMed Central PMCID: PMCPMC7930406.
  37. Cheung KL, Tamura MK, Stapleton RD, Rabinowitz T, LaMantia MA, Gramling R. Feasibility and Acceptability of Telemedicine-Facilitated Palliative Care Consultations in Rural Dialysis Units. J Palliat Med. 2021;24(9):1307-13. Epub 2021/01/21. doi: https://doi.org/10.1089/jpm.2020.0647. PubMed PMID: 33470899; PubMed Central PMCID: PMCPMC8392074.
  38. Hawkins JP, Gannon C, Palfrey J. Virtual visits in palliative care: about time or against the grain? BMJ Support Palliat Care. 2020;10(3):331-6. Epub 2020/07/19. doi: https://doi.org/10.1136/bmjspcare-2020-002498. PubMed PMID: 32680889; PubMed Central PMCID: PMCPMC7456669.
  39. Jiang B, Bills M, Poon P. Integrated telehealth-assisted home-based specialist palliative care in rural Australia: A feasibility study. J Telemed Telecare. 2020:1357633X20966466. Epub 2020/10/21. doi: https://doi.org/10.1177/1357633X20966466. PubMed PMID: 33079611.
  40. Nkhoma KB, Ebenso B, Akeju D, Adejoh S, Bennett M, Chirenje M, et al. Stakeholder perspectives and requirements to guide the development of digital technology for palliative cancer services: a multi-country, cross-sectional, qualitative study in Nigeria, Uganda and Zimbabwe. BMC Palliat Care. 2021;20(1):4. Epub 2021/01/06. doi: https://doi.org/10.1186/s12904-020-00694-y. PubMed PMID: 33397321; PubMed Central PMCID: PMCPMC7784352.
  41. Phongtankuel V, Shalev A, Adelman RD, Dewald R, Dignam R, Baughn R, et al. Mobile Health Technology Is Here-But Are Hospice Informal Caregivers Receptive? Am J Hosp Palliat Care. 2018;35(12):1547-52. Epub 2018/06/05. doi: https://doi.org/10.1177/1049909118779018. PubMed PMID: 29862851; PubMed Central PMCID: PMCPMC6185794.
  42. Hoek PD, Schers HJ, Bronkhorst EM, Vissers KCP, Hasselaar JGJ. The effect of weekly specialist palliative care teleconsultations in patients with advanced cancer -a randomized clinical trial. BMC Med. 2017;15(1):119. Epub 2017/06/20. doi: https://doi.org/10.1186/s12916-017-0866-9. PubMed PMID: 28625164; PubMed Central PMCID: PMCPMC5474887.
  43. National-Cancer-Institute. Levels of Evidence for Supportive and Palliative Care Studies (PDQ®)–Health Professional Version - National Cancer Institute 2010 [updated 01/04/2010 - 07:00]. Available from: https://www.cancer.gov/publications/pdq/levels-evidence/supportive-care#_3
  44. Steindal SA, Nes AA, Godskesen TE, Lind S, Dhle A, Winger A, et al. Advantages and Challenges in Using Telehealth for Home-Based Palliative Care: Protocol for a Systematic Mixed Studies Review. JMIR Res Protoc. 2021 May;10(5):e22626. https://doi.org/10.2196/22626
  45. Mirella Longo AA-CMMAN. In light of the COVID-19 pandemic, a realist synthesis of mobile application-enabled communication and care management for patients in end-of-life care. 2021.
  46. Rebecca Hutchinson YSLBMK-FAS. How is telehealth being used to increase access to specialty palliative care?
  47. University of California SF. Integrative Palliative Care/Psycho-Oncology Telehealth Group Medical Visits for Patients With Advanced Cancer: A Pilot Study. Clinical trial registration. clinicaltrials.gov, 2021 2021/01/27/. Report No.: NCT04697524.
  48. Langbecker D, Caffery LJ, Gillespie N, Smith AC. Using survey methods in telehealth research: A practical guide. J Telemed Telecare. 2017 Oct;23(9):770–9. https://doi.org/10.1177/1357633X17721814
  49. Disalvo D, Agar M, Caplan G, Murtagh FE, Luckett T, Heneka N, et al. Virtual models of care for people with palliative care needs living in their own home: A systematic meta-review and narrative synthesis. Palliat Med. 2021 Sep;35(8):1385–406. https://doi.org/10.1177/02692163211024451
  50. WHO. Research considerations. WHO Guideline. Geneva: World Health Organization, 2019.
  51. AlDossary S, Martin-Khan MG, Bradford NK, Armfield NR, Smith AC. The Development of a Telemedicine Planning Framework Based on Needs Assessment. J Med Syst. 2017 May;41(5):74. https://doi.org/10.1007/s10916-017-0709-4
  52. Holden RJ, Karsh BT. The technology acceptance model: its past and its future in health care. J Biomed Inform. 2010;43(1):159-72. Epub 2009/07/21. doi: https://doi.org/10.1016/j.jbi.2009.07.002. PubMed PMID: 19615467; PubMed Central PMCID: PMCPMC2814963.
  53. Fereidouni A, Rassouli M, Salesi M, Ashrafizadeh H, Vahedian-Azimi A, Barasteh S. Preferred Place of Death in Adult Cancer Patients: A Systematic Review and Meta-Analysis. Frontiers in psychology. 2021;12:704590. Epub 2021/09/14. doi: https://doi.org/10.3389/fpsyg.2021.704590. PubMed PMID: 34512460; PubMed Central PMCID: PMCPmc8429937.
  54. Pfeiffer V, Sojer R. Digital Trends Survey 2021. Schweiz Arzteztg. 2021;102:1189–92. https://doi.org/10.4414/saez.2021.20144 0036-7486
  55. Reinhold S. Angebot und Nachfrage von digitalen Gesundheitsangeboten (Teil 1). Schweiz Aerzteztg. 2018;99(42):1428–31.
  56. Reinhold S. Angebot und Nachfrage von digitalen Gesundheitsangeboten (Teil 2). Schweiz Aerzteztg. 2018;99(48):1686–9.
  57. Mettler AC, Piazza L, Michel J, Müller M, Exadaktylos AK, Hautz WE, et al. Use of telehealth and outcomes before a visit to the emergency department: a cross-sectional study on walk-in patients in Switzerland. Swiss Med Wkly. 2021 Jul;151:w20543. https://doi.org/10.4414/smw.2021.20543

Most read articles by the same author(s)