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

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          Abstract

          Background

          Despite increasing use of telemedicine in the field of palliative care, studies about the best circumstances and processes where it could replace face-to-face interaction are lacking. This study aimed to: (1) identify situations that are most amenable to the use of telemedicine for the provision of palliative care to patients in nursing homes; and (2) understand how telemedicine could best be integrated into the routine practice of mobile palliative care teams.

          Methods

          A qualitative study based on semi-structured focus groups ( n = 7) with professionals ( n = 33) working in mobile palliative care teams in France.

          Results

          Between June and July 2019, 7 mobile palliative care teams participated in one focus group each. Using thematic analysis, we found that telemedicine use in palliative care is about navigating between usual and new practices. Several influencing factors also emerged, which influence the use of telemedicine for palliative care, depending on the situation. Finally, we built a use-case model of palliative care to help mobile palliative care teams identify circumstances where telemedicine could be useful, or not.

          Conclusions

          The potential utility of telemedicine for delivering palliative care in nursing homes largely depends on the motive for calling on the mobile palliative care team. Requests regarding symptoms may be particularly amenable to telemedicine, whereas psycho-social distress may not. Further studies are warranted to assess the impact of influencing factors on real-life palliative care practices. Telemedicine could nonetheless be a useful addition to the mobile palliative care teams’ armamentarium.

          Supplementary Information

          The online version contains supplementary material available at 10.1186/s12904-021-00864-6.

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          Most cited references34

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          Qualitative Research: Introducing focus groups

          J Kitzinger (1995)
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            Telehealth.

            Reed V. Tuckson, Margo Edmunds, Michael L Hodgkins (2017)
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              Adoption of Digital Technologies in Health Care During the COVID-19 Pandemic: Systematic Review of Early Scientific Literature

              Davide Golinelli, Erik Boetto, Gherardo Carullo … (2020)
              Background The COVID-19 pandemic is favoring digital transitions in many industries and in society as a whole. Health care organizations have responded to the first phase of the pandemic by rapidly adopting digital solutions and advanced technology tools. Objective The aim of this review is to describe the digital solutions that have been reported in the early scientific literature to mitigate the impact of COVID-19 on individuals and health systems. Methods We conducted a systematic review of early COVID-19–related literature (from January 1 to April 30, 2020) by searching MEDLINE and medRxiv with appropriate terms to find relevant literature on the use of digital technologies in response to the pandemic. We extracted study characteristics such as the paper title, journal, and publication date, and we categorized the retrieved papers by the type of technology and patient needs addressed. We built a scoring rubric by cross-classifying the patient needs with the type of technology. We also extracted information and classified each technology reported by the selected articles according to health care system target, grade of innovation, and scalability to other geographical areas. Results The search identified 269 articles, of which 124 full-text articles were assessed and included in the review after screening. Most of the selected articles addressed the use of digital technologies for diagnosis, surveillance, and prevention. We report that most of these digital solutions and innovative technologies have been proposed for the diagnosis of COVID-19. In particular, within the reviewed articles, we identified numerous suggestions on the use of artificial intelligence (AI)–powered tools for the diagnosis and screening of COVID-19. Digital technologies are also useful for prevention and surveillance measures, such as contact-tracing apps and monitoring of internet searches and social media usage. Fewer scientific contributions address the use of digital technologies for lifestyle empowerment or patient engagement. Conclusions In the field of diagnosis, digital solutions that integrate with traditional methods, such as AI-based diagnostic algorithms based both on imaging and clinical data, appear to be promising. For surveillance, digital apps have already proven their effectiveness; however, problems related to privacy and usability remain. For other patient needs, several solutions have been proposed, such as telemedicine or telehealth tools. These tools have long been available, but this historical moment may actually be favoring their definitive large-scale adoption. It is worth taking advantage of the impetus provided by the crisis; it is also important to keep track of the digital solutions currently being proposed to implement best practices and models of care in future and to adopt at least some of the solutions proposed in the scientific literature, especially in national health systems, which have proved to be particularly resistant to the digital transition in recent years.
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                Author and article information

                Contributors
                Clément Cormi: ccormi.osteo@gmail.com
                Journal
                Journal ID (nlm-ta): BMC Palliat Care
                Journal ID (iso-abbrev): BMC Palliat Care
                Title: BMC Palliative Care
                Publisher: BioMed Central (London )
                ISSN (Electronic): 1472-684X
                Publication date (Electronic): 14 October 2021
                Publication date PMC-release: 14 October 2021
                Publication date Collection: 2021
                Volume: 20
                Electronic Location Identifier: 156
                Affiliations
                [1 ]GRID grid.440376.2, ISNI 0000 0004 0594 4000, Pôle Territorial Santé Publique et Performance des Hôpitaux Champagne Sud, , Centre Hospitalier de Troyes, ; 101 avenue Anatole France, CS 20718, 10003 Troyes, France
                [2 ]GRID grid.27729.39, ISNI 0000 0001 2169 8047, LIST3N/Tech-CICO, Troyes University of Technology, ; F-10000 Troyes, France
                [3 ]GRID grid.411147.6, ISNI 0000 0004 0472 0283, Unité de soins palliatifs Laroque, CHU Angers, ; F-49000 Angers, France
                [4 ]GRID grid.42399.35, ISNI 0000 0004 0593 7118, Service de médecine palliative et d’accompagnement, , CHU Bordeaux, ; F-33000 Bordeaux, France
                [5 ]Pôle Recherche et enseignement universitaire (SPES), Maison Médicale Jeanne Garnier, F-75015 Paris, France
                [6 ]GRID grid.508487.6, ISNI 0000 0004 7885 7602, Université de Paris, APHP Centre, ; F-75006 Paris, France
                [7 ]Fondation Korian pour le Bien Vieillir, F-75008 Paris, France
                Article
                Publisher ID: 864
                DOI: 10.1186/s12904-021-00864-6
                PMC ID: 8514278
                PubMed ID: 34645445
                SO-VID: 7a9a3b96-0cd7-4047-bdfe-8f5ffa69c51b
                Copyright © © The Author(s) 2021
                License:

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                Date received : 11 February 2021
                Date accepted : 1 October 2021
                Categories
                Subject: Research
                Custom metadata
                issue-copyright-statement © The Author(s) 2021

                ScienceOpen disciplines: Anesthesiology & Pain management
                Keywords: palliative care,telemedicine,remote consultation,nursing homes,intermediate care facilities,patient care team,delivery of health care, integrated,qualitative research
                Data availability:
                ScienceOpen disciplines: Anesthesiology & Pain management
                Keywords: palliative care, telemedicine, remote consultation, nursing homes, intermediate care facilities, patient care team, delivery of health care, integrated, qualitative research

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