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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 references 34

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          Qualitative Research: Introducing focus groups

           J Kitzinger (1995)
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            Telehealth.

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              International study of the place of death of people with cancer: a population-level comparison of 14 countries across 4 continents using death certificate data

              Background: Where people die can influence a number of indicators of the quality of dying. We aimed to describe the place of death of people with cancer and its associations with clinical, socio-demographic and healthcare supply characteristics in 14 countries. Methods: Cross-sectional study using death certificate data for all deaths from cancer (ICD-10 codes C00-C97) in 2008 in Belgium, Canada, Czech Republic, England, France, Hungary, Italy, Mexico, the Netherlands, New Zealand, South Korea, Spain (2010), USA (2007) and Wales (N=1 355 910). Multivariable logistic regression analyses evaluated factors associated with home death within countries and differences across countries. Results: Between 12% (South Korea) and 57% (Mexico) of cancer deaths occurred at home; between 26% (Netherlands, New Zealand) and 87% (South Korea) occurred in hospital. The large between-country differences in home or hospital deaths were partly explained by differences in availability of hospital- and long-term care beds and general practitioners. Haematologic rather than solid cancer (odds ratios (ORs) 1.29–3.17) and being married rather than divorced (ORs 1.17–2.54) were most consistently associated with home death across countries. Conclusions: A large country variation in the place of death can partly be explained by countries' healthcare resources. Country-specific choices regarding the organisation of end-of-life cancer care likely explain an additional part. These findings indicate the further challenge to evaluate how different specific policies can influence place of death patterns.
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                Author and article information

                Contributors
                ccormi.osteo@gmail.com
                Journal
                BMC Palliat Care
                BMC Palliat Care
                BMC Palliative Care
                BioMed Central (London )
                1472-684X
                14 October 2021
                14 October 2021
                2021
                : 20
                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
                864
                10.1186/s12904-021-00864-6
                8514278
                34645445
                7a9a3b96-0cd7-4047-bdfe-8f5ffa69c51b
                © The Author(s) 2021

                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.

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