Web-Based Videoconferencing (WBVC) for Rural Palliative Care Consultation in the Home
Web-Based Videoconferencing (WBVC) can help patients have faster access to expert help without having to leave home. It can also help Palliative Care doctors and nurses see more patients and improve productivity.
Research Results
Findings: Participants included 10 patients (mean age 77), 13 family members, nine Home Care Nurses (HC-Ns), three Palliative Care Clinical Nurse Specialists (PC-CNSs) and two Palliative Care Physician Consultants (PC-MDs). Participants reported they were comfortable discussing concerns by WBVC and felt their needs and concerns were addressed as well as in person. Some patients and family members worried about the privacy and security of the internet connection, despite reassurances. Participants in the home valued being able to “see” the PC-MD and have a thorough discussion of issues as a whole team. Audiovisual quality was not ideal but adequate to enable communication. The WBVC was very convenient for patients and families. It helped them have faster access to the PC-MD without the burden of leaving home. The PCMDs saved the time and travel needed for an in-person visit, freeing up more time to see more patients. Overall, participants felt WBVC was better than a phone call but not as good as an in-person visit.
Impact of findings: Through the use of mobile WBVC for clinical consultation in the home, frail elderly patients and their caregivers will have improved access to clinical specialists and other professional caregivers, resulting in improved support and surveillance in the home. Patients and their caregivers will be able to engage in more timely, comprehensive communication around complex care issues, Advance Care Planning, and treatment planning. Lastly, patients, families, and consultants will save the time, cost, and burden of travel to an in-person visit, and the efficiency and productivity of clinical consultation will be improved, particularly in a dispersed rural population.
About the Project
Seriously ill, frail elderly patients in rural areas often have limited access to specialist palliative care support. It is hard for them to travel to medical visits, and barriers of time and weather can prevent timely home visits by consultants. WBVC offers an alternate visit format that allows patients to see, hear and talk to a health care provider without anyone having to travel.
In this pilot phase, we tested the use of WBVC for rural palliative care consults in the home. A PC-CNS, who was in the home with the patient/family and HC-N, set up a laptop computer with a camera and speakerphone and linked to a distant Palliative Care Doctor over the Internet so everyone could take part in the consult visit. Written surveys, interviews and focus groups helped us learn how well WBVC works for this purpose and the best ways to use it.
Project Team
Principal Investigator:
Linda Read Paul, RN, MN, CHPCN(C) — University of Calgary
Co-Investigators:
Gilian Ho, MD, CCFP — Alberta Health Services
Ayn Sinnarajah, MD, MPH, CCFP(PC) — University of Calgary
Ron Spice, MD, BMedSc, CCFP(PC), FCFP — University of Calgary
Jill Uniacke, RN, MN, CHPCN(C) — Alberta Health Services
Marie Webb, RN, MSc, CHPCN(C) — Alberta Health Services
Project Contact: Linda Read Paul — Linda.ReadPaul@ahs.ca
HTIG 2014-10
Key Findings for Families
- People were comfortable talking about concerns and getting help over the computer
- The video visit helped patients have faster access to the doctor without leaving home
- Doctors saved the time and travel needed for an in-person visit, freeing up more time to see more patients
The use of mobile WBVC can make care better for seriously ill, frail elderly patients and their family/caregivers.
- Patients and families could have quicker help for treating pain and symptoms, making hard choices, and planning for the future
- Increased support through video visits could improve patients’ end of life care and their quality of life
- The burden and expense of travel to doctor visits is removed
Why This Matters
Very sick, older patients in rural areas have trouble getting out to the doctor when they’re dying. This study was needed to test a new way of seeing the doctor without leaving home by using computer video visits. Other studies have shown that health care video visits work well but almost all have been done with patients in hospital video rooms and we don’t know a lot about how they work from home.
About This Study
- We did this study to test the use of a computer video visit for linking very sick, older patients with a distant doctor from their rural homes around Calgary, Alberta
- 10 online video visits were done using a laptop computer with a camera and speakerphone
- A doctor was on the video visit from their office and a nurse was with the patient and family in the home
- We used surveys, interviews and focus groups to see if this was a good way of doing these health care visits
- We asked about comfort talking by video visit, how well needs were met, technical problems and time and travel saved
Key Findings for Policy
- WBVC for Palliative Care Consultation in the home is an effective and efficient way to provide support to seriously ill elderly patients and their families in rural areas
- WBVC saves time & cost compared to an in-person visit
- Fears regarding Internet security and optimizing audiovisual quality are factors in making WBVC a success
Through the use of mobile WBVC many aspects of quality care can be improved for seriously ill, frail elderly patients and their families/caregivers.
Suggestions on how administrators or policy makers could use the findings:
- Expand health administration policies on the use of telehealth for clinical applications
- Revise physician billing codes to allow for proper remuneration for new clinical telehealth processes
- Engage seniors’ health programs to promote innovation in support and surveillance of frail elderly patients
Why This Study was Needed
While there is growing evidence supporting the feasibility, effectiveness and benefits of using telehealth technology to conduct clinical consultations, studies are generally small and methodologically weak and the vast majority of studies are limited to the conduct of videoconferences from facility-based telehealth-enabled rooms. The use of mobile telehealth technology to conduct clinical consultations with patients at home has not been rigorously researched or evaluated, particularly for rural elderly patients in need of palliative care support – so significant knowledge gaps and questions remain. Some of the evidence gaps addressed by our findings include: (1) optimal devices and software, (2) adequacy of connectivity and audiovisual quality, (3) acceptability to health care providers and patients, (4) clinical effectiveness and (5) impact on cost and resource use.
Study Summary
- The objective of this study was to trial and evaluate the use of mobile WBVC to connect frail elderly patients with life limiting illness to a distant Palliative Care Physician (PC-MD) from the comfort of their homes in the rural area surrounding Calgary, Alberta
- This was a descriptive study using mixed methodology
- Ten Web-Based Videoconferences were conducted over a secure, encrypted Internet connection using laptop computers equipped with Microsoft Lync® software, camera, speakerphone and aircard
- Data was collected using questionnaires, interviews and focus groups
- Measured outcomes included comfort discussing concerns, ability to address patient/family needs, ability of patient/family to communicate effectively, ability to improve clinical decision-making, technological functioning, audiovisual quality, improvements in access and savings of time and travel
Key Findings for Researchers
- WBVC for Palliative Care Consultation in the home is an acceptable, effective and convenient way to provide more timely support to seriously ill elderly patients and their families in rural areas.
- Fears regarding internet security must be acknowledged and addressed when using this technology and measures to optimize audiovisual quality must be implemented.
Through the use of mobile WBVC many aspects of quality care can be improved for seriously ill, frail elderly patients and their families/caregivers.
- Seriously ill, frail elderly patients and their caregivers will have improved access to clinical specialists and other professional caregivers, resulting in improved support and surveillance in the home, and potentially improved quality of life
- Patients and their caregivers will be able to engage in more timely, comprehensive communication around complex care issues, Advance Care Planning and treatment planning
- Patients, families and consultants will save the time, cost and burden of travel to an in-person visit, and the efficiency and productivity of clinical consultation will be improved, particularly in a dispersed rural population
Why This Study was Needed
While there is growing evidence supporting the feasibility, effectiveness and benefits of using telehealth technology to conduct clinical consultations, studies are generally small and methodologically weak and the vast majority of studies are limited to the conduct of videoconferences from facility-based telehealth-enabled rooms. The use of mobile telehealth technology to conduct clinical consultations with patients at home has not been rigorously researched or evaluated, particularly for rural elderly patients in need of palliative care support – so significant knowledge gaps and questions remain. Some of the evidence gaps addressed by our findings include: (1) optimal devices and software, (2) adequacy of connectivity and audiovisual quality, (3) acceptability to health care providers and patients, (4) clinical effectiveness and (5) impact on cost and resource use.
How This Study Addresses the Gap
The objective of this study was to trial and evaluate the use of mobile WBVC to connect frail elderly patients with life limiting illness to a distant Palliative Care Physician from the comfort of their homes in the rural area surrounding Calgary, Alberta. We hypothesized that WBVC will be a feasible, acceptable and effective alternative to in-person or telephone visits, will be of adequate quality and will save time and travel.
This was a descriptive, proof-of-concept study using mixed methodology. 10 Web-Based Videoconferences were conducted over a secure, encrypted Internet connection using laptop computers equipped with Microsoft Lync® software, camera, speakerphone and aircard. Data was collected using questionnaires, interviews and focus groups. Measured outcomes included comfort discussing concerns, ability to address patient/family needs, ability of patient/family to communicate effectively, ability to improve clinical decision-making, technological functioning, audiovisual quality, improvements in access and savings of time and travel.
Future Research
- Ability of home care nurses or patients/caregivers to initiate WBVC with distant consultants
- Effectiveness of digital devices to enable more comprehensive clinical examination over WBVC
Presentations
Read Paul, L., Salmon, S., Ho, G., Webb, M., Uniacke, J., Sinnarajah, A., Kettle, J., Mohammed, R., Spice, R. (October 2016). Web-Based Videoconferencing for Rural Palliative Care Consultation in the Home: A First Phase Research Project. (Oral presentation). 27th Annual Palliative Education & Research Days.
Read Paul, L., Salmon, S., Ho, G., Webb, M., Uniacke, J., Sinnarajah, A., Kettle, J., Mohammed, R., Spice. R. (October 2016). Web-based Videoconferencing for Rural Palliative Care Consultation in the Home: A Pilot Project in the Calgary Zone of Alberta Health Services. (Poster presentation). 21st International Congress on Palliative Care.
Read Paul, L., Salmon, S., Ho, G., Webb, M., Uniacke, J., Sinnarajah, A., Kettle, J., Mohammed, R., Spice, R. (April and May 2016). Web-Based Videoconferencing for Rural Palliative Care Consultation in the Home. (Poster presentation). Calgary and Edmonton Continuing Care & Community Living Expo 2016.
Read Paul, L., Salmon, S., Ho, G., Webb, M., Uniacke, J., Sinnarajah, A., Kettle, J., Mohammed, R., Spice. R. (April 2016). Web-based Videoconferencing for Rural Palliative Care Consultation in the Home: A Pilot Project in the Calgary Zone of Alberta Health Services. (Poster and oral presentation). 16th annual Mary O’Connor Palliative and Hospice Care Conference.
Read Paul, L., Salmon, C., Sinnarajah, A., Ho, G., Webb, M., Uniacke, J., Linsey, J., Kettle, J., Mohammed, R., Spice, R. (March 2016). Web-based Videoconferencing for Rural Palliative Consultation in the Home. (Poster presentation). Alberta College of Family Physician’s (ACFP) 61st annual Scientific Assembly.
Read Paul, L., Spice, R., Sinnarajah, A., Ho, G., Uniacke, J., Webb, M., Salmon, C., Kettle, J., Mohammed, R. (September 2015). Web-based Videoconferencing for Rural Palliative Care Consultation in the Home. (Poster presentation). 3rd annual TVN Conference.
Objectives: To trial and evaluate the use of mobile Web-Based Videoconferencing (WBVC) to connect frail elderly patients with life limiting illness to a distant Palliative Care Physician (PC-MD) from the comfort of their homes in the rural area surrounding Calgary, Alberta.
Hypothesis: The use of mobile WBVC technology to connect a PC-MD to frail elderly patients and their families at home will be a feasible, acceptable, effective alternative to in-person or telephone visits, will be of adequate quality and will save time and travel.
Research Plan: This was a descriptive, proof-of-concept study using mixed methodology. Ten WBVCs were conducted over a secure, encrypted internet connection using laptop computers equipped with Microsoft Lync® software, camera, speakerphone, and aircard. In this pilot project, a Palliative Care Clinical Nurse Specialist (PC-CNS) was in the home with the patient/family and Home Care nurse (HC-N) to facilitate connection to a distant PC-MD. Data was collected using questionnaires, interviews, and focus groups.
CFN Webinar (April 12, 2017): Web-Based Videoconferencing (WBVC) for Rural Palliative Care Consultation in the Home