The Impact of Telehealth on Rural Cancer Care: A Review of Current Practices and Guidelines

Rural oncology patients have poor access to oncology care which negatively impacts quality of care and delivery of treatment. Recent telehealth interventions show evidence of improvement on this problem. Policies and guidelines regarding telehealth have enhanced cohesiveness within the field and have the potential to further improve patient care. This review summarizes research on telehealth interventions for rural oncology patients and of related guidelines and standards of practice. The literature review included searches of PubMed and CINAHL using telehealth related terms and was limited to articles published in English in the last ten years (2008 - 2018). A review of guidelines and standards of practice searched health-related organization databases for policies, protocols, and guidelines related to the use of teleoncology and telehealth. Sixteen research articles that evaluated the use of telehealth on cancer care were reviewed. Ten guidelines, policies, and recommendation documents were reviewed that summarized group stances and protocols for telehealth use. Review of the literature reveals the following significant benefits of teleoncology to rural patients: high patient and provider satisfaction, increased access to care, improved symptom management, cost-effectiveness, and safety of the intervention. While research studies on rural teleoncology are limited, existing research demonstrates positive findings on care for the rural cancer patient. Current guidelines and standards help to standardize the practice of telehealth, but further development of guidelines specific to teleoncology are needed to help promote uptake of the practice and reduce barriers to care.Bachelor of Scienc

The Comprehensive Cancer Center

This open access book provides a valuable resource for hospitals, institutions, and health authorities worldwide in their plans to set up and develop comprehensive cancer care centers. The development and implementation of a comprehensive cancer program allows for a systematic approach to evidence-based strategies of prevention, early detection, diagnosis, treatment, and palliation. Comprehensive cancer programs also provide a nexus for the running of clinical trials and implementation of novel cancer therapies with the overall aim of optimizing comprehensive and holistic care of cancer patients and providing them with the best opportunity to improve quality of life and overall survival. This book's self-contained chapter format aims to reinforce the critical importance of comprehensive cancer care centers while providing a practical guide for the essential components needed to achieve them, such as operational considerations, guidelines for best clinical inpatient and outpatient care, and research and quality management structures. Intended to be wide-ranging and applicable at a global level for both high and low income countries, this book is also instructive for regions with limited resources. The Comprehensive Cancer Center: Development, Integration, and Implementation is an essential resource for oncology physicians including hematologists, medical oncologists, radiation oncologists, surgical oncologists, and oncology nurses as well as hospitals, health departments, university authorities, governments and legislators

Dynamic Capabilities in Home Health: IT-Enabled Transformation of Post-Acute Care

Home health care can enable shorter hospital stays, reduce re-hospitalization, and contribute to lowered out-of-hospital morbidity and mortality. However, recent changes in Medicare payments and regulations in the US have challenged home health care providers’ business models. Against this backdrop, we draw on the dynamic capability perspective to examine how one home health care provider responded to this challenge over the period 2000-2009 by combining adaptive organization principles and information technology (IT) to transform its post-acute care delivery. The transformation leveraged the organization’s existing dynamic capabilities; improved nursing practices; engaged physicians, nurses, managers, and patients; and implemented remote patient monitoring and other IT-enabled innovations. Integrating information systems and health services literatures, we identify the processes targeted by the transformation, analyze how the provider built adaptive care delivery capability enabled by IT, and demonstrate how the transformation led to improved clinical and financial outcomes. In addition, we offer new insights into the micro-foundations of dynamic capabilities by distinguishing between capabilities at the transactional and transformational levels, and explaining how different types of IT-enabled capabilities shaped, and were shaped by, the home health care provider’s responses to environmental changes

An action research study to investigate the strategies that can be used by health care professionals, during video consultations with palliative care patients, to enhance the therapeutic alliance

Background: The use of telemedicine was gaining momentum. Although the strength of the therapeutic alliance (TA) correlated with treatment outcomes, there was no research exploring the skills, attitudes and behaviours that enhanced the TA during Skype consultations in palliative care. Aims: This study identified the skills, attitudes and behaviours that affected the TA between palliative care patients and health care professionals during Skype consultations and identified strategies that enhanced the TA. Study Design: Two cycles of action research engaged the participants in self-reflective inquiry and encouraged the identification of strategies that enhanced the TA and the Skype experience. Participants: Six health professionals and nine patients were recruited from a Hospice out patient service in one Health Authority in England. Data Collection: Data from the audio-recorded consultation were managed quantitatively and the TA was measured using the Working Alliance Inventory (S). Qualitative data were collected from participant interviews and focus groups attended by the professionals. Data Analysis: The analysis ran in parallel with the data collection, started after the first consultation and all sources of data were cross-referenced. Thematic analysis was used to sequentially code the qualitative data to help identify, examine and record patterns within the data set. Findings: The findings suggested that it was possible to establish and a positive therapeutic alliance between health professionals and palliative care patients when using Skype. There was a shift in perception for those health professionals who had reservations about their ability to establish a therapeutic alliance (TA) via a computer link. It was demonstrated that advanced communication skills were transferrable between face to face and video consultations. No additional communication skills training was needed to enable a strong TA when using Skype. Including some social talk, working with the patient’s as opposed to the professional’s agenda and actively offering solutions improved the Skype experience for the patients. The strategies that health professionals promoted to enhance the TA included using Skype with appropriately selected patients to complement the existing Service. Mandatory training in the effective use of Skype was recommended even for those health professionals who used Skype socially. Clarification to address the challenge of clinical governance was recommended. In keeping with an action research design the change impacted on both the health professionals own practice and the Organisation’s approach to telemedicine. The potential for using action research to engage nurses and doctors in critical self-reflective inquiry and to empower them to be change facilitators was demonstrated. Conclusion: Although a small sample size, this study identified strategies that enhanced the TA during Skype consultations. The findings were significant because they added to the current body of knowledge about using Skype to facilitate consultations within the palliative care population. Additionally, the findings may be transferable to different populations and healthcare contexts

Impact of an APRN Directed Workflow Change on Outpatient Palliative Care Referral Acceptance Rates

Abstract Patients diagnosed with an advanced disease or serious illness often experience a variety of distressing symptoms that can negatively impact their functional status and quality of life. Outpatient palliative care is a medical specialty that often requires a referral from a primary care or specialty care provider who has identified a need for specialized pain and symptom management, psychosocial or caregiver distress, end-of-life care management, or goals of care discussions. Despite notable effectiveness in the provision of palliative care for patients with advanced disease and serious illness, barriers exist that prevent patients from accepting palliative care referrals even after a need has been identified by their referring provider. This DNP project aimed to increase the rate of palliative care referral acceptance rates in adult patients referred to the outpatient palliative care team within Sansum Clinic, by incorporating an APRN-led workflow change into the initial outreach process for patients referred to the team. Referral and demographic data were analyzed for this DNP project. Considerations for future educational, clinical and research opportunities are discussed