Telemedicine in specialised palliative care: Healthcare professionals' and their perspectives on video consultations—A qualitative study

Aims and objectives: To explore the advantages and disadvantages of using video consultations, as experienced by specialised palliative care healthcare professionals, who are involved in palliative care at home. Background: One challenge in the work of specialised palliative care teams is the substantial resources used in terms of time and transport to and from the patient's home. Video consultations may be a solution for real-time specialised palliative home care. Designs: Hermeneutic, postphenomenology. Methods: An explorative qualitative study utilising data from field notes of an autobiographical diary, participant observations and semi-structured interviews with healthcare professionals. The COREQ guideline was used for reporting the study. See Appendix S1. The data collection took place in patients' homes and at the Department of Oncology, Odense University Hospital, Denmark. Results: Eight participants (n = 8); five community nurses; and three specialised palliative care team members—a head physician, a physiotherapist and a nurse—participated in the study. The healthcare professionals' knowledge was based on n = 82 video consultations with 11 patients. The range of video consultations was 3–18 per patient. The use of tablets in video consultations facilitated direct palliative care and led the community nurses and the specialised palliative care team nurse to co-operate. Potential barriers against using video consultations are the discussions about personal, and private issues regarding the illness, while family members are present. Conclusions: Video consultations in specialised palliative home care are feasible, and the technology can facilitate multidisciplinary participation and co-operation among healthcare professionals. The continuous use of video consultations over time may increase the quality of specialised palliative home care. Relevance to clinical practice: The use of video consultations can provide direct specialised palliative care over distance involving healthcare professionals, patients and their relatives.</p

Australian experience: Civic engagement as symbol and substance

This article outlines how civic engagement has become a distinctive feature of the policy development and review processes of governments in Australia, a federal polity. The patterns of civic engagement are quite variable across policy issues, levels of government and geographical regions. Civic engagement (or community consultation) has become a purposeful and planned dimension of policy development in most Australian jurisdictions since the 1980s. Two main reasons for this development are elaborated: the instrumental arguments about programme improvement and effectiveness, and the normative arguments about democratic legitimacy and rights to civic participation. The role of government-sponsored processes for civic engagement is contrasted with the proliferation of new media and independent civil-society forums available for commentary and advocacy. Key distinctions are drawn between various processes and methods of civic engagement in Australia, raising issues about the scope and authenticity of participation on different types of issues. There are specific challenges of involvement by and for indigenous communities, and the special needs of remote communities whose level of social and economic exclusion remains seriously depressed. The conclusions raise some implications for policy development and for state legitimacy arising from impoverished forms of civic engagement