Telehealth in Palliative Care: A Systematic Review of Patient Reported Outcomes

A systematic review was conducted to explore published quantitative and qualitative research describing patient-reported outcomes of palliative telehealth intervention studies. Multiple databases were searched for articles published between January 2006 and May 2016, which met study criteria. Methodological quality was assessed using Cochrane Collaboration’s tool for assessing risk of bias for quantitative articles. For studies reporting qualitative outcomes, a checklist was used to evaluate trustworthiness of the methodology. Of the 6 studies reporting quantitative outcomes, 3 studies were rated as having moderate study quality, and 3 studies were rated as having low study quality. Of the 6 studies reporting qualitative outcomes, 3 reported 5 different methods for ensuring trustworthiness, whereas 1 article reported 4 methods, 1 reported 3, and 1 article reported 2 methods. Studies were notably diverse in terms of patient population, technology used, outcomes measures, and methodology. Results across studies were also variable. Methodological factors were major limitations. Recruitment problems, participant attrition, and lack of standardized outcomes measures impacted outcome assessment. Overall, research support for positive patient outcomes in palliative telehealth interventions was weak. However, all studies but one found positive results to support the intervention

A Systematic Review of Telehealth in Palliative Care: Caregiver Outcomes

Objective: Telehealth interventions have proven efficacy in healthcare, but little is known about the results of such interventions in palliative care. We conducted a systematic review to evaluate caregiver outcomes related to palliative telehealth interventions. Materials and Methods: We searched multiple databases for articles published between January 2003 and January 2015 related to telehealth in palliative care. Two hundred twenty-one articles were considered; nine of these met study inclusion criteria. Data on study design, population, interventions, methods, outcomes, conclusions, and methodological quality were extracted and evaluated by three investigators. Results: Of the nine studies, five measured caregiver quality of life, three measured caregiver anxiety, and two measured caregiver burden. All the studies measuring caregiver quality of life showed no significant difference after telehealth interventions. The caregiver anxiety score decreased after the intervention in two studies, and one study reported significantly reduced caregiver burden. Although feasibility of or caregiver satisfaction with the telehealth intervention was not the focus of this review, most studies reported such findings. Of the nine studies, the majority were rated as having moderate quality using the Cochrane Collaboration’s tool for assessing risk of bias. Conclusions: This systematic review suggests there is evidence of overall satisfaction in caregivers who undergo a telehealth intervention, but outcomes reported were often not substantial. Methodological flaws and small sample sizes negatively affected study quality. More rigorous research to test and evaluate such palliative interventions is needed

Emotional distress in older adults with cancer : a multilevel longitudinal study.

Data from the Health and Retirement Study (HRS) were used to examine factors that influence emotional distress in older adults with cancer, arid to learn whether these distress trajectories are different from older adults without cancer. The model investigated the influence of life course factors, internal, external and health-related resources on distress over eight years among a nationally representative sample of older adults ages 50-91. Methods: This longitudinal panel study tested a multilevel random intercept multinomial ordered categorical model with a two-nested-Ievel structure using empirical Bayes Markov chain Monte Carlo (MCMC) estimation. The model examined individual differences in distress over eight years (2000-2008), testing multiple potential predictors which were either time-variant within-person or time-invariant between-person data measured at five consecutive time periods. All those with a first diagnosis of cancer in 1998-2000 were included in study (n=200) together with a representative subsample of all non-cancer cases (n=1190), for a total of 1390. Results: In each step, the model fit improved significantly using the DIG statistic. Overall, 33 percent of sample reported one or more depression symptoms in 2000, and by 2008 the number decreased to 30 percent. Keeping all main effects constant, those with cancer had one percent lower probability of depression symptoms over time than those without cancer. Significant two-way interaction effects were detected between having cancer and absence of spouse/partner in the home, and cancer and lower life expectancy; each resulted in higher probabilities of depression symptoms. A significant three-way interaction effect was detected between cancer, gender, and social support with women with a cancer history and low social support having the highest probability of depression symptoms. Conclusions: Those with four or five depression symptoms at the beginning of the study tended to stay the same over time, while those with one to three symptoms tended to improve slightly. A small significant protective factor of cancer on distress over time was detected. A large protective factor of cancer existed for older adults with a partner present in the home, but cancer became a significant risk factor for distress with no partner presence. The protective factor remained for older adults with cancer and longer life expectancy, but cancer became a significant risk factor for distress with low life expectancy. While there was a large protective factor of cancer among women with high social support, cancer history became a risk factor for women with low social support

Functional Capacity Evaluation Part 1: Cutting the Gordian Knot of Secondary Gain, Expert Witness Culture and Validity of Effort Testing

Abstract Workers' compensation cases are often contentious, litigated events. The authors describe a Gordian Knot that is created by competing interests. These interests are manifested in secondary gain issues, non-physical factors (psychological, social, financial and economic) and the expert witness culture. The process of making medical, legal and case management decisions is compromised by the failure to recognize the limitations of the four primary components of the most commonly administered Functional Capacity Evaluation (FCE) protocols. Three of these components (pain questionnaires, intake interview and clinical assessment) are discussed in this first part of a two-part article. This discussion lays the foundation for Part 2, which addresses the fourth FCE component -the most commonly administered tests which are used for the alleged purpose of classifying validity of effort in Part 2. The authors provide insights into how the Gordian Knot can be cut with more accurate, statistically-based testing methods described in peer reviewed publications

The Interdisciplinary Curriculum for Oncology Palliative Care Education (iCOPE): Meeting the Challenge of Interprofessional Education

Abstract Background: Interprofessional education is necessary to prepare students of the health professions for successful practice in today's health care environment. Because of its expertise in interdisciplinary practice and team-based care, palliative care should be leading the way in creating educational opportunities for students to learn the skills for team practice and provision of quality patient-centered care. Multiple barriers exist that can discourage those desiring to create and implement truly interdisciplinary curriculum. Design: An interdisciplinary faculty team planned and piloted a mandatory interdisciplinary palliative oncology curriculum and responded to formative feedback. Setting/Subjects: The project took place at a large public metropolitan university. Medical, nursing, and social work students and chaplains completing a clinical pastoral education internship participated in the curriculum. Measurements: Formative feedback was received via the consultation of an interdisciplinary group of palliative education experts, focus groups from students, and student evaluations of each learning modality. Results: Multiple barriers were experienced and successfully addressed by the faculty team. Curricular components were redesigned based on formative feedback. Openness to this feedback coupled with flexibility and compromise enabled the faculty team to create an efficient, sustainable, and feasible interdisciplinary palliative oncology curriculum. Conclusion: Interdisciplinary palliative education can be successful if faculty teams are willing to confront challenges, accept feedback on multiple levels, and compromise while maintaining focus on desired learner outcomes

“Sacred Work”: Reflections on the Professional and Personal Impact of an Interdisciplinary Palliative Oncology Clinical Experience by Social Work Learners

This study explored the impact of an oncology palliative care clinical experience with older adults on social work learners. A three-member research team conducted a qualitative content analysis of reflective writings. 27 Master of Science in Social Work students enrolled in an interprofessional palliative oncology curriculum and completed a reflective writing assignment to summarize the clinical scenario, analyze the patient/family care provided, and describe the impact of the experience. Using a constant comparison approach based on grounded theory, the research team analyzed the reflections to come to consensus related to the overall impact of the experience. Two overarching themes (professional and personal impact) and 11 subthemes (appreciation of interdisciplinary teams, recognition of clinical skills of other disciplines, insight into clinical skills of the social worker, perception of palliative care, embracing palliative care principles, centrality of communication, importance of social support, family as the unit of care, countertransference, conflict between personal values and patient/family values, and emotional reactions) were identified. Experiential learning opportunities for social work learners in interprofessional palliative care build appreciation for and skills in applying palliative care principles including teamwork, symptom control, and advanced care planning along with a commitment to embrace these principles in future practice