Teleconsultation for integrated palliative care at home: A qualitative study

Abstract

Background:

Interprofessional consultation contributes to symptom control for home-based palliative care patients and improves advance care planning. Distance and travel time, however, complicate the integration of primary care and specialist palliative care. Expert online audiovisual teleconsultations could be a method for integrating palliative care services.

Aim:

This study aims to describe (1) whether and how teleconsultation supports the integration of primary care, specialist palliative care, and patient perspectives and services and (2) how patients and (in)formal caregivers experience collaboration in a teleconsultation approach.

Design:

This work consists of a qualitative study that utilizes long-term direct observations and in-depth interviews.

Setting/participants:

A total of 18 home-based palliative care patients (16 with cancer, 2 with chronic obstructive pulmonary disease; age range 24–85 years old), 12 hospital-based specialist palliative care team clinicians, and 17 primary care physicians.

Results:

Analysis showed that the introduction of specialist palliative care team-patient teleconsultation led to collaboration between primary care physicians and specialist palliative care team clinicians in all 18 cases. In 17/18 cases, interprofessional contact was restricted to backstage work after teleconsultation. In one deviant case, both the patient and the professionals were simultaneously connected through teleconsultation. Two themes characterized integrated palliative care at home as a consequence of teleconsultation: (1) professionals defining responsibility and (2) building interprofessional rapport.

Conclusion:

Specialist palliative care team teleconsultation with home-based patients leads to collaboration between primary care physicians and hospital-based palliative care specialists. Due to cultural reasons, most collaboration was of a multidisciplinary character, strongly relying on organized backstage work. Interdisciplinary teleconsultations with real-time contact between patient and both professionals were less common but stimulated patient-centered care dialogues.

Keywords

Integrated delivery of health care interdisciplinary communication interdisciplinary health teams palliative care teleconsultation

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References

Collis

Al-Qurainy

. Care of the dying patient in the community. BMJ 2013; 347: f4085.

Randall

Downie

. The philosophy of palliative care: critique and reconstruction. Oxford: Oxford University Press, 2006.

Quill

Abernethy

. Generalist plus specialist palliative care—creating a more sustainable model. N Engl J Med 2013; 368: 1173–1175.

Jessup

. Interdisciplinary versus multidisciplinary care teams: do we understand the difference? Aust Health Rev 2007; 31: 330–331.

Körner

. Interprofessional teamwork in medical rehabilitation: a comparison of multidisciplinary and interdisciplinary team approach. Clin Rehabil 2010; 24: 745–755.

Rabow

Dibble

Pantilat

. The comprehensive care team: a controlled trial of outpatient palliative medicine consultation. Arch Intern Med 2004; 164: 83–91.

Marshall

Howell

Brazil

. Enhancing primary care physician capacity to deliver quality palliative home care: an end-of-life, shared-care model. Can Fam Physician 2008; 54: 1703.e1–1703.e7.

Howell

Marshall

Brazil

. A shared care model pilot for palliative home care in a rural area: impact on symptoms, distress, and place of death. J Pain Symptom Manage 2011; 42: 60–75.

Desmedt

Michel

. Palliative home care: improving co-operation between the specialist team and the primary care doctor. Support Care Cancer 2002; 10: 343–348.

10.

Bajwah

Higginson

. General practitioners’ use and experiences of palliative care services: a survey in south east England. BMC Palliat Care 2008; 7: 18.

11.

Gardiner

Gott

Ingleton

. Factors supporting good partnership working between generalist and specialist palliative care services: a systematic review. Br J Gen Pract 2012; 62: e353–e362.

12.

Foy

Hempel

Rubenstein

. Meta-analysis: effect of interactive communication between collaborating primary care physicians and specialists. Ann Intern Med 2010; 152: 247–258.

13.

Carline

Curtis

Wenrich

. Physicians’ interactions with health care teams and systems in the care of dying patients: perspectives of dying patients, primary care members, and health care professionals. J Pain Symptom Manage 2003; 25: 19–28.

14.

Esterle

Mathieu-Fritz

. Teleconsultation in geriatrics: impact on professional practice. Int J Med Inform 2013; 82: 684–695.

15.

Lehoux

Sicotte

Denis

. The theory of use behind telemedicine: how compatible with physicians’ clinical routines? Soc Sci Med 2002; 54: 889–904.

16.

Floriani

Schramm

. Routinization and medicalization of palliative care: losses, gains and challenges. Palliat Support Care 2012; 10: 295–303. DOI: 10.1017/S1478951511001039.

17.

Van Gurp

Van Selm

Vissers

. How outpatient palliative care teleconsultation facilitates empathic patient-professional relationships: a qualitative study. PLoS ONE 2015; 10: e0124387. DOI: 10.1371/journal.pone.0124387.

18.

Charmaz

. Constructing grounded theory: a practical guide through qualitative analysis. London: SAGE, 2009.

19.

Karnofsky

Burchenal

. The clinical evaluation of chemotherapeutic agents in cancer. In: McLeod

(ed.) Evaluation of chemotherapeutic agents in cancer. New York: Columbia University Press, 1949, pp. 191–205.

20.

Yin

. Case study research: design and methods. 2nd ed. Thousand Oaks, CA: SAGE, 1994.

21.

Silverman

. Doing qualitative research: a practical handbook. 2nd ed. London: SAGE, 2005.

22.

Global Initiative for Chronic Obstructive Lung Disease, Inc. (GOLD). Global strategy for the diagnosis, management and prevention of chronic obstructive pulmonary disease, http://www.goldcopd.org/uploads/users/files/GOLD_Report_2014_Jun11.pdf (2014, accessed 9 August 2014).

23.

Murray

Kendall

Boyd

. Illness trajectories and palliative care. BMJ 2005; 330: 1007–1011.

24.

Peterson

. Anthropology & mass communication: media and myth in the new millennium. New York: Berghahn Books, 2003.

25.

Kendall

Murray

Carduff

. Use of multiperspective qualitative interviews to understand patients’ and carers’ beliefs, experiences, and needs. BMJ 2009; 339: b4122.

26.

Murray

Kendall

Carduff

. Use of serial qualitative interviews to understand patients’ evolving experiences and needs. BMJ 2009; 339: b3702.

27.

Eisikovits

Koren

. Approaches to and outcomes of dyadic interview analysis. Qual Health Res 2010; 20: 1642–1655.

28.

Corbin

Strauss

. Basics of qualitative research: techniques and procedures for developing grounded theory. 3rd ed. Thousand Oaks: SAGE, 2008.

29.

Guba

. Criteria for assessing the trustworthiness of naturalistic inquiries. Educ Comm Tech 1981; 29: 75–91.

30.

Mays

Pope

. Qualitative research in health care. Assessing quality in qualitative research. BMJ 2000; 320: 50–52.

31.

Lewin

Reeves

. Enacting “team” and “teamwork”: using Goffman’s theory of impression management to illuminate interprofessional practice on hospital wards. Soc Sci Med 2011; 72: 1595–1602.

32.

Clark

. Between hope and acceptance: the medicalisation of dying. BMJ 2002; 324: 905–907.

33.

Ihde

. Technology and the lifeworld: from garden to earth. Bloomington, IN: Indiana University Press, 1990.

34.

Randall

Downie

. Palliative care ethics: a companion for all specialties. 2nd ed. Oxford: Oxford University Press, 1999.

35.

Van Gurp

Soyannwo

Odebunmi

. Telemedicine’s potential to support good dying in Nigeria: a qualitative study. PLoS ONE 2015; 10: e0126820. DOI: 10.1371/journal.pone.0126820

36.

Van Beek

Woitha

Ahmed

. Comparison of legislation, regulations and national health strategies for palliative care in seven European countries (Results from the Europall Research Group): a descriptive study. BMC Health Serv Res 2013; 13: 275. DOI: 10.1186/1472-6963-13-275.