Department of Family and Community Medicine, Division of Palliative Care, University of Toronto, Toronto, Ontario, Canada.
Baycrest Health Sciences, University of Toronto, Toronto, Ontario, Canada.
Palliat Support Care. 2020 Aug;18(4):460-467. doi: 10.1017/S1478951520000012.
Palliative care plays an essential role in enhancing the quality of life and quality of death for residents in long-term care homes (LTCHs). Access to palliative care specialists is one barrier to providing palliative care to LTCHs. This project focused on palliative telemedicine, specifically evaluating whether integration of early palliative care specialist consultation into an LTCH would be feasible through the implementation of videoconferencing during routine interdisciplinary care conferences.
This was a mixed-methods evaluation of a pilot program implementation over 6 months, to integrate early palliative care into an LTCH. There were two pilot communities with a total of 61 residents. Resident demographics were collected by a chart review, and palliative telemedicine feasibility was evaluated using staff and family member surveys.
For the 61 residents, the average age of the residents was 87 years, with 61% being female and 69% having dementia as the primary diagnosis. The mean CHESS (Change in Health, End-Stage Disease, Signs, and Symptoms) and ADL (Activities of Daily Living) scores were 0.8 and 4.0, respectively, with 54% having a Palliative Performance Scale score of 40. Seventeen clinical staff surveys on palliative teleconferences were completed with the majority rating their experience as high. Ten out of the 20 family members completed the palliative teleconference surveys, and the majority were generally satisfied with the experience and were willing to use it again. Clinical staff confidence in delivering palliative care through telemedicine significantly increased (P = 0.0021).
The results support the feasibility of videoconferencing as a means of palliative care provision. Despite technical issues, most clinical staff and families were satisfied with the videoconference and were willing to use it again. Early integration of palliative care specialist services into an LTCH through videoconferencing also led to improved self-rated confidence in the palliative approach to care by clinical staff.
姑息治疗在提高长期护理院（LTCH）居民的生活质量和死亡质量方面发挥着重要作用。姑息治疗专家的可及性是向 LTCH 提供姑息治疗的一个障碍。本项目专注于姑息治疗远程医疗，特别是评估通过在常规跨学科护理会议期间实施视频会议，将早期姑息治疗专家咨询纳入 LTCH 是否可行。
这是对为期 6 个月的试点计划实施情况的混合方法评估，旨在将早期姑息治疗纳入 LTCH。有两个试点社区，共有 61 名居民。通过病历回顾收集居民人口统计学数据，并通过员工和家属调查评估姑息治疗远程医疗的可行性。
对于 61 名居民，居民的平均年龄为 87 岁，61%为女性，69%以痴呆为主要诊断。CHESS（健康变化、终末期疾病、体征和症状）和 ADL（日常生活活动）评分的平均值分别为 0.8 和 4.0，54%的患者的姑息治疗表现量表评分为 40。完成了 17 份关于姑息治疗视频会议的临床工作人员调查，大多数人对他们的体验评价很高。20 名家属中的 10 名完成了姑息治疗视频会议调查，大多数人对体验总体感到满意，并愿意再次使用。临床工作人员通过远程医疗提供姑息治疗的信心显著增强（P = 0.0021）。
结果支持视频会议作为姑息治疗提供手段的可行性。尽管存在技术问题，但大多数临床工作人员和家属对视频会议感到满意，并愿意再次使用。通过视频会议将姑息治疗专家服务早期纳入 LTCH，也使临床工作人员对姑息治疗方法的自我评估信心得到提高。
