School of Nursing, Center for Palliative and Supportive Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL.
Mayo Clinic, Rochester, MN.
Am Soc Clin Oncol Educ Book. 2021 Mar;41:413-422. doi: 10.1200/EDBK_320979.
Effective delivery of cancer care via telehealth requires a planned care system that accounts for myriad patient, provider, and practice/cancer center resources before, during, and after the care episode. Telehealth is broadly defined as a method to have virtual, bidirectional communication between patients and providers. Telehealth can include methods such as audio-only, video-consultation, and tele-monitoring, which can occur in a synchronous, asynchronous, or blended format. The purpose of this review is to present common foundational principles for providing clinical cancer care via telehealth, followed by an overview of three distinct examples of comprehensive telehealth programs that have been developed to meet the needs of patients and families across the cancer trajectory, including survivorship, rehabilitation, and palliative care phases. The programs described are exemplars that were developed and implemented prior to the coronavirus pandemic, so they reflect many years of planning and evidence. Lessons learned include the need for ongoing patient support, clinician training, and cancer health system/practice programmatic considerations such as billing, scheduling, reimbursement, software, and hardware/platform security. Although the COVID-19 pandemic produced an explosive shift in regulations and implementation, sustainability of these changes may not be long-term. Nevertheless, a permanent shift in cancer care to include telehealth is likely here to stay.
通过远程医疗有效提供癌症护理需要一个计划护理系统，该系统在护理期间和护理前后考虑到无数患者、提供者和实践/癌症中心的资源。远程医疗被广泛定义为一种在患者和提供者之间进行虚拟、双向通信的方法。远程医疗可以包括音频、视频咨询和远程监测等方法，这些方法可以以同步、异步或混合的格式进行。本综述的目的是介绍通过远程医疗提供临床癌症护理的常见基本原理，然后概述三个已开发的综合远程医疗计划的概况，这些计划旨在满足癌症患者和家庭在整个癌症治疗过程中的需求，包括康复和姑息治疗阶段。所描述的计划是在冠状病毒大流行之前开发和实施的范例，因此它们反映了多年的规划和证据。吸取的经验教训包括需要持续的患者支持、临床医生培训以及癌症卫生系统/实践计划方面的考虑，例如计费、预约、报销、软件和硬件/平台安全性。尽管 COVID-19 大流行导致监管和实施的急剧转变，但这些变化的可持续性可能不会长久。然而，将癌症护理永久转变为包括远程医疗可能会持续下去。
