Patients with advanced cancer often have unmet physical, psychological, social and spiritual needs. While most will benefit from a palliative approach to care provided by their usual treating team, many will require referral to specialist palliative care for management of their more complex needs (Palliative Care Australia, 2005). Palliative care in rural and remote areas of Australia is often delivered and coordinated by generalist nurses and doctors with minimal palliative care training and limited access to palliative care specialists. If specialist palliative care services are available in rural Australia, it often involves significant travel for either the patients or clinicians, which has associated time and cost implications.
New innovative and cost-effective models of palliative care delivery that provide efficient and effective care to advanced cancer patients, regardless of location and care setting, are urgently required. Telehealth is one strategy for extending the reach of specialist palliative care support to rural and remote or isolated patients. Telehealth in the context of palliative care may include, but is not limited to the use of:
- after-hours telephone support services
- telephone, video or internet-based conferencing
- coaching sessions.
While there is evidence to suggest that telehealth approaches are acceptable to patients, caregivers and the treating multidisciplinary team, little is known about the effectiveness of these methods in meeting the needs of palliative cancer patients and their families.A number of studies have explored the feasibility and acceptance of teleoncology for advanced cancer patients, but few have examined the effectiveness of these interventions. One study has examined the effectiveness of palliative care video-conferencing interventions for advanced cancer patients, while two randomised controlled trials have explored the use of nurse led telephone or internet delivered interventions to support patients with advanced cancer living at home.
Evidence summary and recommendations
|A weekly telephone multicomponent nurse-led coaching session (focused on problem solving, symptom management, self-care, identification and coordination of care resources, decision making, advance care planning and a life-review component) delivered within 60 days of an advanced cancer diagnosis improved one-year survival. A nurse-led telephone follow-up intervention (involving symptom assessment, review of medication & adverse effects, patient education and psychosocial support) or a controlled telephone intervention provided by non-professional staff improved several cancer related symptoms. Advanced cancer patients who underwent a web-based multi-component caregiver intervention had less symptom distress. This was maintained at eight months post-intervention.||II||, , |
|Regular nurse-led telephone or web-based multi-component coaching sessions (focused on problem solving, symptom management, self-care, identification and coordination of care resources, decision making, advance care planning and a life-review component), provided shortly after diagnosis may lead to some improvements in the symptom distress of advanced cancer patients.||C|
|A feasibility study of multi-disciplinary palliative care video-conference consultations found that patients had lower levels of anxiety and increased appetite at the follow-up teleconference visit, with potential time and cost savings.||IV|||
|If rural, remote or isolated patients with advance cancer have unmet palliative care needs and do not have access to a specialist palliative care team, it is feasible to provide a specialist palliative care video-consultation involving the patient, their family and members of their treatment team.||C|
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