Telehealth provides clinical support, links individuals who are not based in the same location, encompasses numerous types of information and communication technologies and aims to improve health outcomes. Telehealth enhances access to health care in rural environments, results in decreased trips for clinic visits and provides improved access to specialists.
Teleoncology is not a new concept in the nursing field with many papers published on the topic since the 1990’s. Most of these papers are related to the provision of support and follow-up for people affected by cancer by telephone. Despite the various telephone models that are available for nursing services in oncology, there is a paucity of studies of teleoncology models using other modes of communication, including video-conferencing. In addition, the telephone models are primarily focused on supportive care rather than treatment delivery.
Studies of a telephone-based model of care by oncology nurses confirm that this is an acceptable mode of communication to support patients and carers and manage treatment related side effects. One study reported that women were positive about telephone-based care as it removed the need for clinic appointments which impacted on social and work activities. Although Smits et al states that telephone-based nurse-led follow-up support is equal to conventional face-to-face follow up, Cox et al reported that there is limited published evidence regarding this approach from a patient perspective.
Studies that focus on the use of newer technologies such as videoconferencing to deliver nursing services in oncology are limited. Stern et al conducted a mixed-methods case study to investigate how palliative care patients and their caregivers used a home telehealth model and how they felt about this as a component of their care. This study involved patients and their families having access to specialist nurses 24 hours a day by videophones and telephones with the option of a remote monitoring service. Although most study subjects primarily used the telephone for communicating with the specialist nurses, they identified that having a video link provided reassurance. According to Stern et al, this finding is consistent with other research into phone-based models. Jhaveri et al reported that a remote chemotherapy supervision model incorporating telemedicine, telenursing and telepharmacy in Queensland, Australia was welcomed by health professionals.
Patients in rural or remote communities who require specialist cancer treatment, including the administration of chemotherapy generally have to travel or temporarily relocate to access cancer services. Various models of rural chemotherapy administration are in operation based on patient volume and the service capabilities of rural towns.
In larger rural hospitals, resident chemotherapy competent nurses administer chemotherapy with the support of local medical officers, supervised by medical oncologists from urban centres by videoconferencing. In smaller rural hospitals where it is difficult to employ chemotherapy competent nurses, models such as the Queensland Remote Chemotherapy Supervision model (QReCS) are beneficial (Figure One). The QReCS was developed to support the safe administration of chemotherapy closer to home for patients from rural and remote areas using teleoncology. The guide provides 10 minimum requirements for the remote supervision of chemotherapy. The guide does not replace the need for specialist medical oncologists, haematologists, pharmacists and nurses to supervise staff delivering treatment in rural and remote communities.
Figure One: Queensland remote chemotherapy supervision model
All staff involved in the handling and management of chemotherapy medications must have access to information and education. To achieve the required training and address geographical disparity, a nursing model that harnesses technology was developed to facilitate the delivery of theoretical content, demonstrate aspects of clinical care and assess clinical skills. The QReCS telenursing model has expanded the scope of practice of the staff providing care and improved service capability in rural and remote locations. The model saves patient's travel expenditure and enhances quality of life by bringing care closer to home.
The nursing model supported by the QReCS incorporates a chemotherapy proficient nurse from the provider site (where the specialist is located) directly supervising a nurse from the recipient site (where the patient is located) by videoconference. Direct supervision occurs during all phases of the activity – patient assessment, administration of pre-medications (if required) and administration of the antineoplastic medications prescribed by a medical oncologist or haematologist.
|Various chemotherapy regimens have been administered in rural hospitals using either medical teleoncology models or multidisciplinary models incorporating telenursing and telepharmacy.||IV||, |
|Various chemotherapy regimens can be administered in rural towns using either medical teleoncology models or multidisciplinary models incorporating telenursing and telepharmacy.||C|
Nursing staff undertaking training and the delivery of chemotherapy by teleoncology need to receive basic training in the technology to ensure the learning and treatment experience is equitable to face-to-face delivery.
An audit of the environment where chemotherapy is to be administered should be performed to identify risks and hazards and formally document what a facility has or needs to have to meet legislative requirements and best practice standards. The audit should also ascertain if control measures are in place to enable protection of workers, patients, visitors and the environment from undue exposure to hazardous chemicals.
In addition to training related to the safe administration of chemotherapy, nursing staff in rural and remote areas who will be administering chemotherapy must have completed their annual mandatory training (such as basic life support) and education at an appropriate level.
Members of the multidisciplinary team at the provider and recipient sites should be included during all phases of development and implementation of local chemotherapy models to ensure quality and safety.
- Bohnenkamp SK, McDonald P, Lopez AM, Krupinski E, Blackett A. Traditional versus telenursing outpatient management of patients with cancer with new ostomies. Oncol Nurs Forum 2004 Sep;31(5):1005-10 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/15378102.
- Cox A, Faithfull S. Aiding a reassertion of self: a qualitative study of the views and experiences of women with ovarian cancer receiving long-term nurse-led telephone follow-up. Support Care Cancer 2015 Jan 15 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/25588575.
- Smits A, Lopes A, Das N, Bekkers R, Kent E, McCullough Z, et al. Nurse-Led Telephone Follow-up: Improving Options for Women With Endometrial Cancer. Cancer Nurs 2015 May;38(3):232-8 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/25098923.
- Stern A, Valaitis R, Weir R, Jadad AR. Use of home telehealth in palliative cancer care: a case study. J Telemed Telecare 2012 Jul;18(5):297-300 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/22790013.
- Jhaveri D, Larkins S, Kelly J, Sabesan S. Remote chemotherapy supervision model for rural cancer care: perspectives of health professionals. Eur J Cancer Care (Engl) 2015 Apr 14 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/25871852.
- Doolittle GC, Spaulding AO. Providing Access to Oncology Care for Rural Patients via Telemedicine. J Oncol Pract 2006 Sep;2(5):228-30 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/20859340.
- Sabesan S, Larkins S, Evans R, Varma S, Andrews A, Beuttner P, et al. Telemedicine for rural cancer care in North Queensland: bringing cancer care home. Aust J Rural Health 2012 Oct;20(5):259-64 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/22998200.