Web-based videoconferencing for rural palliative care consultation with elderly patients at home
Providing specialized palliative care support to elderly patients in rural areas can be challenging. The purpose of this study was to gain a preliminary understanding of the experience of using mobile web-based videoconferencing (WBVC) for conducting in-home palliative care consults with elderly rural patients with life-limiting illness.
This was a descriptive, exploratory, proof-of-concept study with a convenience sample of 10 WBVC visits. A palliative care clinical nurse specialist (PC-CNS), in the home with the patient/family and home care nurse (HC-N), used a laptop computer with webcam and speakerphone to connect to a distant palliative care physician consultant (PC-MD) over a secure Internet connection. Data was collected using questionnaires, interviews, and focus groups.
Analysis of qualitative data revealed four themes: communication, logistics, technical issues, and trust. Participants reported they were comfortable discussing concerns by WBVC and felt it was an acceptable and convenient way to address needs. Audiovisual quality was not ideal but was adequate for communication. Use of WBVC improved access and saved time and travel. Fears were expressed about lack of security of information transmitted over the Internet.
Using WBVC for in-home palliative care consults could be an acceptable, effective, feasible, and efficient way to provide timely support to elderly rural patients and their families. Having a health care provider in the home during the WBVC is beneficial. WBVC visits have advantages over telephone calls, but limitations compared to in-person visits, suggesting they be an alternative but not replacement for in-person consultations.
KeywordsPalliative care consultation Home care Telehealth Videoconference Rural Elderly
Support for this study from the Information Technology portfolio of Alberta Health Services is gratefully acknowledged. Thanks are due to Rakib Mohammed, Provincial Director, Clinical Telehealth; Jason Kettle, Provincial Director, Unified Communications and Telehealth Technology; and Katie Woo, Provincial Research Program Manager, Clinical Telehealth. Support from the University of Calgary and the AHS Palliative and End of Life Care and Integrated Home Care portfolios is also appreciated. Members of the AHS Calgary Zone Rural Palliative Care Consultation Team are acknowledged for their participation and their contributions to data collection and analysis (Dr. Gilian Ho (GH), Dr. Ron Spice (RS), Linda Read Paul (LRP), Marie Webb (MW), Jill Uniacke (JU)). Lastly, thanks are due to Madalene Earp PhD for her editorial input on this manuscript.
This research was funded by the Canadian Frailty Network (CFN) (known previously as Technology Evaluation in the Elderly Network, TVN) Health Technology Innovation Grant (HTIG) 2014-10. CFN is supported by the Government of Canada through the Networks of Centres of Excellence (NCE) Program.
Compliance with ethical standards
This study was approved by the Calgary Conjoint Health Research Ethics Board (Ethics ID# REB15-0429). Written informed consent was obtained from all individual participants included in the study, and they were able to withdraw from the study at any time.
Conflict of interest
The authors declare that they have no competing interests.
- 8.Redford L, Spaulding RJ (2006) Transforming rural health care: the role of technology. Springer Publishing Co., New YorkGoogle Scholar
- 11.Canadian Hospice Palliative Care Association (2015) The Way Forward National Framework: A roadmap for an integrated palliative approach to care. Available from: External link http://www.hpcintegration.ca/media/60044/TWF-framework-doc-Eng-2015-final-April1.pdf. Accessed January 20, 2018
- 17.Watanabe SM, Fairchild A, Pituskin E, Borgersen P, Hanson J, Fassbender K (2013) Improving access to specialist multidisciplinary palliative care consultation for rural cancer patients by videoconferencing: report of a pilot project. Support Care Cancer 21(4):1201–1207. https://doi.org/10.1007/s00520-012-1649-7 CrossRefPubMedGoogle Scholar
- 33.Bensink ME, Armfield NR, Pinkerton R, Irving H, Hallahan AR, Theodoros DG, Russell T, Barnett AG, Scuffham PA, Wootton R (2009) Using videotelephony to support paediatric oncology-related palliative care in the home: from abandoned RCT to acceptability study. Palliat Med 23(3):228–237. https://doi.org/10.1177/0269216308100251 CrossRefPubMedGoogle Scholar