Modern telemedicine has advanced through telephone and internet based technology and may serve as the only healthcare delivery source for certain demographics. The American Hospital Association estimates that approximately 76 percent of Americans connect with their provider via telemedicine. Despite a clear demand, certain medical specialties have yet to maximize the use of telemedicine.
Hospice care is one field that has yet to realize the full potential of technology and telemedicine. In conversation with the author, many hospice and palliative care providers have noted feeling that telemedicine is too detached to be useful in the intimate world of hospice care. However, when paired with quality home care, telemedicine can actually enhance the “personal” experience that is so often associated with hospice medicine.
A review of research regarding “telehospice” has suggested its promise as a viable tool for healthcare delivery. One study of a facility that uses telehospice reports increased satisfaction among patients, providers, and all participating individuals. This group focused on using telehospice as an assessment tool to determine the necessity of in-person visits. Utilizing telemedicine in this way is less invasive; it allows the patient to spend more time with their family rather than having a hospice nurse constantly coming into the home. Telemedicine should never replace in-person care, especially in the patient-centric hospice environment, but when used appropriately it can provide benefits not found in any other care environment.
Every patient is different and has unique needs; however, some patients’ needs are greater and more frequent than others’. Videoconferencing technology allows medical staff better communication with patients who may need attention more often than an in-person staff member is able to provide. The National Hospice and Palliative Care Organization (NHPCO) asserts that telemedicine provides “real-time service to the patient and family and expands the reach of the provider.” This technology means that providers no longer need to rely on phone calls, enhancing communication and patient experience.
Telemedicine also has an added benefit for family members, who no longer have to wait anxiously for a nurse to arrive or struggle to describe difficult medical issues over the phone. On-call clinicians are able to more effectively evaluate issues as they arise by having visual information and a face-to-face conversation. Also, patients and families have the comfort of being able to actually see a medical provider.
Kansas University Medical Center and Kendallwood Hospice were one of the first partnerships to explore telemedicine in hospice. Their program equipment was placed in the homes of on-call nurses, allowing the nurse to evaluate the patient from home first and assess the necessity of an in-person visit. Kendallwood found this especially useful for the rural population, as it allowed the nurse to begin working with the patient more quickly. Telemedicine has a particularly great benefit for rural patients. Even if a provider were available, depending on the location of the patient and the nurse, it could take well over an hour for a provider to arrive at a patient’s home. While this may not be extreme for an average person, it is far too long to wait for an end-of-life patient experiencing symptom swings or excruciating pain.
Many modern hospices make use of a centralized call center equipped with nurses who can evaluate the situation and dispatch a provider as necessary. Telemedicine in these call centers allows the option of connecting with the patient before, during or after a nurse is deployed. Thus, the call-center nurse can begin working to get the patient’s symptoms to a manageable level while the patient’s regular nurse is enroute, drastically reducing the time the patient is experiencing discomfort. Additionally, depending on the symptoms and severity, there is a possibility of resolving the issue without needing to deploy a nurse. Because treatment can often be as simple as a medication change, telecommunication allows near instant treatment of symptoms for the comfort and convenience of both the patient and the provider.
Telemedicine is not without its challenges. Access to technology, internet connections, patient understanding and provider support are all barriers that telemedicine typically faces. In addition to these, hospice care poses its own set of unique difficulties. A study on Older Adults’ Perceptions of Home Telehealth Services notes that lack of familiarity with and resistance to learning to use advanced technology among elderly patients — who make up the vast majority of hospice care — pose significant barriers to telehospice in this population.
It is difficult to discern what percentage of patients are not willing to participate in telehospice, as all of the existing literature is based on volunteer driven studies. However, even those willing to use the program may suffer from technological challenges that they may not be as adept at resolving. In one study of an unidentified hospice program, several problems arose related to connectivity and hardware. For this reason, a number of participants were not satisfied with the service. Data regarding the patients’ ability to resolve these issues is also lacking, but researchers postulate that a more technologically affluent generation may not suffer the same struggles.
A number of organizations have pioneered different techniques to better utilize technology in this unique care environment, but innovation seems to have stagnated in end-of-life care. Some organizations, however, like Alive Hospice (research still in progress), are not standing by idly; they are meeting the challenges head on and creating new ways to serve patients that will hopefully reinvigorate the telemedicine discussion in hospice care. Working with a grant funded pilot study (still in progress) and in conjunction with graduate students from the Vanderbilt Professional Interdisciplinary Learning (VPIL) program, Alive analyzed a sample of patient calls received. Of those calls, it was determined that approximately twenty-two percent could have benefited from the telehospice platform. Considering this data, and the fact that the program is still being developed, it could further be hypothesized that an even greater number would benefit, once the advantages of telehospice have been fully recognized.
Telecommunications has existed since the dawn of time. From smoke signals to cell phones, parties have been communicating over distances almost as long as they have been communicating. With healthcare continually advancing, increasing efficiency of care seems to be the next logical step that has not fully taken off. As outlined, current telemedicine prospects have demonstrated success. Most healthcare institutions have dedicated programs serving patients remotely. However, some specialties and care providers have been slow to adopt these technologies, including hospice care.
Telehospice and telemedicine are by no means a replacement for traditional in-person comfort and end-of-life care, but when used together, telemedicine can enhance the patient experience and help ease some of the many burdens they are facing in this challenging time. Telehospice is no longer a matter of if; rather, it is now a question of when this level of innovation will become a recognized best practice and what leaders will emerge to help shape the new landscape of care for end-of-life providers.