Optimization of Complex Palliative Care at Home by Making Use of Expert Consultation via Telemedicine
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Abstract
Background
Due to the extensive growth of non-acute ways of dying in Western countries and a growing demand by people to die at home, Western societies have a desire to locate high-quality palliative care at the patient's home.
If Dutch patients decide to die at home, their general practitioners naturally become their primary caregivers. Not all Dutch gp’s, however, have extensive, specialist knowledge about good palliative care at their disposal. To overcome this problem, additional expertise can be called in from existing expert centers. The department of anesthesiology, pain-, and palliative medicine of the Radboud University Nijmegen Medical Centre currently focuses on this knowledge sharing-process by introducing and investigating the practice of telemedicine in a palliative care setting.
Objective
In a research project named Optimization of Complex Palliative Care at Home by Making Use of Expert Consultation via Telemedicine, the consequences of the implementation of an advanced telemedicine-application in a home based palliative care context, as a means of transporting specialist knowledge on palliative care, will be studied. Three different perspectives will be used to describe the implementation of this telemedicine-application.
First, a medical perspective to gather information on the possible change in the use and experience of care, the occurrence of medical complications, and, as a consequence of that, home-hospital transitions. The question is asked whether and how tele-consultation improves the quality of care as well as contributes to more efficient care?
Secondly, a socio-ethical perspective will be used to investigate how patients, proxies, general practitioners, and medical specialists experience a multifunctional telemedicine-application at the patient's home, introduced primarily for the purpose of a weekly palliative care teleconversation between the patient and the specialist palliative care team, and whether (and why) they find this telemedicine-application acceptable.
The focus will, for one thing, be on a) the absorption of the telemedicine-application into existing palliative care giving and/or social routines, or the creation of new routines, b) the transformation of communication patterns, and c) genres used in the (mediated) supportive and/or care giving relationships, and, for another, on d) the 'fit' of telemedicine in participants' and bioethicists' conceptions about a 'good death' and 'good palliative care', and e) the effects of telemedicine on the patient's position in his/her own care process.
The third perspective, which we call the implementation perspective, focuses on a process of designing appropriate content, a business case which offers a solid base to connect telemedicine technologies with existing health care institutions and insurance companies, and practical guidelines, all based on research.
Methods
In the forthcoming presentation in Maastricht a more nuanced description of the research design used in this interdisciplinary project will be presented. This design consists of a complex intertwining between ethical and empirical research in general, an intertwining of qualitative en quantitative research methods in particular, and a collaboration between the medical profession, ethicists, and communication science.
Due to the extensive growth of non-acute ways of dying in Western countries and a growing demand by people to die at home, Western societies have a desire to locate high-quality palliative care at the patient's home.
If Dutch patients decide to die at home, their general practitioners naturally become their primary caregivers. Not all Dutch gp’s, however, have extensive, specialist knowledge about good palliative care at their disposal. To overcome this problem, additional expertise can be called in from existing expert centers. The department of anesthesiology, pain-, and palliative medicine of the Radboud University Nijmegen Medical Centre currently focuses on this knowledge sharing-process by introducing and investigating the practice of telemedicine in a palliative care setting.
Objective
In a research project named Optimization of Complex Palliative Care at Home by Making Use of Expert Consultation via Telemedicine, the consequences of the implementation of an advanced telemedicine-application in a home based palliative care context, as a means of transporting specialist knowledge on palliative care, will be studied. Three different perspectives will be used to describe the implementation of this telemedicine-application.
First, a medical perspective to gather information on the possible change in the use and experience of care, the occurrence of medical complications, and, as a consequence of that, home-hospital transitions. The question is asked whether and how tele-consultation improves the quality of care as well as contributes to more efficient care?
Secondly, a socio-ethical perspective will be used to investigate how patients, proxies, general practitioners, and medical specialists experience a multifunctional telemedicine-application at the patient's home, introduced primarily for the purpose of a weekly palliative care teleconversation between the patient and the specialist palliative care team, and whether (and why) they find this telemedicine-application acceptable.
The focus will, for one thing, be on a) the absorption of the telemedicine-application into existing palliative care giving and/or social routines, or the creation of new routines, b) the transformation of communication patterns, and c) genres used in the (mediated) supportive and/or care giving relationships, and, for another, on d) the 'fit' of telemedicine in participants' and bioethicists' conceptions about a 'good death' and 'good palliative care', and e) the effects of telemedicine on the patient's position in his/her own care process.
The third perspective, which we call the implementation perspective, focuses on a process of designing appropriate content, a business case which offers a solid base to connect telemedicine technologies with existing health care institutions and insurance companies, and practical guidelines, all based on research.
Methods
In the forthcoming presentation in Maastricht a more nuanced description of the research design used in this interdisciplinary project will be presented. This design consists of a complex intertwining between ethical and empirical research in general, an intertwining of qualitative en quantitative research methods in particular, and a collaboration between the medical profession, ethicists, and communication science.
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