Leveraging Telehealth for Delivery of Palliative Care to Remote Communities: A Rapid Review.
Leveraging Telehealth for Delivery of Palliative Care to Remote Communities: A Rapid Review.
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DOI：
10.1177/08258597211001184
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发表时间：
2022-04
影响因子：
1.7
通讯作者：
Smith, Shauna L. H.
中科院分区：
文献类型：
--
作者：
Gordon, Barbara;Mason, Barbara;Smith, Shauna L. H.
姑息治疗包括在疾病的任何阶段为患者提供支持性医疗保健，旨在缓解症状，控制疼痛，管理压力，为护理人员提供喘息机会，并优化生活质量。为了探索增加偏远/农村社区居民获得姑息治疗的机会的战略，对探讨在这一人群中使用远程保健应用的研究进行了快速审查。从2019年12月到2020年2月，PRISMA方法用于收集以英语发表的同行评审研究。检索了MedLine、Google Scholar和EBSCO;未设定日期限制。鉴于研究方法和结果的多样性，研究结果进行了综合叙述。还采用了科克伦协作网的偏倚风险评估工具。最后，这些研究被映射到临床指南的各个方面的质量姑息治疗。2004年至2019年期间发表的18项研究在五大洲的七个国家进行。目的包括评估可行性、有效性和用户满意度。洞察力来自3，313名患者和250名提供者的合并池。大多数研究涉及肿瘤患者，并采用视频会议或网络平台/在线软件进行视频会议。出现了三个主题：提供护理，症状管理和生活质量，以及患者/护理人员/提供者的满意度。事实证明，远程保健对病人和药物监测、提供者和专家预约以及姑息治疗咨询是有效的。运营效益包括节省临床医生的时间，缩短预约等待时间，并降低未出现率;实施挑战也出现了。报告了生活质量和症状管理的统计学改善。近三分之二的研究报告了患者，护理人员和提供者之间的积极经验;约一半包括跨专业团队。这些研究主要集中在结构/过程和物理方面的质量姑息治疗，有一个缺乏见解的精神，文化，生命的尽头，和伦理/法律的方面的照顾。三分之二（12/18）的研究采用描述性设计。所有研究都出现了选择、性能、检测和报告偏倚的风险;例如，只有4项研究包括对照组，不到20%（3/18）报告了研究参与者的流失。其他限制包括快速审查方法严重依赖主要作者的决定，以及仅以英文发表的研究受到限制。需要进行更严格的研究，以确认提供临床护理的可行性，并确定向偏远/农村地区提供优质虚拟姑息治疗的最佳做法。
Palliative care encompasses supportive health care for patients at any stage of illness aimed at relieving symptoms, controlling pain, managing stress, offering respite for caregivers, and optimizing the quality of life. To explore strategies for increasing access to palliative care among individuals living in remote/rural communities, a rapid review was conducted on studies that explored the use of telehealth applications with this population. From December 2019 to February 2020, the PRISMA methodology was used to gather peer-reviewed studies published in the English language. MedLine, Google Scholar, and EBSCO were searched; no date limitations were set. Given the diversity of study methodologies and outcomes, the findings were synthesized narratively. The Cochrane Collaboration’s tool for assessing the risk of bias was also employed. Lastly, the studies were mapped to clinical guidelines for the various aspects of quality palliative care. The 18 studies found, published between 2004 and 2019, were conducted in seven countries and on five continents. Aims included evaluating feasibility, efficacy, and user satisfaction. Insights draw from a combined pool of 3,313 patients and 250 providers. Most studies involved oncology patients and employed videoconferencing or a web platform/online software with videoconferencing. Three themes emerged: delivery of care, symptom management and quality of life, and patient/caregiver/provider satisfaction levels. Telehealth proved effective for patient and medication monitoring, provider and specialist appointments, and palliative care consultations. Operational benefits included clinician time saved, shorter appointment wait times, and reduced no show rates; implementation challenges also emerged. Statistical improvements in quality of life and symptom management were reported. Nearly two-thirds of the studies reported positive experiences among patients, caregivers, and providers; about half included an interprofessional team. The studies primarily focused on the structure/process and physical aspects of quality palliative care, there was a paucity of insights on the spiritual, cultural, end of life, and ethical/legal aspects of care. Two-thirds (12/18) of the studies employed a descriptive design. Risk for selection, performance, detection, and reporting biases emerged for all the studies; for example, only four of the studies included control groups and less than 20% (3/18) reported on attrition of study participants. Additional limitations include the rapid review methodology which relied heavily on the lead author’s decisions and the restriction of studies published only in the English language. More rigorous research is required to confirm the viability of clinical care delivery and establish best practices for quality, virtual palliative care to remote/rural areas.
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