Look Homeward

More than one dozen persons who are actively involved in either providing or planning to provide home telepalliative care services responded to a request for information. Thanks to Kathleen Albright, John Puls, and Megan Monfre, of Honeywell/HomMed, and to Bob Pyke, RN, NP, Telehealth Listserv editor for kindly posting this request.

The following 3 questions were posed and consensus responses are noted in the bulleted areas below the questions:

Question 1: In your experience, how difficult is it for people living with long-term diseases/conditions to access palliative care services?

• All or most agree on a:
  • need for more knowledge (by patients and by professionals) of palliative care service and its availability (where it is available, although that is generally limited today)
  • need for continuum of care service that’s paid for.

Question 2: What role can telehealth tools (in-home telemonitoring) play in providing comprehensive, or at least some measure of, palliative care?

• All or most agree that use of
  • telemonitors has avoided hospitalization, ER visits, and unnecessary nursing visits
  • monitors and/or more contact can help specify appropriate intervention earlier and identify appropriate caregiver (e.g., social worker, pastor, nurse, or other caregivers)

Question 3: Can you please provide an example of a patient who did well with tele-palliative care delivery (or provide an example of a type of telepalliative care service that you hope to or plan to deliver in the future)?

• All suggested appropriateness of this service and some provided examples such using telepalliative care for
• pain control management, particularly for titrating medications;
• anxiety relief (through increased contact, as needed), and
• analysis of vital signs to give reassurance to patients and their families that they were well enough to stay at home and not be reassigned for care elsewhere.

Many additional details were graciously provided by all of the responders, from whom we all have much to learn. Five of these responses are provided in more depth as a glimpse to activities now being undertaken in palliative care. They include:

1. Barbara J. Westland, Director, BJC Hospice, St. Louis, MO, who provides a view of tele-services that should be developed to assist palliative care patients and their families in managing pain and other symptoms, and who also suggests a new view of the kind of visits that should take place.
2. Nancy Dereng, Executive Director of Hospice, Interim Hospice, Spartanburg, SC, who focuses on the great potential impact of telepalliative care in providing patients with chronic disease management skills (delivered by a professional) in their homes, should these telemonitoring services become funded (a need that ought to be high priority).
3. Colleen Gallagher, Director of Special Programs, Natick Visiting Nurse Association, Natick, MA, who reports on her organization’s successes with actually doing telemonitoring with palliative care patients. Two items of note are the reassurance that telemonitoring provides to patients; and the early warning alerts that telemonitoring provides to professionals who will then assist.
4. Dr. Claudia Pagliari, Senior Lecturer in Primary Care, University of Edinburgh, who describes development in the United Kingdom in telepalliative care services—these oftentimes well serving the cancer patient population, with fewer services provided for patients living with other terminal diseases such as COPD and CHF.
5. Antonia Arnaert, Assistant Professor, School of Nursing, McGill Unversity, Montreal, Quebec, Canada, who reports on a range of tele-services in palliative and hospice care being initiated in Quebec, and successes achieved to date to meet challenges of delivering care in very rural settings.

Back to Telepalliative Home Care