Barbara J. Westland, Director, BJC Hospice/Supportive Care, St. Louis, MO

I think any patients with congestive heart failure, diabetes, COPD or pain/ symptom management issues could benefit from telehealth. We do many phone assessments with patients and families and it would be good to have a tool for assessment that would give the control of reporting to the patient and family. If they had this, I think it would also decrease their anxiety. It could even include questions about, what difficulty are you facing today that you need help with?

The greatest area of concern is that of pain management. It would be wonderful to have some type of daily measurement of symptoms: pain, nausea, anxiety, sleeplessness, etc., which could be monitored via telehealth on a daily basis so we could avoid unexpected problems after hours. The after hour visits are our most costly in terms of dollars and the toll it takes on nursing staff. I do believe that nursing often makes visits to assess these areas without any complications found. A monitoring system would make their response more efficient and responsive.

Monitoring anxiety could also help determine when a social worker or chaplain would be more appropriate than the nurse to visit based on the cause of the anxiety. With the nursing shortage, it will be essential for us to do more than make home visits to our hospice patients. We will need to focus on personal calls or review of reported data on a regular basis in order to determine where to focus our staff. The reporting could reduce the visits or ensure that the right discipline is sent to visit.

The other area that can be addressed with telehealth is providing compassionate responses to patients’ fear, anxiety and loneliness. I think it is possible to reduce some of these areas of concern with regular reporting and monitoring of our patients.

As you review the data on palliative care, I am sure that you will see that it applies to the management of symptoms without a prognosis associated to it as hospice has. I think monitoring of patients with potentially life limiting conditions could help in their management tremendously and also give them the independence to actively participate in their own management.

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