title: Study protocol: optimization of complex palliative care at home via telemedicine. A cluster randomized controlled trial.
abstract: BACKGROUND
  Due to the growing number of elderly with advanced chronic conditions, healthcare services will come under increasing pressure. Teleconsultation is an innovative approach to deliver quality of care for palliative patients at home. Quantitative studies assessing the effect of teleconsultation on clinical outcomes are scarce. The aim of this present study is to investigate the effectiveness of teleconsultation in complex palliative homecare.
  
  
  METHODS
  During a 2-year recruitment period, GPs are invited to participate in this cluster randomized controlled trial. When a GP refers an eligible patient for the study, the GP is randomized to the intervention group or the control group. Patients in the intervention group have a weekly teleconsultation with a nurse practitioner and/or a physician of the palliative consultation team. The nurse practitioner, in cooperation with the palliative care specialist of the palliative consultation team, advises the GP on treatment policy of the patient. The primary outcome of patient symptom burden is assessed at baseline and weekly using the Edmonton Symptom Assessment Scale (ESAS) and at baseline and every four weeks using the Hospital Anxiety and Depression Scale (HADS). Secondary outcomes are self-perceived burden from informal care (EDIZ), patient experienced continuity of medical care (NCQ), patient and caregiver satisfaction with the teleconsultation (PSQ), the experienced problems and needs in palliative care (PNPC-sv) and the number of hospital admissions.
  
  
  CONCLUSIONS
  This is one of the first randomized controlled trials in palliative telecare. Our data will verify whether telemedicine positively affects palliative homecare.
  
  
  BACKGROUND
  The Netherlands National Trial Register NTR2817.
authors.affiliation: Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands. F.Duursma@anes.umcn.nl.
authors.forename: Froukje
authors.initials: F
authors.lastname: Duursma
authors.forename: Henk J
authors.initials: HJ
authors.lastname: Schers
authors.forename: Kris Cp
authors.initials: KC
authors.lastname: Vissers
authors.forename: Jeroen
authors.initials: J
authors.lastname: Hasselaar