title: Improving access to specialist multidisciplinary palliative care consultation for rural cancer patients by videoconferencing: report of a pilot project.
abstract: OBJECTIVE
  Palliative care (PC) and palliative radiotherapy (RT) consultation are integral to the care of patients with advanced cancer. These services are not universally available in rural areas, and travel to urban centers to access them can be burdensome for patients and families. The objectives of our study were to assess the feasibility of using videoconferencing to provide specialist multidisciplinary PC and palliative RT consultation to cancer patients in rural areas and to explore symptom, cost, and satisfaction outcomes.
  
  
  METHODS
  The Virtual Pain and Symptom Control and Palliative Radiotherapy Clinic was piloted from January 2008 to March 2011. Cancer patients in rural northern Alberta attended local telehealth facilities, accompanied by nurses trained in symptom assessment. The multidisciplinary team at the Cross Cancer Institute in Edmonton was linked by videoconference. Team recommendations were sent to the patients' family physicians. Data were collected on referral, clinical, and consultation characteristics and symptom, cost, and satisfaction outcomes.
  
  
  RESULTS
  Forty-four initial consultation and 28 follow-up visits took place. Mean Edmonton Symptom Assessment Scale scores for anxiety and appetite were statistically significantly improved at the first follow-up visit (p < 0.01 and p = 0.03, respectively). Average per visit savings for patients seen by telehealth versus attending the CCI were 471.13 km, 7.96 hours, and Cdn $192.71, respectively. Patients and referring physicians indicated a high degree of satisfaction with the clinic.
  
  
  CONCLUSIONS
  Delivery of specialist multidisciplinary PC consultation by videoconferencing is feasible, may improve symptoms, results in cost savings to patients and families, and is satisfactory to users.
authors.affiliation: Department of Symptom Control and Palliative Care, Cross Cancer Institute, Edmonton, Alberta, Canada.
authors.forename: Sharon M
authors.initials: SM
authors.lastname: Watanabe
authors.forename: Alysa
authors.initials: A
authors.lastname: Fairchild
authors.forename: Edith
authors.initials: E
authors.lastname: Pituskin
authors.forename: Patricia
authors.initials: P
authors.lastname: Borgersen
authors.forename: John
authors.initials: J
authors.lastname: Hanson
authors.forename: Konrad
authors.initials: K
authors.lastname: Fassbender
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000416:Alberta; D017028:Caregivers / Q000523:psychology; D005240:Feasibility Studies; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D033183:Interdisciplinary Communication; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D010166:Palliative Care; D017060:Patient Satisfaction; D010865:Pilot Projects; D019114:Remote Consultation / Q000379:methods*; D019035:Rural Health Services; D011795:Surveys and Questionnaires; D017216:Telemedicine; D049269:Videoconferencing; D055815:Young Adult