Teleconsultation for integrated palliative care at home: A qualitative study.
BACKGROUND
Interprofessional consultation contributes to symptom control for home-based palliative care patients and improves advance care planning. Distance and travel time, however, complicate the integration of primary care and specialist palliative care. Expert online audiovisual teleconsultations could be a method for integrating palliative care services.


OBJECTIVE
This study aims to describe (1) whether and how teleconsultation supports the integration of primary care, specialist palliative care, and patient perspectives and services and (2) how patients and (in)formal caregivers experience collaboration in a teleconsultation approach.


METHODS
This work consists of a qualitative study that utilizes long-term direct observations and in-depth interviews.


METHODS
A total of 18 home-based palliative care patients (16 with cancer, 2 with chronic obstructive pulmonary disease; age range 24-85 years old), 12 hospital-based specialist palliative care team clinicians, and 17 primary care physicians.


RESULTS
Analysis showed that the introduction of specialist palliative care team-patient teleconsultation led to collaboration between primary care physicians and specialist palliative care team clinicians in all 18 cases. In 17/18 cases, interprofessional contact was restricted to backstage work after teleconsultation. In one deviant case, both the patient and the professionals were simultaneously connected through teleconsultation. Two themes characterized integrated palliative care at home as a consequence of teleconsultation: (1) professionals defining responsibility and (2) building interprofessional rapport.


CONCLUSIONS
Specialist palliative care team teleconsultation with home-based patients leads to collaboration between primary care physicians and hospital-based palliative care specialists. Due to cultural reasons, most collaboration was of a multidisciplinary character, strongly relying on organized backstage work. Interdisciplinary teleconsultations with real-time contact between patient and both professionals were less common but stimulated patient-centered care dialogues.
Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands Jelle.vanGurp@radboudumc.nl.
Jelle
J
van Gurp
Amsterdam School of Communication Research, University of Amsterdam, Amsterdam, The Netherlands.
Martine
M
van Selm
Ethics Section, Department of IQ Healthcare, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
Evert
E
van Leeuwen
Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
Kris
K
Vissers
Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
Jeroen
J
Hasselaar
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D005260:Female; D006699:Home Care Services / Q000458:organization & administration*; D006801:Humans; D033183:Interdisciplinary Communication; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000628:therapy*; D010166:Palliative Care / Q000458:organization & administration*; D018802:Patient-Centered Care / Q000379:methods; D029424:Pulmonary Disease, Chronic Obstructive / Q000628:therapy*; D036301:Qualitative Research; D019114:Remote Consultation / Q000592:standards*; D055815:Young Adult
Integrated delivery of health care; interdisciplinary communication; interdisciplinary health teams; palliative care; teleconsultation