title: Using telehealth to support end of life care in the community: a feasibility study.
abstract: BACKGROUND
  Telehealth is being used increasingly in providing care to patients in the community setting. Telehealth enhanced service delivery could offer new ways of managing load and care prioritisation for palliative care patients living in the community. The study assesses the feasibility of a telehealth-based model of service provision for community based palliative care patients, carers and clinicians.
  
  
  METHODS
  This study was a prospective cohort study of a telehealth-based intervention for community based patients of a specialist palliative care service living in Southern Adelaide, South Australia. Participants were 43 community living patients enrolled in the Southern Adelaide Palliative Service. To be eligible patients needed to be over 18 years and have an Australian modified Karnofksy Performance Score > 40. Exclusion criteria included a demonstrated inability to manage the hardware or technology (unless living with a carer who could manage the technology) or non-English speaking without a suitable carer/proxy. Participants received video-based conferences between service staff and the patient/carer; virtual case conferences with the patient/carer, service staff and patient's general practitioner (GP); self-report assessment tools for patient and carer; and remote activity monitoring (ACTRN12613000733774).
  
  
  RESULTS
  The average age of patients was 71.6 years (range: 49 to 91 years). All 43 patients managed to enter data using the telehealth system. Self-reported data entered by patients and carers did identify changes in performance status leading to changes in care. Over 4000 alerts were generated. Staff reported that videocalls were similar (22.3%) or better/much better (65.2%) than phone calls and similar (63.1%) or better/much better (27.1%) than face-to-face. Issues with the volume of alerts generated, technical support required and the impact of service change were identified.
  
  
  CONCLUSIONS
  The trial showed that patients and carers could manage the technology and provide data that would otherwise not have been available to the palliative care service.
  
  
  BACKGROUND
  Australian New Zealand Clinical Trials Registry ACTRN12613000733774 registered on 02/07/2013.
authors.affiliation: Palliative and Supportive Services, Flinders University, Bedford Park, South Australia, Australia. jennifer.tieman@flinders.edu.au.
authors.forename: Jennifer J
authors.initials: JJ
authors.lastname: Tieman
authors.affiliation: Southern Adelaide Palliative Services, Repatriation General Hospital, Daw Park, South Australia, Australia.
authors.forename: Kate
authors.initials: K
authors.lastname: Swetenham
authors.affiliation: Palliative and Supportive Services, Flinders University, Bedford Park, South Australia, Australia.
authors.forename: Deidre D
authors.initials: DD
authors.lastname: Morgan
authors.affiliation: Southern Adelaide Palliative Services, Repatriation General Hospital, Daw Park, South Australia, Australia.
authors.forename: Timothy H
authors.initials: TH
authors.lastname: To
authors.affiliation: Palliative and Supportive Services, Flinders University, Bedford Park, South Australia, Australia.
authors.forename: David C
authors.initials: DC
authors.lastname: Currow
mesh_terms: D003153:Community Health Services / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006699:Home Care Services / Q000592:standards; D006801:Humans; D008297:Male; D017146:Models, Organizational; D010166:Palliative Care / Q000379:methods / Q000592:standards; D015397:Program Evaluation; D011446:Prospective Studies; D013021:South Australia / Q000453:epidemiology; D059039:Standard of Care; D017216:Telemedicine; D013727:Terminal Care / Q000379:methods* / Q000592:standards
keywords: Home care services; Palliative care; Telemedicine