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The Use of Telehealth in Pediatric Palliative Care Kirsten Childe, RN, BSN; Jo Dorhout, MA, CEO of Virtual Interactive Families
2 | © 2012 Kirsten Childe has disclosed that she has no relevant financial relationships to disclose. Jo Dorhout is the CEO of Virtual Interactive Families. They have no off label recommendations and/ or investigational use in their presentation. Disclosure
3 | © Learner will describe the benefits of using video visits for a Pediatric Palliative care patient and family caregivers 2. Learner will be able to list resources to learn more about applications of TeleHospice and its use in care of home-based pediatric palliative care patients. 3. Learner will be able to explain how to help a lay user learn and develop trust in the use of telehealth to improve care of pediatric palliative care patients and their families. Objectives
4 | © 2012 WELCOME DISCIPLINES PRESENT EXPERIENCE WITH TELEHEALTH
5 | © 2012 “ My child’s tube is leaking. He has so many… no, I can’t really describe it, but I know it needs to be replaced.” Improved communication and decision-making between palliative care staff and caregivers is a priority for USA federal body the Institute of Medicine. Have You Taken Calls Like This…
6 | © 2012 As Imagined in 1910 Video phone Internet connection History of Video Telehealth
7 | © 2012 Smart phone - Web-Based Consults - Virtuwell™ Virtuwell™ Health Kiosks - Wearable Sensors - Home Based Video Consults – Now
8 | © 2012 Examples of Using Telehealth in Home-based Palliative Care Settings
9 | © 2012 Inclement Weather When you are unable to travel to your home visit
10 | © 2012 Questions Regarding Equipment or Supplies “How do I change that blue thing on the end of the tube?” Troubleshooting equipment such as ventilators, feeding pumps, IV pumps Reinforcing teaching that has been done at a previous time
11 | © 2012 Emotional Assessment that Phone Conversations Can’t Always Provide
12 | © 2012 Assessment and Management of Non-emergent Concerns Rashes, skin integrity IV Sites Enteral Tube Feeding Sites Post-op Wound Checks
13 | © 2012 Triaging Symptoms Better assessment in deciding how to proceed, potentially saving mileage, time and money Avoiding costly ER visits and providing early care Establishing connectedness between family and on-call provider
14 | © 2012 Visits by Provider When child is no longer able to come into clinic Provides more thorough assessment of patient versus conversations over the phone Saves provider time and money
15 | © 2012 Video Telehealth Connections Proprietary Purchase software Institutional Firewalls Need the IP address of nurse to create the call Non-proprietary (Web-Based) Web based, no software required Access from any computer Access with account and password
16 | © 2012 Use of Video Telehealth in Palliative Care Creates better access to 24/7 support 55% of information is communicated non-verbally (McGear & Simms, 1988) Improved communication with Child and nurse Parent and nurse ‘In-home’ nurse and remote staff
17 | © 2012 Supportive Evidence Providers and caregivers supportive of use (Oliver, 2012) Increased inter-team communication during hospice team meetings (Wittenberg-Lyles, 2012) Technology must be reliable and easy to use (Day, 2007)
18 | © 2012 Provides data critical for evaluation of telehealth delivery Why encounter initiated Persons involved in the encounter Outcome of the encounter Patient Satisfaction Questionnaire (PSQ) (Zandbelt, 2004) Nurse and family rating of satisfaction and usefulness with telehealth encounter 5-item tool using visual analog scale (0-100) Evaluating Telehealth Encouters
19 | © 2012 Steps to Successful Implementation Enthusiasm Start with one; evaluate, build on success Knowledge Assess for any hardware needs Policies-(HIPPA) Reimbursement
20 | © 2012 Growth of Internet Usage % of World Population % % % % March % Is the World Ready for Telemedicine? Growth of Internet World Wide Usage
21 | © 2012 Internet Usage Is the World Ready for Telemedicine? December 31, % of population using Internet 2000 – 2011 Growth Africa13.5%2,988.4% Asia26.2% 789.6% Europe61.3% 376.4% Middle East35.6%2,244.8% North America78.6% 152.6% Latin America39.5%1,205.1% Australia/ Oceanic 65.5% 214.0% World Wide32.7% 528.1%
22 | © 2012 Adult Learning Principles to Overcome Implementation Barriers
23 | © 2012 Adults have accumulated a life of experiences −Realistic; know what works and what doesn’t −Able to build on past experiences and knowledge −Enjoy having their talents and knowledge explored Build on prior experiences and opportunity for practical application preferably NOW Adult Learning Principles to Overcome Implementation Barriers
24 | © 2012 Adults have established −Opinions −Values −Beliefs Respect Build on These Adult Learning Principles to Overcome Implementation Barriers
25 | © 2012 Adults are intrinsically motivated −Motivated by relevance of the material −Does it address one of their needs? −Does it address one of their beliefs? −Does it address one of their personal goals? What is standing in their way of accomplishing one of their goals? How can telemedicine help them accomplish that goal? Adult Learning Principles to Overcome Implementation Barriers
26 | © 2012 Adults are goal and relevancy orientated −Task or problem-centered learning more than subject learning −Why am I learning this? −Will it help me accomplish something I am intrinsically passionate about? −Will it help me address one of my personal goals? Adult Learning Principles to Overcome Implementation Barriers
27 | © 2012 Adults are autonomous and self-directed learners −Learn best when they are “ready to learn” −A problem when their employer “forces” it on them Adult Learning Principles to Overcome Implementation Barriers
28 | © 2012 Resources International Society for Telemedicine and e- Health (ISfTeH) m-health Alliance National Telehealth Center, University of Philippines Manila European Commission Information Society, Telemedicine Health Canada American Telemedicine Association (ATA) Center for Telehealth and e- Health Law California Telemedicine and e-Health Center National Library of Medicine Publication Search Virtual Families Interactive
29 | © 2012 Cady, R., Kelly, A., & Finkelstein, S. (2008). Home telehealth for children with special health-care needs. Journal of Telemedicine & Telecare, 14(4), Day, M., Demiris, G., Oliver, D. P., Courtney, K., & Hensel, B. (2007). Exploring underutilization of videophones in hospice settings. Telemedicine and e-Health, 13(1), De Vito,K. (2009). Implementing Adult Learning Principles to Overcome Barriers or Learning in Continuing Higher Education Programs. Online Journal of Workforce Education and Development, 4(3). Doolittle, G. C. (2000). A cost measurement study for a home-based telehospice service. Journal of Telemedicine & Telecare, 6(Suppl 1), S Doolittle, G. C., Whitten, P., McCartney, M., Cook, D., & Nazir, N. (2005). An empirical chart analysis of the suitability of telemedicine for hospice visits. Telemedicine Journal & E-Health, 11(1), Duursma, F., Schers, H. J., Vissers, K. C., & Hasselaar, J. (2011). Study protocol: Optimization of complex palliative care at home via telemedicine. A cluster randomized controlled trial. BMC Palliative Care, 10, 13. Kidd, L., Cayless, S., Johnston, B., & Wengstrom, Y. (2010). Telehealth in palliative care in the UK: A review of the evidence. Journal of Telemedicine and Telecare, 16(7), Knowles, M.S., Holton, E. F., & Swanson, R.A. (1998). The Adult Learner: The Definitive Classic in Adult Education and Human Resources Development (5 th ed.). Houston, TX: Gulf. Maudlin,J.,Keene,J.,Kobb,R. (2006). A Road Map for the Last Journey:Home Telehealth for Holistic End of Life Care. American Journal of Hospice & Palliative Medicine, 23(5), McGear, R., & Simms, J. P. (1988). Telephone triage & management: A nursing process approach. Philadelphia, PA: W.B. Saunders. Oliver, D. R., Demiris, G., Day, M., Courtney, K. L., & Porock, D. (2006). Telehospice support for elder caregivers of hospice patients: Two case studies. Journal of Palliative Medicine, 9(2), Oliver, D. P., & Demiris, G. (2010). Comparing face-to-face and telehealth-mediated delivery of a psychoeducational intervention: A case comparison study in hospice. Telemedicine and e-Health, 16(6), Oliver, D. P., Demiris, G., Wittenberg-Lyles, E., Washington, K., Day, T., & Novak, H. (2012). A systematic review of the evidence base for telehospice. Telemedicine and e- Health, 18(1), Roberts, D., Tayler, C., MacCormack, D., & Barwich, D. (2007). Telenursing in hospice palliative care. Canadian Nurse, 103(5), Schmidt, K. L., Gentry, A., Monin, J. K., & Courtney, K. L. (2011). Demonstration of facial communication of emotion through telehospice videophone contact. Telemedicine and e-Health, 17(5), Washington, K. T., Demiris, G., Oliver, D. P., & Day, M. (2008). Telehospice acceptance among providers: A multidisciplinary comparison. American Journal of Hospice & Palliative Medicine, 25(6), Whitten, P., Holtz, B., Meyer, E., & Nazione, S. (2009). Telehospice: Reasons for slow adoption in home hospice care. Journal of Telemedicine & Telecare, 15(4), Whitten, P., Doolittle, G., & Mackert, M. (2005). Providers' acceptance of telehospice. Journal of Palliative Medicine, 8(4), Wittenberg-Lyles, E., Oliver, D. P., Kruse, R. L., Demiris, G., Gage, L. A., & Wagner, K. (2012). Family caregiver participation in hospice interdisciplinary team meetings: How does it affect the nature and content of communication? Health Communication,, 1-9. Zandbelt, L., Smets, E., Oort, F., Godfried, M., & de Haes, H. (2004). Satisfaction with the outpatient encounter. Journal of General Internal Medicine, 19(11), For More Information…
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