Teleconsultation for integrated palliative care at home: A qualitative study

Jelle van Gurp, Martine van Selm, Evert van Leeuwen, Kris Visser, Jeroen Hasselaar

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

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.
Aim: 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.
Design: This work consists of a qualitative study that utilizes long-term direct observations and in-depth interviews.
Setting/participants: 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.
Conclusion: 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.
Original languageEnglish
Pages (from-to)257-269
Number of pages13
JournalPalliative Medicine
Volume30
Issue number3
DOIs
Publication statusPublished - 2016
Externally publishedYes

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