The Use of Telehealth in Pediatric Palliative

Care

Kirsten Childe, RN, BSN; Jo Dorhout, MA, CEO of Virtual Interactive Families

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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

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1. 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

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WELCOME

DISCIPLINES

PRESENT

EXPERIENCE WITH

TELEHEALTH

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“ 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…

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• As Imagined in 1910

• Video phone

• Internet connection

History of Video Telehealth

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• Smart phone -

• Web-Based Consults - Virtuwell™

• Health Kiosks -

• Wearable Sensors -

• Home Based Video Consults –

Now

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Examples of Using Telehealth in Home-based Palliative Care

Settings

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Inclement Weather

When you are unable to travel to your home visit

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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

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Emotional Assessment that Phone Conversations Can’t

Always Provide

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Assessment and Management of Non-emergent Concerns

• Rashes, skin integrity

• IV Sites

• Enteral Tube Feeding Sites

• Post-op Wound Checks

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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

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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

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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

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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

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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)

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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

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Steps to Successful Implementation

Enthusiasm

Start with one; evaluate, build on success

Knowledge

Assess for any hardware needs

Policies-(HIPPA)Reimbursement

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Growth of Internet Usage% of World Population

1995 0.4%

2000 5.0%

2005 15.7%

2010 28.8%

March 2012 32.7%

Is the World Ready for Telemedicine?

Growth of Internet World Wide Usage

www.internetworldstats.com

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Internet Usage www.internetworldstats.com

Is the World Ready for Telemedicine?

December 31, 2011 - % of population using Internet

2000 – 2011 Growth

Africa 13.5% 2,988.4%

Asia 26.2% 789.6%

Europe 61.3% 376.4%

Middle East 35.6% 2,244.8%

North America

78.6% 152.6%

Latin America 39.5% 1,205.1%

Australia/Oceanic

65.5% 214.0%

World Wide 32.7% 528.1%

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Adult Learning Principles to Overcome Implementation

Barriers

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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 applicationpreferably

NOW

Adult Learning Principles to Overcome Implementation

Barriers

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Adults have established−Opinions−Values−Beliefs

Respect

Build on These

Adult Learning Principles to Overcome Implementation

Barriers

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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

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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

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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

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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

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• Cady, R., Kelly, A., & Finkelstein, S. (2008). Home telehealth for children with special health-care needs. Journal of Telemedicine & Telecare, 14(4), 173-177.

• 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), 25-32.

• 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), S193-5.

• 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), 90-97.

• 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), 394-402.

• Knowles, M.S., Holton, E. F., & Swanson, R.A. (1998). The Adult Learner: The Definitive Classic in Adult Education and Human Resources Development (5th 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), 399-403.

• 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), 264-267.

• 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), 751-753.

• 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), 38-47.

• Roberts, D., Tayler, C., MacCormack, D., & Barwich, D. (2007). Telenursing in hospice palliative care. Canadian Nurse, 103(5), 24-27.

• 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), 399-401.

• 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), 452-457.

• Whitten, P., Holtz, B., Meyer, E., & Nazione, S. (2009). Telehospice: Reasons for slow adoption in home hospice care. Journal of Telemedicine & Telecare, 15(4), 187-190.

• Whitten, P., Doolittle, G., & Mackert, M. (2005). Providers' acceptance of telehospice. Journal of Palliative Medicine, 8(4), 730-735.

• 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), 1088-1095.

For More Information…

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