How outpatient palliative care teleconsultation facilitates empathic patient-professional relationships: a qualitative study

Abstract

Objective: The problems and needs of advanced cancer patients and proxies normally increase as the disease progresses. Home-based advanced cancer patients and their proxies benefit from collaborations between primary care physicians and hospital-based palliative care specialists when confronted with complex problems in the last phase of life. Telemedicine might facilitate direct, patient-centered communication between patients and proxies, primary care physicians, and specialist palliative care teams (SPCTs). This study focuses on the impact of teleconsultation technologies on the relationships between home-based palliative care patients and hospital-based palliative care specialists.

Methods: This work consists of a qualitative study among patients, family members, and caregivers that utilizes long-term direct observations, semi-structured interviews, and open interviews following the observations.

Results: The analysis of the empirical data resulted in three key concepts that describe the impact of teleconsultation on the patient-professional relationship in palliative homecare: transcending the institutional walls of home and hospital; transparency of teleconsultation technology; and technologized, intimate patient-professional relationships. Teleconsultation offers (1) condensed encounters between home-based palliative care patients and distant professionals, (2) a unique insight into the patients' daily lives for palliative care specialists, and (3) long-term interaction that results in trustful relationships and experiences of intimacy and relief.

Conclusions: Teleconsultation fits the practice of home-based palliative care. Teleconsultation can, if well applied, facilitate computer-mediated but empathic patient-palliative care specialist relationships, which enable professional care attuned to the patient's context as well as patient involvement. This article proposes a teleconsultation implementation guide for optimal use of teleconsultation in daily palliative care practice.

Fig 1. Distant care for the dying: a teleconsultation service between a specialist palliative care team, patients, family caregivers and primary care physicians.

Legend: Step 1. a. The NP initiates digital bedside consultations with the patient on a regular basis (starting with 1 teleconsultation a week). b. Duration: approximately 30 minutes. c. Standardized inventory of patient's symptoms and other multidimensional problems. d. The NP provides practical advice on caring and nursing; abstains from direct medical treatment advices and decisions. Step 2 (not the focus of this particular study). a. The NP discusses her findings with palliative care specialist and reports to the primary care physician. b. Involved health care professionals compose and/or discuss the treatment plan. c. As long as the patient resides at home,the primary care physician is responsible for discussing the treatment plan with the patient and together they decide about further treatment and care. Important notes: a. A patient cannot directly contact the SPCT via the teleconsultation route as to secure the primary care physician's central position and to prevent an overload of the care system. b. In case the primary care physician participated 'real time' by visiting the patient at home during teleconsultations, the teleconsultation with a patient/consultation with a primary care physician/feedback to the patient was compressed into a single interaction.

Fig 2. Practical implications: a step-by-step implementation guide for multidisciplinary and/or interdisciplinary palliative homecare by means of teleconsultation.