The need for palliative care has been highlighted throughout this blog, primarily focusing on the quality of life and cost savings perspectives. It is also essential to examine the palliative care provider shortage and how technology is advancing to address this problem as it continues to grow with the impending “silver tsunami.” For example, in California, only 0.9% of all physicians and 0.3% of nurses are certified in palliative care (1). When examined in the context of the needs of the population and comprehensive nature of palliative care, it is clear that technological solutions are needed.
Some general systems currently being used and researched include “remote monitoring devices, telephone, videoteleconferencing (VTC), and mobile devices” (1). Within these umbrellas, providers are able to deliver “out-of-hours telephone support, advice services, […] consultations, and assessments” (2). The discussion on these technological advances is a blog in of itself, but in general these programs allow patients to have access to their provider and other health services remotely. Many telehealth systems allow providers to serve a greater number of patients and meet the needs of patients who struggle to travel to clinics for evaluation (1).
A specific technological innovation that may be a significant game changer for palliative care is known as EIR (3). I wanted to highlight this tool specifically as it aims to address pain which is one of the most significant symptoms managed by palliative care and of personal interest to me and my doctoral project. The EIR software is used for pain monitoring and management (2). It serves the function of supplying the provider with a “summary of the patient’s condition along with suggestions for further investigation and recommended treatment” (3). The software is comprised of medical guidelines and information entered manually by the patient (3). By combining all of the information into one program, researchers hope to optimize symptom management and longevity of life (3).
Because of the lack of provider education in the field of palliative medicine, technology has and will continue to serve as a medium to expand the number of providers being trained on palliative care. Through applications and software, health care professionals have improved access to palliative care education and training (3). An example of a project actively using technology to educate health providers on palliative care is Project ECHO (1). The project aims to increase the number of individuals trained in palliative care to decrease the provider shortage in this specialty (1). Similarly, technology can increase research in the area of palliative medicine. Technology allows researchers to gather data and monitor outcomes in the palliative care population (4).
Some challenges met with advent of many of these technologies include concerns over privacy, security, and ease of use (2). Privacy and confidentiality are always a concern as technology can serve as possible break in the system, potentially exposing important and sensitive health information. As technology continues to advance, it is crucial that necessary precautions are always taken to ensure that information is encrypted and secure, minimizing the risk of information breaches (2). Furthermore, devices and programs need to have interfaces that are simple to learn to meet the needs of an already overburdened population (2). With the increase in technology’s presence in palliative care, it is also important to take a step back to address the issue of who is able to access and use these technologies. Lower income and vulnerable populations are less likely to have computer, tablets, smart phones, etc and therefore may not have access to the varying degrees of telemedicine (2). This of course further expands health disparities already burdening our communities (2). Finally, there is consistently a concern voiced over the “depersonalization” of care with the use of health technologies. These concerns are important for providers to address and ensure that they are still spending one-on-one time with patients in conjunction with touching base via telehealth.
Photo Credits (in order of appearance):
- https://gr-wordpress.s3.amazonaws.com/2014/05/telemedicine-Grand-Rounds-Health.png
- http://www.mesothelioma.com/images/blog/posts/Technology_for_Cancer.jpg
- https://www.ntnu.edu/news/2012-news/palliative-care-congress
- http://echo.unm.edu/
- http://wac.1a76d.edgecastcdn.net/801A76D/mhealth/images/site/articles/2015-04-29-mhealth-implementation-obstacles.png
References:
- Ayers, K. J. (2015). Innovative use of technology for palliative care. Retrieved from http://www.onclive.com/web-exclusives/innovative-use-of-technology-for-palliative-care/1
- Reis, A., Pedrosa, A., Dourado, M., & Reis, C. (2013). Information and communication technologies in long-term and palliative care. Procedia Technology, 9(2013), 1303-1312. doi: 10.1016/j-protcy.2013.12.146.
- Norwegian University of Science and Technology. (2012). Palliative care congress showcases cutting edge technology. Retrieved from https://www.ntnu.edu/news/2012-news/palliative-care-congress
- Kamal, A. H., Swetz, K. M., Dy., S., Tien, A. Y., Temel, J. S., & Abernethy, A. P. (2012). Integrating technology into palliative care research. Current Opinion in Supportive and Palliative Care, 6(00), 1-8. doi: 10.1097/SPC.0b013e32835998c6
The Power of Education 
Thank you for the stimulating discussion regarding numerous important aspects of technology in palliative care!
The EIR software is a fabulous idea. Since it is designed for the patient to self-answer questions and enter the information directly on the iPad, I wonder if it also is applicable for people with moderate to advanced dementia, who are no longer able to effectively communicate their internal experiences? The person’s MPOA or surrogate decision-maker could assist with entering information, particularly if the software is adjusted (if needed) to include current evidence-based tools on assessing pain in non-verbal persons (i.e. the Pain Assessment in Advanced Dementia (PAINAD) scale) 1 Perhaps an interactive educational video could be included to teach the caregiver how to use the PAINAD which is a relatively simple observational tool.
I just watch the video introduction to ECHO—another incredible idea to improve quality of care and reduce suffering. Also a prime way to communicate to healthcare providers and expand knowledge on how to assess and treat pain in advanced dementia. This continues to be challenging for many reasons, including misunderstanding behavioral expressions, including aggression or physical agitation, which should be viewed as possible expressions of pain; and hesitancy to use opioids. 2 I have cared for a number of patients in the end-stage of dementia who recently spent time in geriatric psychiatry facilities for aggression. Often, antipsychotics, antidepressants, antianxiety medications and other sedating medication are given, and zero pain medicine. Upon admission to hospice, I have seen aggression cease, and sometimes appetite improve, once pain is treated.
1Warden V, Hurley AC & Volicer L. Development and psychometric evaluation of the Pain Assessment in Advanced Dementia (PAINAD) Scale. Journal of the American Medical Directors, 2003; 9-15.
2Brecher, D. B., & West, T. L. (2016). Underrecognition and undertreatment of pain and behavioral symptoms in end-stage dementia. Americal Journal of Hospice & Palliative Medicine, 33(3), 276-280.
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I was not aware of Project EHCO. It probably will be a project I start for primary care in rural Texas. This project also assists with some other technological issues within the rural setting, as you mentioned in your article. Due to Project EHCO being an intervention for the primary care provider education and gaining access to experts, technology does not require patient participation. Either as a business expense or a personal computer, providers are better equipped to access and use technology with Project EHCO.
I am writing up a rural palliative care literature review for a class. With such little research and enormous barriers, the rural communities are struggling to acquire any reasonable palliative care. The biggest issue with palliative care in general is beginning the advance care planning before terminal illnesses are diagnosed. The Kaiser Family Foundation survey reported only 27% of adult patients over 65 years of age had an end of life discussion with a provider (DiJulio, Firth, & Brodie, 2015). This survey was not focused to just primary providers or oncologist, which unearths that elderly are the truly underserved population in understanding treatment goals and terminal care.
The ability to identify and refer to palliative care or hospice is a challenge for unprepared providers. Less than 3% of medical and nursing schools offer end-of-life course content, leaving the graduate underprepared to deal with a life process that happens to every person (Lynch, 2012). In addition, one third of health care providers lack the confidence to discuss end-of-life care and may have stunted patients’ acceptance to participate in palliative services (American Heart Association, 2014).
Concluding that your post in January was right on the money, stating ethical and quality end of life care is dependent on the communication between the diagnosed, their family, and health care team. Any effort to improve communication is going to improve palliative care.
Thanks for the palliative care technology post, got some thoughts brewing for my paper.
References
American Heart Association. (2014). Doctors reluctant to discuss end-of-life care with heart failure patients. Retrieved from http://newsroom.heart.org/news/doctors-reluctant-to-discuss-end-of-life-care-with-heart-failure-patients?preview=cafb
DiJulio, B., Firth, J., & Brodie, M. (2015). Kaiser Health Tracking Poll: September 2015. Retrieved from http://kff.org/health-costs/poll-finding/kaiser-health-tracking-poll-september-2015/
Lynch, S. (2012). Hospice and palliative care access issues in rural areas. American Journal of Hospice & Palliative Medicine, 30, 172-177. http://dx.doi.org/10.1177/1049909112444592
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