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Background: Teleconsultation seems to be a promising intervention for providing palliative care to home-dwelling patients; however, its effect on clinically relevant outcome measures remains largely unexplored. Therefore, the purpose of this study was to determine whether weekly teleconsultations from a hospital-based specialist palliative care consultation team (SPCT) improved patient-experienced symptom burden compared to "care as usual". Secondary objectives were to determine the effects of these teleconsultations on unmet palliative care needs, continuity of care, hospital admissions, satisfaction with teleconsultations, and the burden experienced by informal caregivers.

Methods: Seventy-four home-dwelling patients diagnosed with advanced cancer were recruited from outpatient clinics of a tertiary university hospital and from regional home care organizations between May 2011 and January 2015. Participants were randomized to receive weekly, prescheduled teleconsultations with an SPCT-member (intervention group), or to receive "care as usual" (control group), for a period of 12 weeks. The primary outcome of this study was: patient-experienced symptom burden indicated by the following: (1) Total Distress Score (defined as the sum of all nine subscales of the Edmonton Symptom Assessment System) and (2) the Hospital Anxiety and Depression Scale. Mixed models were used to test for differences between the two groups.

Results: The Total Distress Score became significantly higher in the intervention group than in the control group, reaching significance at week 12 (adjusted difference at week 12: 6.90 points, 95% CI, 0.17 to 13.63; P = 0.04). The adjusted anxiety scores were higher in the intervention group than in the control group (estimate effect: 1.40; 95% CI, 0.14 to 2.55; P = 0.03). No difference was found between the groups in adjusted depression scores (estimate effect: 0.30; 95% CI, -1.39 to 1.99; P = 0.73) or in secondary outcome measures.

Conclusions: Adding weekly teleconsultations to usual palliative care leads to worse reported symptom scores among home-dwelling patients with advanced cancer. Possible explanations for these findings include excess attention on symptoms and (potential) suffering, the supply-driven care model for teleconsultations used in this trial, and the already high level of specialist palliative care provided to the control group in this study.

Trial Registration: "The Netherlands National Trial Register", NTR2817 , prospectively registered: March 21, 2011.

Titel:	The effect of weekly specialist palliative care teleconsultations in patients with advanced cancer -a randomized clinical trial.
Autor/in / Beteiligte Person:	Hoek, PD ; Schers, HJ ; Bronkhorst, EM ; Vissers, KCP ; Hasselaar, JGJ
Link:	Volltext (PDF) View record at Springer (Volltext)
Zeitschrift:	BMC medicine, Jg. 15 (2017-06-19), Heft 1, S. 119
Veröffentlichung:	[London] : BioMed Central, 2003-, 2017
Medientyp:	academicJournal
ISSN:	1741-7015 (electronic)
DOI:	10.1186/s12916-017-0866-9
Schlagwort:	Caregivers Female Home Care Services Hospitalization Humans Male Middle Aged Netherlands Outcome Assessment, Health Care Quality of Life Neoplasms therapy Palliative Care Remote Consultation
Sonstiges:	Nachgewiesen in: MEDLINE Sprachen: English Publication Type: Journal Article; Randomized Controlled Trial Language: English [BMC Med] 2017 Jun 19; Vol. 15 (1), pp. 119. <i>Date of Electronic Publication: </i>2017 Jun 19. MeSH Terms: Palliative Care* ; Remote Consultation* ; Neoplasms / *therapy ; Caregivers ; Female ; Home Care Services ; Hospitalization ; Humans ; Male ; Middle Aged ; Netherlands ; Outcome Assessment, Health Care ; Quality of Life Comments: Comment in: Evid Based Nurs. 2018 Jan;21(1):1. (PMID: 29223969) References: Ann Ist Super Sanita. 2016 Jul-Sep;52(3):434-442. (PMID: 27698303) ; Support Care Cancer. 2013 Apr;21(4):1201-7. (PMID: 23161339) ; N Engl J Med. 2013 Mar 28;368(13):1173-5. (PMID: 23465068) ; J Clin Epidemiol. 2011 Dec;64(12):1391-9. (PMID: 21689904) ; Patient Educ Couns. 2000 Sep;41(2):145-56. (PMID: 12024540) ; Behav Res Ther. 2012 Sep;50(9):565-70. (PMID: 22743661) ; Palliat Med. 2015 Feb;29(2):101-11. (PMID: 25395577) ; BMC Palliat Care. 2009 Feb 04;8:4. (PMID: 19193213) ; Br J Gen Pract. 2012 Jul;62(600):e949-57. (PMID: 22782001) ; Telemed J E Health. 2012 Jan-Feb;18(1):38-47. (PMID: 22085114) ; Ann Oncol. 2012 Aug;23(8):2006-15. (PMID: 22345118) ; Curr Oncol. 2009 Jan;16(1):55. (PMID: 19229371) ; Palliat Med. 2002 Nov;16(6):457-64. (PMID: 12465692) ; Palliat Med. 2005 Mar;19(2):111-8. (PMID: 15810749) ; Palliat Med. 2009 Apr;23(3):228-37. (PMID: 19073783) ; Oncology. 2013;84(3):186-90. (PMID: 23328311) ; BMC Palliat Care. 2011 Aug 09;10:13. (PMID: 21827696) ; BMC Palliat Care. 2013 Feb 15;12:7. (PMID: 23414145) ; Palliat Support Care. 2015 Aug;13(4):1025-30. (PMID: 25159308) ; J Pain Symptom Manage. 2004 Oct;28(4):329-41. (PMID: 15471650) ; Acta Psychiatr Scand. 1983 Jun;67(6):361-70. (PMID: 6880820) ; J Diabetes Sci Technol. 2013 May 01;7(3):587-95. (PMID: 23759390) ; Support Care Cancer. 2015 Jul;23(7):2189-202. (PMID: 25894883) ; Palliat Med. 2007 Jul;21(5):391-9. (PMID: 17901098) ; BMC Health Serv Res. 2014 Jul 28;14:328. (PMID: 25069399) ; J Palliat Care. 1991 Summer;7(2):6-9. (PMID: 1714502) ; Curr Oncol. 2010 Jun;17(3):17-27. (PMID: 20567623) ; J Cancer Educ. 2005 Spring;20(1):28-33. (PMID: 15876179) ; Dtsch Arztebl Int. 2012 Jun;109(26):459-65. (PMID: 22833756) ; Tijdschr Gerontol Geriatr. 1995 Oct;26(5):214-9. (PMID: 8750982) ; Cancer. 2000 May 1;88(9):2164-71. (PMID: 10813730) ; Psychol Med. 1997 Mar;27(2):363-70. (PMID: 9089829) ; Support Care Cancer. 2013 Dec;21(12):3293-300. (PMID: 23887739) ; J Gen Intern Med. 2004 Nov;19(11):1088-95. (PMID: 15566437) ; Support Care Cancer. 2009 Sep;17(9):1223-30. (PMID: 19184126) ; Palliat Med. 2007 Jul;21(5):417-23. (PMID: 17901101) ; Lancet. 2014 May 17;383(9930):1721-30. (PMID: 24559581) ; J Telemed Telecare. 2010;16(7):394-402. (PMID: 20813893) ; J Telemed Telecare. 2012 Dec;18(8):438-42. (PMID: 23155114) ; PLoS One. 2015 Apr 22;10(4):e0124387. (PMID: 25902263) ; BMC Med. 2013 Apr 24;11:111. (PMID: 23618406) ; J Med Internet Res. 2014 Mar 07;16(3):e72. (PMID: 24610324) ; BMC Med. 2015 Oct 09;13:235. (PMID: 26449231) ; Cancer. 1986 Jul 15;58(2):387-93. (PMID: 3719533) ; J Med Internet Res. 2013 Nov 19;15(11):e258. (PMID: 24252663) ; J Pain Symptom Manage. 2016 Feb;51(2):262-9. (PMID: 26482223) ; Support Care Cancer. 1998 Nov;6(6):539-41. (PMID: 9833305) Contributed Indexing: Keywords: Advanced cancer; Palliative care; Symptom burden; Teleconsultations; Telemedicine Molecular Sequence: NTR NTR2817 Entry Date(s): Date Created: 20170620 Date Completed: 20171101 Latest Revision: 20191210 Update Code: 20231215 PubMed Central ID: PMC5474887

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The effect of weekly specialist palliative care teleconsultations in patients with advanced cancer -a randomized clinical trial.