Essay On Palliative and/or End of Life care
Palliative and/or End of Life care Essay
Dying is a natural and inevitable part of the life course. Palliative care or end of life care is a holistic approach that includes the management of psychological, physical and spiritual symptoms planned in collaboration with family and carers (Henson et al., 2020). The major goal of end of life care is to improve quality of life both for the dying patient and the family (O’Conner & Alde, 2011). Major innovations have taken place in palliative care services that are working for pain management, non-pharmacological interventions, aids social support and help in reducing the suffering of the patients. One such innovation is the use of telehealth and telemedicine in palliative care provision (Hancock et al., 2019). This essay aims at highlighting the innovation of telehealth in palliative care and emphasizes the solutions offered, barriers to implementation and improvements made by telehealth services in palliative care.
Palliative care programmes have traditionally been focused on cancer care, although there is an increasing expectation that they can offer care to those with any life-limiting illness. This, including an ageing population and rising comorbidity rates, has put pressure on palliative care programmes. The palliative treatment has been found to improve patient quality of life in several trials. Despite this, research work highlights gaps in palliative care service access, with a special emphasis on people with non-cancer conditions, people living in remote areas and out-of-hours care (Wu et al., 2020). The professional palliative care network faces several challenges, including providing palliative care to remote areas ((Finucane et al., 2018). The dying process is still seen the same in the remote areas as they do not have proper access or no access to palliative care. Many of the studies show that due to the unavailability of palliative care many ageing patients suffer immense pain which also makes them suffer physically and mentally (Shahid et al., 2018). This also affects their families in adverse ways. Telehealth is an innovative approach and has no boundaries be it remote area or rural area. Tele-health provides access to dying patients and people living with a terminal illness and aids them with support and assistance. This also does not cost much and hence can be easily affordable for disadvantaged or poor patients living in remote areas.
Telehealth, which incorporates healthcare facilities, information management, and digital technology, is a modern and increasingly growing field. “Telehealth” is the use of telecommunications and interactive media to provide health care other than conventional health-care facilities according to the World Health Organization (WHO) (WHO, 2021). Further, there are many solutions offered by telehealth such as:
Remote patient monitoring- Patients in palliative care who reside in remote areas with restricted healthcare coverage will benefit greatly from telehealth. These patients may receive treatment with the least amount of interruption to their everyday routine. They may also undergo individualised therapies from the convenience of their own homes increasing the quality of life (Worster & Swartz, 2017).
Nurse coaches- Well trained nurse coaches are responsible for regular phone-based sessions, symptom management, advance care planning and communication. The nurse coaches constantly work with the family members and match the values and needs of the palliative care of the dying patient.
Increases medication reconciliation accuracy- medication reminders and health records help the care provider or a family member to manage the medications for the patient. This helps in minimizing adverse symptoms and also alleviates pain and discomfort caused by chronic illnesses. Studies suggest that telehealth medication reminders have helped in reducing medication error by 86% (Worster & Swartz, 2017).
Improves provider coordination and communication- telehealth has improved connectivity in palliative care and improves the doctor-patient relationship. Timely videoconferencing, reminders, phone calls and consultation have helped in improved communication (Powell & Silveira, 2021).
In-person assessments- Telehealth provides have the option for both web-visit and also the patient or the carer can book for an in-person visit which shows easiness in accessibility which further increases quality of life.
Many factors act as barriers to the implementation of telehealth in palliative care. The major barrier is the majority of palliative care patients do not prefer phone interventions and do not have trust in care over the phone (Kruse et al., 2020). Next, the nurse’s coaches training takes a longer period and they train for 24 to 36 hours which can turn into turnover rates. Further, in the case of palliative care, the family and the careers need equal and individualized attention which becomes time-consuming for physicians. Research suggests that initial cases of palliative care coordination through telehealth turned out to be unfounded and had adverse impacts on the quality of life of the patient (Hancock et al., 2019). Cheung et al. (2021) identified some of the issues related to telehealth, following consultations with patients, caregivers, and healthcare practitioners. The study showed that there is a need to develop infrastructure to accommodate telehealth, the expected potential for patient difficulties in handling the technology, and inadequate funding and internet coverage (Cheung et al., 2021). It's worth noting that many of the home telemonitoring findings involved people with particular diagnoses (such as heart problems), instead of a generalized palliative care population. This could be necessary given that different conditions can cause different symptoms, but it could also be a hindrance when considering the number of telehealth services required to meet the needs of the remote palliative care community as a whole (Hancock et al., 2019).
Tele-health innovation has impacted patients in a great way. In a home-based palliative care telehealth programme that used teleconferencing, patients who received telehealth had fewer hospitalizations, higher satisfaction, and extended hours than those who received standard healthcare services (Tasneem et al., 2019). Similarly, a new study found that integrating remote control of symptoms of patients with cancer was linked to improved quality of life, fewer hospitalizations, and longer survival relative to standard treatment (Bonsignore et al., 2018). Patients with a range of life-limiting illnesses can benefit from easy access to general and specialist palliative care services, which may reduce the need for emergency services. The telemedicine programme has received overall favourable feedback from patients, families, and professionals. Three key benefits were listed by respondents: access to physicians, prompt responses, and increased productivity and quality of treatment. Patients and caregivers benefited from improved prescription refill performance, simpler symptom reviews, and increased peace and comfort of mind as a result of this direct, easy, and improved quality and efficiency of care which is the main objective at end of life care (Head et al., 2017). Using this device was initially thought to be troublesome and problematic for remote and elderly patients. Patients, on the other hand, quickly embraced the technology after being taught how to use it. This has provided patients with additional social support as many remote palliatives care live alone and need social support for emotional support and quality of life. The major advantage of telehealth for patients is that majority of the patients in end of life care prefers to be with their families and telehealth allows prompt care by staying with family which improves the quality of life by increased family support (Tasneem et al., 2019). This also improves the quality of life and suffering of the patients in terms of the financial burden as there are fewer consultation fees, travel costs with telehealth and patients are satisfied with low financial pressure on family in their end of life care (Crawford et al., 2013).
From the above assessment, it can be concluded that telehealth is emerging as a powerful innovation in palliative care and is improving access to remote areas and improving the quality of life. It improves remote patient monitoring, coordination and communications. There are many barriers such as handling technology, training professionals and less adaptability of palliative care patients towards care over the phone. In contrast to this telehealth has proved to be successful in terms of quality of life, satisfaction, hospitalization rates, and longer survival, social and family support.