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Table 4 Articles categorised by study design, validity and supportiveness of home telehealth

From: The case for home based telehealth in pediatric palliative care: a systematic review

Article number Study design Author and Year Study population Validity as determined by CASP tool Conclusions for study support for home telehealth-based on validity and study findings
1 Review Bensink, Hailey et al. 2006 [38] 138 studies (only 8 related to ‘videophones’) 8/8 Supportive: Common theme that a lot is written about its potential, but little clinical research and evaluation undertaken
2 Review Oliver, Demiris et al. 2012 [41] 26 articles 4/8 Partially Supportive: Concerns with study validity, outcome reported as supportive. Acknowledged researcher bias in the field, but review limited to ‘hospice’ no palliative care studies included. Evidence base growing and shows lower to medium strength evidence. More RCTs required
3 Review Kidd, Cayless et al. 2011 [40] 21 articles 6/8 Supportive: Telehealth is acceptable to professionals and clinicians, and able to advance the borders of accessible care. Lack of evidenced based research for telehealth in palliative care in the UK
4 Review Gaikwad and Warren 2009 [39] 27 articles 7/8 Supportive: Videoconferencing shown to reduce unplanned admissions, decrease health utilisation, but more studies needed to assess benefit with evidence based outcomes
5 RCT Hebert, Jansen et al. 2006 [42] Planned 320 adult 10/10 Supportive: Flexibility required running a RCT in pall care and telemedicine. Telehealth able to achieve comparable results to face to face visits, but not likely to be used due to external factors such as changes to routines and readiness to use telehealth
palliative care patients
- 44 recruited
6 RCT Bensink, Armfield et al. 2009 [44] 12 pediatric oncology palliative care families 5/8 Supportive: Difficult population to recruit to. Use of telemedicine itself is acceptable and feasible
7 RCT (3 studies) Gagnon, Lamothe et al. 2006 [10] 12- 30 adult palliative care patients 6/10 Partially Supportive: Proactive model can improve outcomes. Difficulties with generalising for telehome care and recruiting to an RCT in this population
8 RCT Morgan, Craig et al. 2008 [3] 27 children with chronic heart disease 9/10 Supportive: Parents prefer to care for their child at home wherever possible. Home videoconferencing reduced anxiety scores (p =0.5)
9 Cohort Young 2006 [11] 63 caregivers of children: 10 standard care, 16 and 34 to 2 arms of home telehealth intervention 8/11 Supportive: Home telehealth consistently reported to be an important resource that supported families. Enabled transition from hospital to home
10 Chart review Hebert 2007 [15] Notes from 345 adult home visits 9/11 Supportive: 43% of visits could have been done by home telehealth
11 Chart review Doolittle 2005 [16] Notes from 597 adult home visits 7/11 Partially Supportive: 64.5% of home visits could have been performed by home telehealth
12 Cost comparison Doolittle 2000 [36] 2 x 3 month periods analysed (adult focus) 7/11 Partially Supportive: Home telehealth visits significantly less than in person visit ($29 vs. $129-141)
13 Quantitative Laila et al. 2008 [13] 6 adult patients surveyed 7/11 Inconclusive: Videophones feasible and satisfactory and may have a positive effect on quality of life
14 Cohort Demiris, Oliver et al. 2007 [28] 12 caregivers of adult palliative care patients 7/11 Partially supportive: Reported decrease in anxiety scores, but multiple confounders within study. Videophones perceived as aiding communication
15 Quantitative Survey Washington 2008 [24] Survey with 160 clinicians (adult focus) 11/11 Inconclusive: Moderately high acceptance, nurses and administrators more likely to use home telehealth, reluctance to use for psychosocial support
16 Qualitative Whitten Doolittle et al. 2004 [14] 187 adult patients and caregivers 8/10 Supportive: Patients very satisfied with telehospice and wanted it used more, although some described feeling overwhelmed by technology
17 Qualitative Demiris, Oliver et al. 2004 [25] 10 Clinicians (adult focused) 10/10 Supportive: Positive perception of telehospice, but emphasised not a replacement for actual visits
18 Qualitative / cost benefit analysis Maudlin, Keene et al. 2006 [17] 190 adult patients 5/10 Partially Supportive: Concerns with study validity. Outcomes reported as supportive; 60% less admissions and other cost benefits with use of videophone and educational prompts
19 Qualitative Bradford, Herbert et al. 2010 [18] 2 pediatric case studies 8/10 Supportive: Web based videoconferencing can be a simple, effective tool for supporting families at home
20 Qualitative Doolittle, Yaezel et al. 1998 [30] 6 adult patients, 3 nurses 7/10 Supportive: Patient’s and clinicians satisfied with using videophone. Particularly helpful for rural patients
21 Qualitative Coyle, Khojainova et al. 2002 [19] 1 adult case study 7/10 Supportive: Palliative care patients may benefit from using technology, bringing a different level of care into a patients home
22 Qualitative Bensink, Armfield et al. 2004 [20] 1 pediatric case study 9/10 Supportive: Videophones provide a feasible method of delivering home telehealth
23 Qualitative Olver, Brooksbank et al. 2005 [26] 7 clinicians (adult focus) 9/10 Supportive: Feasible method that provided additional support. Advantages of vision enhancing communication
24 Qualitative Oliver, Demiris et al. 2006 [22] 2 caregivers of adult palliative care patients 7/10 Supportive: Satisfaction and technical feasibility achieved with videophones. Appears that technology was seen as a burden at the time of death
25 Qualitative Schmidt, Gentry et al. 2011 [21] 1 adult case study 10/10 Supportive: Identified presence of non verbal communication; expression of emotion and facial expression. Videophone has potential in palliative care to provide access to non verbal communication
26 Qualitative Cook, Doolittle et al., 2001 [27] Interviews with 16 clinicians (adult focus) 10/10 Supportive: Barriers identified to use of telehospice program including organizational readiness and individual providers
27 Qualitative Young 2006 [9] Interviews with 20 caregivers of children and 2 adolescent 10/10 Supportive: Home telehealth important resource for supporting home care, provides reassurance and assists developing parental competence
28 Qualitative Whitten 1998 [37] Interviews with 9 clinicians (adult focused) 10/10 Supportive: Telemedicine, when used as a supplement to traditional care, may improve access issues and conceivably decrease costs
29 Mixed Methods Oliver, Demiris et al., 2010 [23] Interviews and questionnaires with 68 caregivers (adult focused) 10/10 Supportive: No difference seen in quality of life, but carers and staff subjectively report benefits of videophone particularly for enriching relationship and potentially to improve pain management
30 Qualitative Johnston, Kidd et al. 2011 [31] Focus group with 22 adult patients and 8 clinicians 10/10 Supportive: Telehealth initiatives welcomed, but should be an adjunct to clinical care rather than replacement of home visits
31 Mixed methods Whitten, Holtz et al., 2009 [29] 25 clinicians (adult focused) 10/10 Inconclusive: Barriers not due to resources, or difficulty operating technology. Underutilization attributed to culture of organisation. Viewed as impersonal and not in alignment with goals of palliative care
32 Qualitative Whitten, Doolittle et al., 2005 [32] Focus groups with 61 clinicians (adult focused) 10/10 Inconclusive: Clinicians are the most important gatekeeper. Concerns regarding how telemedicine will impact on staff autonomy and financial considerations
33 Qualitative Whitten 2005 [33] Focus groups and interviews (adult focused) 10/10 Inconclusive: Nurses are strongest gatekeepers, other organization factors impeded use