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Table 4 Matrix of included articles

From: Patients’ experiences of eHealth in palliative care: an integrative review

Ref no Author, year, country Aim Method, eHealth intervention Sample Main findings
[33] Benze G, Nauck F, Alt-Epping B, Gianni G, Bauknecht T, Ettl J et al.
Germany, Switzerland
The aim of the study was to test and assess whether a patient-reported-outcomes (PRO) - symptom estimation - via a newly developed smartphone application (MeQoL) is feasible for outpatients with advanced cancer Prospective, uncontrolled, multi-centered, feasibility trial. Descriptive statistics.
Smartphone application to monitor symptoms
Patients (n = 37) included in the study. Three patients were lost when three units disappeared in postal management.
Adult patients in home care.
High patient satisfaction when using digital reporting via smartphone. Regular symptoms- and quality of life follow-up via an application shows significant clinical results. Patients experienced that the application could provide guidance and evaluation of given medication for pain. Smartphone application feasible for use in monitoring adherence to medication and facilitates patient guidance.
[34] Bonsignore L, Bloom N, Steinhauser K, Nichols R, Allen T, Twaddle M, et al. (2018)
1) describe a telehealth palliative care program using the TapCloud remote patient monitoring application and videoconferencing; 2) evaluate the feasibility, usability, and acceptability of a telehealth system in palliative care; and 3) use a quality data assessment collection tool in addition to TapCloud ratings of symptom burden and hospice transitions Mixed methods approach to assess feasibility, usability and acceptability; pilot study. Descriptive statistics, qualitative semi-structured interviews (n = 9).
Digital platform for monitoring symptoms and video conferencing.
Patients (n = 101) in palliative care program in rural Western North Carolina with one or more life-limiting illnesses. Adults over the age of 18 with wireless network or 3G / 4G. Increased patient satisfaction, decreases
unnecessary health care, optimizes
health care resources. Patients and the healthcare staff had predominantly
positive experiences of the digital
platform. Easy to use, does not take
long to use. Acceptability, feasibility,
and usability of telehealth and the TapCloud application demonstrated. Has potential to improve patient outcomes, and reduce unnecessary health care utilization, optimize resource allocation, and increase patient satisfaction.
[35] Cooley ME, Nayak MM, Abrahm JL, Braun IM, Rabin MS, Brzozowski J, et al. (2017)
1) describe patient and caregiver perspectives for providing, processing, and managing symptoms and quality of life and (2) explore their perspectives about which components of decision support would be desirable to enhance communication with clinicians about symptoms and quality of life during cancer treatment. Qualitative approach, nine focus groups. Thematic content analysis.
Exploring preferences and suggestions for eHealth applications: symptoms and quality of life
Participants (n = 64), over 18 years, Eng/Spa language with ongoing or given cancer treatment in the last 6 months. Participants were paid. Patients and caregivers described components of an eHealth system that might facilitate communication with clinicians and meet needs: (1) the ability to track symptoms over time, (2) access to Webbased information, including visual information, (3) DS that provides prompts for when to contact the clinicians to report their symptoms (ie, when pain severity reaches a “5” on a 0–10 scale) and/or an alerting system for clinicians, (4) peer support, and (5) access to medical records.
[36] Guo Q, Cann B, McClement S, Thompson G, Chochinov HM.
To explore the feasibility of introducing internet-based communication and information technologies for in-patients and their families, and to describe their experience in using this technology. Cross-sectional study Descriptive and analytic statistics. Qualitative thematic analyses.
Feasibility study of communication through internet using iPad or ThinkPad
Patients (n = 13) between the ages of 42–82 years in a palliative care ward, relatives (n = 38) and medical staff (n = 14). English speakers.
Started with 95 patients and family members - drop out due to. - “not interested” and “inappropriate timing”.
Patient and close relatives used “keep
in touch” KIT technology to communicate which made the patient feel better, became calmer, felt closer to relatives. The feasibility of offering internet-based communication and information technologies on palliative care in-patient units confirmed. Patients and families need to be provided appropriate technical support to ensure that the technology is used optimally to help them accomplish their goals.
[37] Hennemann-Krause L, Lopes AJ, Araujo JA, Petersen EM, Nunes RA.
To examine telemedicine as a form of home and additional support for traditional outpatient care as a way to remotely monitor and manage the symptoms of patients with advanced cancer. Prospective, longitudinal, qualitative, descriptive design with case studies. Interviews with patients.
Using ICT for communication: web conferencing with care team and remote symptom assessments.
Patients (n = 12) older than 18 years with an advanced incurable cancer disease with access to data. Telemedicine allowed greater access to the healthcare system, reduced
the need to employ emergency services, improved assessment/control of symptoms, and provided greater orientation and confidence in the care given by family members through early and proactive interventions. Web conferencing proved to be a good adjuvant to home monitoring of symptoms, complementing in-person assistance.
[38] Hoek PD, Schers HJ, Bronkhorst EM, Vissers KCP, Hasselaar JGJ.
The Netherlands
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
Randomized controlled trial for 12 weeks.
Primary outcome patient-experiences symptom burden comparing care as usual with scheduled telephone meetings.
Teleconsultation with speaker and camera using iPad technology.
Home healthcare patients with cancer (n = 74). Adults over 18 years included. Patients completing study (n = 32). Patients who received weekly contact consultation for the usual palliative
care experienced increased / worse
symptoms (regarding anxiety and
depression) compared to other home
health care patients. The number
of unmet needs, experienced continuity of care, and reported hospital admissions did not differ between groups.
[39] Melton L, Brewer B, Kolva E, Joshi T, Bunch M.
Investigating whether E-health use can be a way for young adults to meet to receive psychotherapy support in groups. Questions online about the technology and its possibilities, satisfaction, as well as qualitative questions were asked.
Telemedicine offering psychotherapy in web conferencing format using iPad technology.
Young adults (n = 8), 18–40 years, with cancer, from Colorado. English speakers. All participants had wireless internet as well as the habit of using an iPad or computer. One participant did not complete the questions. Patients experienced an increased
sense of belonging and satisfaction
through group video conferencing.
Available- warmth and continuity increased and the geographical differences in care reduced. The modern format increased access to care across a geographically diverse population, reducing health disparities between rural and urban communities.
[40] Pinto S, Almeida F, Caldeira S, Martins JC. (2017)
To introduce a web-based application to monitor patients’ well-being in palliative care. Usability and acceptability studied. Pilot study testing feasibility and acceptability in developed app for reporting symptoms and sending messages.
Web-based application to monitor comfort and report symptoms.
Patients (n = 7) with cancer, ALS and MS, in palliative home care. Participants older or equal to 18 years with illness that will shorten their lives. Lost 2 people. The patients experienced a high level
of satisfaction. By having the care
“kept track” of them, the application was very useful and easy to use. All patients gave high rating on 10 rating scale. Prototype feasible and acceptable for use. Needs further testing on larger scale.
[41] Tieman JJ, Swetenham K, Morgan DD, To TH, Currow DC.
Australia, New Zeeland
The study investigates the use of E-health in palliative care for patients, caregivers and clinics. Prospective cohort study, of a telehealth-based intervention for community-based patients of a specialist palliative care service. Descriptive statistics, evaluation.
Video-conferencing, reporting symptoms and accessing information online, using iPad technology.
Patients (n = 43) over 18, in home palliative care, able to manage computers, English speaking. Patients excluded if in bed more than 50% of the time. The trial showed that patients and carers, including patients over 80 years, could manage the technology and provide data that would otherwise not have been available to the palliative care services. Self-reported data entered by patients and carers did identify changes in performance state and in symptom distress triggering alerts to the service provider. Scheduled videocall contacts and contacts made in response to triggers led to changes in care.
[42] Timmerman JG, Tonis TM, Dekker-van Weering MG, Stuiver MM, Wouters MW, van Harten WH, et al. (2016)
The Netherlands
To develop a multimodal application aimed at improving rehabilitation and physical activity after lung cancer surgery in close collaboration with healthcare professionals, and to evaluate the usefulness Evaluation of co-creation and usefulness through semi-structured interviews with patients and healthcare professionals. Focus groups and scenarios for views of the technology.
E-health application for symptom monitoring and physical fitness program.
Patients (n = 12) with lung cancer and healthcare professionals (n = 6). Both patients ‘and carers’ perspectives. Patients older than 18 years. Both nursing staff and patient positive about using e-health applications and consultation. Patients experienced reduced uncertainty around perceived symptoms and increased sense of self-control and access to advice. A telehealthcare application that facilitates symptom monitoring and physical fitness training is considered a useful tool to further improve recovery following surgery of resected lung cancer (LC) patients. Involvement of end users in the design process appears to be necessary to optimize chances of adoption, compliance and implementation of telemedicine.
[43] van Gurp J, van Selm M, Vissers K, van Leeuwen E, Hasselaar J.
The Netherlands
To investigate how consultation via e-health can affect the relationship between patients in palliative home care and specialists in palliative care. Qualitative, longitudinal study. Semi-structured interviews, open interviews and observations.
Teleconsultation through video conference, iPad or computer.
Patients (n = 18) were included in the study, cancer (n = 16) and COPD (n = 2). Family members and caregivers were interviewed. Adults between 24 and 85 years. Patient drop out (n = 2), dissatisfied (n = 1), moved to hospice (n = 2) and asked for euthanasia (n = 1). E-health consultation is appropriate
for palliative care in the home.
The consultation can also facilitate
the contact between patients and
healthcare staff, building relationships and improving quality of care. An implementation guide for e-health is described.
[44] Vitacca M, Comini L, Tabaglio E, Platto B, Gazzi L.
To test the feasibility of, and patient satisfaction with, an advanced care plan for severe COPD patients followed by tele-assistance at home for six months that focused on monitoring patient’s palliative topics through a dedicated checklist. Telephone support by a specialist physician in Palliative care and then structured telephone calls by a nurse once a week about the patient’s clinical status and monthly about the patient’s needs with the help of a checklist. The study went on for 6 months.
Qualitative analysis
Telephone calls, weekly, for psychosocial support and symptom reporting.
Patients (n = 10) with severe COPD with less than one year left to live. Adults At least three of the following: 1) FEV (Forced Expiratory Volume < 30%; 2) at least 3 hospital admissions in the last 12 months 3) > 5 years of long-term oxygen therapy; 4) shortness of breath and signs and symptoms of heart failure. The patient experienced reduced anxiety during the conversation. The patients described even bad days with negative emotions and deterioration in their illness. All patients expressed
a high level of satisfaction with the
support. The feasibility and benefits
(more communication between hospital staff and patients and optimized management of symptoms) of offering a PC intervention to patients confirmed.