Telehealth in geriatric support

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Published: 22 Nov 2016
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Prof Annie Young - University of Warwick, Coventry, UK

Prof Young speaks with ecancertv at SIOG 2016 about supporting elderly patients in distress using mobile technology.

She describes how telehealth can provide a swift response, connecting patients, councillors and oncologists.

This service has been kindly supported by an unrestricted grant from Merck/MSD.

There are many types of telehealth in operation at the moment, usually small studies and we need to coordinate and work internationally in this. Telehealth in general, whatever it may be, video conferencing, and mostly in oncology it’s monitoring the side effects and symptoms of the cancer patient, especially following chemotherapy. We must be cognisant that it must fit in to the culture of the patient. We can adapt some techniques and some devices we’ve got for the individual patient but it also must go into the work-flow of the health care professional. It shouldn’t be an add-on because all health care professionals say, “Oh not another thing to do,” but it should be integrated into their usual work. These are two things that should happen with telehealth in general.

An example of what I’m speaking about at SIOG is a device specially adapted for the older oncology patient and that was finding out how the patient felt at home. These were patients who were on chemotherapy and finding out their signs and symptoms but not only that but really their experiences and how they actually felt so that included quality of life and did they feel distressed at all. That device was a four-button simple home-based gadget in their house that linked in to our oncology unit, to our server which linked into our oncology unit at the University Hospital Coventry in Warwickshire.

What aspects of quality of life were you researching?

We were trying to encourage self-management in the older cancer patient as well. Clearly that may help the organisations like acute hospitals from patients coming to and from hospital all the time. That may decrease the visits for the patients and we’re able to do things such as remote clinics and remote hospital visits through the internet as well. Certainly, encouraging self-management so it’s called supported self-management at home and in end of life care as well.

Has there been any feedback on the devices?

We try to incorporate this study which was the device study, it was called the Health Buddy and it was developed by Bosch Healthcare and we tried to incorporate that into our systems that we had in the hospital. This was not, sadly, in the community but the patient was at home. It was run by the hospital services that we already had and, indeed, the acute oncology team, and that was a nurse led team, looked after all the responses they got. Because the patient was able to say whether it was a red alert so whether it needed us to do something about it within an hour or within 15 minutes in some cases, or whether it was an amber alert, it could wait for a few hours, or whether it was just a normal alert that they needed some reassurance about. So the red alerts all went through this acute oncology team and we would classify them as possibly life-threatening.

We are trying to incorporate it within the teams but interestingly what we found is that mostly the patients were pushing the button on their device for being very distressed so most of the results that we got back and the red alerts that we got back were due to distress and fatigue and things that the acute oncology team were not really experienced in. What we did about this was we trained up a support worker, so a nurse assistant, in order to take the alerts, the distress alerts, so she was trained in counselling cancer patients and took that job on. That decreased the work for the acute oncology team who could concentrate on the more physical side effects. Clearly to the patient the distress and the fatigue and everything was very important to them and we had to deal with that.

What have you found in terms of the concept of treating the person and not the disease?

We found when we phoned the patient back, because the deal was that we phoned the patient back within half an hour if it was a red alert, it was often social problems that were the cause of their distress, so we had to find out the cause. It could be a physical problem like dreadful diarrhoea or whatever with their drug regime but as long as we found out the cause of their distress then they were triaged appropriately really.

Is there any point that you would like to conclude on?

Just as I started just to say that we have to adapt for the geriatric oncology patient. The mean age of our small study with the device in 73 patients was 62, so that was a young population. But when the statistician did the analysis age was not a factor in any of the results. So age did not affect the patient using the device or affect the number of alerts or the types of alerts.