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The Use of Telemedicine for Home-Based Palliative Care for Children With Serious Illness: A Scoping Review
Kimberly A Miller1, Jennifer Baird2, Jessica Lira2
1Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA; Department of Dermatology, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA.
Insights
Telemedicine home-based palliative care (TM HBPC) shows promise for children with serious illnesses. More research is needed on its implementation, effectiveness, and long-term maintenance for wider adoption.
Area of Science:
- Pediatric Palliative Care
- Telemedicine in Healthcare
- Health Services Research
Background:
- Home-based palliative care (HBPC) delivered via telemedicine (TM HBPC) offers potential benefits for children with serious illnesses.
- There is a critical need for evidence to guide the optimal design and delivery of TM HBPC interventions.
Purpose of the Study:
- To conduct a systematic scoping review of existing literature on pediatric TM HBPC.
- To identify facilitators and barriers to the dissemination of TM HBPC interventions using the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework.
Main Methods:
- Systematic scoping review adhering to PRISMA-ScR guidelines.
- Comprehensive search of multiple databases (PubMed, Embase, Cochrane CENTRAL, CINAHL, Web of Science, PsycINFO, ERIC) from January to April 2020.
- Analysis of included studies based on the RE-AIM framework.
Main Results:
- Seventeen articles were included, predominantly small descriptive studies (case reports, feasibility trials).
- TM HBPC was generally found to be acceptable to clinicians and families, with a focus on acceptability in many studies.
- Few studies reported on patient access, patient-centered health outcomes, or quality of life; much of the data was qualitative and subjective.
Conclusions:
- TM HBPC is a promising strategy for improving access to palliative care for pediatric patients with serious illnesses.
- The current literature lacks robust information on the implementation, effectiveness, adaptation, and long-term maintenance of TM HBPC models.
- Further research is required to guide and facilitate the broader dissemination of TM HBPC interventions.
Context:
There is potential value to home-based palliative care for children with serious illness delivered via telemedicine (TM HBPC). Evidence to guide optimal design and delivery of TM HBPC is urgently needed.
Objectives:
To explore the existing literature to identify research on pediatric TM HBPC.
Methods:
Systematic scoping review conducted following preferred reporting items for systematic reviews and meta-analysis for scoping reviews guidelines. PubMed, Embase, Cochrane CENTRAL, CINAHL, Web of Science, PsycINFO, and ERIC were searched (January-April 2020) using keywords and controlled vocabulary. The Reach, Effectiveness, Adoption, Implementation, Maintenance framework was used to identify components in the literature that facilitate or limit dissemination of TM HBPC interventions.
Results:
Seventeen articles were included. Most of the literature comprised small descriptive studies, such as case reports, and feasibility trials. Many studies focused on acceptability, and the TM HBPC model was generally acceptable to both clinicians and families. Few studies measured patient access to care, patient, and family centered health or quality of life outcomes. While included studies addressed multiple criteria for each of the Reach, Effectiveness, Adoption, Implementation, Maintenance dimensions, much of the information was qualitative and subjective.
Conclusion:
TM HBPC is a promising strategy to increase access to palliative care for children with serious illness. However, the current review found a need for more robust information describing implementation and effectiveness of TM HBPC models, adaptation across care settings, and maintenance over time to guide and facilitate broader dissemination.
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