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Continuing Care01:25

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Continuing care describes the variety of health, personal, and social services provided over a prolonged period. The need for continuing care is increasing because people are living longer. Many people do not have families or others to care for them. Continuing care is mainly for patients who are disabled, functionally dependent, or suffering from a terminal disease. It is available within institutional settings or in homes. Examples include nursing centers or facilities, assisted living,...
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Restorative Care01:19

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Related Experiment Video

Updated: Jun 15, 2025

Development and Implementation of a Multi-Disciplinary Technology Enhanced Care Pathway for Youth and Adults with Concussion
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Continuum: A Postdischarge Supportive Care Intervention for Hospitalized Patients With Advanced Cancer.

Daniel E Lage1, Alane S Burger2, Julia Cohn3

  • 1Memorial Sloan Kettering Cancer Center (D.E.L.), New York, NY, USA; Massachusetts General Hospital (D.E.L., M.H., E.J., N.K.H., L.M., C.K., E.K., K.O., D.H., E.M., C.R., R.D.N., L.T., A.E.J., J.A.G., J.S.T.), Boston, MA, USA.

Journal of Pain and Symptom Management
|August 28, 2024
PubMed
Summary

A pilot study found that a video visit with an oncology nurse practitioner (NP) within three days of hospital discharge was feasible and acceptable for advanced cancer patients. This intervention effectively addressed postdischarge needs, improving patient care transitions.

Keywords:
Advanced cancerinterventionpostdischargesupportive care

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Area of Science:

  • Oncology Nursing
  • Health Services Research
  • Digital Health

Background:

  • Patients with advanced cancer face significant post-hospitalization needs and increased risks of readmission.
  • Current interventions for post-discharge care in this population are limited.
  • Transitioning advanced cancer patients home requires robust support systems.

Purpose of the Study:

  • To assess the feasibility and acceptability of a novel post-discharge intervention for advanced cancer patients.
  • To evaluate the effectiveness of telehealth in managing post-discharge symptoms and care coordination.
  • To demonstrate the potential of oncology nurse practitioners in bridging the gap in post-discharge care.

Main Methods:

  • A single-arm pilot trial involving 54 advanced cancer patients undergoing unplanned hospitalization.
  • Intervention: A video visit with an oncology nurse practitioner (NP) within three days of discharge.
  • Feasibility defined by ≥70% enrollment and ≥70% intervention completion; acceptability measured by patient and NP surveys.

Main Results:

  • Enrollment rate was 77.3% (54/75 approached patients).
  • Intervention completion rate was 83.3% within three days of discharge.
  • Patients reported high ease of use (median 9.0) and usefulness (median 7.0) of the video technology.

Conclusions:

  • A post-discharge intervention delivered by oncology NPs via video visits is feasible and acceptable for advanced cancer patients.
  • This telehealth approach effectively addresses critical post-discharge needs, including symptom management and care coordination.
  • The findings support the integration of such interventions into routine care for improved patient outcomes.