Telehospice support may work in assisting caregivers
Caregivers found it useful
A project using videophones found that their quality was satisfactory, and participants found the telehospice form of communication to be useful.1
"We started the project by trying to use videophones to allow caregivers and patients to be visually present during interdisciplinary team meetings," says George Demiris, PhD, an associate professor at the University of Washington School of Medicine and School of Nursing in Seattle.
"This way, the patient and caregiver can be visually present and participate when their case is being discussed," Demiris says. "It's a unique way to bring people together who never see each other face-to-face."
Demiris and other investigators conducted a pilot study using videophones and found a high level of caregiver satisfaction among those participating.
"We had one caregiver who asked us about purchasing a videophone for another family member who was out of state and couldn't see the patient regularly," Demiris recalls. "In our data we found, in one or two cases , that anxiety levels decreased but, given our small sample size, we can't attribute this directly to the videophones."
Nonetheless, the study's findings show there is promise in the technology, he adds.
Here is how a telehospice program might work:
1. Buy the right equipment.
There are commercially available video phones that include monitoring devices, such as blood pressure cups, but if the goal is to merely provide videoconferencing services to patients and caregivers, the extra features may not be necessary, Demiris notes.
"Our emphasis was not to use the video to replace the face-to-face visit, but to use it as an enhancement tool," Demiris says. "We're not changing traditional hospice care, but hopefully adding value by having a videophone for caregivers."
So the equipment necessary included videophones and television screens for the hospice staff to see the patient and caregiver, and vice-versa. The videophones have their own small monitors, but these are very small, so it might work best to have these hooked up to a television set, Demiris says.
The cost of videophones is about $300, and these can be plugged into regular telephone lines, Demiris says.
"We've done a lot of testing with different videophones, and one thing that was an issue for us is that it was functional and easy to use," Demiris says. "We went with one that was more user friendly for senior citizens."
2. Establish protocol for making calls.
With help from an information technology professional, the hospice had the portable videophone set up in a conference room where it could feed into a video screen, Demiris says.
"The family is told that hospice staff will call at a certain time, and then the staff will discuss the case briefly and ask the caregiver or patient if they have any questions," Demiris says.
The calls are kept short, 10 or 15 minutes, because that is the normal amount of time they'd spend on these cases, he notes.
Hospice staff are told to use language that caregivers will understand and to be ready to answer questions, Demiris says.
Also, a hospice might want to prepare for the event of an emergency use of the videophone, Demiris says.
"In our focus groups, a lot of staff members think this can be used as a screening tool in case of an emergency," Demiris says.
For example, the videophone could be used to screen a potential emergency situation to see if a hospice nurse needs to make an unscheduled home visit, he says.
"Having the visual feedback in the middle of the night might help a nurse decide if it's a true emergency or just a panic attack," Demiris says. "The videophone could help nurses better prepare for an emergency visit."
3. Train staff and caregivers and select point person for technical problems.
Hospice staff need to be trained in using the videophones, and they need to know how to train caregivers, Demiris says.
The education should include information about the video image delay, which might cause the picture to a couple of seconds out of synch with the audio communication, he says.
This can be disconcerting to first-time users, Demiris notes.
"We train users and let them know about the delay," he says. "Some aren't used to it and it throws them off when they have to start a conversation."
Another training issue would include explaining how lighting and background noise can distort the videophone image. For example, it is best to install the videophones in areas that have adequate indoor lighting and minimal background distractions.1
Also, when caregivers speak into the videophones they need to have their faces visible on the remote screen, and they need to be told to avoid using rapid hand movements.1
Hospices would need to have some trained to install the phones and be in charge of technical problems, he suggests.
"Sometimes those issues can't be fixed and you have to ship the phone back to the vendor or have it replaced, and that happened once or twice," Demiris says. "You need to have someone in charge so the staff doesn't have the burden of technical maintenance."
Also, a hospice might need to work at obtaining staff buy-in to the idea, Demiris says.
"Staff satisfaction was high but, at the beginning of the study, there were concerns that this new service would increase their workload," Demiris notes. "Namely, they thought caregivers would call more often."
The staff thought the phones might prove burdensome, but these fears were alleviated eventually, he says.
"Over time their satisfaction went up, although some staff members still had concerns about how user-friendly the phones were," Demiris says.
Some of the problems that did arise included the videophones breaking down or audio problems. When these occurred, the staff would have the caregivers switch to an audio telephone, Demiris says.
Reference:
1. Demiris G, Oliver DP & Courtney K. A study of the suitability of videophones for psychometric assessment. Behavior & Infor Tech. 2006;25(3):233-237.
Need More Information?
- George Demiris, PhD, Associate Professor, University of Washington School of Medicine and School of Nursing, Department of Biobehavioral Nursing and Health System, Box 357266, Seattle, WA 98195. Telephone: (202) 221-3866. Email: [email protected]. Web site: www.telehospice-project.org.
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