Short summary

The need for use of telemedicine is expected to increase during the coming years and therefore it becomes important to gain knowledge about the use of video consultations to hematological patients - seen from the patients' and healthcare professionals' perspective. This project is a part of a larger study, where patients with hematological diseases from the island Ærø have been given the opportunity to talk to a hematologist from the outpatient clinic in Odense through a video screen instead of a face-to-face consultation.

Rationale

Patients with hematological diseases spend several hours travelling to the hospital as the treatment is highly specialized and centralized at a few university hospitals in Denmark. Therefor this project will examine how patients and health care professionals experience the use of telemedicine.

In Denmark several pilot-projects covering telemedicine have been conducted. These projects have shown that telemedicine provides benefits in the shape of more self-supporting patients, economical benefits and contiguous patient processes. In a Danish study from 2016 telemedicine was investigated in patients with chronic obstructive pulmonary disease. It was found that the tele consultation was experienced as qualified and was facilitating a close relation between the nurse and the patient. Furthermore, the patients became more active participants in their own treatment. In another Danish study from 2007 the aim was to explore the impact of tele homecare interventions as experienced by patients, healthcare professionals and the healthcare system. In this study the patients were diagnosed with heart failure, heart arrhythmia or diabetes. The results of this study showed that the patients felt more freedom and greater empowerment in relation to their diagnoses. The healthcare professionals experienced a more integrated clinical process for division of tasks.

Yet no projects involving patients with hematological diseases have been conducted, and a systematic database search shows very limited research about video consultations and hematology. The majority of the studies derived from Australia and the US, and only few European studies appeared. In most of the studies found concerning telemedicine and hematology, telemedicine is used due to the long distances and in order to keep the specialized doctors available for patients despite the long distances. The studies shows that further research is needed to explore how hematological patients experience their role during a video consultation and which communicational barriers they might experience.

A study from Australia also shows that patients are satisfied with the use of telemedicine, but points out that there is limited knowledge about the hematologists' perspective on the use of video consultations. What are the limitations and what are the incentives for the hematologist to participate in video consultations and which technology is suitable for the hematological patients are some of the questions the study invites to investigate further.

Dinesen et.al. focus on the importance of knowing which group of patients are suitable for using telemedicine and conclude that there is no "one-size-fits-all" approach when it comes to the use of telemedicine. The diagnoses and patients differ, and there is a need for further investigation of the combination of technology and different patient groups. Kidholm et. al. furthermore define that it is important to find the group of patients that can benefit from the use of telemedicine before the benefits show. They also define that telemedicine cannot stand alone without defined groups of patients.

The existing studies show a lack of knowledge about which group of patients with hematolog-ical diseases can profit from using video consultation and also what perspectives the healthcare professionals have on the use of video consultations.

In the future the mission for the hospitals is to have fewer admitted patients at the hospitals and instead treat the patients in their own homes. The need for use of telemedicine is ex-pected to increase during the coming years, and therefore it becomes important to gain knowledge about the use of video consultation for patients with hematological diseases - seen from both the patients' and healthcare professionals' perspective.

The overall aim is to explore how patients and healthcare professionals experience the use of video consultation.

This will be uncovered through the following research questions:

How do patients and healthcare professionals experience the use of video consultations in place of a face to face consultation (e.g. which issues are addressed during video consultations, the lack of physical contact, the quality of the video consultation, communication through a screen, security, how do participants utilize the technology etc.)?

Which facilitators and barriers are important when using video consultations?

What does it mean to the patient to save the travel time?

How are the roles between patients and healthcare professionals experienced when using video consultation?

Which patients (diagnosis, socio-demographics) can profit from video consultations?

Description of the cohort

Hematological patients living at the Island Ærø have been invited to participate in this project. The doctor who last examined the patient in the out-patient clinic has decided, if the patients disease is stable enough to convert to a video consultation instead of a normal consultation in the out-patient clinic.

Data and biological material

Participant observations of doctors and patients during a video consultation, qualitative interviews with patients and focus-group interviews with the doctors that have participated in the video consultations. 

Collaborating researchers and departments

Hematological Research Department, Odense Universitetshospital

• Assistant Professor Dorthe Boe Danbjørg. PhD
• Research nurse Nina Primholdt Christensen, MS