Short summary

The study will focus on video consultations instead of or as a supplement to a physical nursing consultation and investigate the use of video consultations from the perspective of patients, caregivers and healthcare professionals.

Rationale

Introduction

Patients with an oncologic diagnosis in Denmark may spend several hours traveling to and from the hospital as the treatment is centralized at a few university hospitals (Sundhedsstyrelsen, 2012). The overall aim in this study is to investigate if it makes sense to replace some of these personal appointments with the use of telemedicine. 

Telemedicine is defined by the World Health Organization (WHO) as "the delivery of health-care services, where distance is a critical factor" (WHO, 2018). Thus, the concept refers to a range of different services, for example, monitoring, treatment and communication based on different telemedicine technologies. The study will focus on video consultations instead of or as a supplement to a physical nursing consultation and investigate the use of video consultations from the perspective of patients, caregivers and healthcare professionals.

Background

Different pilot studies covering telemedicine have been conducted in Denmark. These studies showed that telemedicine provides benefits in the shape of more self-supporting patients, economical benefits and contiguous patient processes (Stausholm et al., 2017; Schaarup & Hejlesen, 2015; Clemmensen et al., 2007). 

In a Danish study, telemedicine was investigated with patients with hematological diseases (Christensen & Danbjørg, 2018). The patients n=17 were given the opportunity to talk to a hematologist from the outpatient clinic through a video screen, while the patient was located at the local hospital on a small island instead of face-to-face consultation. It was found that the patients were allowed freedom, despite their illness and the study also demonstrates that the intimacy can be mediated trough a screen and physical presence is not as important to the patient as other things (Christensen & Danbjørg, 2018). 

In other studies with telemedicine in palliative care it is highlighted how video consultations enhanced communication by facilitating not only verbal but also nonverbal communication (Demiris et al., 2007; Demiris et al., 2011; Demiris et al., 2012; Hennemann-Krause et al., 2015; Oliver and Demiris, 2010; Schmidt et al., 2011; Van Gurp et al., 2015)

Through video consultations palliative care professionals could interpret patients' and /or caregivers' silences, body language and facial expressions of emotion (Demiris et al., 2011; Schmidt et al., 2011; Hennemann-Krause et al., 2015) and respond with empathy (Van Gurp et al., 2015; Oliver et al., 2010). Thus, studies mentioned how video consultations provided a platform for face-to-face communication which allowed palliative care professionals, patients and caregivers to interact in a more personal way than by telephone (Morgan et al., 2017). 

Also Danish palliative patients n=11 experienced that video consultations are feasible and facilitated a strengthened involvement between patients, caregivers and team members in the specialized palliative care team (Funderskov et al., 2018).

However, a systematic database search shows very limited research on video consultations with patients with oncological diseases in outpatient clinics nationally and internationally. 

The majority of the existing studies were derived from the United States and Australia and only few European studies appeared in the search. In most of the studies concerning telemedicine and oncology, telemedicine is used between physicians to discuss issues regarding patients and their treatment (Greenhalgh, 2018; Mair et al., 2000; Stelson et al., 2016, Rising et al., 2016). However, the literature search revealed that, as of yet, to our knowledge, no studies involving patients with oncological diseases in a nursing outpatient clinic have been conducted in a Danish context and not internationally.

Dinesen et al. focus on the importance of defining which group of patients who are suitable for using telemedicine and conclude that there is no one-size-fits-all approach when it comes to the use of telemedicine (Dinesen et al., 2016). Furthermore Kidholm et al. state that it is important to find the group of patients who can benefit the most from the use of telemedicine (Kidholm et al., 2015). 

In the futures hospital, the intention is to have fewer admitted patients and instead treat the patients in outpatient clinics or in their own homes (Sundhedsstyrelsen, 2017). As such, the need for using telemedicine including video consultations is expected to increase during the coming years, and therefore it is important to gain knowledge about video consultations for nursing outpatient clinics as seen from the perspective from all stakeholders. 

Description of the cohort

Patients over eighteen with gastrointestinal tumors who are going to be assessed for treatment readiness before their second chemotherapy will be invited to participate in the study. 

Nurses who have the role of executing video consultations with patients will be invited to participate in the study.

Data and biological material

This study will be designed as a mixed methods study with a strong focus on the qualitative approach, but with collection of a questionnaire containing quantitative questions. 

We would like to evaluate the study against the Model for Assessment of Telemedicine (MAST) (Kidholm et al., 2017). MAST gives a solid base for making a decision to introduce and the use of telemedicine. This is done by evaluating telemedicine and including e.g. the clinical effects, patient safety, perspectives of the patients and informal caregivers, financial and organizational effects, including, ethics and socio-cultural effects. 

Collaborating researchers and departments

Department of Oncology, Odense University Hospital

• Associate Professor Karin Brochstedt Dieperink, RN, MCN, PhD