Palliative care at home is only possible in more complex cases if GPs are supported by palliative specialists. This project showed that this can be done in the Netherlands by using video consultation. Elderly patients had no trouble using the technology, and the contact was experienced as positive. One condition, however, is that there must be a clear distribution of responsibilities between care providers. In Nigeria, however, problems were encountered with this technology.

With the ageing of the population, demand for palliative care is increasing. In this project, the researchers found that many patients prefer to receive such care at home and that, when the time comes, they would like to die in their own home too. High-quality palliative care at home can reduce the need for transfers to hospital at the end of a patient’s life, which is burdensome for the patient as well as being expensive. It is therefore important to provide high-quality palliative care at home. One way in which this can be done is by providing palliative telecare, and not just in the Netherlands. Developing countries in particular, where hospitals are often few and far between, or where the number of hospital beds is limited, could benefit from new technological opportunities for remote healthcare.

This project examined whether and how teleconsultation could be considered to be a socially-responsible innovation for providing complex palliative care at home. Parallel to the research carried out in the Netherlands, an exploratory study was also carried out into possibilities for palliative care at home in Nigeria. The main findings in the Netherlands were:

• Palliative care providers expect teleconsultation to result in an additional “grey” network beyond the formal hierarchical structures of established palliative healthcare. This can result in people missing out on care from healthcare practitioners as well as confusion regarding who is responsible for what. It must be clear what the division of responsibilities is, for all stakeholders. Only in this way can continuity of care be guaranteed.
• Palliative care providers are also concerned that teleconsultation will be implemented at the cost of personal contact, therefore endangering good anamnesis and diagnosis. They also worry that there will be less “real contact” with the person behind the patient. On the other hand, care providers recognise that teleconsultation can have a positive impact on health, due to the extra time and digital attention that patients receive.

The project concluded that, if provided carefully, teleconsultation is well received by patients. Despite being a remote form of care, the closeness and personal forms of contact experienced are maintained or are given a different form. Given the right support, elderly patients are also able to cope with the technology.

Expectations

Other expectations were also identified during interviews and meetings with palliative care professionals:

• teleconsultation gives patients more control over their care process;
• teleconsultation produces an extra information flow that can be used by palliative care professionals to check the accounts given by patients and medical specialists.

Good palliative care in Nigeria

The results of the exploratory study in Nigeria were:

• Taboos surrounding illness and death form a barrier to palliative care. Much more attention needs to be given to informing and educating patients, their families and their communities.
• Other barriers include a failing government palliative care policy and the complex relationship between medical care and religion.
• The main problem concerning the implementation of remote palliative care in Nigeria is however technical: the irregular internet bandwidth, poor network coverage and frequent power cuts. Palliative care will only work if it uses simple technology with non-synchronous online communication.

The project team involved interdisciplinary cooperation between the medical sciences (medical specialist, GP), the communication sciences and ethical and policy/healthcare management.

Telecare

How is telecare technology or “e-health” used exactly? Through video consultation, a specialist palliative care team (secondary healthcare) can provide palliative care at home. For example, they can support GPs (primary healthcare) in providing home care. Palliative specialists can also contact the patient directly. Teleconsultation is becoming increasingly popular, both for home care and in hospitals.

Video consultation is one example of telecare technology. This is remote medical care that is made possible using information and communications technology. This telecare can take various forms, such as the remote monitoring of a patient’s physical condition, consultations and coaching.

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