The Impact of Telemedicine to Support Palliative Care Resident in Nursing Home

Not Applicable

Withdrawn

• Conditions: Palliative Care
• Interventions: Other: Telemedicine consultation; Other: usual palliative care

• Registration Number: NCT02821143
• Lead Sponsor: University Hospital, Toulouse

Brief Summary

Investigators hypothesize that telemedicine may be an effective tool to improve palliative care in nursing home, by providing on-site specialized and interprofessional consultation. The objective of this study is to assess the impact of telemedicine in decreasing the rate of hospitalization, compared with usual care, in nursing home resident with palliative care needs.

Detailed Description

According to current statistics, approximately 12 % of all deaths in France occur in Nursing Home, with the number over 25% in USA. With the ageing of the population, this rate is expected to dramatically increase in the next years, to reach 40% in USA in 2020. Yet, there is some evidence that palliative care is often inadequate in Nursing Home: there is a difficulty to recognize residents who might benefit palliative care and their needs, an underassessment and under-treatment of pain and other end-of-life symptoms, and frequent burdensome treatments and hospitalizations. Several programs including palliative care consult service (with outside consultant), Nursing Home-based palliative care or Nursing Home-hospice partnerships, have succeeded in delivering high-quality palliative care in Nursing Home. But, to our knowledge, no studies examined the benefit of telemedicine for palliative care in nursing home.

During a 6 month-inclusion period, residents with palliative care needs will be included in both arms. In the intervention group, Telemedicine consultations involving Nursing Home staff and the palliative and/or geriatric unit from the University Hospital, will be organized systematically at inclusion and during the follow-up if needed. In both groups, hospitalizations and emergency hospitalizations, quality of life of the resident, satisfaction of the nursing home staff and health costs will be recorded during 6 months.

Study Timeline

• Study First Submitted: 2016-06-29
• Study First Submitted QC: 2016-06-29
• Study First Posted: 2016-07-01
• Study Start: 2019-01
• Primary Completion: 2020-07
• Study Completion: 2020-07
• Status Verified: 2022-01
• Last Update Submitted: 2022-01-26
• Last Update Posted: 2022-01-27

Recruitment & Eligibility

• Status: WITHDRAWN
• Sex: All
• Target Recruitment: Not specified

Inclusion Criteria

• Residents with palliative care needs:

  • Diagnosis of advanced or terminal disease: advanced cancer, advanced congestive Hearth Failure, end-stage pulmonary disease, end-stage hepatic disease, end-stage neurologic disease, other end-stage medical diagnosis.
  • ≥ A unplanned acute hospital episodes within the past 6 months
  • Activity of daily life ≤ 1 and/or bed/chair ridden residents for at least 30 days.
  • Weight loss ≥ 10% of body weight in the last 6 months.
  • The " surprise question " approach: " Would I be surprised if this patient died within the next 6-12 months? "

• Informed and written consent by the patient or the legal representative or the reliable person when appropriate.

• General Practitioner agreement.

Exclusion Criteria

• No agreement of study participation of patients or legal representative or the reliable person when appropriate.

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Intervention group	Telemedicine consultation	Every patient identified as belonging to a palliative care after the inclusion criteria will receive intervention with a follow-up with Telemedicine consultation
Control group	usual palliative care	Every patient identified as belonging to a palliative care after the inclusion criteria will receive Usual palliative care

Primary Outcome Measures

Name	Time	Method
Evaluation of tele-expertise effectiveness on hospitalization rates	through the end of study (24 months)	Evaluation by proportion of subject hospitalized at least one time during follow-up period

Secondary Outcome Measures

Name	Time	Method
Evaluation of tele-expertise effectiveness on emergency	through the end of study (24 months)	Emergency hospitalization rates with proportion of subject hospitalized in emergency at least one time during follow-up period
Evaluation of tele-expertise effectiveness on last 15 days of life hospitalization rates	through the end of study (24 months)	proportion of subject hospitalized in the last 15 days of life at least one time during follow-up period
Patient quality of life	Last patient's 3 days of life	Assessed by Palliative Care Outcome Scale (PCOS)
Caregivers satisfaction	through the end of study (24 months)	Assessed through a satisfaction survey
Economical evaluation	through the end of study (24 months)	Evaluation of taking care costs with french social security scheme data