Studies have examined the potential of telecommunications; ways in which technology can function as a support mechanism for caregivers of hospice patients,5
an assessment of the readiness of hospice organizations to accept technological innovation,6
and the creation of a Web-based worksheet that allows for expert feedback in a community-based hospice.7
Long et al.8
explored whether computers and the Internet are used in home care and hospice agencies, conducting a survey that indicated the potential of advanced technologies remains to a great extent unexplored. Finally, several studies focused on the use of telehealth or videoconferencing technologies in hospice (telehospice) describing the concept and potential of telehospice, 9–13
pilot projects with a small numbers of subjects,14–16
ethical considerations associated with the use of telehealth technologies in hospice care,17
hospice agencies’ readiness to adopt telehealth,6
and patients’ acceptance.22,23
In spite of the limited evidence of IT use specifically in hospice, there are successful demonstrations of IT implementation in home care that highlight the potential of informatics to improve palliative and hospice care. Home-based telehealth applications (also known as telehomecare applications) are based on the utilization of telecommunication and videoconferencing technologies to enable a healthcare provider at the clinical site to communicate with patients at their home. Such an interaction via videoconferencing is called a ‘virtual visit.’ Johnston et al.24
evaluated the use and costs of remote video technology in the home care setting for congestive heart failure patients and determined that this approach achieved cost savings and improved access to home care support while producing no differences in clinical outcomes when compared to traditional home care. Similarly, a telehealth application developed at Columbia University25
for diabetic home care patients showed that the intervention led to measurable improvements in clinical status for the patients. Obviously, the evaluation of telehealth in hospice will focus on outcomes such as patient’s comfort or caregiver anxiety or cost, rather than long term clinical outcomes that are the focus of the chronic condition, telehealth interventions in home care.
The Internet provides a platform for consumers to access health information and can therefore play a role in end of life care as well. Over the years, the number of web-based patient education sites that allow patients to access information related to their condition has been increasing. Such sites, however, do not always protect visitors from misleading or inaccurate data. There are examples of successful implementation of Web-based systems that empower patients such as the home asthma telemonitoring (HAT) system26
which provides patients with continuous web-based individualized help in the daily routine of asthma self-care or a web-based system for patients who manage insulin-dependent diabetes mellitus.27
Again, this domain has not been studied extensively in the hospice setting. Willis et al,28
conducted a systematic literature review to identify current Internet-based interventions in hospice and palliative care and the evidence of their effectiveness. The authors found only six studies evaluating web-based clinical interventions for patients, caregivers and hospice/palliative care providers.
Mobile devices are widely utilized in other clinical settings and may find utility in palliative care as well. For health care practitioners, the use of mobile IT not only can bring additional resources to the point-of-care, but it can actually change the point of care itself. Within the mobile IT disease management literature, there appears to be a gradual transition from provider-centric applications to applications that include the patient within the process. Earlier research into using mobile IT devices, such as PDAs or cellular phones, emphasized the collection of data from the patient in order to facilitate clinician decision making.29
Decision support for these devices has been mainly on the clinician (receiver) side; however there are a few applications that are also providing real-time decision support to the patients.30
Interestingly, despite the movement towards patient-centric applications, most of the current application descriptions rely on an older medical model of decision making in which the patient is a receiver of instructions rather than a participant in the management process.31
In hospice care, the use of mobile devices has been studied by Kuziemsky et al.32
as a tool to enhance pain management; however, the tool is used solely by health care providers and does not involve patients.
When considering the potential of IT the digital divide becomes a challenge that needs to be addressed. The term is used to refer to the gap in computer and Internet access between population groups segmented by income, age, educational level, or other parameters. Several efforts have been made to address this divide focusing primarily on providing access to computers, the Internet, and training. While lower socioeconomic groups are increasingly gaining Internet access, it is considered likely that the digital divide will persist as new technologies become available. For example, as sophisticated multimedia services become an integral part of Internet-based applications, broadband access may become as important for accessing health care sites as narrowband access is today for obtaining Web-based health information. In that case, the digital divide can exist between two groups that both have PC hardware and Internet access, simply due to different access protocols. Furthermore, access to infrastructure is only one dimension of the digital divide, of which health literacy and appropriate web content are additional key components. These issues play a key role in the diffusion of informatics applications in hospice and palliative care especially systems that are to be used or implemented in the patients and families’ homes.