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Cited by 20Palliative Care and End-of-Life IssuesTelemedicine and Telehealth ImplementationPalliative and Oncologic Care

The DOI matches its Crossref record, with a small difference in title or year; 37 of the 37 references it cites were found in a registry or an index.

Findings and lessons learnt from early termination of a pragmatic comparative effectiveness trial of video consultations in home-based palliative care

Nguyen, Huong Q., McMullen, Carmit, Haupt, Eric C, Wang, Susan E, Werch, Henry, Edwards, Paula E, Andres, Gina M, Reinke, Lynn, Mittman, Brian S, Shen, Ernest, Mularski, Richard A·2022·BMJ Supportive & Palliative Care
DOI 10.1136/bmjspcare-2020-002553
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Abstract

Background: Health systems need evidence about how best to deliver home-based palliative care (HBPC) to meet the growing needs of seriously ill patients. We hypothesised that a tech-supported model that aimed to promote timely inter-professional team coordination using video consultation with a remote physician while a nurse is in the patient’s home would be non-inferior compared with a standard model that includes routine home visits by nurses and physicians. Methods: We conducted a pragmatic, cluster randomised non-inferiority trial across 14 sites (HomePal Study). Registered nurses (n=111) were randomised to the two models so that approximately half of the patients with any serious illness admitted to HBPC and their caregivers were enrolled in each study arm. Process measures (video and home visits and satisfaction) were tracked. The primary outcomes for patients and caregivers were symptom burden and caregiving preparedness at 1–2 months. Results: The study was stopped early after 12 months of enrolment (patients=3533; caregivers=463) due to a combination of low video visit uptake (31%), limited substitution of video for home visits, and the health system’s decision to expand telehealth use in response to changes in telehealth payment policies, the latter of which was incompatible with the randomised design. Implementation barriers included persistent workforce shortages and inadequate systems that contributed to scheduling and coordination challenges and unreliable technology and connectivity. Conclusions: We encountered multiple challenges to feasibility, relevance and value of conducting large, multiyear pragmatic randomised trials with seriously ill patients in the real-world settings where care delivery, regulatory and payment policies are constantly shifting.

Overview

Integrity signals

Registry

Crossref · 10.1136/bmjspcare-2020-002553

Cites

37 of 37 references verified0 citation errors · 0 not checkable

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Citations

Cites

Research works printed but not linked: 2

  1. Clinical Practice Guidelines for Quality Palliative Care, Fourth Edition. Richmond, VA: National Consensus Project for Quality Palliative Care 2018.
  2. Pawson R , Tilley N . Realistic evaluation. London: Sage Publications, 1997.

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Metadata

Authors
Nguyen, H. Q., McMullen, C., Haupt, E. C., Wang, S. E., Werch, H., Edwards, P. E., Andres, G. M., Reinke, L., Mittman, B. S., Shen, E., & Mularski, R. A.
Affiliations
  • Kaiser Permanente (US)
  • VA Puget Sound Health Care System (US)
Corresponding author
Nguyen, Huong Q.
ORCID
Venue
BMJ Supportive & Palliative Care
Publisher
BMJ
Published
2020-10-13
Volume
12
Issue
e3
Pages
e432-e440
ISSN
  • 2045-435X (ISSN-L)
  • 2045-4368
DOI
10.1136/bmjspcare-2020-002553
OpenAlex
W3091813837
Cited by
20
References
37
Citations by year
2026: 1 · 2025: 3 · 2024: 5 · 2023: 2 · 2022: 4 · 2021: 4 · 2020: 1
FWCI
2.06
Type
journal article
Language
en
Open access
closed
Locations
  • BMJ Supportive & Palliative Care (publishedVersion)
  • PubMed (publishedVersion)
Funders
Patient-Centered Outcomes Research Institute (PLC-1609-36108)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative and Oncologic Care
Keywords
home-based palliative care, video consultation, telemedicine, early trial termination, nurse-led care, home visits, symptom burden, caregiver preparedness, implementation barriers, workforce shortage

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