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Cited by 13Telemedicine and Telehealth ImplementationPalliative Care and End-of-Life IssuesPalliative and Oncologic Care

Enhancing palliative care for advanced cancer patients: evaluating implementation and impact of a virtual nurse-led symptom monitoring and telehealth initiative

Open access
Neo, Shirlyn Hui-Shan, Mok, Natalie, Ng, Xin-Hui, Zhu, Xia·2024·BMC Palliative Care
DOI 10.1186/s12904-024-01541-0PMC PMC11463080
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Abstract

BACKGROUND: As a result of the COVID-19 pandemic, we implemented a novel nurse-led symptom monitoring and virtual telehealth program for patients with advanced cancer on palliative care. AIMS: To evaluate the reach, effectiveness, adoption, implementation, maintenance and acceptability of our program. METHODS: This was a prospective study carried out in a cohort of patients with advanced cancer over the period of 3rd June 2020 to 22nd October 2021. Demographic characteristics, cancer diagnosis, and functional status of patients were collected upon recruitment. Patients were asked to complete a patient-reported outcome measure (the Integrated Palliative Care Outcome Scale, IPOS) prior to the first palliative care consult and subsequently every week for the duration of their participation in the program (12 weeks). The IPOS measures the severity of physical symptoms, emotional concerns, information, and financial needs. Participants' utilization of healthcare services by participants 3 months before, during and 3 months after the telemedicine program was reviewed. At the end of the program, a client satisfaction questionnaire (CSQ-4) to survey participants' experience with the telehealth program and their willingness to pay for this program was administered. RESULTS: Reach: The recruitment to adoption ratio of the program was 0.71. Acceptability:: Participants expressed satisfactory experience. EFFECTIVENESS: We noted that the severity of patients' symptoms and number of emergency department visits decreased over time with nurse support. Adoption: we received referrals from 23 oncologists, yielding an adoption rate of 70%. IMPLEMENTATION: Of the 99 patients recruited for the program, 88.9% of them managed to complete their initial video consults as planned. 16% of them failed to complete the program due to factors such as patient demising. Maintenance: The declining rate of IPOS completion throughout the study period (98.9% at week 1 to 60.8% at week 12) demonstrated the difficulties in sustaining regular administration of self-reported patient outcome measures. CONCLUSION: The telemedicine program was effective and acceptable. We noted challenges in sustaining the administration of patient reported outcome measures over time. Further studies on how we can improve the sustainability of symptom monitoring in a telehealth program for patients with advanced illnesses, under palliative care, should be conducted.

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  • Digital literacy, language, access to devices, reliable internet connectivity, and confidence using technology affected participation across several studies.

    “Digital literacy, language, access to devices, reliable internet connectivity, and confidence using technology affected participation across several studies [25,37,46,48,50,58].”

    From Digital health technologies in oncology services: A scoping review of clinical implementation, organisational evidence gaps, and policy implications (2026) · cites this paper as [50]

    The Discussion (Main findings; page not available) says technological literacy was correlated with the telemedicine service’s reach. Results (Reach; page not available) also lists IT-related difficulties among reasons for nonparticipation. The paper does not establish that language, device access, reliable internet connectivity, or confidence using technology affected participation. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • Digital tools could add to clinician workload when alerts were excessive, outputs were not actionable, or responsibilities for responding were unclear.

    “Several studies showed that digital tools could add to clinician workload when alerts were excessive, outputs were not actionable, or responsibilities for responding were unclear [23,45,50,55].”

    From Digital health technologies in oncology services: A scoping review of clinical implementation, organisational evidence gaps, and policy implications (2026) · cites this paper as [50]

    The Methods (Intervention description; page unavailable) describe a nurse reviewing symptom surveys and triaging patients, but do not assess whether the tool increased clinician workload. The Discussion (Main findings; page unavailable) addresses patient survey completion and access barriers, not excessive alerts, unactionable outputs, or unclear response responsibilities. Searches for those terms and clinician workload found no supporting passage in our copy. (LLM, conf=0.76)

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Research works printed but not linked: 16

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Cited by

Sorted by citations

Authors
Neo, S. H.-S., Mok, N., Ng, X.-H., & Zhu, X.
Affiliations
  • SingHealth (SG)
  • National Cancer Centre Singapore (SG)
Corresponding author
Neo, Shirlyn Hui-Shan
ORCID
Neo, Shirlyn Hui-Shan
Venue
BMC Palliative Care
Publisher
Springer Science and Business Media LLC
Published
2024-10-08
Volume
23
Issue
1
Pages
238-238
ISSN
1472-684X (ISSN-L)
DOI
10.1186/s12904-024-01541-0
PMC
PMC11463080
OpenAlex
W4403226304
Cited by
13
References
4
Citations by year
2026: 10 · 2025: 3
FWCI
5.38
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Palliative Care (publishedVersion, cc-by-nc-nd)
  • PubMed Central (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
Funders
SingHealth Duke-NUS (AM/CSP004/2020)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
  • 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 › Palliative and Oncologic Care
Keywords
palliative care, advanced cancer, telemedicine, COVID-19 pandemic, Integrated Palliative Care Outcome Scale, patient-reported outcomes, emergency department visits, program implementation, acceptability, health care utilization
MeSH terms
Patient Reported Outcome Measures, COVID-19, SARS-CoV-2, Adult, Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Neoplasms, Palliative Care, Prospective Studies, Telemedicine

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