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Our Tele-Oncology Experience Carmel O’Kane Oncology Nurse Practitioner
Tele-Oncology In 2012 - 2014 Professor Kannourakis and myself participated in a tele-oncology trial- this trial was focussed on utilising 3 d technology for the consultations. While the idea was good- 3 D technology is not as important for us- and the idea of participating in a consultation with 3 D glasses…. well it just was not feasible for Oncology- this same technology though, is proving very useful in tele-dentistry as you can imagine. The trial consultations using the 2 D with the Vidyo technology- were okay- but there was poor sound, and many issues with the technology- so much that often George and I would end up doing the consultation on the phone. - but we loved the idea. On 25 th November 2015, Wimmera Oncology patients in Horsham were linked via tele-health to Professor George Kannourakis' rooms at Ballarat Oncology. 1. Twenty one patients were able to have their consultation with Wimmera Health Care Group oncology nurse practitioner Carmel O'Kane using Carmel's desk computer to speak directly with Professor Kannourakis. 2. On 15 th June 2016, the same method of tele-health consultations was conducted with Dr Stephen Vaughn with twenty one patients.
The Link The videoconference link was established using the Health Direct web based platform. Donna Bridge (Wimmera Southern-Mallee Health Alliance Project Officer) worked with myself and Kate Wyatt (Ballarat Oncology Practice Manager) to make the link which utilises Google Chrome, a free program. A virtual Wimmera Oncology Consulting room was established which can be used again for future consultations.
The process The patient needs support- so at the patient end there needs to be someone who understands what is being said. - for example a NP, or a Doctor.
Exemplar 70 year old with non small cell lung cancer- previous well and managing treatment well- was in for a routine chemotherapy review. Presented to my office- extremely breathless and unhappy. During consultation it was clear that his symptoms were new and were significant. Physical examination demonstrated an elevated pulse rate as well- there was also significant new back pain. The medical Oncologist and myself planned to admit to perform an urgent CT and admit to hospital. We found a new heart condition ( minor), as well as an impending spinal cord compression, and fluid on the lungs. This man has seen his GP already that day- but the GP is not a cancer specialist- and while he had sent the patient for a heart test- as he recognised that symptom- he did not recognise that the shortness of breath and new back pain were signs of a medical emergency in Oncology.
Feedback What did patients think about using tele-health for their oncology consultation? Fourteen (14) patients completed the survey – 8 for Prof. Kannourakis and 6 for Dr Vaughn. The main results indicated that: Most patients felt highly satisfied about communicating about their healthcare using the video link. The majority of patients felt that the consultation was just the same as a face to face consultation. Only one patient wouldn’t be comfortable using video consulting again in a clinic situation. Most patients were not familiar with video communication in other settings. One patient was not satisfied with using video technology for health related consultations (one other had marked not satisfied however this was inconsistent with their other responses which were all highly satisfied – so it appears they marked the wrong end of the Likert scale for this question). The majority of patients indicated that they had saved time travelling and costs. Less waiting time to see their specialist was also noted.
Clinician feedback Clinician’s feedback echoed that of patients. Ease of use of IT platform was much improved form the previous trial- and improved with each clinic conducted. Ease of consultation were similar to face. Patient selection for Teleconsultations is an area that needs some work to ensure patients do not miss out on the very important face to face contact with their treating Oncologist.
Challenges we still need doctor hours, and NP hours for that matter We need to have a system that can schedule patients so that they receive a mix of consultations We need to fully integrate the consultations into clinical practise. We also need to keep the system flexible enough that consults can be added with a degree of urgency
Implications for the future Telehealth consults can replace a regular face to face consultation (it is not an extra consult) in a structure clinic system whereby Teleconsultations are scheduled for between face to face consultations Telehealth consults may also provide a suitable option for ‘urgent’ consultations and will add to a simple phone consultation. Patients can save considerable time, travel and $$$ with tele-health Utilising Telehealth for oncology can save specialists time travelling to the Wimmera A structured process for determining which patients could benefit from a tele-health consult and when (review) is vital to successfully manage a Cancer patient’s treatment continuum safely. i. e. 1: 3 consultations could be via tele-health Having planned tele-health consulting dates would allow clinicians to safely and appropriately allocate patients to these clinic dates
Where to from here: Develop a brief structured process that can be utilised for appropriate patients- this structure should include- patient consent to be included; agreed intervals between consultations (i. e. 1: 3); who is to conduct the consultations. Plan and book teleoncology consultations for the rest of the year- and add them to the consultation roster. Reassess the clinics prior to completing the BOHS outreach roster for 2017.