Understanding Experiences of Telehealth in Palliative Care: Photo Interview Study.
Mahima Kalla, Teresa O'Brien, Olivia Metcalf, Rashina Hoda, Xiao Chen, Andy Li, Catriona Parker, Michael Edward Franco, Sam Georgy, Kit Huckvale, Christopher Bain, Peter Poon
Author Information
Mahima Kalla: Centre for Digital Transformation of Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne Connect, 700 Swanston St, Carlton, VIC 3053, Australia, 61 0390355553. ORCID
Teresa O'Brien: Centre for Digital Transformation of Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne Connect, 700 Swanston St, Carlton, VIC 3053, Australia, 61 0390355553. ORCID
Olivia Metcalf: Centre for Digital Transformation of Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne Connect, 700 Swanston St, Carlton, VIC 3053, Australia, 61 0390355553. ORCID
Rashina Hoda: Faculty of Information Technology, Monash University, Melbourne, Australia. ORCID
Xiao Chen: School of Information and Physical Sciences, College of Engineering, Science and Environment, University of Newcastle, Callaghan, Australia. ORCID
Andy Li: Faculty of Information Technology, Monash University, Melbourne, Australia. ORCID
Catriona Parker: Transfusion Research Unit, Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, Australia. ORCID
Michael Edward Franco: Faculty of Information Technology, Monash University, Melbourne, Australia. ORCID
Sam Georgy: Healthdirect Australia, Sydney, Australia. ORCID
Kit Huckvale: Centre for Digital Transformation of Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne Connect, 700 Swanston St, Carlton, VIC 3053, Australia, 61 0390355553. ORCID
Christopher Bain: Alliance for Digital Health At Monash, Faculty of Information Technology, Monash University, Clayton, Australia. ORCID
Peter Poon: Supportive and Palliative Care Unit, Monash Health, Melbourne, Australia. ORCID
Background: It is widely accepted that the COVID-19 pandemic has accelerated the era of online health care delivery, including within community palliative care. This study was part of a larger project involving a collaboration between universities, health care services, government agencies, and software developers that sought to enhance an existing telehealth (video call) platform with additional features to improve both patient and health care professional (HCP) experience in a palliative care context. Objective: The aim of this study was to understand palliative care patients' and HCPs' experiences of telehealth delivery in a palliative care context in Victoria, Australia. For the purposes of this study, telehealth included consultations by both video and telephone calls. By better understanding users' experiences and perceptions of telehealth, we hoped to determine users' preferences for new telehealth enhancement features. Methods: A total of 6 health care professionals and 6 patients were recruited from a major tertiary hospital network's palliative care unit in Victoria, Australia. Participants were asked to generate 3-5 photographs depicting their telehealth experiences. These photographs were used as visual aids to prompt discussion during subsequent one-on-one interviews. Intertextual analysis was conducted to identify key themes. Results: A total of 3 overarching themes emerged: comfort (or lack thereof) afforded by telehealth, connection considerations in telehealth, and care quality impacts of telehealth. Patients (n=6) described telehealth as supporting their physical and psychological comfort and maintaining connection with HCPs, yet there were specific situations where it failed to meet their needs or impacted care quality and delayed treatment. HCPs (n=6) recognized the benefit of telehealth for patients but reported several limitations of telehealth, in particular due to lack of physical examination opportunities. Participants indicated that 2 types of connection were imperative for effective telehealth delivery: technical connection (eg, good internet connectivity or clear phone line) and interpersonal connection (ie, good rapport and therapeutic alliance between the HCPs and patients). Often technical connection issues impeded the development of interpersonal connection between the HCPs and patients in telehealth. Conclusions: The findings presented in this study combined with other co-design activities, which are outside the scope of this paper, indicated the potential value of a telehealth enhancement feature that generates patient-facing clinical consultation summaries. Our team has developed a video telehealth enhancement feature (or "add-on"), which will enable clinicians to distill key actionable advice and self-management guidance discussed during teleconsultations for a take-home summary document for patients. The add-on's prototype has also been subjected to an initial simulation study, which will be reported in a future publication.
