Near Far Wherever You Are: The Role of Video Consulting in Palliative Care.

Abstract

The covid-19 outbreak has been a source of undeniable hardship for many healthcare systems globally, including the UK’s National Health Service (NHS). For clinicians, maintaining the safety of vulnerable patients became a more complex endeavor due to the added risk of virus transmission. Thus, the government adopted strict social distancing and shielding measures to facilitate infection control and ensure those who were vulnerable due to a high morbidity and mortality risk were protected. Consequentially, many patients and their families were left feeling isolated. With physical safety taking priority, the traditional methods used to conduct consultations were no longer considered safe. To ensure healthcare continuity, clinicians from all specialties began developing novel ways to communicate with patients via video conferencing platforms. These methods reflected an increasingly widespread reliance on telecommunication among the public as a result of the pandemic. Thus, from the rubble rose an influx of innovation, which helped shape a new era of digital healthcare.

Full text

Wright, et al,. J Palliat Care Med 2021, 11:5
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ISSN: 2165-7386
Commentary Open Access
Volume 11 • Issue 5 • 1000408
J Palliat Care Med, an open access journal
ISSN: 2165-7386
Journal of Palliative Care & Medicine
Near Far Wherever You Are: The Role of Video Consulting in Palliative
Care
Poppy Wright*, Gemma Johns, Sara Kahlil, Mike Oggonosky and Alka Ahuja
Department of psychology, Swansea University, United Kingdom
*Corresponding author: Poppy Wright, Department of Psychology, Swansea
University, United Kingdom, Tel: +447940319716; E-mail: Poppy.Wright@wales.
nhs.uk
Received April 30, 2021; Accepted May 26, 2021; Published May 30, 2021
Citation: Wright P, Johns G, Kahlil S, Oggonosky M, Ahuja A (2021) Near Far
Wherever You Are: The Role of Video Consulting in Palliative Care. J Palliat Care
Med 11: 408.
Copyright: © 2021 Wright P, et al. This is an open-access article distributed under
the terms of the Creative Commons Attribution License, which permits unrestricted
use, distribution, and reproduction in any medium, provided the original author and
source are credited.
e covid-19 outbreak has been a source of undeniable hardship for
many healthcare systems globally, including the UK’s National Health
Service (NHS). For clinicians, maintaining the safety of vulnerable
patients became a more complex endeavor due to the added risk of
virus transmission. Thus, the government adopted strict social
distancing and shielding measures to facilitate infection control
and ensure those who were vulnerable due to a high morbidity and
mortality risk were protected. Consequentially, many patients and
their families were left feeling isolated. With physical safety taking
priority, the traditional methods used to conduct consultations
were no longer considered safe. To ensure healthcare continuity,
clinicians from all specialties began developing novel ways to
communicate with patients via video conferencing platforms.
These methods reflected an increasingly widespread reliance on
telecommunication among the public as a result of the pandemic.
Thus, from the rubble rose an influx of innovation, which helped
shape a new era of digital healthcare.
In partnership with the CWTCH project and Welsh Government,
TEC Cymru helped introduce the NHS Wales Video Consulting Service
using an approved communication platform (Attend Anywhere)
within all seven Health Boards and trusts across Wales. Among the
services utilizing video consultation was palliative care. Much like
other specialties, the covid-19 outbreak led to a vast acceleration in
uptake and implementation. e NICE guidelines stipulate that end
of life and dying patients have the right to supportive and palliative
care, regardless of circumstances [4] and video consultations helped
provide this populations with access to healthcare during the
pandemic. However, video consultations have also been used to aid
communication between hospitalized patients and their families.
Severe illness and life challenges are understood to have an
enormous impact on the family unit; inuencing each family member’s
health and well-being [5]. With 100% of palliative care family members
rating the video consultation quality as excellent [1], it is important
that Palliative Care clinicians are encouraged to use alternative means
of communication, like video consultation, to maintain interaction
between clinicians, sick relatives and family members throughout
periods of hospitalization. e argument for the importance of
communication continuity was reinforced in the qualitative responses,
which inferred that family members greatly valued the opportunity to
see their loved ones via digital means:
“is is a really good alternative for appointments which helps me
to feel safe at this time”
(Palliative Care, family member)
“[An] excellent alternative [to a face-to-face conversation]”
(Palliative Care, family member)
What place does Video Consultation have beyond
COVID-19?
Other specialties have demonstrated a wealth of benets related
to video consultations which will remain applicable within a post-
social distancing landscape. Namely, promoting patient and clinician
convenience, reducing travel emissions and facilitating remote
working, among many others. A conversation with a Clinical Director
and Consultant in Palliative Medicine, Aoe Gleeson (Aneurin Bevan
University Health Board) indicate that further investigation would
portray a similar message within community care and outpatient
palliative care services:
“I am a big advocate of Attend Anywhere…From community/
outpatient point of view it has helped us to support patients in a very
timely fashion…where there is a huge geographical area to cover, it’s
very helpful to be able to set up an attend anywhere link.”
Although these ndings were representative of the communication
between clinician and patient, many of these benets are applicable for
family and patient communication also. For example, in other settings
such as care homes, video consultation provided residents with the
ability to speak and visually connect with family members living locally
and abroad, celebrate birthdays and attend virtual funerals [2]. ere
had even been reports of residents meeting their great-grandchildren
for the rst time via video consultation. In synthesis, these examples
begin to build a picture of the prospective advantages of using video
consultation within palliative care and ITU services whose purpose
could extend to linking up families and their loved ones irrespective of
logistic and pandemic-related barriers.
But what is wrong with using a telephone?
Nothing. An in-house evaluation by TEC Cymru recommends a
blended approach [3]. Video consultations are oen thought of as a
“tool in the toolbox” (Clinician Quote), meaning that the collaborative
decision to utilize video consultation is one made with the needs of
the patient, clinician and service in mind. However, video consultation
can oen provide an opportunity to engage and communicate via non-
verbal cues, enhancing the quality of the interaction.
In conclusion, video consultation is an adaptable, versatile tool
suitable not only to provide healthcare from afar but also to bridge the
gap between families and vulnerable patients. With such promising
preliminary outcomes, palliative care clinicians and families must
become aware of video consultation’s potential benets so that it can
be used to their advantage and improve the patient experience.
Funding: TEC Cymru and the National Video Consultation (VC)
Service is a funded programme by the Welsh Government (no award
number provided).

Citation: Wright P, Johns G, Kahlil S, Oggonosky M, Ahuja A (2021) Near Far Wherever You Are: The Role of Video Consulting in Palliative Care. J
Palliat Care Med 11: 408.
Page 2 of 2
J Palliat Care Med, an open access journal
ISSN: 2165-7386 Volume 11 • Issue 5 • 1000408
Transparency Statement
e guarantor arms that this manuscript is an honest, accurate
and transparent account.
Ethical Approval
TEC Cymru use a Quality Improvement (QI) methodology to
evaluate NHS Wales services, in that typically no ethical approval
is required. However, TEC Cymru did obtain full ethical approval
and risk assessments from Aneurin Bevan University Health Board
Research & Development combined permissions and risk committee
(R&D Reference Number: SA/1114/20).
Contribution Statement
Poppy Wright is a Research Support Assistant for Technology
Enabled Care (TEC) Cymru. Gemma Johns is the Research &
Evaluation Lead for TEC Cymru. Sara Khalil is the Programme
Lead for TEC Cymru. Mike Ogonovsky is Assistant Director of
Informatics ABUHB and Senior Responsible Officer for TEC
Cymru. Alka Ahuja is a Child and Adolescent Mental Health
Psychiatrist in ABUHB, Honorary Professor, and National Clinical
Lead for TEC Cymru.
References
1. Johns G, Kahlil S, Ognonovsky M, Wright P, Williams J, et al. (2020) Chapter 6:
Care Homes Interview Data with Care Home Sta. tec CYMRU
2. Johns G, Kahlil S, Ognonovsky M, Wright P, Williams J, et al. (2020) Phase 1
‘Live’ Survey Data – Patients & Clinicians. tec CYMRU.
3. Johns G, Kahlil S, Ognonovsky M, Wright P, Williams J, et al. (2020) Chapter
4: Palliative & Intensive. Care tec CYMRU.
4. NICE Clinical Guidelines Overview (2019) End of life care for adults: service
delivery
5. Wright LM, Leahey M (2005). Nurses and families: a guide to family assessment
and intervention (4th ed.) Philadelphia: F. A. Davis