Comments of Chapter 7: Supportive and palliative care

The small picture the nuts and bolts

The use of new technology (95) has allowed for a greater attention to quality and safety through closer monitoring of patients without their needing to leave the comfort of their own homes, a very important consideration in frail individuals at the end of their lives. This can be accomplished through:

- Telehealth services-using remote telecommunications equipment for consultations and to monitor the condition of a patient, and relay information over a telephone line or wireless connection back to individual health professionals or a program's headquarters. Various sensing devices connected to a monitor by a patient's bedside can transmit pulse, blood pressure, respiratory and pulse oxymetry readings. This not only reduces travel costs and improves accessibility, but also provides a sense of reassurance to patients and their families. Use need not necessarily be restricted to the medical and nursing members of the team. The counselor or social worker can similarly make use of video conferencing devices to assess and address identified psychosocial, emotional or spiritual needs.

- Point-of-care computing with wireless or broadband grids on portable computers at the patient's home and other sites of care allows for rapid, timely and accurate access to information and medical records (96-99), rescheduling of visits, help in retrieving essential contact information, guides the systematic assessment of patients and documents the care provided. This can also include links to evidencebased practices and decision-making tools and prompts to guidelines in patient management, preventing drug-related errors.

- Microdiagnostic technologies such as glucose monitoring and electrocardiography already exist. More can be done and made available to staff in the field as diagnostic equipment becomes cheaper, smaller and easier to use. Such technologies allow for rapid assessments, which may be especially pertinent in patients in the entryreentry trajectory.

Technology is also revolutionizing education and the decision-making process, particularly through Web-enabled tools (100). Last Acts, a national communications campaign sponsored by the Robert Wood Johnson Foundation is a case in point. It began in 1995 and ended in 2005, and was a coalition of more than 800 national health and consumer groups that worked together to improve communication and decision-making for consumers about their own death, to change the culture of health care institutions, to change our culture and attitudes toward death. Though this highly acclaimed program has come to a close, it has left as its legacy a wealth of web content from the various projects it funded over the years. Many of these innovations (101) are still relevant to this day. In the past decade, patient and family education has gone beyond paper and person-to-person interactions. The popular media, such as movies, television, theatre, press and literature, can also be used effectively to help change perceptions of death and dying (102) and expectations of healthcare at the end of life.

The new age, however, belongs to interactive technologies and online resources (103-105). Social networks, video chat and instant messaging platforms are already shaping the way patients and their healthcare workers interact, increasing accessibility to services and nurturing a more responsive healthcare system with personalization of care. Peer-to-peer interactions through social media are in particular playing an increasingly important role, as support from people in similar circumstances is highly valued by patients (106), even for those who report high levels of support from family members (107). Such interactions can yield a unique sense of community, reassurance
and practical information that cannot be gained from other supportive relationships and can improve relations with family and friends by relieving their burden of care (108).

Building these forms of communication into supportive and palliative care system development, coupled with the appropriate reimbursement incentives, will be essential in dealing with a new generation of patients in the 21st century. OPIMEC could play a key role in making this possible.

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