Sabe Sabesan

Telemedicine for rural cancer care in North Queensland: Bringing cancer care home

OBJECTIVE To describe the use of telemedicine in cancer care (teleoncology model of care) for rural patients in North Queensland. DESIGN This is a descriptive study. Data on demographical and clinical factors were retrieved from the teleoncology database of Townsville Hospital and review of medical records for the period between May 2007 and May 2011. SETTING AND PARTICIPANTS The medical oncologists at the Townsville Cancer Centre, a regional cancer centre in North Queensland, have been providing their services to rural hospitals in Townsville and Mt Isa districts via videoconferencing since 2007. INTERVENTION   Cancer care delivery to rural sites via Townsville teleoncology model. MAIN OUTCOME MEASURES The ability of the teleoncology model to provide the following services to rural towns: (i) specialist consultations; (ii) urgent specialist medical care; (iii) care for Indigenous patients; and (iv) remote supervision of chemotherapy administration. RESULTS Between May 2007 and May 2011, 158 patients from 18 rural towns received a total of 745 consultations. Ten of these patients were consulted urgently and treatment plans initiated locally, avoiding interhospital transfers. Eighteen Indigenous patients received consultative services, being accompanied by more than four to six family members. Eighty-three patients received a range of intravenous and oral chemotherapy regimens in Mt Isa and oral agents in other towns through remote supervision by medical oncologists from Townsville. CONCLUSION Teleoncology model of care allows rural and Indigenous cancer patients to receive specialist consultations and chemotherapy treatments closer to home, thus minimising the access difficulties faced by the rural sector.

Cost savings from a telemedicine model of care in northern Queensland, Australia.

Objective: To conduct a cost analysis of a telemedicine model for cancer care (teleoncology) in northern Queensland, Australia, compared with the usual model of care from the perspective of the Townsville and other participating hospital and health services.

Medical oncology clinics through videoconferencing: an acceptable telehealth model for rural patients and health workers.

Background:  Since 2007, Townsville Cancer Centre (Queensland, Australia) has provided routine and urgent medical oncology services to rural and remote communities through videoconferencing. At remote sites, patients were accompanied by doctors and other health workers. The aim of this study was to describe satisfaction of patients and rural health workers with this model of teleoncology.

Telerheumatology: an idea whose time has come

Australia is a vast country with one‐third of the population living outside capital cities. Providing specialist rheumatologist services to regional, rural and remote Australians has generally required expensive and time‐consuming travel for the patient and/or specialist. As a result, access to specialist care for remote Australians is poor. Rheumatoid arthritis is a common disease, but like many rheumatic diseases, it is complex to treat. Time‐dependent joint damage and disability occur unless best evidence care is implemented. The relatively poor access to rheumatologist care allotted to nonmetropolitan Australians therefore represents a significant cause of potentially preventable disability in Australia. Telehealth has the potential to improve access to specialist rheumatologists for patients with rheumatoid arthritis and other rheumatic diseases, thereby decreasing the burden of disability caused by these diseases. Advances in videoconferencing technology, the national broadband rollout and recent Federal government financial incentives have led to a heightened interest in exploring the use of this technology in Australian rheumatology practice. This review summarises the current evidence base, outlines telehealths strengths and weaknesses in managing rheumatic disease, and discusses the technological, medicolegal and financial aspects of this model of care. A mixed model offering both face‐to‐face and virtual consultations appears to be the best option, as it can overcome the barriers to accessing care posed by distance while also mitigating the risks of virtual consultation.

Teleoncology for Indigenous patients: The responses of patients and health workers

PROBLEM Townsville Cancer Centre provides video-consultation (VC) services to patients in rural/remote regions of North Queensland in order to improve access to specialist cancer care. The experience and responses of indigenous patients using this service have not been studied. Our objective is to assess the level of satisfaction and the responses of Indigenous patients, their families and health workers (HWs) to VC and such teleoncology service. DESIGN Descriptive study, using semistructured interviews. SETTING Tertiary referral centre (Townsville Cancer Centre) and various rural and remote towns in Queensland. KEY MEASURES FOR IMPROVEMENT Satisfaction levels of Indigenous patients, their family members and Indigenous HWs with various aspects of the teleoncology service. LESSONS LEARNT Our evaluation suggests that teleoncology is an acceptable model of care for Indigenous patients, with high levels of satisfaction expressed from patients, families and HWs. Health professionals involved with providing this service need to be adaptive to the needs of individual patients and local communities in order to provide culturally appropriate care. Formal skills training for staff, effective communication between specialist and local HWs, and informed consent procedures are essential to maintain safety of practices. Strategies for change are: • Mandatory informed consent procedure for all patients offered with VC. • Formalised competency training for staff in skills essential to maintain safe practices in teleoncology. • Clear clinical documentation to facilitate improved communication in patient management between medical staff at main centre and distant sites. • Further efforts in promotion, education and support for staff to participate in telemedicine.

Attitudes, knowledge and barriers to participation in cancer clinical trials among rural and remote patients

Aim:  To assess the knowledge of randomized clinical trials and willingness and barriers to participation among rural, remote and regional cancer patients of North Queensland.

Practical aspects of telehealth: doctor-patient relationship and communication

The fourth in a series of articles about the practical aspects of telehealth, this paper provides advice and information for specialists to communicate effectively with patients during a telehealth video consultation.

Quality of life in patients with K-RAS wild-type colorectal cancer: the CO.20 phase 3 randomized trial.

The CO.20 trial randomized patients with K‐RAS wild‐type, chemotherapy‐refractory, metastatic colorectal cancer to receive cetuximab (CET) plus brivanib alaninate (BRIV) or CET plus placebo (CET/placebo).

Remote supervision of medical training via videoconference in northern Australia: a qualitative study of the perspectives of supervisors and trainees

Objectives Telemedicine has revolutionised the ability to provide care to patients, relieve professional isolation and provide guidance and supervision to junior medical officers in rural areas. This study evaluated the Townsville teleoncology supervision model for the training of junior medical officers in rural areas of North Queensland, Australia. Specifically, the perspectives of junior and senior medical officers were explored to identify recommendations for future implementation. Design A qualitative approach incorporating observation and semistructured interviews was used to collect data. Interviews were uploaded into NVivo 10 data management software. Template analysis enabled themes to be tested and developed through consensus between researchers. Setting One tertiary level and four secondary level healthcare centres in rural and regional Queensland, Australia. Participants 10 junior medical officers (Interns, Registrars) and 10 senior medical officers (Senior Medical Officers, Consultants) who participated in the Townsville teleoncology model of remote supervision via videoconference (TTMRS) were included in the study. Primary and Secondary outcome measures Perspectives on the telemedicine experience, technology, engagement, professional support, satisfaction and limitations were examined. Perspectives on topics raised by participants were also examined as the interviews progressed. Results Four major themes with several subthemes emerged from the data: learning environment, beginning the learning relationship, stimulus for learning and practicalities of remote supervision via videoconference. While some themes were consistent with the current literature, new themes like increased professional edge, recognising non-verbal cues and physical examination challenges were identified. Conclusions Remote supervision via videoconference provides readily available guidance to trainees supporting their delivery of appropriate care to patients. However, resources required for upskilling, training in the use of supervision via videoconference, administration issues and nursing support, as well as physical barriers to examinations, must be addressed to enable more efficient implementation.

Do teleoncology models of care enable safe delivery of chemotherapy in rural towns

Objectives: To compare the dose intensity and toxicity profiles for patients undergoing chemotherapy at the Townsville Cancer Centre (TCC), a tertiary cancer centre in northern Queensland, with those for patients treated in Mount Isa, supervised by the same medical oncologists via teleoncology.