Effectiveness of eHealth Interventions and Information Needs in Palliative Care: A Systematic Literature Review

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Abstract

Background

One of the key components in palliative care is communication. eHealth technologies can be an effective way to support communications among participants in the process of palliative care. However, it is unclear to what extent information technology has been established in this field.

Objective

Our goal was to systematically identify studies and analyze the effectiveness of eHealth interventions in palliative care and the information needs of people involved in the palliative care process.

Methods

We conducted a systematic literature search using PubMed, Embase, and LILACS according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We collected and analyzed quantitative and qualitative data regarding effectiveness of eHealth interventions and users’ information needs in palliative care.

Results

Our search returned a total of 240 articles, 17 of which met our inclusion criteria. We found no randomized controlled trial studying the effects of eHealth interventions in palliative care. Studies tended to be observational, noncontrolled studies, and a few quasi-experimental studies. Overall there was great heterogeneity in the types of interventions and outcome assessments; some studies reported some improvement on quality of care, documentation effort, cost, and communications. The most frequently reported information need concerned pain management.

Conclusions

There is limited evidence around the effectiveness of eHealth interventions for palliative care patients, caregivers, and health care professionals. Focused research on information needs and high-quality clinical trials to assess their effectiveness are needed.

Related collections

Most cited references 24

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Palliative Care: the World Health Organization's global perspective.

Cecilia R. Sepulveda, Amanda Marlin, Tokuo Yoshida … (2002)

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Overcoming Depression on the Internet (ODIN) (2): A Randomized Trial of a Self-Help Depression Skills Program With Reminders

Greg Clarke, Donna Eubanks, Ed Reid … (2005)

Background Guided self-help programs for depression (with associated therapist contact) have been successfully delivered over the Internet. However, previous trials of pure self-help Internet programs for depression (without therapist contact), including an earlier trial conducted by us, have failed to yield positive results. We hypothesized that methods to increase participant usage of the intervention, such as postcard or telephone reminders, might result in significant effects on depression. Objectives This paper presents a second randomized trial of a pure self-help Internet site, ODIN (Overcoming Depression on the InterNet), for adults with self-reported depression. We hypothesized that frequently reminded participants receiving the Internet program would report greater reduction in depression symptoms and greater improvements in mental and physical health functioning than a comparison group with usual treatment and no access to ODIN. Methods This was a three-arm randomized control trial with a usual treatment control group and two ODIN intervention groups receiving reminders through postcards or brief telephone calls. The setting was a nonprofit health maintenance organization (HMO). We mailed recruitment brochures by US post to two groups: adults (n = 6030) who received depression medication or psychotherapy in the previous 30 days, and an age- and gender-matched group of adults (n = 6021) who did not receive such services. At enrollment and at 5-, 10- and 16-weeks follow-up, participants were reminded by email (and telephone, if nonresponsive) to complete online versions of the Center for Epidemiological Studies Depression Scale (CES-D) and the Short Form 12 (SF-12). We also recorded participant HMO health care services utilization in the 12 months following study enrollment. Results Out of a recruitment pool of 12051 approached subjects, 255 persons accessed the Internet enrollment site, completed the online consent form, and were randomized to one of the three groups: (1) treatment as usual control group without access to the ODIN website (n = 100), (2) ODIN program group with postcard reminders (n = 75), and (3) ODIN program group with telephone reminders (n = 80). Across all groups, follow-up completion rates were 64% (n = 164) at 5 weeks, 68% (n = 173) at 10 weeks, and 66% (n = 169) at 16 weeks. In an intention-to-treat analysis, intervention participants reported greater reductions in depression compared to the control group (P = .03; effect size = 0.277 standard deviation units). A more pronounced effect was detected among participants who were more severely depressed at baseline (P = .02; effect size = 0.537 standard deviation units). By the end of the study, 20% more intervention participants moved from the disordered to normal range on the CES-D. We found no difference between the two intervention groups with different reminders in outcomes measures or in frequency of log-ons. We also found no significant intervention effects on the SF-12 or health care services. Conclusions In contrast to our earlier trial, in which participants were not reminded to use ODIN, in this trial we found a positive effect of the ODIN intervention compared to the control group. Future studies should address limitations of this trial, including relatively low enrollment and follow-up completion rates, and a restricted number of outcome measures. However, the low incremental costs of delivering this Internet program makes it feasible to offer this type of program to large populations with widespread Internet access.

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Cost Effectiveness of Internet Interventions: Review and Recommendations

Deborah Tate, Eric Finkelstein, Olga Khavjou … (2009)

Background Internet interventions have a large potential for public health impact, and their efficacy has been established over the past 10–15 years. Cost effectiveness of Internet interventions is one of the most frequently cited reasons for developing such treatments. Purpose This paper provides a review of economic evaluations of Internet interventions with specific recommendations for future economic analyses of Internet interventions. Methods A review of PubMed from 1995 through 2008 was conducted. Results We identified eight studies that reported specific economic indicators associated with an Internet intervention, though many were lacking comprehensive analyses. Issues related to analysis perspective, included costs, type of analysis performed, and appropriate outcomes for Internet interventions are explored. Conclusions The lack of cost data published to date is likely a reflection of the early stage of research for many papers published during the review period. As the field now moves to effectiveness studies, it is important for cost-effectiveness data to be collected.

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Author and article information

Contributors

Daniel Capurro:

Evidence Based Health Care Program, Department of Internal MedicineEscuela de MedicinaPontificia Universidad Católica de ChileLira 63Santiago, 8330074Chile56 22354304056 223543030dcapurro@med.puc.cl

Journal

Journal ID (nlm-ta): J Med Internet Res

Journal ID (publisher-id): JMIR

Title: Journal of Medical Internet Research

Publisher: JMIR Publications Inc. (Toronto, Canada )

ISSN (Print): 1439-4456

ISSN (Electronic): 1438-8871

Publication date Collection: March 2014

Publication date (Electronic): 07 March 2014

Volume: 16

Issue: 3

Electronic Location Identifier: e72

Affiliations

[1] ¹Evidence Based Health Care Program, Department of Internal Medicine Escuela de Medicina Pontificia Universidad Católica de Chile SantiagoChile

[2] ²Department of Biomedical Informatics and Medical Education University of Washington Seattle, WAUnited States

[3] ³Institute of Medical Biometry and Informatics University of Heidelberg HeidelbergGermany

[4] ⁴School of Public Health and Administration Universidad Peruana Cayetano Heredia LimaPeru

Author notes

Corresponding Author: Daniel Capurro dcapurro@ 123456med.puc.cl

Article

Publisher ID: v16i3e72

DOI: 10.2196/jmir.2812

PMC ID: 3961802

PubMed ID: 24610324

SO-VID: 385fb664-c67d-4cad-84b0-d7106026859a

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on http://www.jmir.org/, as well as this copyright and license information must be included.

History

Date received : 02 July 2013

Date revision requested : 29 July 2013

Date revision received : 17 September 2013

Date accepted : 09 January 2014

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