Frances Josephine Drummond

Background: Research has revealed a dramatic rise in the adoption of telehealth by healthcare professionals (HCPs). Limited evidence exists focusing solely on HCPs’ adoption and use of telehealth in palliative care and lacks nuance about when and how telehealth is clinically appropriate. Objective: The aim is to deepen understanding of HCPs’ behavioural intention (BI) regarding the adoption and use of telehealth in palliative care, and to examine their current patterns of telehealth use. Methods: Cross-sectional data were collected from HCPs working in palliative care between July 27th and September 22nd, 2023. A probit analysis examined the difference between users and non-users of telehealth in palliative care, while a multiple linear regression assessed the association between a HCPs’ BI of using telehealth and Performance Expectancy, Effort Expectancy, Facilitating Conditions, and Social Influence. Results: Perceived benefits to clinical performance were associated with increased willingness to adopt telehealth. Workplace culture, experience, opportunity to use telehealth, and peer encouragement were highlighted as important contributors to a supportive environment. However, despite positive BIs, many previous users reported infrequent use in practice, suggesting a gap between intention and routine clinical integration. Conclusion: HCPs recognised the benefits of telehealth, but concerns remained regarding treating and managing physical symptoms in palliative care. Telephone-based services were still primarily used, though hybrid models were recognised as needed at times in some clinical situations. Patterns of use suggested distinct user groups, indicating that telehealth implementation requires tailored training, organisational supports, and clear escalation pathways for transitioning from virtual to in-person care. Addressing these factors may support more sustainable and clinically appropriate telehealth delivery in palliative care, with potential benefits for patient outcomes and experiences.

During the first wave of the COVID-19 pandemic, the delivery of life-saving and life-prolonging health services for oncology care and supporting services was delayed and, in some cases, completely halted, as national health services globally shifted their attention and resources towards the pandemic response. Prior to March 2020, telehealth was starting to change access to health services. However, the onset of the global pandemic may mark a tipping point for telehealth adoption in healthcare delivery. We conducted a systematic review of literature published between January 2020 and March 2021 examining the impact of the COVID-19 pandemic on adult cancer patients. The review’s inclusion criteria focused on the economic, social, health, and psychological implications of COVID-19 on cancer patients and the availability of telehealth services emerged as a key theme. The studies reviewed revealed that the introduction of new telehealth services or the expansion of existing telehealth occurred to support and enable the continuity of oncology and related services during this extraordinary period. Our analysis points to several strengths and weaknesses associated with telehealth adoption and use amongst this cohort. Evidence indicates that while telehealth is not a panacea, it can offer a “bolstering” solution during a time of disruption to patients’ access to essential cancer diagnostic, treatment, and aftercare services. The innovative use of telehealth has created opportunities to reimagine the delivery of healthcare services beyond COVID-19.

Cancer patients and their families experience a range of physical, psychological and financial adverse effects. Community-based cancer centres offer a range of services and interventions, free of charge, to support those affected by cancer. While shown to be effective, there is a lack of information on the costs of these services. Our aim was to estimate the resource impact of a community-based cancer support centre. Over a 7-month period, there were 2032 contacts with 238 clients whose average age was 60 years. The most frequently used services were transport to treatment (20%), complementary therapies (48%), exercise classes (10%) and counselling (9%). This cost analysis estimated total annual cost to provide all services was €313,744. Average annual cost per person was €1138. Current uptake at the centre represents 8% of all cancer incidences in seven counties surrounding the centre. If uptake increases by 10%, scenario analyses predict an increase in total costs increase to €429,043 and a decrease in costs per patient to €915. As cancer incidences increase, the need for supportive care is growing. Community-based services have been established to meet these needs and fill this gap in national health services. Long-term sustainability of these centres is uncertain as they are entirely reliant on donations and volunteers. This analysis estimates the costs of one such community-based cancer support centre, for the first time in Ireland. Findings can be used to inform future planning of cancer supportive care services, including establishing links between tertiary and community-based centres, and cost effectiveness analyses, nationally and internationally.

Early warning score systems have been widely recommended for use to detect clinical deterioration in patients. The Irish National Emergency Medicine Programme has developed and piloted an emergency department specific early warning score system. The objective of this study was to develop a consensus among frontline healthcare staff, quality and safety staff and health systems researchers regarding evaluation measures for an early warning score system in the Emergency Department. Participatory action research including a modified Delphi consensus building technique with frontline hospital staff, quality and safety staff, health systems researchers, local and national emergency medicine stakeholders was the method employed in this study. In Stage One, a workshop was held with the participatory action research team including frontline hospital staff, quality and safety staff and health systems researchers to gather suggestions regarding the evaluation measures. In Stage Two, an electronic modified-Delphi study was undertaken with a panel consisting of the workshop participants, key local and national emergency medicine stakeholders. Descriptive statistics were used to summarise the characteristics of the panellists who completed the questionnaires in each round. The mean Likert rating, standard deviation and 95% bias-corrected bootstrapped confidence interval for each variable was calculated. Bonferroni corrections were applied to take account of multiple testing. Data were analysed using Stata 14.0 SE. Using the Institute for Healthcare Improvement framework, 12 process, outcome and balancing metrics for measuring the effectiveness of an ED-specific early warning score system were developed. There are currently no published measures for evaluating the effectiveness of an ED early warning score system. It was possible in this study to develop a suite of evaluation measures using a modified Delphi consensus approach. Using the collective expertise of frontline hospital staff, quality and safety staff and health systems researchers to develop and categorise the initial set of potential measures was an innovative and unique element of this study.

Objective: Despite a generally good prognosis, many prostate cancer survivors have poor quality of life (QOL). A greater understanding of how psychological appraisals influence QOL is merited given their potentially modifiable nature. In this study, we considered how elements of survivors' retrospective and prospective appraisals relate to QOL.Methods: A total of 1229 prostate cancer survivors between 2 and 5 years post‐diagnosis, identified from a population‐based National Cancer Registry, were asked questions on their socio‐demographics, health, treatment received, and adverse‐effects using a cross‐sectional design. QOL was assessed using the EORTC QLQ‐C30. Retrospective appraisals were assessed by asking survivors to reflect on their experience of treatment‐related adverse‐effects compared with their prior expectations. A fear of recurrence scale assessed prospective appraisals of future disease course. A multiple regression model explored the impact of psychological appraisals on QOL, after controlling for socio‐demographic, treatment, and health‐related factors.Results: The model was significant explaining 37% of variance in QOL. The strongest associate with QOL was fear of recurrence (β = −.29; P < .001). Survivors who experienced side effects that were worse than expected had significantly lower QOL (β = −.10; P = .002). Other significant correlates of lower QOL were presence of comorbidities, having undergone a less invasive treatment, and having more advanced disease. Working at diagnosis and having a higher level of education were significantly associated with higher QOL.Conclusions: Results suggest both retrospective and prospective appraisals are independently related to QOL in prostate cancer. Providing survivors with more information about possible adverse effects of treatment, as well as providing appropriate information regarding future disease progression, may improve QOL.

We investigated associations between treatment decision making (TDM) and global health-related-quality-of-life (gHRQoL) among prostate cancer (PCa) survivors.

Prostate cancer treatments are associated with various physical after-effects, including urinary, sexual, and bowel symptoms.1 These after-effects can have an i

Objective: Many men undergo prostate biopsies each year. Most data on consequences of prostate biopsy for men pertain to physical after‐effects and/or come from clinical trial populations. We quantified prevalence of, and identified factors associated with, procedure‐related distress in men having prostate biopsies in routine clinical practice.Methods: Men who had undergone prostate biopsy for follow‐up of a raised prostate specific antigen test result and/or abnormal digital rectal examination in 6 centres in Ireland completed questionnaires. Biopsy‐related psychological distress was measured using the Impact of Event Scale. An Impact of Event Scale score ≥ 9 was considered significant biopsy‐related distress. Logistic regression was used to identify predictors of significant distress.Results: Three hundred thirty‐five men completed questionnaires. Overall, 49% had significant biopsy‐related distress; this was higher in men whose biopsy result indicated cancer (59%) and those who did not have a definitive result (54%) than those with a negative result (35%; P < .001). In multivariable analyses, the odds of significant distress were 3 times higher in men with cancer (OR = 3.33, 95% CI, 1.83‐6.04) and more than twice as high in men without a definitive result (OR = 2.61, 95% CI, 1.43‐4.78) compared to men with a negative result. Men with intermediate (OR = 3.19, 95% CI, 1.85‐5.53) or high (OR = 7.10, 95% CI, 3.45‐14.57) health anxiety (propensity to worry about one's health) also had significantly increased odds of biopsy‐related distress.Conclusions: Significant distress is common after prostatic biopsy. Some men, including those who are highly health anxious and those awaiting definitive results, may benefit from additional support around the time of and/or following prostate biopsy.