Purpose/Objectives: To explore the feasibility of rural home telemonitoring for patients with lung cancer.
Design: Exploratory, descriptive, observational.
Setting: Patient homes within a 75-mile radius of the study hospital in West Virginia.
Sample: 10 patients hospitalized with lung cancer as a primary or secondary-related diagnosis.
Methods: Data included referral and demographics, chart reviews, and clinical data collected using a HomMed telemonitor. Five patients received usual care after discharge; five had telemonitors set up at home for 14 days with daily phone calls for nurse coaching; mid- and end-study data were collected by phone and in homes through two months.
Main Research Variables: Enrollment and retention characteristics, physiologic (e.g., temperature, pulse, blood pressure, weight, O2 saturation) and 10 symptom datapoints, patient and family telemonitor satisfaction.
Findings: Of 45 referred patients, only 10 consented; 1 of 5 usual care and 3 of 5 monitored patients completed the entire study. Telemonitored data transmission was feasible in rural areas with high satisfaction; symptom data and physiologic data were inconsistent but characteristic of lung cancer.
Conclusions: Challenges included environment, culture, technology, and overall enrollment and retention. Physiologic and symptom changes were important data for nurse coaching on risks, symptom management, and clinician contact.
Implications for Nursing: Enrollment and retention in cancer research warrants additional study. Daily monitoring is feasible and important in risk assessment, but length of time to monitor signs and symptoms, which changed rapidly, is unclear. Symptom changes were useful as proxy indicators for physiologic changes, so risk outcomes may be assessable by phone for patient self-management coaching by nurses.
References
Borak, J., Salipante-Zaidel, C., Slade, M.D., & Fields, C.A. (2012). Mortality disparities in Appalachia: Reassessment of major risk factors. Journal of Occupational and Environmental Medicine, 54, 146-156. doi:10.1097/JOM.0b013e318246f395
Chaudhry, S.I., Mattera, J.A., Curtis, J.P., Spertus, J.A., Herrin, J., Lin, Z., … Krumholz, H.M. (2010). Telemonitoring in patients with health failure. New England Journal of Medicine, 363, 2301-2309.
Chen, Y.J., Narsavage, G.L., Culp, S.L., & Weaver, T.E. (2010). The development and psychometric analysis of the short-form Pulmonary Functional Status Scale (PFSS-11). Research in Nursing and Health, 33, 477-485. doi:10.1002/nur.20403
Cook, R. (2012). Exploring the benefits and challenges of telehealth. Nursing Times, 108(24), 16-17.
Dellifraine, J.L., & Dansky, K.H. (2008). Home-based telehealth: A review and meta-analysis. Journal of Telemedicine and Telecare, 14, 62-66.
Finkelstein, S.M., Speedie, S.M., & Potthoff, S. (2006). Home telehealth improves clinical outcomes at lower cost for home healthcare. Telemedicine Journal and E-Health, 12, 128-136.
Fox, S.W., & Lyon, D.E. (2006). Symptom clusters and quality of life in survivors of lung cancer. Oncology Nursing Forum, 33, 931-936. doi:10.1188/06.ONF.931-936
Garcia-Aymerich, J., Hernandez, C., Alonso, A., Casas, A., Rodriquez-Roisin, R., Anto, J.M., & Roca, J. (2007). Effects of an integrated care intervention on risk factors of COPD readmission. Respiratory Medicine, 101, 1462-1469.
Giamouzis, G., Mastrogiannis, D., Koutrakis, K., Karayannis, G., Parisis, C., Rountas, C., … Triposkiadis, F. (2012). Telemonitoring in chronic health failure: A systematic review. Cardiology Research and Practice, 1(1), 410820. doi:10.1155/2012/410820
Hendryx, M., O'Donnell, K., & Horn, K. (2008). Lung cancer mortality is elevated in coal-mining areas of Appalachia. Lung Cancer, 62(1), 1-7. doi:10.1016/j.lungcan.2008.02.004
McLean, S., Nurmatov, U., Liu, J.L., Pagliari, C., Car, J., & Sheikh, A. (2012). Telehealthcare for chronic obstructive pulmonary disease: Cochrane Review and meta-analysis. British Journal of General Practice, 62(604), e739-e749.
Paget, T., Jones, C., Davies, M., Evered, C., & Lewis, C. (2010). Using home telehealth to empower patients to monitor and manage long term conditions. Nursing Times, 106(45), 17-19.
Puig-Junoy, J., Casas, A., Font-Planells, J., Escarrabill, J., Hernández, C., Alonso, J., … Roca, J. (2007). The impact of home hospitalization on healthcare costs of exacerbations in COPD patients. European Journal of Health Economics, 8, 325-332. doi:10.1007/s10198-006-0029-y
Sicotte, C., Paré, G., Morin, S., Potvin, J., & Moreault, M.P. (2011). Effects of home telemonitoring to support improved care for chronic obstructive pulmonary diseases. Telemedicine and e-Health, 17(2), 95-103. doi:10.1089/tmj.2010.0142
