Rural palliative care in cancer: Using telemedicine to bridge the gap.
Notice bibliographique
Résumé
e13807 Background: Despite the rapid growth in palliative care (PC) services, many rural regions remain without access to specialty palliative care. Community-based telemedicine may offer solutions to underserved populations from rural areas within the United States. Methods: This is a retrospective review of the creation of 2 separate rural clinics attached to the VCU Massey Comprehensive Cancer Center at CMH in South Hill, VA in 2018 (with interruption related to the Covid-19 pandemic) and in Tappahannock, VA in 2021. In addition to operational descriptions a chart review was conducted of all encounters for these clinics. Care provided was coordinated by the University PC service and the oncology clinics, including nurses and oncologists. Regulatory, legal, Information Technology (IT), and systems logistics were developed in partnership for 6-9 months prior to each pilot. There were over 100 encounters from the two periods of care for CMH (2018 until paused for pandemic towards the end of 2020; and March of 2021 to current) and greater than 50 at Tappahannock. All visits were conducted in the rural oncology clinics with assistance of oncology nursing during the encounter. Results: The average patient age was 57, and over 90% had solid tumors. On average, patients had 1-2 telemedicine visits. The most common reason for referral was symptom management, predominantly pain. Edmonton Symptom Assessment scales were collected at all visits by oncology nursing. Physical exams were completed with electronic stethoscopes and supported by oncology nursing. Medications were prescribed to rural pharmacies electronically directly by the PC physician; for the periods of clinic over the course of the Covid-19 public health emergency this included prescriptions for controlled substances (almost exclusively long and short acting opioids). For patients requiring advance care planning documents were completed electronically or by trained interdisciplinary team members in clinic in partnership with the PC physician. Technological issues occurred rarely (less than 1% of visits) and resolved without IT involvement. Conclusions: Our pilot program integrated specialist palliative care into two rural oncology clinics providing supportive care, including symptom management and goals of care discussions. Further research should define optimal integration of PC telemedicine into rural oncology.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,007 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,002 |
| Science ouverte | 0,000 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,012 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».