Avaliação do potencial da Telemedicina em Cuidados Paliativos no câncer avançado

Abstract

This study assessed telemedicine potential as a complementary support to ambulatory care in monitoring symptoms in patients with advanced cancer. Twelve patients were followed up at the Palliative Care Nucleus ambulatory of the Pedro Ernesto University Hospital (NCP-HUPE) from January 2011 to August 2013. Monthly, assistance were made by physician and multidisciplinary team. Meanwhile, patients at home, with their personal computer connected to UERJ Telehealth Laboratory webconference service, interacting with the same ambulatory physician. Patients also had access to doctor s cellphone and e-mail. At each interview (personal and remote) was applied the Edmonton Symptom Assessment System (ESAS), collected data on other biopsychosocial and spiritual complaints, health problems, audio and video quality connection, family's evaluation about Telemedicine and Telemedicine interference on patient's place of death. There was difficulty to select patients because HUPE is a public hospital whose population assisted has typically low educational and socioeconomic status, and restricted ability to deal with computers. The mean follow-up time was 195 days (SD ± 175.11; range: 11-553 days). All were diagnosed with advanced cancer and had transportation difficulties. There is no doubt that ESAS favored symptoms communication with health professionals; however, singular clinical conditions and symptom control assessed at different moments and subjected to many factors, preclude conclusions regarding alleged advantages. Clinical monitoring, detection of health problems and physical, psychosocial and spiritual symptoms were possible to be observed by Telemedicine, and were confirmed and treated at face-to-face consultations. Webconference connection was made by family members, because no patient operated computers. Death at home occurred in 41.67% and everyone, even the hospital deaths, received NCP support at distance. During the study was made 305 contacts; 110 face-to-face consultations to patients and families and 195 by Telemedicine (77 webconference, 38 telephone calls and 80 emails). Telemedicine allowed better access to health system (greater number of contacts), reduced search for emergency services, helped symptom control and provided orientations and reassurance to family members. This support favored early and proactive interventions and continuing assistance till death. Telemedicine has proved to be a good adjuvant in home monitoring and managing symptoms in palliative care patients, complementing face-to-face assistance, but not substituting it.