In association with Simon Fraser University & Vancouver Coastal Health... Simon Fraser University
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In association with Simon Fraser University & Vancouver Coastal Health Research Institute Simon Fraser University Great Northern Way Campus 555 Great Northern Way Vancouver, BC, Canada V5T 1E2 tel: 1.604.268.7306 fax: 1.604.268.7309 email: act4hlth@sfu.ca website: www.sfu.ca/act4hlth A study of the impacts of technology on palliative care delivery (Theme II) Investigators: Craig Kuziemsky and Francis Lau Research Partners: University of Victoria (School of Health Information Science), Victoria Hospice Society (VHS) Project Description In March of 2000, Victoria Hospice Society (VHS) began using palm pilot computers for data collection on palliative patients, but issues surrounding use of the technology caused VHS to stop using palm pilots in August 2002. Recently, VHS expressed a desire to reinstate technology and more specifically a doctoral research project is underway at VHS that involves using PDAs and tablet PCs as tools to assist in the management of severe pain. This study takes a critical review of the adoption, use and impact of PDAs and tablet PCs in palliative care at VHS. It features both a retrospective study of PDA-use as well as a prospective study of design and preliminary testing of a computer based severe pain management tool. Research questions include: How does the use of technology differ across different palliative professionals (physicians, nurses and counsellors)? How do palliative professionals perceive the use of technology in practice both before and after implementation of technology? What were the issues that arose from the implementation of technology into VHS? Methods The retrospective phase will involve analysis of data collected during the initial implementation of palm pilots at VHS (2000-2002). The prospective phase will be done in conjunction with a doctoral research project involving the development of an assessment tool for severe pain management. This study uses grounded theory and participatory design as research methods. Each of those methods contributes a different perspective of how palliative care and technology should interact to be successful. Grounded theory (GT) is being used to develop a conceptual framework of severe pain management that will include details on the roles, data, documents and process that a palliative healthcare provider goes through during severe pain management. GT will allow us to understand the specific details of the theory behind palliative pain management including how different palliative healthcare providers (physicians, nurses and counsellors) interact and what processes the technology needs to support, which will allow us to develop technology that fits with palliative practice. The conceptual framework from grounded theory will formalized into a computerized severe pain management tool using the participatory design (PD) methodology. PD is a method that stresses active and ongoing involvement of stakeholders and will provide a rich perspective of the technical aspects of palliative care pain management. That perspective will include layouts of graphical interfaces and what palliative education material should be delivered via the tool. Benefits to Research Partners This project has helped the hospice make sense of the issues surrounding the use of Information Systems (IS) tools in their clinical practice, as well as better position the University of Victoria for success in future palliative care IS research. In addition, research initiatives like ACTION for Health at VHS have enabled collaborations with VIHA and other palliative research centres, which will only enhance future palliative care delivery. In association with Simon Fraser University & Vancouver Coastal Health Research Institute Simon Fraser University Great Northern Way Campus 555 Great Northern Way Vancouver, BC, Canada V5T 1E2 tel: 1.604.268.7306 fax: 1.604.268.7309 email: act4hlth@sfu.ca website: www.sfu.ca/act4hlth Background Modern palliative care, defined as care that addresses multiple dimensions such as physical, spiritual and psychosocial among others and is delivered through hospices was first established in 1967 in England and in 1974 in Canada. Palliative care involves care for dying persons and is a person centered field of medicine where the goal is the best quality of life for patients and their families, a large part of which involves the relief of symptoms. Although there has been some adoption and use of technology such as computers in palliative care, the overall principles of palliative care such as the concept of a person-centered approach to medicine that considers each patient unique have raised concerns about whether technology such as computers are antithetical to palliative principles1. Seely and Mount describe technology as dealing with the material world and being impersonal, objective and generalizable, which is a contrast to the subjective and unique patient1. However, despite the concerns about how technology may impact palliative care there are new efforts., including local projects at palliative centers including Edmonton and Victoria as well as national projects from Health Canada that looks to use information and computing technology to enhance palliative care delivery. Perhaps the best approach to those new endeavours is to learn from previous implementations of technology in palliative care to gain a richer understanding of how palliative care and technology interact, and those interactions affect the people, processes and roles that are involved in palliative care delivery. If we can better understand the issues that come between palliative care and technology then we stand a better chance of overcoming those issues and forming a successful hybrid between palliative care and technology. 1 Seely JF, Mount BM. “Palliative medicine and modern technology”. Journal of the Canadian Medical Association. 2 Nov. 1999, 161 (9).
