Mobile Palliative Care - development of a sensor-based monitoring system to support people at the end of life and their family caregivers

Cooperation

The project cooperation partners are the Palliative Bridging Service of the Krebsliga Ostschweiz, the Institute of Information and Process Management IPM-FHS and the Institute of Applied Nursing Science IPW-FHS of the FHS St.Gallen, University of Applied Sciences.

Background  

Family caregivers represent a significant yet vulnerable resource in the care of people at the end of life. They ensure that those concerned can remain at home for as long as possible. The monetary value of informal care is a source of enormous support for the Swiss health care system. However, provision of care at home can lead to physical and emotional exhaustion that can transform into a crisis for the family. Responding to symptom-clusters of people in their final stages of life can be especially challenging for relatives. However, detailed data on symptoms at the level of the individual concerned and the quality of life of informal carers are still insufficient, especially over a longer period of time and within the home care sector. New sensor-based monitoring systems are available measuring vital signs longitudinally in daily life. This allows us to draw conclusions on quality of life, disease transitions and acute events.

Aim

The aim of this interdisciplinary study is to develop a systematic symptom documentation that preventatively stabilizes domestic palliative care and avoids critical events from occurring.

Methods

The planned interdisciplinary project will represent an exploratory concurrent mixed methods design that will portray characteristics of a multiple cross-case study by comprehensively working with and integrating qualitative and quantitative data. For each case, we will conduct a within-case analysis that will then be analyzed and compared in a cross-case analysis to find patterns of palliative home care crises and undetected transitions.

The study duration is set for 24 months with a twelve-month data collection period. We will include forty to sixty patients that are accompanied by the Mobile Palliative Bridging Service at home. Aside of the subjective situation- and symptom assessment, participants will receive an upper-arm sensor from the firm Biovotion measuring pulse, oxygen saturation, temperature, blood circulation and movement simultaneously. As the family is frequently involved in the provision of care, we will assess their wellbeing by using the Caregiver Quality of Life Index–Cancer (CQOLC) scale.

The ethics committee Ostschweiz (EKOS) deemed the study eligible.

Results

Based on the data from the subjective assessment and the sensor, an emergency plan and a concept for the division of roles among different actors and professions will be developed, thereby protecting patients and their families. Finally, an evaluation and an impact-analysis/cost-effectiveness analysis will be undertaken. First results are expected by the end of 2018.

Interpretation

The findings will provide important insights into the symptom burden of patients at the end of life and of family caregivers, enabling the development of a cross-detection tool. Future provision of care by palliative care professionals in a patient's home can be improved by such targeted assessment. This avoids unnecessary strain on patients and their relatives in the palliative home care setting.