Investigating video consultations as a new form of care for neuropalliative patients in specialized outpatient care : results from the project TANNE (telemedical answers to neurological inquires in real time)

Kurzfassung/Abstract

Background:
Currently, there is no standardized care for neuropalliative outpatients in Germany. Those who require specialized palliative care often receive it from a Specialized Outpatient Palliative Care (SOPC) team or hospice, but without regularly access to neurological expertise. The TANNE project elaborated hints for a cost-effective telemedical link between neuropalliative expertise (a Neuropalliative Telemedicine Center) and existing comprehensive palliative care structures such as SOPC team and hospice. Video consultations enable a joint assessment of symptoms and targeted therapy. The TANNE project aims to ensure that patients with neurological diseases or neurological symptoms in the palliative phase receive professional neurological/neuropalliative care at home or in hospices in a resource-efficient manner.

Methods:
A prospective, partly-cluster-randomized, two-arm intervention study with a delayed-start design was conducted between May 2021 and June 2023. The intervention group received video consultations whenever neurological problems occurred (event). The control group continued to receive treatment as usual. Primary endpoint was the change in symptom burden (iPOS – Integrated Palliative Outcome Scale) measured intra-individually before and after an event. Various secondary endpoints were assessed, namely patient’s general well-being and patient’s and professional’s satisfaction with treatment.

Results:
A total of 32 teams participated, recruiting 114 patients and registering 77 events. The primary endpoint showed a reduction in symptom burden of 2.6 (±4.15) points after teleconsultation, compared to 1.3 (±8.36) points in the control group (not statistically significant on a 5 percent level). This reduction was more pronounced in the ‘Psychological and Practical Problems’ subscale. High satisfaction scores with treatment and care were found in the intervention groups among patients and professionals.

Discussion/Conclusion:
The teleconsultation evaluated in the TANNE project represents a form of interaction between neuropalliative expertise and specialized palliative care (SOPC team, hospice) that has not existed in this form and scope before. Due to insufficient number of cases in combination with teams’ rejection to participate and additional withdrawals the projected primary endpoint could not be satisfied on a statistically relevant level. Nevertheless, results provide reliable points of reference for further research on the support of decision-making processes within SOPC and hospice teams in neurological cases through targeted teleconsultation services.