Pilot project offers home care to N.S. palliative patients through iPad

A pilot project that used an iPad and a cellphone connection to care for dying patients could soon help people across Nova Scotia receive the same sort of care in their homes.

The project began as an idea between Dr. Robert Horton, an associate professor of palliative medicine at Dalhousie University in Halifax, medical student Claire Slavin-Stewart and registered nurse Amber Phillips.

Horton and Phillips were already delivering palliative care to patients in the Windsor, N.S., area when they began the eight-month experiment in 2017.

"Many of them live in rural areas that don't have regular access to palliative care expertise and some of them don't even have regular access to a family physician," Horton said.

He's based in Halifax and visits the Windsor area twice a month, while Phillips is based out of Windsor's Hants Community Hospital and often visits patients in their homes.

Horton said the families of patients might call an RN for a variety of reasons.

"That could be escalation of symptoms, it could be a need to come into hospital, it could be somebody who's been stable, but then all of a sudden is changing towards dying and needs a plan in place to meet their goals and many times that would be dying at home," he said.

Previously, Phillips consulted with Horton from the patients' homes over the phone, but that conversation didn't involve the patient or their families.

"I think when you're actually able to view your patients, you get a better sense of how things are actually going," Phillips said.

During the pilot project, Phillips carried an iPad with a cellphone connection, and she was able to set it up so that everyone in the room could see and talk to the doctor in Halifax.

"They were all very comfortable with it and thought it was fantastic," Phillips said. "And the key was they were able to get their symptoms addressed and didn't have to leave their homes, which is huge."

Pilot participants

Horton and Phillips used the FaceTime app on the iPad to consult with nine women and six men between the ages of 55 and 88. All of the patients had advanced forms of cancer or a cardiac condition.

The patients completed questionnaires rating their experience with the iPad consultation. Fourteen patients said they were very satisfied, while one person did not return the questionnaire, so their response was unknown.

Horton said he was pleasantly surprised to find the rural cellphone network was strong enough to complete all the video calls. There were only two dropped calls, and they were able to re-establish the connections right away.

Horton and Phillips are now working with the Nova Scotia Health Authority to improve its Virtual Care program, which allows people to set up a video call with a specialist from certain locations around the province.

Horton said the problem with this program is most of the locations are inside a hospital or other community building, which is hard on palliative patients.

"Many of them aren't able to do that because they're simply too sick," he said.

Program drawbacks

Horton said there are some drawbacks to telemedicine, such as physicians not being able to do a physical exam.

There is some risk that a patient's medical information could be hacked, but the pilot project used encrypted video to minimize the chance anyone could intercept the transmission.

Horton said he's optimistic the technology is quickly improving and will become available across the province.

"I think what it means is that Nova Scotians going into the future are going to have increased access to palliative care expertise and family doctors, and primary care providers will be able to rely on that expertise without necessarily having the palliative care physician present in the patient's home or in the community," he said.