HOME palliative care-Nepal: A cell-phone/website it system.

Abstract

e23134 Background: Worldwide, major clinical barriers to effective palliative care are the absence of: 1. Current data on symptom type and intensity; 2. Immediately accessible information on practical, affordable, and effective interventions; and 3. Self-sustaining systems to facilitate currently limited physician engagement in continuing palliative care. In Nepal, essentially all families have a cell phone, the majority of which are Android smart phones. 80% of the population lives in rural settings. Methods: Following a cross sectional study in 383 Nepalis with advanced cancers using a cell-phone “app” on the Android platform with a validated 15-item symptom questionnaire, in which all approached patients agreed and were able to complete the instrument in under 3 minutes, we assembled a Nepali/US development team of clinicians and computer scientists to create a tele-home palliative care system centered on use of this app. Results: We have developed an internet website (homepalliativecareNepal.net) with patient/family and physician information pages, a guest health professional site, and a password-protected physician site with organized patient demographic and medical summary data, and telephone-submitted app-symptom reports, local clinical practice guidelines, and an intervention menu of 30 written and mini-video items and links (the majority non-pharmacologic) including start-up drug prescriptions (5), which can be personalized and directly sent to the patient by phone. The system is managed by a local organization that also ensures regular physician/clinic visits by the patient, or by a family member with a patient phone check-in, at least every two weeks, with creation of documentation of provided services. Conclusions: Our adaptable, patient-centered, IT-tools-facilitated, and economical system offers significant potential for addressing the need to engage all types of health care practitioners in palliative care in different cultural settings.