ASCO: Smart Technology Monitoring System Improves Care at End of Life

A phone-based symptom monitoring system using "smart technology" led to improvements in patient quality of life during the final weeks of home hospice care.

A telephone-based symptom monitoring system equipped with “smart technology” led to significant improvements in quality of life for patients and caregivers during the final weeks of home hospice care, according to findings reported recently at the inaugural Palliative Care in Oncology Symposium in Boston.

In the study, 319 families were randomly assigned to receive usual care or a telephone-based intervention consisting of automated coaching for caregivers and an electronic alert system that facilitated communication between families and hospice nurses. Caregivers in the intervention group reported improved well-being after using the system and patients had 44% fewer days of moderate or severe symptoms compared with those in the usual care group.

“Automated collection of patient-reported symptoms is increasingly used in oncology, but it has not yet extended to home hospice settings,” said lead study author Kathi Mooney, PhD, RN, distinguished professor at the University of Utah College of Nursing. “Although this system is the initial prototype version, it clearly shows that using smart technology for symptom monitoring and coaching adds another layer of support during hospice care and provides additional comfort for patients at the end of life.”

Caregivers interacted with the automated system to report on symptoms patients experienced over the past 24 hours as well as their own well-being. Patients were monitored for symptoms including fatigue, pain, poor appetite, anxiety, or changes in thinking. The system also tracked caregivers for signs of fatigue, anxiety, lack of sleep, and negative mood.

During a “conversation” with the automated system, caregivers received real-time coaching on how to deal with patient symptoms, such as how to position the patient for greater comfort or improve breathing. They also received suggestions on how to deal with the stress of caregiving, such as how to find others to assist and how to alleviate anxiety and sadness.

The system explained what was happening with the patient and what to discuss with the hospice nurse. At the close of an automated call, any symptoms reported by the caregiver were sent electronically to the nurse’s mobile device.

The findings suggest that smart technology can augment care and provide needed support to family members caring for patients in the last stages of life, the authors noted. That support is crucial considering those family caregivers must make judgments about medication intake and other interventions to improve the patient’s comfort.

“The family caregiving experience can be rewarding but also stressful with negative consequences for the caregiver’s health and emotional well-being during bereavement,” according to a news release from the American Society of Clinical Oncology (ASCO), which co-sponsored the symposium. “Prior research has shown that caregiver distress is closely associated with the severity of patient symptoms, so monitoring and improving both the patient’s care and the caregiver’s well-being is critical to improving end-of-life care for the whole family.”