Advance Care Planning in Patients with Suspected or Proven COVID: Are We Meeting Our Own Standards?

OBJECTIVE: Given the importance of advance care planning (ACP) in the context of a pandemic, we aimed to assess current adherence to local policy recommending ACP in all hospitalised adult patients with suspected or proven COVID-19 at Liverpool Hospital, Sydney, Australia. DESIGN: A retrospective cohort study. SETTING: A tertiary referral and teaching hospital. PARTICIPANTS: A select sample of adult patients admitted to Liverpool Hospital in 2019-2021 with suspected or proven COVID-19. MAIN OUTCOME MEASURES: Proportion of patients with documented ACP and format of ACP. RESULTS: Amongst 209 patients with proven or suspected COVID-19 hospitalised between March 2019 through to September 2021, median frailty score was 3, the median Charlson Comorbidity Score was 4, median age of the patients was 71 years, and median length of hospital stay was 5 days (range 0-98 days). Almost all patients were tested for COVID-19 (n = 207, 99%) of which 15% (31) were positive. Fewer than a quarter of the patients had documented ACPs (50, 24%) and 17 patients had existing formal advance care directives. Patients who had ACP were older, more likely to be frail and more likely to have higher rates of comorbidity compared to those without ACP. ACP was more commonly discussed with family members (41/50) than patients (25/50) and others (5/50). CONCLUSION: Adherence to the local ACP policy mandating such discussions was low. This reinforces the need for prioritising ACP discussions, especially for unwell patients such as those with COVID, likely involving further input to improve awareness and rates of formal documentation.

Clinical and cost-effectiveness of telehealth for Indigenous and culturally and linguistically diverse (CALD) people: a scoping review.

OBJECTIVES: To examine the modalities and clinical and non-clinical effectiveness of telehealth services available to people from Indigenous and culturally and linguistically diverse backgrounds (CALD). MATERIALS AND METHODS: A scoping review of peer-reviewed publications (2000-2021) on the effectiveness of telehealth interventions for Indigenous and CALD groups based on searches of Medline, CINAHL, and PsycInfo and manual searches from reference lists of captured literature reviews. RESULTS: Of the initial 601 articles, 10 met the inclusion criteria (seven of clinical effectiveness and three of non-clinical effectiveness), with participants from the USA, Australia, New Zealand, and Canada, with sample sizes ranging from 19 to 1,665 participants (overall 327 Indigenous and 2,030 CALD patients). Telehealth was delivered via telephone or by videoconference-with or without data uploads-and follow-up ranging from 6 months to 5 years. DISCUSSION: The findings suggest that telehealth shows some promise in: diabetes, depression, neuro/cognitive assessment, and health program adherence/service utilisation/cost. However, our confidence in the accuracy of the results is undermined by the mixed quality of designs and outcome measurements, and the high risk of bias derived from not proper random selections and small sample sizes. CONCLUSIONS: The available literature suggests acceptable clinical and non-clinical effectiveness of telehealth against usual care in Indigenous and/or CALD groups but methodological limitations diminish their value in informing practice. Therefore, we consider it is premature to use the findings of these primary studies to draw conclusive recommendations about clinical or other effectiveness of telehealth for the two target groups. Further randomised trials with adequate sampling frames and objective outcome assessments are warranted.

Feasibility, satisfaction, acceptability and safety of telehealth for First Nations and culturally and linguistically diverse people: a scoping review.

OBJECTIVES: The COVID-19 pandemic has highlighted the importance of access to telehealth as an alternative model of service during social restrictions and for urban and remote communities alike. This study aimed to elucidate whether First Nations and culturally and linguistically diverse (CALD) patients also benefited from the resource before or during the pandemic. STUDY DESIGN: This study was a scoping review. METHODS: A scoping review of MEDLINE, CINAHL and PsycINFO databases from 2000 to 2021 was performed. Paired authors independently screened titles, abstracts and full texts. A narrative synthesis was undertaken after data extraction using a standard template by a team including First Nations and CALD researchers. RESULTS: Seventeen studies (N = 4,960 participants) mostly qualitative, covering First Nations and CALD patient recipients of telehealth in the United States, Canada, Australia, and the Pacific Islands, met the inclusion criteria. Telehealth was perceived feasible, satisfactory, and acceptable for the delivery of health screening, education, and care in mental health, diabetes, cancer, and other chronic conditions for remote and linguistically isolated populations. The advantages of convenience, lower cost, and less travel promoted uptake and adherence to the service, but evidence was lacking on the wider availability of technology and engagement of target communities in informing priorities to address inequalities. CONCLUSIONS: Further studies with larger samples and higher level evidence methods involving First Nations and CALD people as co-designers will assist in filling the gap of safety and cultural competency.