Remote Vital Sign Monitoring in Palliative Care Patients Using a Wearable ECG Monitor

Remote Vital Sign Monitoring in Palliative Care - VITAL-PC

The goal of this study is the assess the use of remote monitoring of vital signs using commercially available medical devices in patients with advanced cancer admitted to a hospice inpatient unit for end-of-life care.

The objectives of the study are:

1. could remote monitoring of vital signs improve patient care through the earlier identification of infections and other (potentially reversible) problems;
2. could remote monitoring of vital signs improve the accuracy of our estimates about how long a person has to live; and c) determine the relationship between complaints of pain / other symptoms and vital signs.

This study will take place in the palliative care unit at Our Lady's Hospice & Care Services and will consist of applying a small, flexible, patch-like device to the participant's chest with an adhesive patch.

If the participant is happy to take part in the study, they will be visited by a member of the research team. This meeting provides the opportunity to discuss the study, answer any questions and complete a consent form.

The researcher will also collect some information about the participant's condition, and medication from their medical notes and drug chart. The participant will need to wear the device for the duration of their time in the hospice. The research team will remotely check that the device is working properly, and will change the device when the battery needs re-charging (every 14 days). The research team will review the participant after 24 hr (to ensure no problems), and then a couple of times a week during the study. The nursing team will check that the patch is sticking properly every day.

The medical / nursing team will not have access to the information from the device, and so will not make any clinical decisions on the basis of this information.

The device will continue to be worn until the patient dies, the patient withdraws, the patient is discharged, or the patient improves (and is no longer receiving end-of-life care). At the end of the participant's stay on the hospice the device will be removed and cleaned / sterilized according to the manufacturer's instructions (the adhesive patches that secure the device to the chest wall are disposable / not reusable).

The study will recruit 120 patients - this number is pragmatic, and based upon annual admission data for OLH&CS (and the likelihood of end-of-life patients to engage in research).

Currently, the plan is to use descriptive statistics, and standard statistical methods to analyse the study data. However, we are engaging with colleagues at UCD about using machine learning to undertake further analyses. A formal statistical analysis plan will be developed prior to the primary analysis.

Inclusion Criteria:

• Age ≥ 18 years old
• Primary diagnosis of malignant disease
• Admitted for end-of-life care (or focus of care changed to end-of-life care)
• Estimated prognosis < 14 days

Exclusion Criteria:

• Primary diagnosis of non-malignant disease
• Inability to provide informed consent
• Contraindications to use of biosensor adhesive patch (e.g. chest wall skin problem, allergy to adhesive)