Exploring underutilization of videophones in hospice settings.

The aim of this study was to evaluate hospice providers' attitudes and perceptions regarding videophone technology in settings where the technology was introduced but underutilized. Specifically, the project seeks to provide an in-depth understanding of attitudes and perceptions that may lead to failure of a telehealth implementation in the hospice setting in the context of the technology acceptance model. Two hospice agencies were selected as a purposive sample. Both agencies had acquired videophones that were meant to be integrated into care delivery but ultimately were underutilized or never used. Interviews with staff were conducted over the telephone. The interview guide was constructed to capture staff perceptions and attitudes concerning videophone technology. Interviews were audiotaped and transcribed for content analysis. A total of 17 (n = 17) participants (2 hospice administrators, 1 hospice management staff, 10 nurse case managers, and 4 social workers) were interviewed. Participants found videophones to be useful in hospice care but expressed specific practical challenges, such as lack of equipment reliability, lack of human resources, and lack of clarity pertaining to caregiver eligibility criteria. While perceived usefulness of videophones was high among respondents, practical concerns can be interpreted as lack of perceived ease of use. Findings indicate that the Technology Acceptance Model (TAM) provides a good framework for an understanding of telehealth underutilization. Staff perceived that videophones were useful, but they were discouraged by their perception that the videophones were not reliable or easy to use and by their uncertainty about the cases that they were best suited for. Lessons learned are integrated into a randomized clinical trial currently under development.