Send to

Choose Destination
BMJ Support Palliat Care. 2015 Dec 1. pii: bmjspcare-2015-000935. doi: 10.1136/bmjspcare-2015-000935. [Epub ahead of print]

Supporting and improving community health services-a prospective evaluation of ECHO technology in community palliative care nursing teams.

Author information

N. Ireland Hospice, Belfast, Northern Ireland.
Institute of Nursing and Health Research, Ulster University, Newtownabbey, Northern Ireland.
School of Psychology, Ulster University, Coleraine, Northern Ireland.



Project ECHO (Extension for Community Healthcare Outcomes) uses teleconferencing technology to support and train healthcare providers (HCPs) remotely, and has improved care across the USA. A 6-month pilot was trialled in a community palliative care nursing setting to determine if ECHO would be effective in the UK in providing education and support to community hospice nurses (CHN).


The pilot involved weekly 2 hour sessions of teaching and case-based discussions facilitated by hospice staff linking with nine teams of CHN using video conferencing technology. A mixed-methods prospective longitudinal cohort study was used to evaluate the pilot. Each CHN provided demographic data, and completed a written knowledge assessment and a self-efficacy tool before and after the pilot. Two focus groups were also performed after the pilot.


28 CHNs completed the evaluation. Mean knowledge score improved significantly from 71.3% to 82.7% (p=0.0005) as did overall self-efficacy scores following the ECHO pilot. Pre-ECHO (p=0.036) and Retro-Pretest ECHO (p=0.0005) self-efficacy were significantly lower than post-ECHO. There was no significant difference between Pretest and Retro-Pretest ECHO self-efficacy (p=0.063). 96% recorded gains in learning, and 90% felt that ECHO had improved the care they provided for patients. 83% would recommend ECHO to other HCPs. 70% stated the technology used in ECHO had given them access to education that would have been hard to access due to geography.


This study supports the use of Project ECHO for CHNs in the UK by demonstrating how a 6-month pilot improved knowledge and self-efficacy. As a low-cost high-impact model, ECHO provides an affordable solution to addressing growing need.


Education and training; Home care; Project ECHO; evaluation-educational intervention; innovative educational interventions; teleconferencing

Supplemental Content

Full text links

Icon for HighWire
Loading ...
Support Center