Enhancing Palliative Care Through Digital Health Interventions

Role of Digital Health on Palliative Care: Umbrella Review 🔗

Background: Digital health (DH) provides a valuable opportunity for accessible and efficient palliative care delivery. In recent years, an expanding body of systematic reviews and meta-analyses has examined DH-based interventions in palliative care. However, their conclusions regarding effects remain inconsistent, often constrained by methodological limitations and the variable quality of primary studies, making it difficult to form a coherent appraisal. Objective: This umbrella review aimed to examine, appraise, and synthesize previous systematic reviews and evaluate the role of DH-based services on palliative care, and to identify barriers to using DH-based services in these settings. Methods: Systematic reviews with or without meta-analysis focusing on DH within palliative care settings were considered eligible. Seven electronic databases, including PubMed, Web of Science, Embase, Cochrane Library, CNKI, Wangfang, and VIP, were searched for eligible studies published from inception to April 2024. The inclusion criteria were identified based on the principles of the PICOS (Population, Intervention, Comparison, Outcomes, and Study Type) framework. Two reviewers independently screened records and extracted data. Eligible studies were appraised for methodological quality using the JBI (Joanna Briggs Institute) Critical Appraisal Checklist for Systematic Reviews and Research Syntheses. A narrative synthesis, supported by tabulated summaries of the results, was used in this umbrella review. Results: A total of 25 systematic reviews (4 with meta-analyses) published between 2012 and 2024 met our inclusion criteria, most of which were evaluated as moderate quality. Reported outcomes ranged from symptom management effectiveness to psycho-social burden (ie, mood, distress, and emotional well-being), quality of life, caregiver burden, decision-making, cost-effectiveness, communication, self-efficacy and self-management efficacy, resource use, family empowerment, and acceptability. The effect of DH-based interventions for palliative care was basically consistent, with all included reviews reporting either significant improvements or noninferiority of DH-based interventions as compared to usual care. Technical challenges, organizational factors, ethical concerns, resource constraints, nonverbal communication, and perceptions were considered as barriers to the use of DH-based services. Conclusions: Across included reviews, DH was found to be beneficial or noninferior to standard care, with no reported adverse effects, supporting its safety and feasibility as a mode of service delivery. To ensure successful implementation and long-term sustainability, a multifaceted strategy is needed that integrates technological enhancements and training, organizational commitment, ethical safeguards, infrastructure development, and equitable access. Trial Registration: PROSPERO CRD42024539963; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024539963

Digital health (DH) plays a significant role in enhancing palliative care by improving access and efficiency in service delivery. An umbrella review synthesized findings from 25 systematic reviews to evaluate the effects of DH-based interventions on various aspects of palliative care, including symptom management, psychological well-being, caregiver burden, and communication. Results indicated that DH interventions are generally beneficial or at least noninferior to standard care, without reported adverse effects. However, barriers such as technical challenges, resource constraints, and ethical concerns hinder the widespread adoption of these services. The review emphasizes the need for a comprehensive strategy that includes training, organizational support, and equitable access to ensure successful implementation of DH in palliative care.

What outcomes did the review find related to digital health interventions in palliative care?

The review found that DH interventions improved symptom management, reduced caregiver burden, enhanced communication between patients and healthcare providers, and positively impacted psychological well-being. Most studies reported either significant benefits or noninferior results compared to standard care.

What barriers were identified that hinder the use of digital health in palliative care?

Barriers include technical challenges such as insufficient technology literacy, organizational factors like lack of leadership support, ethical concerns regarding privacy and security, and resource constraints, particularly in rural areas where internet access is limited.

What recommendations does the review provide for the implementation of digital health in palliative care?

The review recommends developing continuous training programs for healthcare professionals and caregivers, encouraging leadership support for DH initiatives, implementing robust privacy policies, and expanding internet infrastructure to improve access to DH services, especially in underserved regions.