JMIR Publications

ABSTRACT

Background:

Digital health (DH) provides a valuable opportunity in accessible and efficient palliative care delivery. Given the increasing complexity and demand for palliative services due to an aging population and rising prevalence of chronic diseases, there is a compelling need to explore how DH technologies can be harnessed to enhance care delivery in this critical domain.

Objective:

The aim of this umbrella review was to examine, appraise and synthesise previous systematic reviews and evaluate the impact of DH-based services on palliative care, and to identify barriers to using DH-based services in this settings.

Methods:

Seven electronic databases were searched for eligible studies published from inception to April 2024. Systematic reviews with or without meta-analysis focusing on DH within palliative care sittings were considered eligible. Eligible studies were appraised for methodological quality using the JBI Critical Appraisal Checklist for Systematic Reviews and Research Syntheses.

Results:

A total of 25 systematic reviews published between 2012 and 2024 (4 with meta-analyses) that met our inclusion criteria, most of which were evaluated as moderate quality. Reported outcomes ranged from symptom management effectiveness to psychosocial burden (i.e., mood, distress, emotional well-being), quality of life, caregiver burden, decision-making, cost effectiveness, communication, self-efficacy/ self management efficacy, resource utilization, family empowerment and acceptability. The impact of DH-based interventions for palliative care was basically consistent, with all included reviewa reporting either significant improvements or noninferiority of DH-based interventions as compared to usual care. Technical challenges, organizational factors, ethical concerns, resource constraints, non-verbal communication and perceptions were considered as barriers to the use of DH-based services.

Conclusions:

While some reviews did not consistently find DH-based palliative care to be superior to standard care, none reported any negative effects, indicating that DH is a safe alternative for palliative care delivery. To ensure its successful implementation and long-term sustainability in palliative care sittings, a multifaceted approach is crucial, involving technology improvements, ethical policy development, and enhanced resource allocation for infrastructure and training to overcome barriers. Clinical Trial: PROSPERO CRD42024539963; https://www.crd.york.ac.uk/PROSPERO/#recordDetails