JMIR Publications

ABSTRACT

Background:

Telehealth technologies can enhance patients’ and their families’ access to high-quality resources in home-based palliative care. Nurses are deeply involved in delivering telehealth home-based palliative care. However, no previous integrative systematic reviews have synthesized evidence on nurses’ role, effectiveness, facilitators and barriers to the implementation of nurse-delivered telehealth home-based palliative care.

Objective:

Guided by the updated Consolidated Framework for Implementation Research (CFIR) 2022, this integrative systematic review aims to identify the role of nurses, evaluate the effectiveness of telehealth intervention delivered by nurses or a multi-professional team, and identify the facilitators and barriers in the implementation of telehealth in home-based palliative care.

Methods:

This integrative systematic review was conducted using Joanna Briggs Institute (JBI) Methodological Guidance and in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. We systematically searched articles published from January 1 2014 to May 2024 in PubMed, Embase, Web of Science, CINAHL, and Cochrane Library. We included English, peer-reviewed, original qualitative, quantitative, and mixed methods studies that centered on nurse-delivered telehealth in home-based palliative care. We used a mixed-method appraisal tool to assess the quality of the included articles. Three authors independently assessed eligibility, extracted data, and assessed the quality of articles.

Results:

This integrative systematic review identified 4819 unique articles, including 32 papers from 25 studies. The role of nurses in telehealth home-based palliative care involves palliative care nurse, community nurse, nurse coordinator, nurse coach or nurse navigator, and nurse case manager. Telehealth home-based palliative care could improve the patients’ quality of life and reduce health service utilization, and telehealth technologies were well-received by patients, their family caregivers, and healthcare providers. Guided by the CFIR 2022, facilitators and barriers to implementing nurse-delivered telehealth home-based palliative care were identified to 6 implementation levels and 13 constructs: national and local health (policies, laws, financing, culture, local attitudes, and critical incidents), organizations and institutions (partnerships, connections, structural characteristics, compatibility, and available resources), multi-professional team (communications), healthcare providers (capability and motivation), family and home (engaging), and homebound patient (engaging). The key facilitators included the COVID-19 pandemic, a structured and integrated telehealth system, and so on. The barriers included technical problems, insufficiently trained healthcare providers, and so on.

Conclusions:

Nurses play a central role in implementing telehealth home-based palliative care through interprofessional coordination. Professional palliative care training builds nurses’ professional identity. Telehealth improves quality of life and reduces healthcare utilization. A blended model combining initial in-person assessments with telehealth follow-ups and individualized follow-up frequencies is advocated. Cost-effective low-tech modalities (e.g., telephone consultations) show optimal scalability. Key recommendations include: integrating telehealth systems, nurses’ role identification and competency training in telehealth and palliative care, and homebound patients and family caregivers’ engagement. Clinical Trial: PROSPERO CRD42024541038.