JMIR Publications

ABSTRACT

Background:

The demand for palliative care is rising due to population aging and increased chronic illness. However, access to timely palliative care remains limited, particularly for patients receiving home-based hospice care in rural areas. Digital health technologies present an opportunity to enhance care delivery and communication at home.

Objective:

This pilot study aimed to 1) develop the Hospice@Home system, a digital in-home hospice care solution, 2) assess its usability and feasibility among terminal cancer patients and their caregivers, and 3) identify challenges for future implementation.

Methods:

Hospice@Home was developed following the human-centered, evidence-driven Adaptive Health Experience and Application Design approach. After the prototype was developed, alpha testing was conducted with two simulated patients to assess system functionality and identify technical issues. Usability was measured through structured observation and task completion success during these sessions. Feasibility was evaluated during a 3-week beta test involving five terminal cancer patient–caregiver dyads, recruited through a home hospice agency. Challenges were identified through user feedback, field notes, and technical logs collected throughout the testing period.

Results:

Hospice@Home is a web application optimized for Android devices. It integrates wearable biosignal data—blood pressure, heart rate, respiratory rate, sleep patterns, and oxygen saturation—measured via the Samsung Galaxy Watch 6. It also allows self-reporting of body temperature, pain levels, bowel movements, and the severity of symptoms tailored to individual patients. Medication compliance, including scheduled and PRN (pro re nata) analgesics, was recorded in a smart medication box and automatically transmitted to Hospice@Home. Over three weeks, five patients (aged 53–93) with terminal cancer and their caregivers (aged 38–63) explored the system. Both patients and caregivers appreciated the consolidated symptom reporting and real-time data sharing, noting that the system helped them feel more reassured and connected to clinical support. Usability was assessed via satisfaction ratings, averaging 3.3 (SD 0.5) for patients and 4.0 (SD 0.7) for caregivers (5-point scale). Feasibility was evaluated through task compliance; dyads completed ≥13 of 18 tasks during stable periods. No major technical issues were reported. Challenges to consistent system use included patient fatigue, cognitive impairments that posed occasional challenges to interacting with the app, even with its intuitive interface and a general preference among patients and caregivers for phone calls rather than using the in-app communication feature.

Conclusions:

Hospice@Home was perceived as user-friendly, with an intuitive and easy-to-navigate interface, though some users faced challenges depending on their health status. The system was expected to provide meaningful support for home-based palliative care for both patients and caregivers. While early findings suggest its potential to improve palliative care delivery and communication, continuous refinement and iterative usability testing are needed to address engagement barriers and enhance the systems’s effectiveness.