JMIR Publications

ABSTRACT

Background:

Home is a preferred place for people in need of palliative care. There have been efforts to design, implement, and evaluate telehealth interventions for people who are receiving home-based palliative care. However, their conclusions regarding effects on symptom management remain inconsistent.

Objective:

To identify and synthesize telehealth components for symptom management and evaluate their effects within home-based palliative care.

Methods:

Ten databases were searched: CINAHL, Cochrane Library, EMBASE, PsychInfo, PubMed, Scopus, Web of Science, CNKI, WANFANG, and VIP. Studies were searched from inception to Sep 2023 and then updated to May 2025. Methodological qualities of included studies were assessed using Mixed Methods Appraisal Tool (MMAT). JBI convergent segregated approach were followed to synthesize findings. The quantitative components considered studies that evaluated effects on symptom managements when using telehealth compared to usual care, other telehealth approaches, or no comparator. The qualitative components considered studies that explored the symptom experiences and symptom management experiences from the perspectives of patients, caregivers and healthcare providers. Then quantitative and qualitative data were synthesized deductively as guided by symptom management theory.

Results:

A total of 25 studies were included, comprising 5 qualitative, 9 quantitative and 11 mixed method designs. Core intervention components comprised symptom monitoring, alerts, and management strategies. Fifteen studies developed mobile applications or web-based platforms. Quantitative findings were mixed; the impact on symptom severity and quality of life was heterogeneous. In contrast, evidence on the usability and feasibility of telehealth was consistently positive, demonstrating moderate to good patient completion rate and satisfaction. Qualitative findings identified 6 themes, and 17 subthemes: Symptom experience: i) Enhancing patient confidence and assurance in symptom care; ii) The tech-induced struggles in symptom care; Symptom management: iii) Telehealth streamlines delivery of symptom management at home; iv) Lack personal care and physical proximity when managing symptom remotely; Symptom outcomes: v) Improved patients’ performance and satisfaction; vi) Improved end-of-life care quality.

Conclusions:

Telehealth is a valuable but complex intervention for symptom management in home-based palliative care. Synthesized evidence indicates potential telehealth benefits in symptom evaluation, timely connection, and increased satisfaction, but inconsistent quantitative results. Using telehealth in symptom management needs to go beyond the technical level, incorporate patient-centered design, robust health providers support, to ensure effective end-of -life guidance when intimate support is needed. Further research should explore intelligent monitoring that distinguish home-manageable symptoms from those requiring referral, thereby providing patients with more precise symptom, decision-making, and family care support. Clinical Trial: PROSPERO CRD42023463939.