Re iew
Heal h Ca e P o essionals’Expe iences and Pe spec i es on
Using Teleheal h o Home-based Pallia i e Ca e:Scoping Re iew
Elias Da id Lunde eng1,2, OCN, MSc; And éa Apa ecida Gonçal es Nes1*, RN, PhD; Heidi Holmen3,4*, RN, PhD;
Ane e Winge 3, RN, PhD; Hilde Thygesen5,6, OT, PhD; Nina Jø anson5, RN, PhD; Ch is ine Råheim Bo ge7,8, RN,
PhD; Ola Dajani2, MD, PhD; Ka i L Ma iussen1, BSc; Simen A S eindal1,5, RN, PhD
1Lo isenbe g Diaconal Uni e si y College, Oslo, No way
2Eu opean Pallia i e Ca e Resea ch Cen e (PRC), Depa men o Oncology, Oslo Uni e si y Hospi al, Oslo, No way
3Facul y o Heal h Sciences, Depa men o Nu sing and Heal h P omo ion, Oslo Me opoli an Uni e si y, Oslo, No way
4The In e en ion Cen e, Oslo Uni e si y Hospi al, Oslo, No way
5Facul y o Heal h S udies, VID Specialized Uni e si y, Oslo, No way
6Depa men o Occupa ional The apy, P os he ics and O ho ics, Oslo Me opoli an Uni e si y, Oslo, No way
7Resea ch Depa men , Lo isenbe g Diaconal Hospi al, Oslo, No way
8Depa men o In e disciplina y Heal h Sciences, Uni e si y o Oslo, Oslo, No way
* hese au ho s con ibu ed equally
Co esponding Au ho :
Elias Da id Lunde eng, OCN, MSc
Eu opean Pallia i e Ca e Resea ch Cen e (PRC)
Depa men o Oncology
Oslo Uni e si y Hospi al
Ki ke eien 166
Oslo, 0450
No way
Phone: 47 23027762
Email: [email p o ec ed]
Abs ac
Backg ound: Teleheal h seems easible o use in home-based pallia i e ca e (HBPC). I may imp o e access o heal h ca e
p o essionals (HCPs) a pa ien s’homes, educe hospi al admissions, enhance pa ien s’ eelings o secu i y and sa e y, and inc ease
he ime spen a home o pa ien s in HBPC. HBPC equi es he in ol emen o a ious HCPs such as nu ses, physicians, allied
heal h p o essionals, die i ians, psychologis s, eligious counselo s, and social wo ke s. Accep ance o he use o echnology
among HCPs is essen ial o he success ul deli e y o eleheal h in p ac ice. No scoping e iew has mapped he expe iences and
pe spec i es o HCPs ega ding he use o eleheal h in HBPC.
Objec i e: The aim o his e iew was o sys ema ically map published s udies on HCPs’expe iences and pe spec i es on he
use o eleheal h in HBPC.
Me hods: A scoping e iew was conduc ed using he me hodology o A ksey and O’Malley. The e iew was epo ed acco ding
o he P e e ed Repo ing I ems o Sys ema ic Re iews and Me a-Analyses ex ension o scoping e iews. A sys ema ic sea ch
was pe o med in AMED, CINAHL, Embase, MEDLINE, PsycINFO, and Web o Science o s udies published in pee - e iewed
jou nals be ween Janua y 1, 2000, and Augus 23, 2022. The e e ence lis s o he included pape s we e hand sea ched o iden i y
addi ional s udies. The inclusion c i e ia we e (1) s udies using quali a i e, quan i a i e, o mixed me hods; (2) s udies including
HCPs using eleheal h wi h pa ien s in HBPC; (3) s udies on HCPs’ expe iences and pe spec i es on he use o eleheal h in
HBPC; (4) s udies published be ween Janua y 1, 2000, and Augus 23, 2022; and (5) s udies published in English, Po uguese,
No wegian, Danish, Swedish, o Spanish. Pai s o au ho s independen ly included s udies and ex ac ed da a. The i s 2 s ages
o hema ic syn hesis we e used o hema ically o ganize he da a.
Resul s: This scoping e iew included 29 pape s om 28 s udies. Fou desc ip i e hemes we e iden i ied: (1) easy o use bu
echnological issues unde mine con idence, (2) adds alue bu pe sonal and o ganiza ional ba ie s challenge adop ion, (3) po en ial
o p o ide use ul and meaning ul pa ien - epo ed da a, and (4) mu ual us as a p e equisi e o in e pe sonal ela ionships.
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Conclusions: Teleheal h in HBPC seems o be easy o use and may imp o e he coo dina ion o ca e, ime e iciency, clinical
assessmen s, and help build and enhance pe sonal and p o essional ela ionships. Howe e , he in oduc ion o echnology in
HBPC is complex, as i may no align well wi h he o e all aim o pallia i e ca e om HCPs’poin o iew. Fu he , changes in
p ac ice and equi emen s o HCPs may educe mo i a ion o he use o eleheal h in HBPC. HCPs conside hemsel es o ha e
cen al oles in implemen ing eleheal h, and a lack o accep ance and mo i a ion is a key ba ie o eleheal h adop ion. Policy
make s and eleheal h de elope s should be awa e o his po en ial ba ie when de eloping o implemen ing new echnology o
use in HBPC.
In e na ional Regis e ed Repo Iden i ie (IRRID): RR2-10.2196/33305
(J Med In e ne Res 2023;25:e43429) doi: 10.2196/43429
KEYWORDS
heal h echnology; homeca e se ices; pallia i e ca e; e iew; eleheal h; elemedicine; ca e; echnology; easibili y; da a;
decision-making; policy make s
In oduc ion
A key goal in pallia i e ca e is o p o ide access o coo dina ed,
con inuous, and specialized pallia i e ca e se ices a he
loca ion desi ed by pa ien s [1]. Pallia i e ca e is a
mul idisciplina y app oach and equi es he in ol emen o
a ious heal h ca e p o essionals (HCPs) such as nu ses,
physicians o di e en special ies (eg, gene al p ac i ione s,
pallia i e physicians, anes he is s, psychia is s, oncologis s,
and o he disease-speci ic specialis s), allied heal h p o essionals
(eg, physio he apis s, occupa ional he apis s, speech, and
language he apis s), die i ians, psychologis s, eligious
counselo s, and social wo ke s [2]. The p e e ed place o ca e
o mos pallia i e ca e pa ien s is hei own homes [3,4].
Howe e , unme pallia i e ca e needs, uncoo dina ed ca e, and
insu icien communica ion wi h HCPs [5,6], as well as he
demanding collabo a ion be ween specialis s and home ca e
p o essionals, make his challenging [7]. The inc easing heal h
ca e cos s in he inal yea s o li e [8] a e p ima ily d i en by
hospi aliza ions [9,10]. Consequen ly, swi ching om
hospi al-o ien ed pallia i e ca e o communi y-based pallia i e
ca e has become a p io i y o heal h ca e sys ems o educe he
socie al cos s o he aging popula ion [8,11].
Teleheal h is de ined “as he p o ision o heal h ca e emo ely
by means o a a ie y o elecommunica ion ools” [12]. The
adop ion o eleheal h is apidly changing he way we deli e
heal h ca e, and he use o elec onic heal h eco ds, decision
suppo ools, and ideocon e encing has al eady been
implemen ed in many coun ies [13]. The use o eleheal h in
home-based pallia i e ca e (HBPC) may enhance access o
HCPs a home, p omo e sel -moni o ing, and enhance pa ien s’
eelings o sa e y and secu i y [14]. Teleheal h may con ibu e
o cos -e ec i e pallia i e ca e by p e en ing and educing
hospi al admissions, eme gency depa men a endance, and
hospi al dea hs [15-17]. I may also acili a e collabo a ion
be ween di e en heal h ca e se ices by imp o ing in o ma ion
low [17,18]. Du ing he COVID-19 pandemic, he use o
eleheal h in pallia i e ca e was p omo ed as a way o imp o e
communica ion be ween isola ed pa ien s and hei amilies,
and be ween pa ien s and HCPs, while educing he isk o
exposing ulne able pa ien s o hospi al-based pa hogens
[19-21].
While eleheal h appea s p omising in deli e ing HBPC, many
HCPs eel ha eleheal h is unsui ed o he pallia i e ca e
popula ion because o pa ien s’ apid de e io a ion, age, and
illness bu den [16]. HCPs may pe cei e pallia i e ca e as high
ouch a he han high ech, and hey could be conce ned abou
eleheal h being bu densome o pa ien s [22,23]. The e is also
a conce n ha he inc easing amoun o pa ien -gene a ed da a
makes HCPs mo e a en i e o he echnology han o he pa ien ,
a he expense o ac ual suppo and ca egi ing. This could be
pa icula ly de imen al in a pallia i e ca e con ex in which a
us ing ela ionship is a key ac o [13].
A lack o accep ance o using eleheal h among HCPs seems o
be a ba ie o implemen ing eleheal h in HBPC [9]. Teleheal h
s udies mus iden i y he ba ie s o and acili a o s o he
adop ion o echnology, as hese equi emen s will in luence
he design, use, and unc ion o he de eloped echnology [24].
P e ious li e a u e e iews ega ding he use o eleheal h in
pallia i e ca e ha e p ima ily ocused on pedia ic pallia i e
ca e [25,26], olde pa ien s wi h ch onic condi ions [22,27,28],
o pa ien s wi h cance [29-31] and ha e examined pa ien o
ca egi e ou comes and expe iences [14,17,23,32]. Some
sys ema ic e iews ha e in es iga ed he use o ideo
consul a ions only [33] o o echnology in gene al and
specialized pallia i e ca e om mul iple pe spec i es, such as
hose o pa ien s, ca egi e s, and HCPs [34]. The e ha e also
been sys ema ic e iews ega ding how eleheal h can imp o e
access o and he ex ension o pallia i e ca e se ices in u al
a eas [35,36].
Wi h he apid implemen a ion o eleheal h in HBPC and he
eme ging esea ch in his ield, he e is a need o desc ibe
indings and s udies ela ed o HCPs’ expe iences wi h he use
o eleheal h. Al hough echnology accep ance among HCPs is
essen ial o he success ul implemen a ion o eleheal h in
HBPC, ini ial li e a u e sea ches showed ha no scoping e iew
has examined he expe iences and pe spec i es o HCPs on he
use o eleheal h in HBPC. A scoping e iew is sui able o
ga he ing li e a u e in disciplines wi h eme ging e idence [37],
o helping iden i y esea ch gaps ega ding eleheal h in HBPC
associa ed wi h HCPs, and o de e mining he easibili y o
conduc ing a sys ema ic e iew [38]. Consequen ly, he aim o
his scoping e iew was o sys ema ically map published s udies
on he use o eleheal h in HBPC, wi h a ocus on he
expe iences and pe spec i es o HCPs. Ou esea ch ques ion
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was as ollows: wha is known om published s udies abou
HCPs’ expe iences and pe spec i es on using eleheal h in
HBPC?
Me hods
O e iew
This scoping e iew used he me hodology o A ksey and
O’Malley [38], which consis s o he ollowing s ages: (1)
iden i ying he esea ch ques ion; (2) iden i ying ele an
s udies; (3) selec ing s udies; (4) cha ing he da a; and (5)
colla ing, summa izing, and epo ing he esul s. The epo ing
o his scoping e iew was guided by he P e e ed Repo ing
I ems o Sys ema ic Re iews and Me a-Analyses (PRISMA)
ex ension o scoping e iews (PRISMA-ScR) [39]. The
PRISMA-ScR checklis is p o ided in Mul imedia Appendix
1. De ia ions om he published p o ocol [40] a e shown in
Mul imedia Appendix 2.
Eligibili y C i e ia
The inclusion and exclusion c i e ia a e shown in Tex box 1.
The i s and he las au ho s independen ly es ed he inclusion
and exclusion c i e ia on he same 5% o he e ie ed s udies
o assess he obus ness o he c i e ia in cap u ing ele an
publica ions. The language c i e ia a e based on he au ho s’
luency in he included languages.
Tex box 1. Inclusion and exclusion c i e ia.
Type o s udies
•Inclusion
•Quali a i e, quan i a i e, o mixed me hods s udies published in pee - e iewed jou nals
•Exclusion
•Any ype o e iew, case epo , le e , book chap e , guideline, commen , discussion, edi o ial, con e ence abs ac , s udy p o ocol, mas e ’s
hesis, o PhD hesis
Time pe iod
•Inclusion
•Janua y 1, 2000, o Augus 23, 2022
•Exclusion
•Be o e Janua y 1, 2000, and a e Augus 23, 2022
Language c i e ia
•Inclusion
•English, Po uguese, No wegian Danish, Swedish, o Spanish
•Exclusion
•All o he languages
Type o pa icipan s
•Inclusion
•Pape s including heal h ca e p o essionals using eleheal h wi h pa ien s in home-based pallia i e ca e
•Exclusion
•Pape s including heal h ca e p o essionals using eleheal h wi h pa ien s ou side o a pallia i e ca e en i onmen , hose ha only end o
amily ca egi e s, o s udies ha do no p esen da a om he pe spec i e o heal h ca e p o essionals
Phenomenon o in e es
•Inclusion
•Heal h ca e p o essionals’expe iences o and pe spec i es on he use o eleheal h in home-based pallia i e ca e
•Exclusion
•Heal h ca e p o essionals’expe iences o and pe spec i es on he use o eleheal h a home wi hou in e ac ion wi h he pa ien , o expe ience
o use o eleheal h in a hospi al, nu sing home, o hospice. Teleheal h includes only elephone ollow-up
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In o ma ion Sou ces
A sys ema ic sea ch was conduc ed in he elec onic da abases
o AMED, CINAHL, Embase, MEDLINE, PsycINFO, and Web
o Science on July 5, 2021. The sea ch was upda ed on Augus
23, 2022.
Sea ch S a egy
The sea ch s a egy in MEDLINE was de eloped by an
expe ienced esea ch lib a ian (KM) and by he i s and he
las au ho s using MeSH e ms and ex wo ds ela ed o h ee
main hemes: (1) pallia i e ca e, (2) eleheal h, and (3) home
se ing. The sea ch s a egy was pilo ed o alida e he
app op ia eness o ex wo ds and MeSH e ms, and i was
pee - e iewed by a second expe ienced esea ch lib a ian
(MAØ) using he Pee Re iew o Elec onic Sea ch S a egies
checklis [41]. The sea ch s a egy was adap ed o each da abase
(Mul imedia Appendix 3). The e e ence lis s o included pape s
we e hand sea ched o iden i y addi ional s udies o ele ance.
Da a Managemen
The esea ch lib a ian uploaded he publica ions iden i ied in
he sea ches o EndNo e o he emo al o duplica es and
ans e ed he publica ions in o he web applica ion Co idence
[42] o acili a e he s o age and independen selec ion o eligible
publica ions.
Selec ion P ocess
Pai s o au ho s independen ly sc eened i les, abs ac s, and
ull- ex pape s o de e mine hei eligibili y. Con lic s among
he pai s we e esol ed by he i s and he las au ho s based
on discussions and consensus.
Da a Collec ion P ocess
A s anda dized da a cha ing o m was de eloped and used o
cha ele an da a om he included pape s. The da a cha ing
o m was e iewed by he en i e esea ch eam p io o he da a
collec ion and was pilo es ed by he i s and he las au ho s
on 5 s udies o ensu e ha he o m cap u ed he in o ma ion
accu a ely. The ollowing da a we e included: au ho s,
publica ion yea , coun y, aim, sample, eleheal h solu ion,
design, and indings ela ed o he esea ch ques ion. Pai s o
au ho s conduc ed he da a cha ing. One au ho ex ac ed he
da a, while he o he au ho con olled o accu acy. Any
disc epancies we e discussed among he pai s o au ho s, and
ag eemen was based on consensus o he in ol emen o he
i s and he las au ho s.
Risk o Bias and Quali y App aisal
The sou ces o e idence included in his e iew we e no
assessed o isk o bias o me hodological quali y as scoping
e iews aim o p o ide an o e iew o he exis ing li e a u e
ega dless o me hodological igo o isk o bias [39].
Da a Syn hesis
The i s 2 s ages o hema ic syn hesis [43] we e used o
induc i ely o ganize he da a. The quali a i e da a analysis
so wa e NVi o (QSR In e na ional) [44] was used o o ganize
he da a. In s age 1 o he hema ic syn hesis, he da a om he
esul s sec ion o he s udies included we e ead mul iple imes
and coded line by line by he i s au ho o iden i y pa e ns,
simila i ies, and di e ences in he expe iences and pe spec i es
o HCPs on he use o a ious echnological solu ions in HBPC.
Nume ical da a p esen ed in ables and igu es we e ans o med
in o a quali a i e o ma [45]. The line-by-line coding esul ed
in 303 sou ce exce p s ac oss all s udies included. In s age 2,
he exce p s we e compa ed o simila i ies and di e ences, and
hey we e me ged and o ganized in o 25 codes. The codes we e
hen o ganized in o 4 desc ip i e hemes using a low deg ee o
abs ac ion and in e p e a ion o de elop desc ip ions g ounded
in he included ma e ial ha answe ed he aim o he scoping
e iew. The codes and desc ip i e hemes we e discussed wi h
he las au ho , and all he au ho s ag eed on he inal desc ip i e
hemes. This enhanced he us wo hiness o he indings, as
he membe s o he esea ch eam ha e di e se clinical and
esea ch expe ise. To u he illus a e he p ocess o o ganizing
he da a [46], an example o a hie a chical coding ee o 2
desc ip i e hemes is illus a ed in Figu e 1. A equency able
illus a ing which pape s we e included in which desc ip i e
hemes was made (Table 1).
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Figu e 1. Example o a hie a chical coding ee o 2 desc ip i e hemes.
Table 1. A icles included in he hema ic g oupings.
A icles, nS udyTheme
22Osuji e al [47], Nguyen e al [48], Funde sko e al [49], Hochs enbach e al [50], Lind e al [51], Ha ding
e al [52], Whi en e al [53], Adam e al [54], S e n e al [55], Whi en e al [56], Shul e e al [57],
Miyazaki e al [58], Read Paul e al [59], Collie e al [60], McCall e al [61], Oelschlägel e al [62], Bha ga a
e al [63], Came on e al [64], Eas man e al [65], Haydon e al [66], Sco ano e al [67], and Weck e al [68]
Easy o use bu echnolog-
ical issues unde mine
con idence
18Bonsigno e e al [69], Collie e al [60], Funde sko e al [49] Hacke e al [70], Helleman e al [71],
Oelschlägel e al [62], Read Paul e al [59], Shul e e al [57], Ha ding e al [52], Whi en e al [56],
Hochs enbach e al [50], Lind e al [51], Nguyen e al [48], an Gu p e al [72], S e n e al [55], Haydon e
al [66], Sco ano e al [67], and Weck e al [68]
Adds alue bu pe sonal
and o ganiza ional ba i-
e s challenge adop ion
23Collie e al [60], Hacke e al [70], Ha ding e al [52], Hochs enbach e al [50], Lind e al [51], McCall e
al [61], Adam e al [54], Funde sko e al [49], Read Paul e al [59], Whi en e al [53], Miyazaki e al [58],
Tieman e al [73], an Gu p e al [74], Nguyen e al [48], Whi en e al [56], Oelschlägel e al [62], Shul e
e al [57], Alodhayani e al [75], Bha ga a e al [63], Came on e al [64], Haydon e al [66], Sco ano e al
[67], and Weck e al [68]
Po en ial o p o ide use-
ul and meaning ul pa-
ien - epo ed da a
21Bonsigno e e al [69], Funde sko e al [49], Helleman e al [71], Hochs enbach e al [50], Lind e al [51],
McCall e al [61], Nguyen e al [48], Oelschlägel e al [62], an Gu p e al [72], Whi en e al [56], Collie
e al [60], Miyazaki e al [58], Tieman e al [73], Hacke e al [70], an Gu p e al [74], Osuji e al [47],
Alodhayani e al [75], Came on e al [64], Eas man e al [65], Haydon e al [66], and Sco ano e al [67]
Mu ual us as a p e eq-
uisi e o in e pe sonal
ela ionships
Resul s
O e iew
The sea ch yielded 5465 ci a ions. A e he emo al o 2649
duplica es, 2816 ci a ions we e sc eened. The ull ex s o 138
ci a ions we e ead; 114 ci a ions we e excluded. Fi e addi ional
ci a ions we e iden i ied h ough o he sou ces, such as hand
sea ches and ci a ion sea ching. A o al o 29 pape s om 28
s udies we e included. The eason o he exclusion o ull- ex
pape s is shown in Figu e 2.
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Figu e 2. P e e ed Repo ing I ems o Sys ema ic Re iews and Me a-Analyses lowcha .
Desc ip ion o he S udies Included
The s udies included we e conduc ed in he Uni ed S a es (n=6),
Aus alia (n=5), he Ne he lands (n = 4), Canada (n=4), he
Uni ed Kingdom (n=3), Ge many (n=1), Denma k (n=1), B azil
(n=1), Saudi A abia (n=1), Sweden (n=1), No way (n=1), and
c oss-na ional (India, Uganda, and Zimbabwe, n=1). The sample
size o he s udies included anged om 4 o 111 pa icipan s,
and in 12 pape s, he samples consis ed o ewe han 10
pa icipan s. In all bu 1 [68] s udy, he samples consis ed o
nu ses wi h a ious special ies [47-67,69-75]; in 13 s udies,
physicians we e included [47,49,51,52,54,63,64,66,68,
70,72,74,75]; and in 3 s udies, hospice wo ke s (ie, nu ses,
physicians, social wo ke s, and spi i ual ca e p o ide s) we e
included [53,56,64]. Ele en s udies had mul ip o essional
pe spec i es, including HCPs wi hin ehabili a ion, allied heal h,
esiden ial ca e, and pallia i e ca e [57,66]; case manage s,
coo dina o s, and espi a o y he apis s [58]; physician
consul an s [59]; eleheal h p o ide s o echnologis s [69,75];
and ehabili a ion physicians, occupa ional he apis s, physical
he apis s, speech he apis s, die icians, and social wo ke s
[49,62,71]. Th ee s udies included only nu ses in hei sample
[48,67,73], while 1 s udy included only physicians [68].
In he majo i y o he s udies (n=13), pa ien s wi h cance
ecei ing pallia i e ca e we e he ecipien s o he eleheal h
in e en ion [49-51,54,55,59,61-63,70,72-74]. Ele en s udies
did no epo speci ic diagnoses o he han se ious illnesses
[47,48,57,58] o pa ien s ecei ing pallia i e ca e [60,65,66,69]
o end-o -li e ca e [53,56,64]. One s udy included pa ien s wi h
amyo ophic la e al scle osis [71], 1 s udy included pa ien s
wi h majo o gan ailu e o HIV/AIDS in addi ion o pa ien s
wi h cance [52], 1 s udy included ge ia ic pa ien s [75], 1 s udy
included pa ien s wi h enal disease ecei ing home dialysis
[67], and 1 s udy included pa ien s wi h neu ological disease
o diseases wi h neu ological symp oms [68].
Thi een pape s used a quali a i e design
[49-51,53,54,57,60,62,66,70,72,74,75], 12 pape s used a mixed
o mul ime hods design [47,52,55,56,58,59,61,64,67-69,71],
and 4 pape s used a quan i a i e design [48,63,65,73]. The
cha ac e is ics o he s udies included a e shown in Mul imedia
Appendix 4.
Video-based echnology (n=16) was he mos equen ly used
eleheal h app in HBPC [47-49,53,56-59,64-68,72-74].
Teleconsul a ions among pa ien s, amilies, and HCPs we e
used o discuss pa ien s’needs, conce ns, symp oms, and o he
p oblems and o gi e pa ien s and hei amilies com o and
ad ice. In 7 s udies, eleheal h was deli e ed by hospi al-based
HCPs [49,57,66,67,72-74]; in 3 s udies, eleheal h was deli e ed
by hospice wo ke s [53,56,64]; and in 6 s udies, eleheal h was
deli e ed by home ca e p o essionals [58,65] o by home ca e
p o essionals in collabo a ion wi h hospi al-based s a
[47,48,59,68].
Web-based apps (n=12) in ended o use on mobile phones
[50,52,55,61,75], able s [54,60,62,69,71], o pe sonal compu e s
[63,70], as well as digi al pens and dia ies [51] (n=1), we e used
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o pain educa ion and o moni o ing and managing pain and
o he symp oms. Fou s udies applied combina ions o
ideo-based echnology o con e encing and pa ien - epo ed
da a o moni o ing [55,60,69,75]. In 7 s udies, he eleheal h
deli e y was hospi al based [50,51,55,61,63,71,75]; in 5 s udies,
i was communi y based [54,60,62,69,70]; and 1 s udy had a
combina ion o communi y- and hospi al-based eleheal h
deli e y [52].
We iden i ied ou desc ip i e hemes om he s udies included:
(1) easy o use bu echnological issues unde mine con idence,
(2) adds alue bu pe sonal and o ganiza ional ba ie s challenge
adop ion, (3) po en ial o p o ide use ul and meaning ul
pa ien - epo ed da a, and (4) mu ual us as a p e equisi e o
in e pe sonal ela ionships.
Easy o Use bu Technological Issues Unde mine
Con idence
Ac oss s udies, HCPs exp essed ha eleheal h was accep able,
com o able, in e es ing, and easy o lea n and use. In mos
cases, hey did no pe cei e he use o eleheal h as bu densome,
ime consuming, o one ous. Ra he , hey we e en husias ic
abou new echnologies and el compe en in oubleshoo ing
echnical p oblems [47-56,64,67,68]. HCPs conside ed ha hey
had su icien skills o pe o m key pallia i e ca e ac i i ies in
he con ex o eleheal h, such as ideo isi s [47,57,58,68].
They also epo ed ha pa ien s and amilies ound eleheal h
easy o ope a e and use ul o imp o ing hei access o help
and p o iding com o and enhanced eelings o sa e y compa ed
wi h in-pe son ca e [48,50,51,61,63,64,66,68].
Equipmen p oblems, such as un eliable, slow- unning, o
c ashing echnology [48,54,55,63,65]; issues wi h he sc een
size [54,68]; a lack o in e ne connec i i y [47,48,52,59,64,68];
and audio o imaging issues [58,59,68] we e epo ed. Un eliable
echnology and connec i i y issues unde mined HCPs’
con idence in using eleheal h, and hey el pe sonally and
p o essionally esponsible when eleheal h solu ions ailed
[48,60]. Fu he mo e, a lack o unc ionali ies, such as ailo ed,
pe sonalized, o supplemen a y ques ions o symp om
assessmen s [50,54,61,62], e ospec i e logging o b eak h ough
doses o o he pa ien da a [51,54], upload con i ma ion [52],
cha unc ionali y [64], and equipmen po abili y [55], we e
epo ed. A lack o desi ed unc ionali y inc eased he likelihood
o HCPs e e ing o o me ways o wo king [48,60]. They
also exp essed conce ns ega ding da a secu i y, lack o p i acy
du ing ideo consul a ions, and he legali y o digi al pa ien
assessmen s [48,49,58-60].
Adds Value bu Pe sonal and O ganiza ional Ba ie s
Challenge Adop ion
HCPs epo ed ha eleheal h added alue o HBPC, as i
imp o ed hei access o pa ien s, acili a ed quick and imely
esponses, and imp o ed ime e iciency, quali y, coo dina ion,
and con inui y o ca e wi hou inc easing hei o e all wo kload
compa ed wi h in-pe son isi s [49,59,60,62,66,68-71,76]. Fo
u al HCPs, an added bene i was ha ideo isi s inc eased he
capaci y and ex ension o pallia i e ca e se ices while
minimizing he need o a eling [57,60,66,69]. Fu he mo e,
eleheal h p o ided an a enue o en y poin o ollow-up on
isola ed pa ien s o pa ien s who we e eluc an o le HCPs in o
hei homes [57,62].
Teleheal h b ough wi h i new asks, di e en esponsibili ies,
and unknown echnologies, which we e epo ed as challenging
o adjus o [50-53,56,57,60]. HCPs we e no always mo i a ed
o use new echnology, and a lack o knowledge, unde s anding,
and amilia i y wi h eleheal h educed hei engagemen in
using i as in ended o in encou aging pa ien s o use i
[48,50,51,53,56,60,70]. Howe e , p io expe ience wi h he use
o echnology, ei he h ough eleheal h o wi h he use o
echnological de ices, such as able s, in daily clinical p ac ice
enhanced he accep ance o and con idence in using eleheal h
[49,57,67]. A lack o a ailable comp ehensi e echnical suppo
[53,57] and in eg a ion wi h exis ing heal h ca e se ices we e
ac o s ha nega i ely a ec ed he success ul adop ion o
eleheal h se ices [50,55,57,62,72]. P oac i e suppo and
mo i a ion om eleheal h esea che s o HCPs deli e ing
eleheal h inc eased encou agemen among HCPs [53,62,70].
Po en ial o P o ide Use ul and Meaning ul
Pa ien -Repo ed Da a
O e all, HCPs pe cei ed eleheal h o p o ide meaning ul,
imely, synch onous, and asynch onous pa ien - epo ed clinical
da a. The da a suppo ed clinical assessmen s and mu ual
decision-making be ween pa ien s and HCPs, imp o ed HCPs’
assessmen and unde s anding o pa ien s’ symp oms, and
enhanced symp om con ol [50-52,54,60,61,68,70]. Teleheal h
made HCPs mo e esponsi e and a en i e o changes in
pa ien s’ symp oms, and i made pa ien - epo ed symp om
assessmen s mo e ac i ely used in decision-making
[49,51,53,54,59,61,63,66,67,70]. The pa ien -gene a ed da a
helped HCPs p io i ize pa ien s based on he needs o he
pa ien s [52,58,70]. Mo eo e , he isual ea u es o eleheal h
enabled HCPs o emo ely no ice isual cues o de e io a ion,
such as acial colo and he pa ien s’su oundings, o o assess
he pa ien s’ li ing si ua ions and emo ional s a es
[49,54,58-60,64,68,73-75]. Video isi s made i possible o
assis o he HCPs o amilies who we e p esen wi h he pa ien
in doing clinical assessmen s, p o ide aining in using medical
equipmen , o coo dina e du ing an eme gency
[48,53,56,58,64,75].
Al hough eleheal h o e ed use ul insigh s in o pa ien s’
condi ions, HCPs we e some imes conce ned abou missing
impo an pa ien in o ma ion. They exp essed ha ideo
echnology did no adequa ely con ey impo an o smalle
nuances o isible cues, such as body language, acial
exp essions, physical signs o decline, and li ing si ua ions
[57,62,70]. Mo eo e , clinical da a ob ained om pa ien
epo ing we e some imes pe cei ed as ambiguous and
dependen on HCPs’ expe iences and knowledge o he
indi idual pa ien , leading o di e en esponses om di e en
HCPs [50,51,60,62]. One s udy desc ibed ha o pa ien s wi h
cogni i e impai men , pa ien in o ma ion was p ima ily
con eyed h ough he amilies, c ea ing unce ain y among
HCPs abou he alidi y o he in o ma ion he amily p o ided
[75]. Fu he mo e, HCPs expe ienced ale s and eminde s o
some imes be bu densome, and hey exp essed conce ns ha
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symp om assessmen s we e cons an eminde s o disease
p og ession o he pa ien s [51,52,60,62,70].
Mu ual T us as a P e equisi e o In e pe sonal
Rela ionships
HCPs epo ed ha eleheal h p o ided eassu ance, ad ice, a
sense o con ol, and secu i y, and i ensu ed he in ol emen
o pa ien s and amilies while imp o ing he con inui y o ca e
[48-51,56,61,62,66,69,71,72,75]. HCPs el mo e connec ed
wi h pa ien s and hei amilies when using eleheal h han
h ough he elephone, as eleheal h o e ed an oppo uni y o
engagemen and inqui y abou he pa ien s’ su oundings,
making he consul a ions mo e pe sonal [48,51,60,61].
Teleheal h also acili a ed 3-pa y consul a ions, which enabled
he in ol emen o amilies and he c ea ion o mo e us wo hy
ela ionships [49,61,64]. I enabled guidance, he exchange o
knowledge, educa ion, and bila e al in ol emen be ween
di e en HCPs wo king a di e en le els o heal h ca e, leading
o eelings o imp o ed collabo a ion, pa ne ship, and pee
suppo [49,58,66,67,72,73].
Ne e heless, HCPs did no always pe cei e eleheal h o
p o ide he same le el o pa ien - ailo ed o in-dep h ca e
compa ed wi h in-pe son ca e [60,65,69,70]. In addi ion, HCPs
exp essed ha i is challenging o discuss sensi i e opics
because hey ind i di icul o con ey ca ing o empa hy
emo ely [48,74]. These p o essionals also emphasized ha
eleheal h equi es a us ing ela ionship be ween di e en
HCPs and be ween HCPs, pa ien s, and hei amilies
[49,50,62,75]. They el ha ideo isi s could be mo e
app op ia e o ollow-up, as hey expe ienced ha p e ious
in-pe son encoun e s wi h pa ien s inc eased he com o wi h
and e ec i eness o ideo consul a ions and helped o m an
o e all pic u e o pa ien s’ con ex s and li e si ua ions
[47,48,62].
Discussion
P incipal Findings
This scoping e iew aimed o sys ema ically map published
s udies ha ocus on HCPs’ expe iences and pe spec i es on
he use o eleheal h in HBPC. Ou indings sugges ha
eleheal h is easy o use wi hou being bu densome o HCPs,
and i shows po en ial o imp o e ime e iciency and he
ex ension o pallia i e ca e se ices while enabling close
connec edness wi h pa ien s and amilies. Teleheal h may also
imp o e collabo a ion be ween HCPs wo king a di e en le els
o heal h ca e, as well as make hem mo e a en i e and
esponsi e o changes in pa ien s’ symp oms o gene al
well-being. Howe e , p oblema ic aspec s o he use o
eleheal h in HBPC we e also desc ibed, such as echnical issues,
esis ance o change among HCPs, challenges wi h emo ional
suppo , ambiguous pa ien da a, and he p e equisi e o mu ual
us and amilia i y o he success ul use o eleheal h.
Ou indings sugges ha HCPs ound eleheal h easy o use o
hemsel es and o pa ien s, and hey desc ibed posi i e
ou comes o bo h pa ien s and hei amilies. P e ious esea ch
on pa ien s’ expe iences o using eleheal h suppo s he
easibili y and ela i e ease o using eleheal h among pa ien s
[14-17]. Howe e , echnological issues and legal conce ns we e
epo ed in ou e iew, which unde mined HCPs’ con idence
and made hem e e o p e ious ways o wo king. HCPs ai h
in eleheal h seems o be ela ed o use - iendly, eliable, and
pe sonalized echnology [33], and eleheal h aining should
ocus on main aining HCPs’ con idence in p o iding ca e
emo ely [77]. Consis en wi h ou indings, sys ema ic e iews
ha e ound ha HCPs ha e posi i e a i udes owa d he use o
echnology bu ha e exp essed conce ns ega ding echnical
challenges and p i acy [26,33]. HCPs who lack expe ience wi h
he use o eleheal h may ha e misconcep ions ega ding i ,
such as loss o pe sonalized ca e, missing i al in o ma ion, o
assump ions ha olde pa ien s would no be in e es ed in o
able o use eleheal h [9,78]. This is suppo ed by ou indings
showing ha p io expe ience wi h he use o echnology
enhanced accep ance among HCPs.
Ou indings indica e ha eleheal h adds alue o HBPC by
imp o ing access o pa ien s, ime e iciency, quali y, con inui y,
and coo dina ion o ca e while inc easing he capaci y and
ex ension o HBPC se ices. Simila desc ip ions ha e been
ound in p e ious sys ema ic e iews [15-17]. Ou e iew
showed ha eleheal h p o ides an a enue o HCPs who a ely
in e ac physically o come oge he o e a digi al medium. A
lack o con ac be ween di e en le els o heal h ca e may be
a key ba ie o success ul collabo a ion [7], which is a challenge
ha could be me by eleheal h [79]. Howe e , ou indings also
showed ha eleheal h p esen ed a new way o wo king, which
was challenging o adjus o, and ha a lack o mo i a ion among
HCPs educed eleheal h engagemen . A mixed me hods
sys ema ic e iew desc ibed ha he use o eleheal h equi es
subs an ial adjus men om he HCPs [77], and ha esis ance
o change among HCPs is a ba ie o he implemen a ion o
eleheal h [80]. Al hough eleheal h could educe HCPs’
wo kload [27,34], HCPs may ha e conce ns abou eleheal h
inc easing hei wo kload [26,33] due o he equi ed aining
in how o use i and he need o egula e eshe cou ses
[33,51,70]. I HCPs do no pe cei e eleheal h o bene i
wo kload o clinical p ac ice, he solu ion will o en no be
adhe ed o o welcomed [81]. Resea che s and policy make s
should emphasize he po en ial bene i s o using eleheal h,
a he han only ocusing on how o ope a e i [81]. Ou indings
desc ibed ha a lack o in eg a ion wi h exis ing heal h ca e
se ices nega i ely a ec s he success ul adop ion o eleheal h.
S udies ha e desc ibed in eg a ion and in e ope abili y issues
as key aspec s o nega i e use expe iences [82,83]. HCPs’
mo i a ions o any change depend on hei abili y o in luence
he change, be p epa ed o i , and alue he change [84]. This
unde lines he impo ance o including HCPs when de eloping
o implemen ing new echnology o use in HBPC [85].
Ou e iew desc ibes eleheal h as enabling HCPs o obse e
pa ien s and hei su oundings emo ely, which was pe cei ed
as use ul in clinical assessmen s and pa ien examina ions.
Howe e , HCPs also exp essed conce ns ega ding missing
impo an pa ien in o ma ion and he ailu e o ideo echnology
o con ey impo an isual nuances. Resea ch sugges s ha
while ideo isi s may o e a glimpse in o pa ien s’ li es and
social con ex s, hey may no p o ide he same le el o
pa ien - ailo ed o in-dep h ca e ha in-pe son ca e p o ides
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[33]. Ou indings indica e ha pa ien - epo ed da a we e use ul
o suppo ing clinical assessmen s, imp o ing symp om con ol,
and helping HCPs p io i ize pa ien s. Howe e , such da a we e
some imes pe cei ed as con using, c ea ing unce ain y abou
wha he p ope ac ions would be. As he a ailabili y o
pa ien -gene a ed da a inc eases, HCPs may wan mo e
uni o mi y in how o in e p e pa ien -gene a ed da a and
inco po a e hese in o clinical decision-making [50].
A us ing ela ionship is a key ac o in pallia i e ca e [13],
and conce ns ha e been aised whe he he use o eleheal h
could a ec he pa ien –HCP ela ionship and come a he
expense o ac ual suppo and ca egi ing [13,22]. Ou indings
sugges ha eleheal h enabled meaning ul and us ing
ela ionships wi h pa ien s and amilies and ha i made HCPs
mo e connec ed wi h pa ien s and hei amilies han h ough
adi ional ollow-up. This is in line wi h an in eg a i e e iew
o he use o ideo in pallia i e ca e [33]. Howe e , he goal o
ideo consul a ions eplacing a signi ican p opo ion o
ace- o- ace ca e may be misplaced [80]. Based on ou indings,
we sugges ha ideo consul a ions could be mo e app op ia e
o ollow-up; HCPs emphasized ha he use ulness o eleheal h
depends on all pa icipan s ha ing exis ing us and ha
p e ious in-pe son encoun e s wi h pa ien s inc eased he
com o wi h and e ec i eness o ideo consul a ions. S udies
sugges ha HCPs in ol ed in pallia i e ca e may p e e he
ini ial con ac o be ace- o- ace [86], and HCPs may be skep ical
o echnologies ha aim o eplace all ace- o- ace encoun e s
wi h pa ien s [87].
Consis en wi h ou e iew, a sys ema ic e iew [88] ound ha
HCPs may ind i di icul o p o ide psychoemo ional com o
and discuss end-o -li e issues emo ely [88]. In e es ingly, his
could be con a y o he pe cep ions o pa ien s, as s udies ha e
shown ha pa ien s may ind eleheal h equal o o be e han
in-pe son consul a ions a p o iding emo ional suppo , and
hey may conside i easie o discuss sensi i e opics in he
com o o hei own homes [14,89]. Unde s anding he po en ial
o eleheal h o suppo he apeu ic ela ionships be ween
pa ien s and HCPs and being awa e o he possible di icul ies
and ensions i may c ea e a e c i ical o i s success ul and
accep able use [13].
Ou e iew included s udies ha we e mainly conduc ed in
high-income coun ies [90] in Eu ope and No h Ame ica. Only
2 s udies [52,67] we e conduc ed in low- and middle-income
coun ies (LMICs) [91]. The use o eleheal h is g owing in
many LMICs [92]; howe e , he widesp ead adop ion o
eleheal h in LMICs emains limi ed by esou ce sca ci y,
un eliable powe , poo in e ne connec i i y [93], and subs an ial
in as uc u e and egula o y ba ie s [92], which may explain
why ew s udies conduc ed in LMICs we e iden i ied in ou
e iew.
The e is an inc easing end o deli e pallia i e ca e se ices
a home and o include diagnoses o he han cance [94].
Howe e , in he majo i y o he s udies included, eleheal h was
deli e ed o pa ien s wi h cance by specialized pallia i e ca e
se ices loca ed a hospi als. This may ein o ce he imp ession
ha mos pallia i e ca e se ices and esea ch a e s ill being
conduc ed in cance and hospi al se ings [95,96]. The s udies
in ou e iew consis ed o he e ogeneous samples o HCPs, bu
nu ses and physicians we e he p o essionals included in mos
o he s udies. Pallia i e ca e unde lines he impo ance o an
in e disciplina y eam app oach [97], and occupa ional
he apis s, psychologis s, o social wo ke s, o ins ance, could
also play impo an oles when eleheal h is used in HBPC [98].
Fu u e s udies need o add ess he expe iences o using eleheal h
among mo e di e se HCPs wo king in se ings o he han
hospi als wi h pa ien s wi h diagnoses o he han cance . Finally,
mo e esea ch is needed in LMICs and in di e en cul u al
se ings, as he e may be o he pe spec i es and expe iences
wi h he use o eleheal h in HBPC ac oss cul u al se ings.
Limi a ions
Technology has de eloped apidly o e he las 2 decades, and
some o he s udies included in his scoping e iew desc ibe he
expe iences o HCPs in using echnology ha is ou da ed
compa ed wi h oday’s s anda ds. This may pa icula ly be he
case in e ms o sc een size, image esolu ion, colo quali y,
and b oadband issues, as mobile and ne wo k echnology oday
o e s signi ican ly imp o ed imaging echnology and ne wo k
s abili y compa ed wi h ha 2 decades ago. Howe e , ou
indings s ill highligh hese impo an ea u es om he poin
o iew o HCPs, which will be i al o inco po a e in u u e
solu ions. Despi e ou comp ehensi e and sys ema ic sea ch
s a egy, he e may be s udies ha we ha e no been able o
iden i y. Se e al e ms a e used o bo h eleheal h and pallia i e
ca e, and eleheal h in e en ions o pa ien s wi h incu able
diseases o li e-limi ing illnesses may no ha e been classi ied
as pallia i e ca e o eleheal h in e en ion. Fu he , he e exis s
a subs an ial amoun o g ay li e a u e on his subjec , which
was no included since ou e iew was limi ed o he inclusion
o s udies published in pee - e iewed jou nals. One o he
s udies [75] included desc ibed cul u al ba ie s o he use o
eleheal h ha we e no desc ibed in he o he s udies. This
sugges s ha he e may be cul u al ba ie s ha we ha e no
been able o ully iden i y and desc ibe. Finally, ou sea ch
s a egy had language es ic ions, as we included only s udies
in English, No dic, Spanish, and Po uguese. Howe e , as s a ed
in he published p o ocol [40], we we e able o include Chinese
publica ions in he ini ial sc eening o published s udies,
al hough no ele an publica ions we e iden i ied. Due o hese
limi a ions, he e may be expe iences and pe spec i es om
HCPs on he use o eleheal h in HBPC we we e no able o
iden i y and desc ibe.
Conclusions
O e all, HCPs seem o ind eleheal h in HBPC easy o use
wi hou being bu densome. Ou indings sugges ha HCPs
conside eleheal h o imp o e pa ien ou comes in HBPC by
p o iding pa ien s and amilies wi h mo e pe sonalized and
accessible ca e. Teleheal h enables HCPs o moni o pa ien s
mo e closely, and espond mo e quickly o changes in hei
symp oms o heal h s a us. Fu he , eleheal h can help
s eamline p ocesses, such as pa ien assessmen s o symp oms
managemen , making i easie o HCPs o p o ide HBPC.
Digi al ools o e ed h ough eleheal h can also acili a e
imp o ed communica ion be ween pa ien s and HCPs, allowing
o mo e con enien and e ec i e ca e, while also enabling a
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