The need for palliative care is expected to increase globally due to a number of socioeconomic factors, consequently it is important to explore opportunities to innovate care services to improve access and quality.1 Digital health is an example of such innovation, where technology has been used to transform the delivery of health and social care and help citizens to manage their own health.2-4 When used well, digital health can improve healthcare delivery and access; however, many barriers have prevented its meaningful use in palliative care.5 These barriers include expense, inter-operability issues, data privacy and security concerns, lack of effectiveness, equity, and the concern that technology will reduce face-to-face consults between patients and clinicians.6 7

There is potential to improve palliative care through better use of digital health. Many authors have explored the potential to support palliative care with different technologies, such as artificial intelligence,8 9 big data,5 robotics,7, virtual reality10-12 and more. Currently, many of these studies are exploratory, and further research is needed to determine the efficacy and effectiveness of these approaches. In an effort to provide focus to this rapidly evolving area, we have completed a (pre COVID19) Delphi study to identify technology research priorities in palliative care. We identified the following areas which were: big data, mobile devices, telehealth and telemedicine, virtual reality, artificial intelligence, the smart home, biotechnology and digital legacy.13

The COVID19 pandemic has highlighted the potential to use technology to support healthcare delivery. Restrictions in person-to-person contact has led to adoption of technology, combined with new models of care, to engage with clinicians, patients, families and caregivers. Adopted solutions have included the use of video-conferencing technologies (e.g. for clinical assessment, handover, and education), social media (communication and engagement with both professional and lay groups) and more purposeful use of existing cloud storage, email and telephony services.14

Technology has been used in a variety of ways to support palliative care during the COVID19 pandemic. Telehealth was the most common application, with many palliative care services using this to provide remote clinical support.15-27 Video communication technology (e.g. Zoom, Microsoft Teams) has been used to support communication between healthcare professionals in the workplace and home.28 Educators have also used telehealth to train medical students, by using this technology to facilitate observation of tele-palliative care clinics.29 Furthermore, many individuals have developed virtual communities of palliative care practice,30 by sharing information through online webinars and virtual scientific meetings.31 Public and professionals have used a variety of technologies to maintain social connection, for example social messaging apps, video messaging applications, virtual reality (VR) and gaming.30 VR has also been used to provide psychological care and comfort for patients and their families.32 33 The authors of these studies talk positively about the use of this technology in palliative care; however, its rapid implementation of has created some challenges. Examples of these challenges include difficulties experienced by the user (e.g., problems accessing content, issues navigating software and sharing resources), technical issues relating to hardware and software (e.g., problems with connectivity and video/audio quality), data security issues (e.g., privacy and ethical concerns) and wellbeing issues (e.g., managing distress virtually and blurring of boundaries between work and home).28

Further research and policy work is needed to ensure that technology is used meaningfully for those with palliative care needs. This is important, as the user requirements for people with palliative care needs are likely to differ from the general population. Furthermore, because we lack resources for wide-spread implementation of all technologies currently, it is important that future research provides the evidence needed to determine how they are best used in palliative care. Researchers should use a number of methodologies to explore these questions and should consider broader areas such as ethical issues, data security, and design. From a policy perspective, policymakers should address issues related to governance and ethics of current and future digital interventions and systems.

It is important that we strive to improve palliative care by using technology better. There is a real opportunity to palliative care through clinical innovation, research and policy reform. However, it is important that the barriers and risks of using these technologies in palliative care are properly addressed to ensure that these tools are used meaningfully, wisely and safely and that we do not cause unintentional harm.


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