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.
- Bone AE, Gomes B, Etkind SN, et al. What is the impact of population ageing on the future provision of end-of-life care? Population-based projections of place of death. Palliative Medicine 2017;32(2):329-36. doi: 10.1177/0269216317734435
- Topol E. Preparing the Healthcare Workforce to Deliver the Digital Future the Topol Review: An Independent Report on Behalf of the Secretary of State for Health and Social Care. NHS Health Education: London, UK 2019
- Department of Health Social Care. The future of healthcare: our vision for digital, data and technology in health and care: DHSC London, 2018.
- Haghi M, Thurow K, Stoll R. Wearable Devices in Medical Internet of Things: Scientific Research and Commercially Available Devices. Healthcare informatics research 2017;23(1):4-15. doi: 10.4258/hir.2017.23.1.4 [published Online First: 2017/03/07]
- Nwosu AC, Collins B, Mason S. Big Data analysis to improve care for people living with serious illness: The potential to use new emerging technology in palliative care. Palliative Medicine 2018;32(1):164-66. doi: 10.1177/0269216317726250
- Hancock S, Preston N, Jones H, et al. Telehealth in palliative care is being described but not evaluated: a systematic review. BMC palliative care 2019;18(1):114.
- Nwosu AC, Sturgeon B, McGlinchey T, et al. Robotic technology for palliative and supportive care: Strengths, weaknesses, opportunities and threats. Palliat Med 2019;33(8):1106-13. doi: 10.1177/0269216319857628 [published Online First: 2019/06/30]
- Chan A, Chien I, Moseley E, et al. Deep learning algorithms to identify documentation of serious illness conversations during intensive care unit admissions. Palliat Med 2019;33(2):187-96. doi: 10.1177/0269216318810421 [published Online First: 2018/11/15]
- Avati A, Jung K, Harman S, et al. Improving palliative care with deep learning. BMC medical informatics and decision making 2018;18(Suppl 4):122. doi: 10.1186/s12911-018-0677-8 [published Online First: 2018/12/13]
- Niki K, Okamoto Y, Maeda I, et al. A Novel Palliative Care Approach Using Virtual Reality for Improving Various Symptoms of Terminal Cancer Patients: A Preliminary Prospective, Multicenter Study. J Palliat Med 2019;22(6):702-07. doi: 10.1089/jpm.2018.0527 [published Online First: 2019/01/25]
- Perna M, MSW, Letizia, Lund S, White N, et al. The Potential of Personalized Virtual Reality in Palliative Care: A Feasibility Trial. American Journal of Hospice and Palliative Medicine® 2021:1049909121994299.
- Nwosu AC, Mills M, Roughneen S, et al. Virtual reality in specialist palliative care: a feasibility study to enable clinical practice adoption. BMJ supportive & palliative care 2021
- Nwosu AC, McGlinchey T, Mason S. 144 The ‘technology in palliative care’(TIP) study: a delphi study to define research priorities for the use of technology for the clinical management of people with serious illness: British Medical Journal Publishing Group, 2020.
- Greenhalgh T, Koh GCH, Car J. Covid-19: a remote assessment in primary care. Bmj 2020;368
- Calton B, Abedini N, Fratkin M. Telemedicine in the Time of Coronavirus. J Pain Symptom Manage 2020;60(1):e12-e14. doi: 10.1016/j.jpainsymman.2020.03.019 [published Online First: 2020/04/03]
- Grewal US, Terauchi S, Beg MS. Telehealth and Palliative Care for Patients With Cancer: Implications of the COVID-19 Pandemic. JMIR Cancer 2020;6(2):e20288. doi: 10.2196/20288 [published Online First: 2020/10/14]
- Ritchey KC, Foy A, McArdel E, et al. Reinventing palliative care delivery in the era of covid-19: how telemedicine can support end of life care. American Journal of Hospice and Palliative Medicine® 2020;37(11):992-97.
- Bettini EA. COVID-19 Pandemic Restrictions and the Use of Technology for Pediatric Palliative Care in the Acute Care Setting. J Hosp Palliat Nurs 2020;22(6):432-34. doi: 10.1097/njh.0000000000000694 [published Online First: 2020/09/15]
- Chávarri‐Guerra Y, Ramos‐López WA, Covarrubias‐Gómez A, et al. Providing Supportive and Palliative Care Using Telemedicine for Patients with Advanced Cancer During the COVID‐19 Pandemic in Mexico. The oncologist 2020
- Mackey RM, Yeow ME, Christensen AR, et al. Reconnecting: Strategies for Supporting Isolated Older Adults during COVID-19 through Tele-palliative Care. Clinical gerontologist 2020:1-8.
- Harris DA, Archbald-Pannone L, Kaur J, et al. Rapid Telehealth-Centered Response to COVID-19 Outbreaks in Postacute and Long-Term Care Facilities. Telemedicine and e-Health 2021;27(1):102-06.
- Flores S, Abrukin L, Jiang L, et al. Novel Use of Telepalliative Care in a New York City Emergency Department During the COVID-19 Pandemic. The Journal of emergency medicine 2020;59(5):714-16.
- Lu Y, Xie D, Zhang X, et al. Management of intractable pain in patients with implanted spinal cord stimulation devices during the COVID-19 pandemic using a remote and wireless programming system. Frontiers in neuroscience 2020;14
- Sansom‐Daly UM, Bradford N. Grappling with the ‘human’problem hiding behind the technology: Telehealth during and beyond COVID‐19. Psycho-oncology 2020
- Samara J, Liu W-M, Kroon W, et al. Telehealth Palliative Care Needs Rounds During a Pandemic. The Journal for Nurse Practitioners 2021
- Chua IS, Jackson V, Kamdar M. Webside Manner during the COVID-19 Pandemic: Maintaining Human Connection during Virtual Visits. J Palliat Med 2020;23(11):1507-09. doi: 10.1089/jpm.2020.0298 [published Online First: 2020/06/12]
- Lally K, Kematick BS, Gorman D, et al. Rapid Conversion of a Palliative Care Outpatient Clinic to Telehealth. JCO Oncol Pract 2021;17(1):e62-e67. doi: 10.1200/op.20.00557 [published Online First: 2020/12/12]
- Crosby B, Hanchanale S, Stanley S, et al. Evaluating the use of video communication technology in a hospital specialist palliative care team during the COVID-19 pandemic. AMRC Open Research 2021;3(5):5.
- Lal A, Bell G, Curseen K, et al. Teaching Telepalliative Care: An Elective Rotation for Medical Students during the COVID-19 Pandemic. Journal of Palliative Medicine 2020
- Abel J, Taubert M. Coronavirus pandemic: compassionate communities and information technology. BMJ Supportive & Palliative Care 2020;10(4):369-71. doi: 10.1136/bmjspcare-2020-002330
- Mills J, Li C, Fullerton S, et al. Staying connected and informed: Online resources and virtual communities of practice supporting palliative care during the novel coronavirus pandemic. Progress in Palliative Care 2020;28(4):251-53. doi: 10.1080/09699260.2020.1759876
- Niki K, Okamoto Y, Ueda M. Response to Wang et al., Virtual Reality as a Bridge in Palliative Care during COVID-19 (DOI: 10.1089/jpm.2020.0212). J Palliat Med 2020;23(7):892-94. doi: 10.1089/jpm.2020.0261 [published Online First: 2020/05/13]
- Wang SS, Teo WZ, Teo WZ, et al. Virtual reality as a bridge in palliative care during COVID-19. Journal of palliative medicine 2020;23(6):756-56.
Dr Amara Nwosu
Lancaster University (UK)