Review article: Biomedical intelligence

Feasibility, acceptability and needs in telemedicine for palliative care

A pre-implementation phase scoping review

Publication Date: 09.03.2022
Swiss Med Wkly. 2022;152:w30148

Andreas S.  Ebnetera, Thomas C.  Sauterb, Andri Christena, Steffen Eychmuellera

a University Centre for Palliative Care, Inselspital University Hospital Bern, Switzerland

b Department of Emergency Medicine, Inselspital University Hospital Bern, Switzerland


BACKGROUND: Telemedicine in palliative care was initially developed in countries where geography or resources limit access to care services. Recently, largely owing to the COVID-19 pandemic, this technology is being increasingly used in highly urbanised countries such as Switzerland. However, there is still scepticism regarding whether these tools can be used effectively in palliative care, a relationship-based speciality that is generally highly dependent on compassion, communication and direct human interaction. The objective of this review was to analyse the needs, elements of feasibility, and reasons for acceptance or possible barriers before the implementation of a telemedicine intervention in Switzerland.

METHODS: The method used was a scoping review, following the PRISMA-ScR reporting guidelines. We searched the PubMed, Ovid SP, Medline, Cochrane and Scopus databases for relevant reports. Charting and analyses of the data were done by a single researcher. A total of 520 records were screened and assessed for eligibility. Finally, 27 studies and 4 registry entries were included. Main reasons for exclusion were wrong population and intervention.

RESULTS: The prevailing study type was the single-arm intervention study. Most studies originated from countries with geographic barriers to access. Feasibility was good in 69% of all studies. Good acceptability (84.1–100%) was confirmed in the majority of the studies. The needs of the patients or the healthcare professionals were directly addressed in only five (16%) studies. Three needs were consistently reported: communication, coordination and technical reliability

CONCLUSION: Despite a broad range of studies on telemedicine in palliative care, patients’ needs are rarely addressed. Therefore, especially in countries such as Switzerland, a needs assessment is recommended before the implementation of a new telemedicine intervention, to guarantee high feasibility and acceptability.


Telemedicine is a growing field. According to the definition of the World Health Organization (WHO), telemedicine encompasses virtual communication and remote monitoring tools in the large field of digital health intervention [1]. Historically, virtual communication was only rarely used by healthcare professionals [2]. Today, this communication modality is widely accepted by patients and caregivers, and is gaining acceptance from professionals [3]. The two main drivers of this development have been first, general technological advances in digitalisation [4] and second, the acceleration in use due to the COVID-19 pandemic [5, 6].

In general medicine, these interventions are commonly used in medical specialities such as psychiatry, dermatology, neurology, radiology and rehabilitation [7]. There are some proven benefits of telemedicine in general practice, but these cannot be generalised well due to the heterogeneity of the tools and populations [8].

In palliative care, recent reviews of the subject show good feasibility and some evidence of the effectiveness of telemedicine [3, 9, 10]. The review of Gordon et al. showed that a clear majority of patients were satisfied with these tools and view them as potentially equal to fact-to-face contact [10]. The meta-review of Finuance mainly explored aspects of the effectiveness of a variety of telemedicine technologies, ranging from social media to video-conferencing. The main focus of the studies was video-conferencing, and the positive effects described related primarily to psychological symptoms, communication, information sharing and use of resources [3].

Most of the studies focused on feasibility and acceptability and did not evaluate the formal needs of patients and healthcare providers before design of the intervention, probably because there was an immediate necessity for the implementation of the tools (i.e., distance/COVID).

If there is no existing telemedicine policy or overall concept, many digital tools are used for the convenience of patients or providers, but the actual needs of patients/caregivers remain unknown.

Countries with easy access to health care, such as Switzerland, have been less pressured by necessity to use telemedicine. This situation allows to carefully prepare and tailor digital health interventions from the outset, beginning with an assessment of the feasibility and of the patients/caregivers and health care provider’s needs.

The development of a complex intervention such as telemedicine should be based on a thorough understanding and the experience of existing practice models. The results of this review can be the basis for planning and tailoring a specific telemedicine intervention for palliative care patients, caregivers and professionals. According to the MORE Care Guidelines [11], we regard this review as the preliminary step in the evaluation for such an intervention in a practice environment where it has not yet been implemented.

Therefore, the objective of this review was to evaluate the existing literature on the feasibility and acceptability of a telemedicine intervention in palliative care with a focus on the needs of patients/caregivers and healthcare professionals in both in- or outpatient palliative care by addressing the following question:

What are the known needs, elements of feasibility,and reasons for acceptance of a telehealth intervention in palliative care?


This review follows the recommendation of Munn et al. [12], the PRISMA 2020 Statement [13] and PRISMA-ScR [14] guideline/checklist (appendix 1) and was registered as a project on the OSF registry (10.17605/OSF.IO/KJ346).

Eligibility criteria

All reports that involved adult (>18 years) palliative care patients, caregivers and healthcare professionals in an in- or outpatient palliative care service were included. Supportive care and general medicine patients without the designation of palliative were not included. No language or study design restrictions were applied. Telemedicine interventions of interest were virtual visits, virtual peer-to-peer communication and remote monitoring (2.4.1–2.4.4 of the WHO telemedicine classification) [1]. All other interventions, especially telephone-based or asynchronous digital communication modalities, were not eligible. To be included, the reports/studies had to present a measurement of “feasibility”, “acceptability” or “needs” as an outcome. Studies with only indirect markers, for example, simple satisfaction surveys or using consistent adherence as a surrogate marker for feasibility and acceptability, were excluded.

Databases and search strategy

The PubMed, Ovid SP, Medline, Cochrane and Scopus databases where searched on 29 April 2021 for reports matching the terms of the inclusion criteria. Prospero,, and OFS were searched for studies/reviews on telemedicine in palliative care. The PubMed database was searched with the following main search terms using the advanced search function: ((Telemedicine) OR (Telehealth) OR (Digital health interventions)) AND (Palliative Care)) AND ((Feasibility) OR (Acceptability) OR (needs)). Dates were restricted to 2010 or later. The Ovid SPN and Scopus databases were searched with the same search strategy. Registries were searched more broadly, with the terms “Telemedicine and Palliative Care.” The Cochrane library was searched with the use of the terms “Digital” and “Telemedicine.”

Details of the search strategy can be found in appendix 2.

Study selection

Studies were selected in two steps by a single researcher (AE). A second researcher (SE) resolved uncertainties through discussions with the first when necessary. The titles and abstracts of all reports from the literature search were screened for eligibility using the following inclusion criteria: (1) population (adult in/outpatient palliative care patient/caregivers and professionals) and (2) intervention (telemedicine as defined by the WHO).

This was followed by a full-text analysis of the eligible reports. All inclusion criteria were sequentially applied in this second step : first, by assuring the full text still matched the right population and intervention; second, by assessing them for one of the predefined outcomes (“feasibility”, “acceptability”, “needs”).

Data extraction

Charting was done by a single researcher (AE), using the spreadsheet function of Excel, according to PRISMA [15]. A second researcher (AC) double-checked the methodological characteristics of the charted studies. We collected data on each report (author, year, study design), such as the population (origin, age, setting and sample size), the intervention (technology, main purpose, follow-up time), and, finally, the outcomes and key findings (feasibility, acceptability and needs). For records from registries, we collected information about the author, project start, expected finishing year, study design, population (origin, type and sample size), the intervention (technology), and outcomes (feasibility, acceptability and needs). No protocol deviation was noted.


We found 643 records and 61 registry entries. After removal of duplicates, a total of 520 records (459 reports, 61 registry entries) were screened for eligibility. Of these, 411 (388 report, 44 registry entries; 79%) were excluded, mainly because they did not correspond to the required population or were not related to telemedicine. After excluding one conference paper, 67 further records were excluded (54 studies, 13 registry entries) mainly because they did not match the predefined intervention or outcome (feasibility, acceptability and needs) criteria. Of the 98 (19% of initial yield) remaining full-text reviewed records, 27 reports and 4 registry entries were selected for the analysis. Details are described in a PRISMA 2020 flow diagram [16] (fig. 1)

Figure 1

PRISMA flow diagram, adapted from

In the 27 reports, the 3 most common designs were single-arm intervention studies (9; 33%) [17–25], reviews (6; 22.2%) [3, 26–30], and qualitative studies (4; 14.8%) [31–34]. The remainder were cohort, cross-sectional studies or reports / expert opinions [35–41], with only one randomised controlled study [42]. The quality of the original studies was categorised according to the PDQ® level of evidence, a four-level grading scale developed by the National Cancer Institute specifically for studies in the field of supportive and palliative care [43]. There was only one level I original study [20], whereas 15 were level II, 5 were level III and the rest were level IV. Only four registry entries of ongoing studies were included, three reviews [44–46] and one pilot study [47]. All four should be completed by 2022.

A summary of the characteristics of the selected studies was created as a simplified table containing the following items: author, year, study design, population, intervention, and outcome (as a dichotomised value: present / not present) (tables 1 and 2). A comprehensive overview of the different users, independence of use and main elements of the three outcomes (feasibility, acceptability, and needs) can be found in appendix 3.

Table 1

Characteristics of the sources of evidence in the included studies/reports (summary).

Author(s)/yearStudy designPopulationSettingInterventionFeasibilityAcceptabilityNeeds
Finucane et al. (2021)Systematic reviewMixedMixedMixed 
Jess et al. (2019)Systematic reviewAdultMixedVideo consultation 
Zheng et al. (2016)Systematic reviewMixedMixedVideo consultation 
Hoek et al. (2017)Randomised controlled trialAdult, oncologyOutpatientVideo consultation  
Chávarri-Guerra et al. (2021)Cohort studyAdult, oncologyOutpatientVideo consultation / telephone  
Jiang et al. (2020)Cohort studyAdult, oncologyOutpatient, ruralVideo consultation 
Nkhoma et al. (2021)Cross sectional surveyAdultPublic facilitiesTelemedicine in general (√)
Phongtankuel et al. (2018)Cross sectional surveyAdultOutpatientMobile app
Cheung et al. (2021)Non-randomised trialAdult, non-oncologicalOutpatient (dayclinic), ruralVideo consultation 
Bentley et al. (2020)Single-arm intervention studyAdultOutpatientVideo consultation 
Bonsignore et al. (2018)Single-arm intervention studyAdultOutpatientruralVideo consultation; remote monitoring(√)(√) 
Elk et al. (2020)Single-arm intervention studyAdultInpatientVideo consultation(√)
Kuntz et al. (2020)Single-arm intervention studyAdultInpatientVideo consultation 
Moore et al. (2020)Single-arm intervention studyAdultMixedVideo consultation 
Schoppee et al. (2020)Single-arm intervention studyAdultOutpatientData-transmision 
Slavin-Stewart et al. (2020)Single-arm intervention studyAdult, oncologyOutpatientVideo consultation 
Tieman et al.(2016)single-arm intervention studyadult, oncologyoutpatientTelemedicine in general(√) 
Weck et al. (2019)Single-arm intervention studyAdult, non-oncologicalOutpatientVideo consultation 
Funderskov et al. (2019)Qualitative studyAdultOutpatientVideo consultation 
Portz et al. (2020)Qualitative studyAdultMixedTelemedicine in general  
Read Paul et al. (2019)Qualitative studyAdult, oncologyOutpatientVideo consultation 
Tasneem et al. (2019)Qualitative studyAdult, oncologicalOutpatient, urbanVideo consultation(√)
Steindal et al. (2020)Review-otherAdultOutpatientVideo consultation 
Sutherland et al. (2020)Review-otherMixedMixedVideo consultation  
Widberg et al. (2020)Review-otherAdultMixedTelemedicine in general 
Calton et al. (2019)OtherAdultn/aVideo consultation(√)(√)(√)
Hawkins et al. (2020)OtherAdultn/aVideo consultation  (√)

Table 2

Characteristics of the sources of evidence in the included ongoing studies (summary).

Author(s)/start–endStudy designPopulationSettingInterventionFeasibilityAcceptabilityNeeds
Steindal et al. (2020–2021)Systematic reviewAdultOutpatientMixed  
Longo et al. (2020–2021)Systematic reviewAdultOutpatientMixed 
Hutchinson et al. (2020–2021)Systematic reviewAll ages?Mixed 
University of California(2021–2021)Pilot studyAdultOutpatientVideo consultation 

Virtual visits, defined as digital video consultations between patient and healthcare provider were the most frequently used (70.4%) form of telemedicine [17, 19–21, 23, 25–28, 30, 31, 33–39, 42]. The outpatient setting was mostly studied, with only two interventional trials [19, 20] focusing on the inpatient setting. Geographically, most studies were conducted in countries with large geographic distances (appendix 4). The clients were primarily patients and/or caregivers (70%) [17–25, 27–30, 33, 34, 36, 37, 39, 41, 42]. The most common providers were physicians alone (33%) [17–20, 27, 33, 34, 37, 39] and the core palliative care team (physician and nurse) (40%) [21, 23–25, 28–31, 36, 38, 42]. Four reports (15%) [3, 26, 35, 40] described multiple/mixed providers, and only one study (4%) [22] involved nursing providers exclusively.

Independence of use, meaning that the tools were used independently by the patient or caregiver, was reported in eight studies [17, 18, 22, 24, 36, 40–42].


Feasibility was a specific outcome in 23 (85%) of the 27 studies included [3, 17–31, 33–37, 39, 41] and was mainly (82%) assessed with purpose-designed questionnaires or questions. Most studies define “feasibility” as the technical efficacy of the digital connection and the telemedicine intervention. Only one study [21] used a validated tool, the Telehealth Usability Questionnaire [48]. Technical feasibility rated by the patient and healthcare professional was found to be good in 74% of the assessed interventions [3, 17, 18, 20, 21, 23–31, 33–37, 39]; most patients described a good user experience. The reliability of the connection, security and usability were the main elements of concern for the patient and healthcare professional [33, 41]. As an example, the study by Read et al. [33], which analysed client to provider telemedicine in a rural setting, proved that effective communication was possible with only a few technical issues.


Acceptability was described as a specific outcome in 24 (89%) of the 27 studies analysed [3, 17–31, 33–35, 37, 39–42]. The assessment tools were more heterogeneous than those used for feasibility; four were validated questionnaires [19, 21, 22, 42], and the rest were interviews [18, 25, 32–34, 40] and purpose-built questionnaires. The definition of acceptability was more variable, mostly referring to three themes: general satisfaction, positive acceptance as a communication tool and not inferior to physical visits.

General satisfaction ranged from 84.1–100% in the original studies that specifically analysed this item [21, 29, 39], and this was confirmed by two reviews [29, 30].

Generally, patients, caregivers, and healthcare professionals alike accepted these tools as a valid way of communication [27]. The acceptance of it as a communication tool is confirmed on different levels; patients experienced a feeling of connectedness [37]. The addition of a visual component enhanced the experience of the patient [25] and the discussion of concerns is possible [33]. In the context of a family meeting, understanding was good and the virtual visit helped to increase trust in the treatment in a positive way; interestingly, the sharing of wishes and hopes was only possible for 50% of the participants [20].

There is substantial evidence that virtual visits can be seen as equal to physical visits in an appropriate setting [24, 29, 35, 37, 39]. Three sources even mentioned that some patients preferred (42–77%) telemedicine over physical visits in a variety of different settings [24, 37, 39].


Only seven studies (26%) with different methodologies (two cross-sectional surveys, one single-arm intervention study, two qualitative studies and two expert opinions) assessed the needs of patients, caregivers and healthcare professionals regarding telemedicine tools [19, 32, 34, 35, 38, 40, 41]. Even fewer (four, 15%) assessed the needs in the context of a digital health intervention directly [19, 32, 40, 41], and all of these used qualitative methods. The definition of “needs” is broad and heterogeneous, and generally refers to the preference of the client. Direct evidence of need was any qualitative statement from a stakeholder (patient, caregiver or healthcare professional) that expressed a wish or a need for a specific function in the tool; indirect evidence was statements regarding preferences for or essential elements of a telemedicine tool. Most stakeholders were able to identify at least one or several potential or actual needs for digital tools in palliative care. In addition, being able to access a service at home without the need for travel seemed to be included in the indirectly mentioned needs [34].

Independent of the role of the stakeholder (patient, caregiver, healthcare professional or policy-maker), the three most commonly mentioned needs were: improvement of communication, coordination of care and technical usability.

First, under improvement of communication, visual contact, increased accessibility (including after-hours) and better follow-up seemed to be the most important needs in this theme [32, 40, 41].

Second, under coordination of care, several studies described needs related to coordination, for example, scheduling, central triage, collaboration between different health services and resources planning [32, 40, 41]. This need is equally important to the patient and the family caregiver, and focuses on improving care at home. For the healthcare professional and policy maker, an additional focus is to improve the performance of the service by analysing trends and resource needs and being able to access recent data [40].

Third, under technical usability, one need that was stated either directly or indirectly is the technical reliability and security of the tools. These tools should provide a stable connection, be simple to use and ensure privacy. It should be accessible to a broad population and there should be support from digital natives in the use of it. Finally, and importantly, the tools should be affordable [19, 40].

In addition, another indirectly mentioned need is the availability of a service at home without the need for travel [34].

A critical view from one study was that participants who stated few needs regarding digital communication tools (continuity of care, visual identification of the person as a healthcare professional and presence of family) focused more on potential discomfort with digital tools and cultural incomprehension [19].


In essence this review showed that telemedicine seems to be a feasible digital health intervention in palliative care and that patients, caregivers and health professionals are accepting it. The question of which needs should be considered could be answered only partially because few studies addressed the key needs of telemedicine in this population.

Feasibility and acceptability

In line with the most recent meta-reviews [3], this review confirmed the feasibility of telemedicine as a communication tool in palliative care. In addition to ease of use and stability of the internet connection, adequate training of healthcare professionals is important. The question of whether these tools can be reliably used without the help of a third party remains. The patient or caregiver was aided by the healthcare person with the set-up of the tool in more than half of the home deployments.

There seemed to be a high rate of acceptability. Especially related to communication, the patients were confident that these interventions do not significantly affect their experience of quality of communication compared with a face-to-face consultation [35]. A greater proportion of patients even perceived the virtual visit to be comparable to physical visits, referring to the visual connection [27, 29]. Therefore, we suggest that the visual component of the communication is of great importance, and one can argue that the advantages will outweigh the inconvenience (lack of physical connection) or the fear of information breaches. There was a difference between the acceptability among the patients/caregiver (clients) and the healthcare professionals), with the latter being somewhat more critical of the new tools [37].

Acceptability seemed to be influenced by barriers and facilitators for both the patients/caregivers and the healthcare professionals. The recent systematic review by Disalvo et al. [49] provided an overview of these. Their findings confirmed the results of this review through emphasising the importance of an efficient infrastructure (system level), positive attitude and adequate training (clinician level and patient level). The main differences compared with our study were (a) the large array of technologies, including e-mail, telephone and SMS text messaging, (b) the inclusion of all ages, (c) the focus on barriers and facilitators and not, like our study, on needs.


A direct needs assessment did not seem to be a priority  in the studies that evaluate telemedicine in palliative care. This is remarkable, especially since it is generally acknowledged that a needs assessment is necessary before the implementation of any digital health intervention [50, 51]. The reason for this might be linked to the fact that most of these tools were born out of necessity (distance, pandemic) and that the barrier to access was considered a generally accepted need that overrules other individual needs of patients, caregivers, and healthcare professionals. Nonetheless, the studies that addressed needs directly or indirectly as an outcome show three important factors, namely communication, coordination and technical aspects (usability).

Almost all digital health interventions have a dominant communication element and good communication is the major element in palliative care [3, 40]. This review showed that most needs seem to relate to the quality of the interaction (visual, follow-up possibility) and the accessibility.

Coordination is a major challenge in palliative care as many members of the interdisciplinary team interact with the so-called “unit of care”, the patient and the caregiver. Therefore, it is not surprising that multiple needs were described, ranging from simple scheduling to coordination of care at home. Both patients/caregivers and healthcare professionals attached equal importance to coordination [40].

Technical reliability is important for the “perceived ease of use” and “behavioural intention to use” aspect of the acceptance of the technology (TAM-Model) [52]. Low quality connections and unreliable digital tools are a source of frustration; therefore, addressing these issues is important. As mentioned before, in the majority of cases, a third person assisted with the set-up of the tool, which strongly indicates that patients do not use the tool autonomously, or at least not during the first virtual visit.

Being able to access a service from home was a factor towards acceptability [49], but it was rarely evaluated as a need. If asked, patients agreed that there is a need for digital health interventions to facilitate their lives at home [34], for example, by having follow-up visits without the necessity to travel [40]. This corresponds to the general preference for home care in palliative care, even in end-of-life situations [53].

Notably, only a few studies reflected a critical view of the tools [19]. Our hypothesis is that, as most of the studies focused on quality control, there might be a selection bias in the population because of the inclusion of participants less critical of technology, and a possible publication bias. Another reason could be that the convenience (ease of access, less travel) largely outweighed any negative points, thereby reducing any criticism.

Impact on the planning of the implementation of such a tool

Implementing telemedicine in a medical system that has good availability of care and openness to digitalisation is only low to moderate [54] is a challenge. This holds true for the healthcare system in Switzerland, where digital tools were viewed critically by healthcare professionals and patients alike before the pandemic [55–57]. In contrast to other countries, this critical view seems to have been only slowly changing since the onset of the COVID-19 pandemic [54].

Feasibility seems largely proven, and the components to ensure acceptability are known and likely to be universal [49]. Therefore, we propose that the potential of telemedicine to improve palliative care in Switzerland should be evaluated, in regard to the need, feasibility and acceptability of such a service. Should there be a clear need for it, a secure and easy-to-use telemedicine intervention in palliative care should be evaluated for its efficacy.


This review has several limitations. First, the scientific evidence was mainly based on low to moderate quality studies. Most studies were single-arm quality-control/implementation studies, and comparison groups were lacking; therefore, their results should be viewed with caution. The reason is probably that most studies evaluated existing tools, which were born out of necessity (distance or epidemic (COVID-19)) and, thus, they should be interpreted in that specific context.

This leads us to the second limitation, namely, generalisability. As most studies were conducted in countries with significant distances or low-density medical environments, it is difficult to generalise to settings with a highly developed medical service density, such as central Europe.

Third, the method used in this review could cause a selection and detection bias because only a single author selected and charted the information. Additionally, the search strategy was not as large as in other reviews. The results of other reviews addressing the most commonly assessed outcomes (feasibility and acceptability only) are similar to our review, therefore we believe that the relevant literature was identified by our work.


The growing field of telemedicine has arrived in a relationship-based speciality such as palliative care. The necessity created by long distances and restricted access due to the pandemic are two of the major drivers of this development. Telemedicine is feasible and accepted as a means of communication in such settings, but a direct need assessment before a new deployment of such a tool was only rarely done.

Many countries with dense, highly accessible medical systems, similar to the situation in Switzerland, have begun to adopt these tools. They do not have the same elements of necessity, such as in large countries. Therefore, a comprehensive, adaptive needs assessment should be done, involving both the users and providers in these countries, before or during the implementation of a new tool, especially in palliative care.

Financial disclosure

The review was founded by the University centre of palliative care.

Conflicts of interest

All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. TCS holds the endowed professorship for emergency telemedicine at the University of Bern founded by the Touring Club Switzerland. The sponsor had no influence on the content of the research or the decision to publish. No other potential conflict of interest was disclosed.


Andreas Samuel Ebneter, MD

Inselspital / Universitätsspital Bern

CH-3010 Bern



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30. Zheng Y, Head BA, Schapmire TJ. A Systematic Review of Telehealth in Palliative Care: caregiver Outcomes. Telemed J E Health. 2016 Apr;22(4):288–94. PubMed 1556-3669

31. Funderskov KF, Boe Danbjørg D, Jess M, Munk L, Olsen Zwisler AD, Dieperink KB. Telemedicine in specialised palliative care: healthcare professionals’ and their perspectives on video consultations-A qualitative study. J Clin Nurs. 2019 Nov;28(21-22):3966–76. PubMed 1365-2702

32. Portz JD, Ford KL, Doyon K, Bekelman DB, Boxer RS, Kutner JS Using Grounded Theory to Inform the Human-Centered Design of Digital Health in Geriatric Palliative Care. J Pain Symptom Manage. 2020;60(6):1181-92 e1. Epub 2020/07/03. doi: . PubMed PMID: 32615298; PubMed Central PMCID: PMCPMC7323666.

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36. Chavarri-Guerra Y, Ramos-Lopez WA, Covarrubias-Gomez A, Sanchez-Roman S, Quiroz-Friedman P, Alcocer-Castillejos N Providing Supportive and Palliative Care Using Telemedicine for Patients with Advanced Cancer During the COVID-19 Pandemic in Mexico. Oncologist. 2021;26(3):e512-e5. Epub 2020/10/24. doi: . PubMed PMID: 33094533; PubMed Central PMCID: PMCPMC7930406.

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41. Phongtankuel V, Shalev A, Adelman RD, Dewald R, Dignam R, Baughn R Mobile Health Technology Is Here-But Are Hospice Informal Caregivers Receptive? Am J Hosp Palliat Care. 2018;35(12):1547-52. Epub 2018/06/05. doi: . PubMed PMID: 29862851; PubMed Central PMCID: PMCPMC6185794.

42. Hoek PD, Schers HJ, Bronkhorst EM, Vissers KCP, Hasselaar JGJ. The effect of weekly specialist palliative care teleconsultations in patients with advanced cancer -a randomized clinical trial. BMC Med. 2017;15(1):119. Epub 2017/06/20. doi: . PubMed PMID: 28625164; PubMed Central PMCID: PMCPMC5474887.

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Appendix 1: PRISMA-ScR checkist

Table S1

Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist.

SectionItemPRISMA-ScR Checklist itemReported on page # in the PDF version of the article
Title1Identify the report as a scoping review.1
Structured summary2Provide a structured summary that includes (as applicable): background, objectives, eligibility criteria, sources of evidence, charting methods, results, and conclusions that relate to the review questions and objectives.1
Rationale3Describe the rationale for the review in the context of what is already known. Explain why the review questions/objectives lend themselves to a scoping review approach.1
Objectives4Provide an explicit statement of the questions and objectives being addressed with reference to their key elements (e.g., population or participants, concepts, and context) or other relevant key elements used to conceptualize the review questions and/or objectives.2
Protocol and registration5Indicate whether a review protocol exists; state if and where it can be accessed (e.g., a Web address); and if available, provide registration information, including the registration number.2
Eligibility criteria6Specify characteristics of the sources of evidence used as eligibility criteria (e.g., years considered, language, and publication status), and provide a rationale.2
Information sources*7Describe all information sources in the search (e.g., databases with dates of coverage and contact with authors to identify additional sources), as well as the date the most recent search was executed.2
Search8Present the full electronic search strategy for at least 1 database, including any limits used, such that it could be repeated.2
Selection of sources of evidence**9State the process for selecting sources of evidence (i.e., screening and eligibility) included in the scoping review.2
Data charting process***10Describe the methods of charting data from the included sources of evidence (e.g., calibrated forms or forms that have been tested by the team before their use, and whether data charting was done independently or in duplicate) and any processes for obtaining and confirming data from investigators.2
Data items11List and define all variables for which data were sought and any assumptions and simplifications made.2
Critical appraisal of individual sources of evidence****12If done, provide a rationale for conducting a critical appraisal of included sources of evidence; describe the methods used and how this information was used in any data synthesis (if appropriate).n/a
Synthesis of results13Describe the methods of handling and summarizing the data that were charted.2
Selection of sources of evidence14Give numbers of sources of evidence screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage, ideally using a flow diagram.2
Characteristics of sources of evidence15For each source of evidence, present characteristics for which data were charted and provide the citations.2
Critical appraisal within sources of evidence16If done, present data on critical appraisal of included sources of evidence (see item 12).n/a
Results of individual sources of evidence17For each included source of evidence, present the relevant data that were charted that relate to the review questions and objectives.4
Synthesis of results18Summarize and/or present the charting results as they relate to the review questions and objectives.4
Summary of evidence19Summarize the main results (including an overview of concepts, themes, and types of evidence available), link to the review questions and objectives, and consider the relevance to key groups.5
Limitations20Discuss the limitations of the scoping review process.6
Conclusions21Provide a general interpretation of the results with respect to the review questions and objectives, as well as potential implications and/or next steps.6
Funding22Describe sources of funding for the included sources of evidence, as well as sources of funding for the scoping review. Describe the role of the funders of the scoping review.6

JBI = Joanna Briggs Institute; PRISMA-ScR = Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews.

* Where sources of evidence (see second footnote) are compiled from, such as bibliographic databases, social media platforms and Web sites.

** A more inclusive/heterogeneous term used to account for the different types of evidence or data sources (e.g., quantitative and/or qualitative research, expert opinion, and policy documents) that may be eligible in a scoping review as opposed to only studies. This is not to be confused with information sources (see first footnote).

*** The frameworks by Arksey and O’Malley and Levac and colleagues and the JBI guidance  refer to the process of data extraction in a scoping review as data charting.

**** The process of systematically examining research evidence to assess its validity, results, and relevance before using it to inform a decision. This term is used for items 12 and 19 instead of "risk of bias" (which is more applicable to systematic reviews of interventions) to include and acknowledge the various sources of evidence that may be used in a scoping review (e.g., quantitative and/or qualitative research, expert opinion, and policy document).

From: Tricco AC, Lillie E, Zarin W, O'Brien KK, Colquhoun H, Levac D, et al. PRISMA Extension for Scoping Reviews (PRISMAScR): Checklist and Explanation. Ann Intern Med. 2018;169:467–473 [18]

Appendix 2: Details of search strategy

Search strategy – Academic publications
Key concepts:

(Telemedicine OR Telehealth OR Digital health interventions) AND (Palliative Care) AND (Feasibility OR Acceptability OR needs)

Filters: Date: from 2010/1/1 – 2021/4/28


(("telemedicine"[MeSH Terms] OR "telemedicine"[All Fields] OR "telemedicine s"[All Fields] OR ("telehealth s"[All Fields] OR "telemedicine"[MeSH Terms] OR "telemedicine"[All Fields] OR "telehealth"[All Fields]) OR (("lancet digit health"[Journal] OR "digit health"[Journal] OR ("digital"[All Fields] AND "health"[All Fields]) OR "digital health"[All Fields]) AND ("intervention s"[All Fields] OR "interventions"[All Fields] OR "interventive"[All Fields] OR "methods"[MeSH Terms] OR "methods"[All Fields] OR "intervention"[All Fields] OR "interventional"[All Fields]))) AND ("palliative care"[MeSH Terms] OR ("palliative"[All Fields] AND "care"[All Fields]) OR "palliative care"[All Fields]) AND ("feasibilities"[All Fields] OR "feasibility"[All Fields] OR "feasible"[All Fields] OR "feasiblity"[All Fields] OR ("accept"[All Fields] OR "acceptabilities"[All Fields] OR "acceptability"[All Fields] OR "acceptable"[All Fields] OR "acceptably"[All Fields] OR "acceptance"[All Fields] OR "acceptances"[All Fields] OR "acceptation"[All Fields] OR "accepted"[All Fields] OR "accepter"[All Fields] OR "accepters"[All Fields] OR "accepting"[All Fields] OR "accepts"[All Fields]) OR ("health services needs and demand"[MeSH Terms] OR ("health"[All Fields] AND "services"[All Fields] AND "needs"[All Fields] AND "demand"[All Fields]) OR "health services needs and demand"[All Fields] OR "needed"[All Fields] OR "needs"[All Fields] OR "needing"[All Fields]))) AND (2010/1/1:2021/4/28[pdat])

Search terms (free text and controlled vocabulary):

Telemedicine: "telemedicine"[MeSH Terms] OR "telemedicine"[All Fields] OR "telemedicine's"[All Fields]

Telehealth: "telehealth's"[All Fields] OR "telemedicine"[MeSH Terms] OR "telemedicine"[All Fields] OR "telehealth"[All Fields]

Digital health: "Lancet Digit Health"[Journal:__jid101751302] OR "Digit Health"[Journal:__jid101690863] OR ("digital"[All Fields] AND "health"[All Fields]) OR "digital health"[All Fields]

interventions: "intervention's"[All Fields] OR "interventions"[All Fields] OR "interventive"[All Fields] OR "methods"[MeSH Terms] OR "methods"[All Fields] OR "intervention"[All Fields] OR "interventional"[All Fields]

Palliative Care: "palliative care"[MeSH Terms] OR ("palliative"[All Fields] AND "care"[All Fields]) OR "palliative care"[All Fields]

Feasibility: "feasibilities"[All Fields] OR "feasibility"[All Fields] OR "feasible"[All Fields] OR "feasiblity"[All Fields]

Acceptability: "accept"[All Fields] OR "acceptabilities"[All Fields] OR "acceptability"[All Fields] OR "acceptable"[All Fields] OR "acceptably"[All Fields] OR "acceptance"[All Fields] OR "acceptances"[All Fields] OR "acceptation"[All Fields] OR "accepted"[All Fields] OR "accepter"[All Fields] OR "accepters"[All Fields] OR "accepting"[All Fields] OR "accepts"[All Fields]

needs: "health services needs and demand"[MeSH Terms] OR ("health"[All Fields] AND "services"[All Fields] AND "needs"[All Fields] AND "demand"[All Fields]) OR "health services needs and demand"[All Fields] OR "needed"[All Fields] OR "needs"[All Fields] OR "needing"[All Fields]


( TITLE-ABS-KEY ( telemedicine ) OR TITLE-ABS-KEY ( telehealth ) OR TITLE-ABS-KEY ( digital AND health AND interventions) AND TITLE-ABS-KEY ( palliative AND care ) AND TITLE-ABS-KEY ( feasibility ) OR TITLE-ABS-KEY ( acceptability ) OR TITLE-ABS-KEY ( needs ) ) AND ( LIMIT-TO ( PUBYEAR , 2021 ) OR LIMIT-TO ( PUBYEAR , 2020 ) OR LIMIT-TO ( PUBYEAR , 2019 ) OR LIMIT-TO ( PUBYEAR , 2018 ) OR LIMIT-TO ( PUBYEAR , 2017 ) OR LIMIT-TO ( PUBYEAR , 2016 ) OR LIMIT-TO ( PUBYEAR , 2015 ) OR LIMIT-TO ( PUBYEAR , 2014 ) OR LIMIT-TO ( PUBYEAR , 2013 ) OR LIMIT-TO ( PUBYEAR , 2012 ) OR LIMIT-TO ( PUBYEAR , 2011 ) OR LIMIT-TO ( PUBYEAR , 2010 ) )


Search strategy - Registries


(Telemedicine OR Digital Health intervention OR Telehealth) AND Palliative Care


Telemedicine AND Palliative Care


Digital OR Telemedicine

Appendix 3: Chart summary of users 

Table S2

Chart summary of users, independence of use, and the three outcome (feasibility, acceptability, and needs)

Author(s) / Year of publicationClientProviderIndependent useFeasibilityAcceptabilityNeeds
Chávarri-Guerra et al. (2021)Patient and caregiverPhysician, nurseYesNo barriers to initiation of intervention (58%)n/an/a
Cheung et al. (2021)PatientPhysicianNoTechnical success rate 94%Overall rating (patient) 81% at least as good as/ 42% better that physical consultation, relevance 84% Technical communication quality (1-5) 1.2–1.3, connection (approachable) 1.1, relevance 1.7n/a
Overall rating (physician): 60% equal to physical visits, 36% better than physical visit
Finucane et al. (2021)MixedMixedn/aGoodGood (qualitative statement)n/a
Nkhoma et al. (2021)MixedMixedYesn/aPositive attitude (bridging distance) Concerns regarding privacyPatients and caregivers: facilitated contact with HCP, access to care/disease information and after hours support, care coordination / HCP: Follow up, remote care delivery, improvement of efficiency / Policymakers: planning of care services, collaboration, improving value of care Service Resources requirements: Privacy, confidentiality, network stability, financial capacity, accessible technology, support for non-users
Bentley et al. (2020)PatientPhysicianYesGood (qualitative statement)4.33/5 recommend online consultationn/a
Elk et al. (2020)Phase 1: community and caregiver / Phase 2: community and professional / Phase 3: patient and caregiverPhysicianNoIndirect: few referrals from hospitalsOn the selected items: all satisfied or very satisfied (4-5/5)Phase 1: Experience in various treatment centres (indirect): lack of trust in the health care system; not comfortable with telehealth;family and culture centred care; clarity about opiate dosage; advanced care planning; need for service / Phase 2 (Discomfort with telemedicine and other concerns):Wear white coat, acknowledge that not the same as 1:1, continuity, family presence
Hawkins et al. (2020)MixedPhysician, nursen/an/an/aFacilitating factors: preference of patient, convenience for patient (distance), establish rapport
Jiang et al. (2020)PatientPhysicianNoDuration slightly shorter that analogue; comfortable with equipment (95%)Patient: overall satisfaction: 100%, patient-clinician rapport: 100%, superior to physical: 77%; caregiver convenience and reduced travel time: 100%n/a
Kuntz et al. (2020)CaregiverPhysicianNoOverall quality (physicians): 3.18 (Likert Scale 1-5)General: good response, good usability, acceptable, comfortable with tool / Communication: understanding 90%, understanding thoughts and wishes 50%, help to trust team: 90%n/a
Moore et al. (2020)PatientPhysician, nurseNoGood audio connection 91.6% good visual connection 84%Satisfied 88.6% / would use it again 91.7%n/a
Portz et al. (2020)Mixedn/an/an/an/aIndirect: connection with the family, communication and information need / Direct: Symptom monitoring: patient portal, interoperability, medication reminders, goal setting features / Psychosocial support: photos of loved ones, encouraging SMSs, music / Decision support: checklists for specific situations / Family support: Syncing to family organisation apps, resources / Spiritual care: Connection with spiritual social media / Goal setting: in-app goal setting / Educational resources: credible links / Algorithm features: communication features patient – family, video visits, in-app games
Schoppee et al. (2020)Patient caregiverNurseYesn/aPatients 87%, caregivers 70%; age slightly negative, gender and race, no influencen/a
Slavin-Stewart et al. (2020)PatientPhysician, nurseNoVideo/audio quality 100%, > 4/5; connection stability 100%, > 4/5Patient/caregiver satisfaction, overall 4.29, concerns addressed 4.71, use again 4.64n/a
Steindal et al. (2020)PatientPhysiciann/aIf app simple: good usability, comfort / barriers to use; poor health, physical limitations / technical: small font, equipment not portableVideo useful for communicationn/a
Sutherland et al. (2020)Patient and caregiverPhysician, nursen/aGoodn/an/a
Widberg et al. (2020)PatientPhysician, nursen/aUser-friendly and feasiblehighly satisfactory, eventually preferred to 1:1n/a
Calton et al. (2019)MixedMixedn/aFeasible for a wide range of patients (incl. vulnerable populations)No difference between physical and virtual visits > 50%Patient: convenience, access, quality HCP: not well studied
Funderskov et al. (2019)MixedPhysician, nurseNoEase of use in daily practiceDevice did not negatively influence daily practicen/a
Jess et al. (2019)MixedMixedn/aPatient/caregiver: good / HCP: good – reluctant Technology: user-friendliness and reliabilityPatients/caregiver/HCP: positive user perceptionn/a
Read Paul et al. (2019)PatientPhysicianNoEffective communication: patients 90%, HCPs 100% / Technical stability: patients 65%, HCPs 72% / Critique: Poor quality of video, extra time required to set up the equipmentComfortable discussing concerns: patients 90%, / HCPs 100% / Addressed needs as well as in person: patients 80%, HCPs 90% / Would use again: patients and HCPs 90%N/A
Tasneem et al. (2019)PatientPhysiciann/aAccess to device 90%, but desired training; age or racial background, no influenceNo concern about privacy (internal), some concern about "external" IT threats / 10/12 no concern about changes in relationship with physicianIndirect: 10/13 enthusiastic about "having a visit without leaving home"
Weck et al. (2019)PatientPhysician, nurseNoGood (convenient, access to care)Positive impact, high acceptance, significance of the visual componentn/a
Bonsignore et al. (2018)PatientPhysicianYesGoodYesn/a
Phongtankuel et al. (2018)Caregivern/aYesConcerns: security (35%), usability (42%)Receptive: 78% (< 65y, 85%, > 65y 62%)Features: Communication (video 70%, chat 52%, SMS 16%, sharing video/image 11%) / Access to care information (48%; medication information 32%, symptom information 31%, hospice contact information 6%) / Education (39%; EoL Information 11%, caregiving 10%) / Update and schedules (16%; scheduling 10%, patient update 6%)
Hoek et al. (2017)PatientPhysician, nurseYes (after first visit)n/aHigh satisfaction (patients 90.4%, health care providers, 87%)n/a
Tieman et al. (2016)Patient and caregiverPhysician, nurseYesGoodVideo consultation: similar/better 22.3%/65.2% than phone calls, similar/better 27.1%/63.1% than face-to-facen/a
Zheng et al. (2016)CaregiverPhysician, nursen/aFeasibility good (44% of all studies)(All studies) 55%n/a

Appendix 4: Scopus™ territory analysis

Figure S1

Scopus™ territory analysis (28 April 2021). Documents by country or territory. Compare the document counts for up to 15 countries/territories. 

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