We based this scoping review on the methodological framework of Arksey and O’Malley [27] and current methodological guidance [28,29]. Arksey and O’Malley’s framework consists of the following stages: identifying the research questions; identifying relevant studies; selecting studies; charting the data; and collating, summarizing, and reporting the results. Scoping reviews address broader topics and less specific research questions than systematic reviews and can include studies with different research designs and methods in addition to gray literature [27]. In line with the methodological guidance [27], we did not appraise the methodological quality of the included publications [30]. We reported the review according to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) checklist [30] (Multimedia Appendix 1). Deviations from the published protocol [31] are reported in Multimedia Appendix 2.

We formulated the following research questions: (1) What is known about existing health technologies and infrastructures for supporting communication in home-based PPC? (2) How can existing knowledge about health technologies and infrastructures inform future health technology development for home-based PPC?

The eligibility criteria are described in Textbox 1 using the population (P), concept (C), and context (C) framework [29], including the period, type of literature, and language.

We included studies regardless of study design and methods and gray literature to identify a broad range of relevant publications. We limited the literature to publications in Danish, English, Norwegian, or Swedish (the languages understood by our research team). We chose the period for the searches (2018-2025) to identify up-to-date, relevant health technologies and infrastructures that can inform future research, the development of health technology and services, education, and clinical practice.

We performed a comprehensive search on November 27, 2023, of the ASSIA, CINAHL, Embase, MEDLINE, PsycINFO, and Web of Science databases to identify relevant literature. The database search was updated on August 28, 2025. The updated search comprised publications within 2023-2025, due to technical settings in the databases, only allowing to limit the search to whole years. Thus, the updated search will contain duplicates from the initial search, and the updated search is consequently reported as one search rather than specified to each database.

The search strategy was built in MEDLINE by 2 academic librarians (Elisabeth Karlsen and Ingjerd L Ødemark) with expertise in systematic searches for medical research databases in collaboration with the research team members SAS, EB, and HH. The search strategy was piloted by SAS and EB. Then, the search strategy was peer reviewed according to the Peer Review of Electronic Search Strategies guidelines [32] by a third librarian (Camilla Thorvik). The final search strategy was adopted for the remaining databases. The search strategy covered three elements: (1) palliative care, (2) children, and (3) health technology (Multimedia Appendix 3). We manually searched the reference lists of included studies to perform forward citation tracking using Google Scholar, and we also manually searched the Journal of Medical Internet Research and the Journal of Telemedicine and Telecare.

We transferred the publications identified from the database searches to EndNote (Clarivate) to remove duplicates and then transferred them to Covidence (Veritas Health Innovation). Covidence is a systematic review web tool that ensures that the study selection process is blinded and that 2 researchers independently assess all publications. In total, all authors screened the publications in 2 steps. We screened titles and abstracts, uploaded full-text publications to Covidence, and assessed them against the eligibility criteria. In both steps, conflicts among the authors were resolved by SAS or HH.

We developed a standardized data charting form using Microsoft Word and included the following data items: author, year, country, type of literature, aim of study, sample, research design (when applicable), results, aim of health technology, development of health technology, users of health technology, health technology, follow-up service, mode of delivery, and infrastructure. SAS and HH piloted the data charting form using 4 publications. Based on the pilot and discussions within the research team, we collapsed some of the data items and restructured the data charting form to facilitate an overview of the extracted information. SAS and HH extracted data from the included publications, while AW, KR, and WC checked the data accuracy against the publications.

The first (SAS) and last authors (HH) summarized and organized the data according to the standardized data charting form using a quantitative descriptive approach [33]. Data in each column of the data charting form were grouped based on similarities and differences across the included publications. For instance, studies with comparable aims were grouped based on similarities, the different groups were categorized, and then, the number of studies in each group was counted and summarized, and percentages were calculated. Studies reporting on the use of comparable health technology such as monitoring apps or reporting on the same type of infrastructure were grouped together. Furthermore, for instance, the different users of health technology (ie, children, families, HCPs, or others) and the modes of delivery (ie, asynchronous, synchronous, and both delivery modes) were counted and summarized across the publications, and then, percentages were calculated. The coauthors provided feedback and agreed on the summarization and organization of the data.

Through database searches, a total of 16,209 records were identified. After we deleted duplicates, we screened the titles and abstracts of 9238 records. We then assessed the full texts of 289 publications and included 39 publications. Two of these publications were identified in the updated database search. The manual searches yielded 2 eligible publications. The final sample consisted of 41 publications (Figure 1).

The characteristics of the health technologies and infrastructures reported in the included publications are described in Multimedia Appendix 4 [26,34-73].

The final sample consisted of 41 publications: 20 empirical papers, 6 protocol papers, 7 abstracts, 3 brief publications, 2 review papers, and 3 case publications. The characteristics of the included publications are described in Multimedia Appendix 5 [26,34-73].

The aim of this scoping review was to systematically map the literature on health technologies and infrastructures for supporting communication in home-based PPC.

We identified and summarized numerous technologies, features, and their associated infrastructures. Overall, in a limited number of publications, the users (ie, children and caregivers) participated in the technology development process for home-based PPC, and children with cancer and their caregivers were the most frequently reported users. The most frequent delivery mode for such technology was via combined asynchronous and synchronous modes. Apps for symptom monitoring were the most frequent health technology apps for communication regarding home-based PPC. However, details of health technology infrastructures for home-based PPC were lacking or insufficiently accounted for in the publications.

Our review revealed that only 29.3% of the publications included users, such as children, caregivers, and HCPs, in the development of health technology and follow-up services. Furthermore, around 46% of the publications provided no information about the development processes or the participation of users. Consequently, we may assume that users were not included in the development in these cases. This omission was unsurprising, as another scoping review claimed that children were rarely included in research before and after interventions [75]. However, users may have been included in the development process, but this information may have been omitted from the papers due to the word limitation, or the researcher may be unsure what to report regarding the inclusion of users. It is imperative for users to participate in developing and tailoring health technology to align more closely with patient needs [21] and to avoid posing additional strain and burden on these families causing harm. Furthermore, adults (ie, caregivers and HCPs) may not fully understand what children experience or understand and what their needs might be [76,77]. Therefore, including children in the development of health technology is crucial for designing effective and useful communication systems. Services for children in need of PPC must be tailored to their ages, developmental capacities, and preferences [78]. Future studies should strive to include children in the development of health technology and follow-up services. However, such inclusion could be challenging due to children’s health conditions. Developing personas based on, for instance, interview data about the needs of children in PPC may be one approach to include children’s voices in the development process. Personas are concrete, specific, and fictitious representations of end users and represent end users with common behavioral features that may facilitate designers’ ability to develop usable and useful designs (ie, of health technology) [79] and engage users in expressing their needs [80]. Furthermore, future studies should develop guidelines for reporting user participation, especially when children are included in the development of health technology. This could enhance the transparency and the reliability of such development.

We found that the most frequently reported mode of delivery of health technology for communication combined asynchronous and synchronous modes. This could enable children or caregivers to report symptoms and needs at home, while HCPs are remotely available for communication, support, and interventions when needed. This approach may enhance caregivers’ perceptions of normalcy, their ability to maintain a normal family life, and their feelings of being supported at home [2,8]. Furthermore, caregivers may need easily accessible long-term support from HCPs to manage difficult situations in the future, especially for patients discharged from the hospital to home-based care [81]. Bergstraesser [82] emphasized the importance of care delivery that is flexible, individualized, and considers the individual needs of children and their caregivers. Consequently, future studies should be aware that combining asynchronous and synchronous modes of delivery may facilitate children’s and caregivers’ access to and support from HCPs.

In around 17% (7/41) of the included publications, children used health technology autonomously, while in around 46% (19/41) of the publications, children used technology together with their caregivers to communicate with HCPs. The Convention on the Rights of the Child advocates for promoting children’s interests and views [76]. Health technology could facilitate children’s ability to express their needs to both their caregivers and HCPs. Children, especially adolescents, may appreciate direct communication with HCPs rather than communicating through their parents [81], and similarly, HCPs value the opportunity to communicate directly with children [26]. In most of the included publications reporting on children actively participating in their care using health technology, the children had cancer diagnoses. However, children with diagnoses other than cancer may have other PPC needs, and some may have difficulty expressing themselves verbally and may communicate using eye movements [78,83]. Furthermore, children with diagnoses other than cancer may receive PPC from multiple sites, and their caregivers may lack a support system and feel isolated [78]. Health technology could mitigate the logistical issues associated with in-person consultations for children with complex medical needs, prevent interruptions to the children’s routines or medical care, and ease the complications of moving children who are medically vulnerable [84]. Future studies should develop or tailor health technology for children with primary diagnoses other than cancer and their caregivers to align more closely with their needs and facilitate communication with HCPs in the broader context of home-based PPC.

We found that the most frequently used health technology apps for communication in home-based PPC were symptom-monitoring apps. This attention to symptom monitoring is not surprising, as children in PPC, regardless of their diagnoses, often experience burdensome symptoms during their illness trajectories [7]. The aim of PPC is to prevent and alleviate burdensome symptoms and improve quality of life [1], and symptom assessment is a prerequisite for optimal symptom management. Apps that allow children or caregivers to report children’s symptoms to HCPs in real time can facilitate and improve HCPs’ understanding of children’s conditions [35]. In several of the included publications, children used apps including patient-reported outcomes to communicate their symptoms to HCPs. Children’s voices are crucial, since self-reporting of symptoms is the gold standard for assessing symptoms, given that caregivers and HCPs often underreport the number and severity of symptoms children experience [35]. Patient-reported outcome data may improve care delivery by shaping children’s and HCPs’ expectations, facilitating communication about important issues, and enhancing shared decision-making, which might facilitate interventions to address children’s specific needs [35]. HCPs need to tailor care and symptom management to children according to their cognitive, emotional, social, and physical stages of development [1]. The use of existing symptom monitoring apps rather than developing new ones may conserve resources and enhance sustainability, and may be transferable to children with complex needs such as diabetes. However, as PPC includes a heterogeneous group of children with diverse and complex needs as well as various abilities to use such apps, these apps need to be tailored to both the conditions, the needs of the individual child, and the services there are to function within. Notably, only a few of the publications used gamification to allow children to report their symptoms. This absence is not surprising since gamification has been applied to a limited extent in PPC [85]. Gamification may support children’s creativity and provide them with choices; children may enjoy the rewards, incentives, and personalized aspects of such apps, which may also ease symptom reporting and help in specifying symptom locations [86]. However, a recent scoping review on gamification in mobile apps for children with disabilities demonstrated potential benefits across different populations but highlighted mixed results due to gamification’s impact on the health, health behavior outcomes, and health development of children with disabilities [87]. Future studies should investigate whether and how gamification could be used in home-based PPC to facilitate communication between children, caregivers, and HCPs. Studies should also investigate the possible side effects of gamification.

Our findings suggest that the internet, Wi-Fi, and mobile data are common infrastructures needed to use health technologies for home-based PPC. Even though such infrastructures were only reported in around 36% of the publications, we assumed that they were prerequisites for the technologies reported in all the publications. Information about infrastructure is essential for policymakers, health care managers, and HCPs who want to implement health technology in home-based PPC by providing information about what is needed to secure the implementation of such services and to assess resource use and cost as well as the need for training for HCPs. Dependence on access to the internet creates a new vulnerability for communication in home-based PPC and may impose an additional burden on children and parents as well as HCPs. A scoping review found that unreliable technology and connectivity issues may undermine HCPs’ confidence in using health technology, and that HCPs may feel professionally and personally responsible if health technology solutions fail [23]. Only a few publications reported measures to mitigate such risk, such as an app that could be used when the internet did not function properly [44] and hotspots to reduce Wi-Fi barriers [59,62]. Mobile devices (ie, smartphones, tablets, and laptops) could also create challenges for caregivers who cannot afford such devices. The costs involved could increase health inequity and the digital divide. For instance, purchasing technology or an expensive internet plan may be a heavy financial burden that can limit technology access for families with several children. One potential solution for enhancing technology access for families in home-based PPC could be that hospitals or home care services lend out devices such as smartphones or tablets to families. Furthermore, few technology resources and low technological literacy may hinder people’s ability to engage in necessary health care activities, such as video consultations [74].

The included publications mainly accounted for the type, feature, and content of the health technology and follow-up from HCPs, while the infrastructure needed to use health technology was insufficiently reported or lacking. Furthermore, even though privacy and data security are prerequisites for using health technology in home-based PPC, only a few publications have addressed these issues. Privacy and confidentiality may pose important legal and ethical challenges for the use of health technology, especially during video consultations. Furthermore, HCPs using health technology in home-based palliative care have access to large portions of patients’ daily life data, including a great deal of sensitive information. These sensitive data must be protected against unauthorized access and misuse [88]. An overview of the infrastructure may be essential to tailor or implement existing health technology in home-based PPC to save costs and resources and enhance sustainability. Consequently, future studies should develop a checklist for reporting health technology infrastructure and health economic evaluations.

A strength of our review was that we registered the review protocol a priori and used an acknowledged methodological framework to guide our review. We developed the search strategy in collaboration with experienced research librarians, and independent pairs of researchers conducted the study selection and data extraction. The inclusion of studies was limited to 2018-2025, which enabled us to identify and map up-to-date, relevant health technologies for home-based PPC. However, relevant health technologies may have been reported in studies published before 2018, which we were not able to identify. Another strength was that we searched for and included diverse literature to enhance the mapping of the existing technology for home-based PPC. However, the conference abstracts provided only limited descriptions of health technologies and infrastructures. A limitation is that we may not have identified all the relevant search terms for PPC and health technology. Our inclusion criteria restricted the review to only publications in the English and Scandinavian languages. We did not search specific databases for gray literature, but the type of literature included in our review is indexed in the chosen databases. Consequently, there may be publications that we did not identify. Furthermore, our findings may have some transferability to children with complex care needs, but it is different for children to live with a life-limiting or life-threatening condition than a chronic illness such as diabetes. However, regarding transferability, HCPs and researchers must assess whether our findings are relevant for their context.

Based on the included publications, children with cancer and their families are the primary users of health technology to communicate with HCPs in home-based PPC, although there is limited use among children with diagnoses other than cancer and their families. Combined asynchronous and synchronous modes are the most frequent modes of health technology delivery. Furthermore, children and their families often communicate with HCPs using symptom monitoring apps. The reporting of health technology infrastructures for home-based PPC is lacking or insufficiently accounted for.

Future studies should strive to include the voices of children, especially children with diagnoses other than cancer, to align health technology more closely with their needs. Studies should explore and evaluate whether gamification is feasible for children who require PPC and potentially develop such health technology for home-based PPC. Reporting guidelines for the inclusion of users in the development of health technology, especially children, as well as health technology infrastructure would be beneficial for supporting clinicians and researchers in gaining an overview of the infrastructure needed to implement health technology and follow-up services. This may conserve resources, reduce costs, and prevent research waste.