The included studies described the use of HWT in PC on an individual level (including patients, informal caregivers, and health care professionals) and on an organizational level. The synthesis resulted in 7 themes, which are presented in the following subsections (Table 2 provides an overview).

This theme focuses on the potential of HWT to support and prevent disease progression, physical and mental symptoms, and to relieve disease-related stress [47-72]. Types of HWT involved in symptom control and disease progression were technology for symptom monitoring [47,50,52-55,60,64,65,69,71], telehealth consultations and conferences [47,48,52,55-57,60,61,63,64,66-68,70], remote therapy and treatment interventions [58,59,62,72], and technology for education and support [49,51,56].

Among the included studies, the potential of HWT to support and prevent disease progression was mainly reported and discussed by 2 studies. Kazankov et al [47] described how a digital health solution with monitoring of heart rate, blood pressure, weight, body water, and cognitive function, for individuals with cirrhosis could facilitate timely intervention to prevent disease progression. Jiang et al [48] described how a model with a communication platform resulted in less functional decline. A total of 3 studies explored the effects of HWT on mortality, none of which could show any significant effects [49-51].

The impact of HWT on physical and mental symptoms was described by several studies. Positive impact on physical symptoms related to cancer illness and treatment was described by Tumeh et al [52], Mooney et al [53], Besse et al [54], and Cornetta et al [55]. Ngoma et al [50] reported no differences in overall symptoms when using remote symptom assessment and care coordination, although there were effects on symptom severity. Mark et al [56] reported a positive impact on dyspnea with an online teaching intervention for persons with COPD. Rafter [57] showed that an eHealth system allowed hospice professionals to deliver more effective care, with improvement in pressure ulcers for end-of-life patients. Impact on mental symptoms, such as anxiety and depression, was reported in 7 of the included studies. Positive effects were reported in cancer care studies using symptom monitoring [52], a virtual reality headset [58], a mindfulness intervention [59], telemedicine [60], videoconferencing [61], and web-based psychotherapy for informal caregivers [62]. On the other hand, one study using teleconsultations showed no differences in depression scores and increased anxiety scores [63]. Eight of the included studies showed the potential of HWT to contribute support in symptom management [64-71].

HWT was also used to relieve disease-related stress. For example, studies showed that an online support system in the care of patients with cancer has the potential to reduce symptom distress [49], mindfulness via video could reduce cancer-related stress [59], telehealth music therapy had positive affective effects [72], and teleconsultations resulted in lower distress symptom scores [68]. Maguire et al [69] showed that using a remote symptom monitoring system provided reassurance about symptom experience and the feeling of being listened to. However, Hoek et al [63], on the other hand, reported that adding weekly teleconsultations to usual PC led to a higher total distress score among home-dwelling patients with advanced cancer.

This theme describes patients’ and caregivers’ quality of life [52,56,60,69,73,74] and support in end-of-life phase and death [75-78]. It involves HWT for symptom monitoring [52,60,69], telehealth consultations and conferences [52,56,60,74,75,77,78], sharing of patient information [76], remote therapy and treatment interventions [73], and education and support [56,74].

Five of the included studies showed some effects on patients’ and informal caregivers’ quality of life with the use of HWT for symptom monitoring [52,60], training delivered over Skype for patients with COPD [56], a supportive care mobile app intervention [74], and a cognitive-behavioral therapy mobile app for anxiety [73]. Maguire et al [69] found that a system with daily symptom reports provided reassurance, but it did not lead to changes in quality of life.

Outcomes regarding support in the end-of-life phase and death were reported in 4 of the included studies. The potential to support dying at home or in another community setting was reported using an electronic PC coordination system [76], home care delivery with point-of-care technology and remotely located health care professionals [78], and a PC after-hours telephone number [75]. Johnston et al [77] reported the potential of Skype calls with dying persons and family members to bring closure and reconciliation, inclusion in the dying process, and healthy grieving.

Competence and palliative literacy refer to knowledge and understanding, self-efficacy, and insight into norms and values [74,75,79-85]. This theme includes HWT for symptom monitoring [80,81], telehealth consultations and conferences [74,83], remote therapy and treatment interventions [85], and education and support [74,75,79,82-84].

Different HWT interventions have been shown to increase knowledge and understanding of health, diagnosis, symptoms, and concerns among patients [74,79], informal caregivers [80,81], and health care professionals [82,83]. An e-learning intervention for nurses to increase knowledge of PC and attitudes toward dying patients and death showed positive effects [82]. Teleconferencing technology to support and train hospice nurses remotely was perceived to improve knowledge as well as self-efficacy in caring of patients in PC [83]. The intervention had given them access to education that otherwise would have been difficult to obtain due to geography. Self-efficacy to manage their own condition was reported by patients with advanced cancer using a digital support app [75]. Digital information and education were also shown useful for addressing insights into one’s own thoughts and values related to advanced dementia among patients [84] and related to caring for a person with advanced cancer among informal caregivers, including accepting experiences of negative thoughts and feelings and being more aware of personal values [85].

PC provision includes subthemes such as care satisfaction [50,87], medication use and compliance with therapies [72,73,81,82,87,88], prevention of excessive care [48,51,64,65,68,69,76,86,89-98], care coordination [75,83,94,102-110], accelerating advanced care planning [51,84,87,93,94,97,99-101], and access to care [68,74,96,106,108,111-117]. This was mainly related to use of technology for telehealth consultations and conferences [48,64,68,74,75,83,84,87,88,91-96,98,100,102-104,106,108,109,111-116], but also technology for symptom monitoring [50,64,65,69,81,89,96,98,106,107,110,117], education and support [51,74,82-84,86,90,97,99,101,117], sharing of patient information [76,100], and remote therapy and treatment interventions [72,105].

The use of HWT was shown to be promising in the provision of care, including care satisfaction [50,87] and medication use and compliance with therapies [73,82,87,88]. Zeiser et al [72] reported that music therapy telehealth services increased compliance with other therapies. Other studies reported decreased polypharmacy and potentially decreased adverse drug events [88], but no effects on analgesic adherence [82] and no differences in anticipatory medication prescribing [87].

Some studies reported positive impacts on care coordination [102], care provision [83], increased efficiency [103-108], increased care resource use [75], and positive outcomes related to quality of care [94,106]. For example, Groothuizen et al [109] reported that virtual team meetings resulted in increased flexibility, reduced travel time, and easier real-time access to patient information for health care professionals. Health care professionals in the study by Oelschlägel et al [110], on the other hand, found that organizational challenges made it difficult to obtain and share the information necessary to provide seamless and optimal service to patients.

Prevention of excessive care is a core purpose of technology in PC and relates to the use of hospice care, emergency care, and hospitalization. Among the included studies, no effects were shown on hospice enrollment or length of stay [51], nor on time until entry into hospice [98]. Emergency department visits and admission could be avoided or decreased in several studies [65,69,76,86,89,90,92]. The HWT used in these studies varied. Technology to support patients (symptom monitoring and means to communicate needs to health care professionals) showed positive effects [65,69,89,92], as did technology used to support health care professionals in their work [76,86,90]. Manz et al [51] showed that opt-out text messages to prompt serious illness conversations decreased end-of-life systemic therapy relative to controls, but there was no effect on hospice enrollment or length of stay, inpatient death, or end-of-life intensive care unit use. Nor did a teleconsultation service with a triage system change the number of emergency visits [91]. HWT to support patients in communication with health care professionals [48,91,94,96] showed potential to decrease the need for hospital referrals. Unnecessary hospital transfers could also be prevented by improved collaboration among physicians using telemedicine [95]. Moreover, an advance care planning video program intervention increased documented “Do Not Hospitalize” orders among nursing home residents with advanced illness, but did not significantly reduce hospitalizations [97].

Technology was also used to accelerate advance care planning, with promising results in 7 studies [51,84,94,97,99-101], but no results in 2 studies [87,93].

Other positive effects reported were increased access to care [69,96,106,108,111-114] and increased continuity of care [113,115,116]. HWT was shown to enable health care professionals to respond quickly to patients’ care needs [96,106], allowing them to reach more patients [68,111], especially during epidemics or when out of town. For patients and informal caregivers, the technology increased the sense of security related to the ability to contact the clinic when needed [96,117].

Multidimensional care relationships concern the ability to use HWT to form partnership between patients and health care teams, companionship with significant others, and interprofessional collaboration [65,69,77,96,104,110,114,116,118-127]. HWT used in the studies related to this theme included technology for symptom monitoring [65,69,96,110,119,120], telehealth consultations and conferences [77,96,104,110,114,116,118,119,122,127], and education and support [121,123-126].

Whether remote care can affect the partnership between patients and health care teams varies between studies and within studies. Rosa et al [118] described positive as well as negative impacts on the quality of relationships with patients, families, and between health care professionals. For health care professionals, increased availability to patients and their caregivers was positive, but there was a perceived loss of nonverbal cues, which made communication more difficult. Some health care professionals also experienced difficulties being supportive remotely during difficult times. It also put a strain on relationships among coworkers. Other studies reported no negative effects on relationships [114], enhanced connectivity with the care team [70,96], and contributions of unique insight into the daily lives of patients [116]. Over time, care delivered with support of HWT, such as telehealth consultations, can result in trustful relationships [116]. The introduction of technologies has the potential to alter the dynamic of relationships between patients, families, and community PC clinicians, serving as a means to complement in-person care [119]. Among the included studies, there were also reports of positive impacts on patient–caregiver communication regarding symptom management [66] and perceptions that it was easier to discuss psychological and care needs remotely [120].

Moreover, HWT can be used to facilitate companionship with and among significant others and informal caregivers [67,78,104,121-125]. The use of technology, such as video calls, was shown to be able to connect patients and family members at the end of life [78]. Another area of use is online support groups for informal caregivers, with the aim of forming companionship between peers [121].

Other studies have shown the ability of HWT to increase professional collaboration [126,127], offering an understanding of each other’s professions [126].

This theme focuses on the ability to use HWT to support professionals’ understanding, patient empowerment, and support for the caring role among informal caregivers. Telehealth consultation and conference technology [56,57,67,91,96,102,103,110-112,114,117,118,127,129,133] and technology for education and support [56,86,125,126,128,130-135,137-139] were the most common HWT, followed by technology for symptom monitoring [96,110,117,138,139] and remote therapy and treatment interventions [62].

Among the included studies, HWT was used to support professionals’ understanding. Oelschlägel et al [110] described how remote home care helped municipal health care professionals shift their perspective toward patients’ priorities. In the study by Rosa et al [118], remote care used as an alternative to in-person care during the COVID-19 pandemic led to changes in perceived self-efficacy among health care professionals in managing their job responsibilities. HWT, such as videoconferences, can also be used by senior professionals to support and mentor the junior workforce [86].

According to the included studies, HWT can play a role in empowering patients, for example by increasing involvement and enabling patients to take an active part in their care [96,117], feel in control of treatment [117], and manage everyday life [110]. HWT was useful in preparing patients before care visits [128], providing support [91,102,112,129], facilitating comfort, safety, and independence for patients [103,114], and increasing patient satisfaction [68].

Technologies were also used to support informal caregivers. Examples of technologies addressing their needs included interventions for mental and emotional support [63,130,131]. These were shown to have potential for preparing individuals for the caring role [86] and addressing unmet needs [63]. Digital technology interventions were used to support informal caregivers in managing everyday challenges and stress [57,132-135]. For example, an education intervention delivered through a smartphone app was effective in improving family readiness and quality of life among family members [135]. However, other studies were not able to show this potential. According to Dionne-Odom et al [130] a telehealth intervention to educate and support informal caregivers of patients with heart failure did not provide any significant effects on quality of life, mood, or caregiver burden.

Other technologies, which primarily focus on patient’s needs, may also be used to support the caregiver role, with increased caregiver involvement [136], increased connection between caregivers and patients [125], reduced caregiver burden [64,137], and effects such as less negative mood and emotional distress [138], as well as reduced loneliness [134]. Access to hospice personnel provided by HWT might be perceived as comforting [68]. Among the included studies, one study was not able to show any significant effects on caregiver burden, self-efficacy, or quality of life with the use of an eHealth self-management application for caregivers of patients with incurable cancer [139].

Organizational outcomes reported were related to cost-effectiveness [61,111], time and travel [96,108,109,114,140], and job satisfaction and distress [62,68,111,118]. The most common HWT related to the theme was telehealth consultations and conferences [61,62,68,96,108,109,111,114,118,140], although one study also involved HWT for symptom monitoring [96].

Two studies reported results related to cost-effectiveness. Compared with traditional in-person service, telehealth services resulted in equivalent costs but greater efficiency by allowing PC to reach more patients [111]. Video consultations with the PC team for rural patients were found feasible and resulted in travel and cost savings for patients [62]. The potential to minimize travel is clear, as reported by several studies. According to the case report by Morgan et al [96], telehealth-supported care was an effective adjunct to routine clinical care, Groothuizen [109] reported that virtual PC team meetings reduced travel time. Others reported that video-based consultations reduced the burden and expense of travel for patients, families, and consultants [108,114], and patient-reported satisfaction with telehealth in oncology was mainly attributed to advantages in travel and time savings [140]. Using telehealth services and eHealth systems increased job satisfaction due to the patient-centered nature of the care service, increased peer support, and increased professional development [111]; having 24/7 access to hospice triage personnel [68]; and effective care and good patient experiences [58]. On the other hand, a multidisciplinary PC team delivering telecare for hospitalized patients with cancer during the COVID-19 pandemic expressed distress related to competing loyalties (such as institutional obligations, ethical obligations to patients, resentment, and distrust of leadership) and feelings of disempowerment (due to guilt in providing subpar support, decisional regret, and loss of identity as a provider) [118].