Using Complex Interventions to Develop Programme Theory for a Family-Focused Model of Telepalliative Care.
Eithne Hayes Bauer, Anders Nikolai Ørsted Schultz, Anthony C Smith and 3 others
PMID 41556232WHAT IT FOUND
Patients, families and palliative care staff described video consultations as flexible and useful for including distant relatives, but many preferred face-to-face visits for first meetings, bad news or serious treatment decisions.
It is theory-building, not evidence that video care improves outcomes.
Key findings
01Video consultations were valued for flexibility and for letting family members take part remotely, but face-to-face visits were often preferred for first meetings, bad news and serious treatment decisions.
02Palliative care teams adapted by asking patients to show pain, perform simple movements, adjust camera or lighting, and use extra verbal and non-verbal cues, while technical problems and low digital competency caused frustration.
03Participants identified uncertainties about governance and equity, including unclear community nurse roles, need for training and reliable support, and risk that video care could exclude older, remote or low digital-skill patients or reduce home visits.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This was a theory-building qualitative study, not a test of whether telepalliative care improves symptoms, quality of life, family support or hospital admissions. All patient participants had cancer diagnoses, so findings may not apply to palliative care patients with non-cancer diagnoses. Recruiting younger patients and families was difficult, so their views may be underrepresented. Only five participants were included in six observations, so observational detail was limited. The study was set in Danish specialised palliative care services, so transferability to other health systems may be limited. Key uncertainties about clinical effectiveness, emotional needs and equitable access were not resolved.
Declared interests
The funding declaration states that the authors have nothing to report, and the authors declare no conflicts of interest.
The easy way to misread this
Do not conclude that telepalliative care improves patient or family outcomes. The paper develops programme theory from stakeholder workshops and observations; it does not test the intervention or measure symptoms, quality of life, hospital admissions or death at home.