Effectiveness of and implementation requirements for telehealth in palliative care patients with advanced cancer: A systematic review and meta-analysis.

What is already known about the topic?

Telehealth is increasingly integrated into palliative care for patients with advanced cancer to reduce geographical barriers and enhance access to specialized palliative care services.

Although telehealth was widely adopted during the COVID-19 pandemic, evidence on its clinical effectiveness in palliative care and implementation requirements remains limited.

What this paper adds?

This meta-analysis found that the use of telehealth in palliative care significantly improves quality of life and reduces symptom burden among patients with advanced cancer but has no significant effect on depression.

This review identified key requirements for implementation, including trained multiprofessional teams, accessible digital infrastructure, sustainable reimbursement mechanisms, and standardized outcome measurements.

Implications for practice

To ensure equitable access to palliative care, the implementation of telehealth in palliative care must be expanded to underserved populations, including rural and socioeconomically disadvantaged groups.

It is essential to establish guidelines that incorporate the identified requirements to support the effective integration of telehealth into routine palliative care.

Introduction

Individuals with advanced cancer often experience complex symptoms, functional decline, and increasing dependence on caregivers. Although hospital visits are often necessary for medical assessment and treatment, they can be physically, psychosocially, and spiritually burdensome. 1 Geographical distance, in particular, often limits timely access to specialized palliative care services. 2 In the wake of the COVID-19 pandemic, telehealth rapidly expanded as a practical approach to overcoming these barriers 3 and improving both access to and experiences of specialized palliative care services for individuals with advanced cancer.

Previous studies have reported numerous benefits of the use of telehealth in the palliative care of patients with advanced cancer. For example, Greer et al. 4 found that patients receiving early palliative care through video visits report a quality of life comparable to those receiving in-person care. Other studies have shown that receiving care at home, in a private and familiar environment, helps patients feel more emotionally supported and secure. 5 Additionally, telehealth interventions such as remote symptom monitoring and regular vital sign checks can lead to the early detection of clinical deterioration, promote patient engagement, and facilitate timely palliative care interventions. 6 For family caregivers, telehealth can ease travel demands and reduce physical caregiving burdens. 7 , 8 Additionally, regular virtual contact with the care team can help caregivers feel more supported and informed, ultimately reducing their stress. 9 For healthcare providers, telehealth in palliative care can improve time and resource efficiency by reducing the time spent in home visits and enabling more flexible scheduling. 10 Moreover, some studies have reported that early integration of telehealth into palliative care may contribute to cost savings at the health system level. 11 Overall, telehealth has the potential to complement or, in some contexts, be an alternative to traditional face-to-face palliative care.

Despite growing evidence supporting the feasibility of telehealth, its effectiveness in palliative care remains unclear. Previous systematic or scoping reviews have largely examined how telehealth has been implemented and used in specific contexts. These include advanced cancer, chronic heart failure, family caregivers, pediatric populations, home-based care, nursing homes, and rural or underserved settings. 12 – 18 The reviews have primarily discussed its benefits and challenges, such as barriers and facilitators to adoption and ethical considerations. 19 , 20 However, randomized controlled trials have produced mixed results regarding the impact of telehealth on quality of life, symptom burden, and depression. Furthermore, key requirements—including human resources, technological infrastructure, and financial frameworks—for using telehealth in palliative care, along with outcome measures for evaluating telehealth in palliative care are yet to be clearly defined.

A comprehensive synthesis is essential to clarify the effectiveness of and implementation requirements for telehealth in palliative care patients with advanced cancer. 21 Therefore, this study conducted a systematic review and meta-analysis to evaluate the effectiveness of telehealth on patients’ quality of life, symptom burden, and depression, and to synthesize implementation requirements related to human resources, technological infrastructure, and financial frameworks in the palliative care of patients with advanced cancer. With this objective, the study aimed to support clinical practice, guideline development, and policymaking concerning the palliative care of patients with advanced cancer.

Methods

Design

We conducted a systematic review and meta-analysis to assess the effectiveness of and implementation requirements for telehealth in the palliative care of patients with advanced cancer. The protocol was registered in PROSPERO in 2024 (CRD42024581786, https://www.crd.york.ac.uk/PROSPERO/view/CRD42024581786 ). Additionally, the review was conducted in accordance with the Cochrane Handbook for Systematic Reviews of Interventions, and its reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. 22 , 23 This study did not require ethical approval because we used only publicly available data.

Data source and search strategy

We searched MEDLINE, Embase, and Cochrane Library including the Cochrane Central Register of Controlled Trials for relevant articles published in English from the date of inception to September 5, 2025. A concept-based search strategy was collaboratively developed by the research team, informed by previous systematic reviews 5 , 8 , 24 – 26 and focused on two core concepts: (1) population—patients with advanced cancer and (2) intervention—telehealth. Palliative care was not used as a separate search concept because of heterogeneous terminology (e.g. symptom management, comfort care). Instead, eligibility regarding the definition of palliative care was determined during screening. Moreover, we supplemented the electronic database searches by conducting additional manual searches. Supplemental Table 1 presents the full search strategy. All retrieved records were managed using Rayyan and EndNote software. Rayyan was used for title and abstract screening, while EndNote was used for full-text and reference management.

Eligibility criteria

We included randomized trials and observational (including descriptive) and qualitative studies involving adults (individuals aged 18 or older) with advanced cancer who received telehealth in palliative care. Telehealth was defined as the use of telecommunications technology to enable real-time, bidirectional communication between healthcare providers and patients or family caregivers, aligning with the WHO definitions of telemedicine and eHealth. 25 Palliative care was defined based on the framework used by Kavalieratos et al. 26 We included interventions that addressed at least two of the eight domains of palliative care outlined by the National Consensus Project for Quality Palliative Care. 27 In accordance with the American Cancer Society 28 and the Cochrane review, 29 advanced cancer was defined as cancer that “cannot be cured,” including cases of metastatic or unresectable disease. We excluded studies that (1) addressed only a single symptom or domain (e.g. opioids for dyspnea or advance care planning), to focus on interventions delivering holistic or multidimensional palliative care, 30 (2) targeted only caregivers or other non-patient populations, as our review focused on telehealth interventions delivered to patients to evaluate direct effects on patient outcomes, or (3) were not original research articles, reviews, editorials, commentaries, conference abstracts, or publications written in English ( Supplemental Table 2 ).

Study selection and data extraction

Figure 1 illustrates the study selection process. Ten reviewers independently screened titles and abstracts. AK, ST, and AU independently reviewed the full texts of potentially eligible studies, and discrepancies were resolved either by consensus or adjudication by KS. Data extraction was conducted by AK and TN; they collected the following information from each study: author, year, country, study design, sample size, participant characteristics, telehealth modality, palliative care domains addressed, comparator (if any), outcomes, and details of the implementation requirements. The inter-rater reliability of full-text screening between AK, ST, and AU was assessed using the percentage of agreement.

Quality appraisal of the included studies

To assess the risk of bias, we used the Risk of Bias 2 tool for randomized controlled trials and the Risk Of Bias In Non-randomized Studies - of Exposures tool for non-randomized studies. 31 , 32 AK and ST independently evaluated each study. AK was contacted to provide additional details required for making informed judgments.

Data analysis and synthesis

We performed descriptive analyses and narrative syntheses for all included studies to describe the implementation requirements for telehealth and other outcomes that could not be included in the meta-analysis because of heterogenous outcome measures. Specifically, we narratively synthesized information on implementation requirements, including human, technological, and financial factors, along with outcome measurements used to evaluate implementation effectiveness, as reported in each included study. These domains were identified based on commonly reported facilitators and barriers to telehealth in palliative care described in previous literature.

The meta-analysis involved the synthesis of outcomes related to patients’ quality of life, symptom burden, and depression. For our analysis, we treated depression separately from overall symptom burden because depression-specific measures are more sensitive to psychological changes, whereas symptom burden scales combine a range of physical and psychosocial symptoms into a summary score. Only studies with sufficient outcome data, either available in the published article or obtained through contact with the authors, were included in the meta-analysis. Given the diversity of measurement tools across the studies, effect sizes were expressed as standardized mean differences. To account for the anticipated heterogeneity among the included trials, random-effects models were employed using the R software (version 4.5.0). Statistical significance was determined using two-tailed tests, with a p -value less than 0.05 considered significant. Between-study heterogeneity was assessed using the I 2 statistic, with qualitative interpretation thresholds of low (25%–50%), moderate (50%–75%), and high (75%–100%), and further evaluated using τ 2 statistics. 33 To minimize variations in follow-up duration, only outcomes assessed between 1 and 3 months were included in the meta-analysis. When multiple outcomes were reported within the 1- to 3-month window, the latest time point within that range was used for the analysis. We could not conduct sensitivity analyses based on risk of bias or the follow-up window because the number of included studies was limited. 23 Potential publication bias was examined by visual inspection of funnel plots.

Results

Selection of studies

The electronic database search identified 5333 records (4596 from databases and 737 from trial registers). After removing duplicates, 4232 records were screened according to the title and abstract. Of them, 202 were assessed for eligibility. Following full-text screening, 42 reports 3 , 4 , 34 – 73 met the inclusion criteria, among which six 27 , 50 , 51 , 59 , 68 , 69 were eligible for meta-analysis ( Figure 1 ). The most common reasons for exclusion were not targeting patients with advanced cancer and not being related to palliative care. The interrater agreement for full-text screening among the independent reviewers was 90% for abstract screening and 94% for the full-text review.

Characteristics of the included studies

The 42 included reports encompassed various study designs, such as randomized controlled trials ( n = 13), prospective cohort studies ( n = 10), retrospective studies ( n = 7), pilot and feasibility studies ( n = 7), and qualitative studies ( n = 5; Table 1 ). Moreover, some studies employed multiple designs. The studies were conducted in several countries, with the United States being the most common setting ( n = 17), followed by Canada ( n = 6) and the United Kingdom ( n = 5). Across the studies, the sample size ranged from 6 to 586 participants, with a combined total of 7627 participants. The participants’ mean or median ages ranged from 55 to 75 years. The proportion of female participants ranged from 34% to 85%. Furthermore, all studies targeted adult patients (patients aged 18 or older) with advanced cancer, including those with metastatic, incurable, or stage IV cancer.

Regarding settings, the patients resided at home and received palliative care delivered by outpatient clinics, cancer centers, or community-based services. The studies involved diverse models of palliative care, such as specialized palliative care led by multiprofessional specialist teams and general palliative care provided by non-specialists in palliative care. Telehealth services were delivered via videoconferencing, telephone calls, and messaging through mobile applications, with some studies also incorporating remote symptom monitoring ( Table 2 ). Furthermore, the most frequently addressed palliative care domains were physical care, psychological care, and end-of-life care. Palliative care was categorized into domains according to its stated components (e.g. physical symptom management as “physical care,” mental health support as “psychological care,” and comprehensive support for patients’ needs in the final days of life as “end-of-life care”). These domains often overlap, but we categorized them for analytical purposes while recognizing that palliative care is fundamentally a philosophy of holistic care.

Quality appraisal of the included studies

Supplemental Tables 4–8 summarize the methodological quality of the 42 reports included in this review. Summary of findings table was shown in Supplemental Table 9 . Among the randomized controlled trials, two were judged to have some concerns, while others exhibited a high risk of bias due to issues such as lack of blinding of outcome assessor. Among the observational studies, most demonstrated a high risk of bias, mainly due to confounding and selection biases.

Eligibility criteria for participants across included studies

Three studies set an upper age limit of ⩽ 75 years. The most common types of cancer were lung cancer ( n = 12), breast cancer ( n = 9), and colorectal cancer ( n = 7), although some studies included patients with multiple types of cancer. Eighteen studies included patients with a prognosis of 6–24 months. Regarding functional status, 16 studies included patients with poor performance, which was defined as a Karnofsky Performance Status of ⩽ 60 or an Eastern Cooperative Oncology Group Performance Status of ⩽ 3. Fourteen studies required participants to be alert to complete symptom assessments or surveys, whereas eight studies excluded participants with cognitive impairments. Access to technology, more specifically access to smartphones, tablets, or desktop computers with Internet connectivity, was a prerequisite in 21 studies. Finally, nine studies required patients to have at least one caregiver to assist with complex care needs or to facilitate telehealth participation.

Meta-analysis

Patients’ quality of life

Five randomized controlled trials involving a total of 655 patients assessed how the use of telehealth in palliative care impacted patients’ quality of life at 1.5- to 3-month follow-up. The quality of life was measured using the summary score on the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30, the Functional Assessment of Cancer Therapy – General questionnaire, and the Functional Assessment of Chronic Illness Therapy – Palliative Care questionnaire. Across all questionnaires, higher scores indicated better quality of life. A random-effects meta-analysis demonstrated a statistically significant improvement in quality of life in the intervention group compared with the control group (standardized mean difference (SMD): 0.81; 95% CI: 0.09–1.53), although heterogeneity was high (I 2 = 93%, τ 2 = 0.62, p < 0.01; Figure 2 , Supplemental Figure 1 ). Individual effect sizes ranged from a large, significant benefit (SMD of 1.73 in Bergerot et al. 69 ) to a small, non-significant effect (SMD of −0.10 in Bakitas et al. 35 ).

Symptom burden

Four randomized controlled trials involving a total of 431 patients evaluated how the use of telehealth in palliative care affects symptom burden at 2- to 3-month follow up. The symptom burden was measured using the Symptom Distress Scale, the total distress score on the Edmonton Symptom Assessment System, and the symptom burden subscale of the Quality of Life at the End of Life scale. A random-effects meta-analysis demonstrated a statistically significant reduction in symptom burden in the intervention group compared with the control group (SMD: −1.44; 95% CI: −2.24 to −0.65), although heterogeneity was high (I 2 = 88%, τ 2 = 0.59, p < 0.01; Figure 3 , Supplemental Figure 2 ). Individual effect sizes ranged from a large benefit (SMD of −2.14 in Bakitas et al. 35 ) to a small, non-significant effect (SMD of −0.23 in Hoek et al. 50 ).

Depression

Five randomized controlled trails encompassing a total of 528 patients evaluated how the use of telehealth in palliative care impacted depressive symptoms at 2- to 3-month follow-up. Three studies used the Hospital Anxiety and Depression Scale–Depression subscale, one used the Center for Epidemiologic Studies Depression Scale, and one used the Geriatric Depression Scale. Across all instruments, higher scores indicated more severe depressive symptoms. A random-effects meta-analysis found a non-significant effect in the intervention group compared with the control group (SMD: −0.43; 95% CI: −1.17 to 0.31), with substantial heterogeneity ( I 2 = 91%, τ 2 = 0.65, p < 0.01; Figure 4 , Supplemental Figure 3 ).

Human resource-related requirements for using telehealth in palliative care

Most interventions were conducted by multiprofessional teams that included, at a minimum, palliative care physicians and nurses ( n = 14). Some studies encompassed additional team members, such as pharmacist, psychologists, social workers, music therapists, physiotherapists, and chaplains. 49 , 51 , 69 , 72 Physicians played a central role, particularly in video consultations. Their specialties included palliative care, pain medicine, and oncology. 4 , 36 , 38 Nurses were particularly central to telephone- and text-based interventions. Their responsibilities included symptom assessment, patient education, medication management, care coordination, follow-up, and monitoring. Regarding the training of personnel, five studies reported that personnel received preparatory instruction. The training topics included telehealth communication skills, use of digital platforms and equipment, symptom triage and escalation protocols, principles of foundational palliative care, and multiprofessional collaboration protocols. Only seven studies explicitly reported that staff members had prior experience in oncology, palliative care, or psychosocial care ( Supplemental Table 3 ). While psychosocial expertise may be expected in specialized palliative care teams, most studies did not document such experience.

Technological infrastructure-related requirements for using telehealth in palliative care

Most interventions involved video-based communication platforms, typically requiring patients to have access to Internet-connected devices—such as smartphones, tablets, laptops, and desktop computers—along with reliable broadband or wireless networks. In nine studies, the participants were required to own or have access to devices equipped with a camera and microphone (e.g. smartphones and tablets) and sufficient internet speed (e.g. ⩾ 256 kbps). In some studies, tablet computers or laptops were provided to patients who lacked the necessary equipment. 4 , 63 Some interventions employed HIPAA-compliant platforms (e.g. VSee and Zoom), whereas some platforms offered accessibility features tailored to older adults, such as text-to-voice functionality and adjustable font size. 63 One study employed WhatsApp for remote assessments because of its widespread accessibility, built-in encryption, and the use of disappearing messages after 24 h to enhance security. 69 Technical issues such as audio-visual distortion, unstable Internet connections, and equipment malfunction were reported in six studies, although most interruptions were described as minor. 40 , 61 , 65

In seven studies that encompassed telephone-based care, patients were required to have a mobile phone service, and one study excluded individuals with unstable telephone access. 35 Interventions involving text messaging or mobile applications required Internet access and mobile devices at home. 37 , 53 , 66 In some studies ( n = 6), symptom monitoring platforms were accessible via web portals or smartphone applications. 37 , 39 , 41 , 53 , 58 , 59 These platforms also included features such as automated alerts to notify healthcare providers of concerning symptoms.

Financial and reimbursement considerations for using telehealth in palliative care

Although detailed descriptions of reimbursement mechanisms were often lacking, several studies provided insights into program costs and cost-saving potential. Several studies suggested that telehealth may reduce costs by decreasing patient travel and acute-care utilization. 4 , 34 , 69 , 70 In a rural-focused intervention, the goal was to reduce indirect costs for patients such as transportation expenses. 61 A cost analysis of a multicomponent telehealth intervention reported an average cost of about USD 1100 per patient and demonstrated substantial annual cost savings compared to standard care. 63 One study analyzed the cost impact of reduced emergency department visits and hospital admissions, 37 while another reported a cost reduction associated with shorter hospital stays. 53 Some studies have acknowledged the high costs of advanced technologies and emphasized limited scalability due to their lack of large-scale production and limited public accessibility. 47 One study noted that recent changes in French healthcare policy now allow reimbursement for remote-monitoring services and that this development can support long-term implementation. 53 Another study from Taiwan highlighted that bundled payments under the National Health Insurance system did not fully account for the provision of 24-h telehealth services, resulting in limited incentives for providers. 70

Outcome measures used to evaluate telehealth in palliative care

The outcome measures examined in the included studies were categorized into five key domains: (1) symptom management, (2) quality of life, (3) psychosocial and emotional well-being, (4) patient and caregiver experience, and (5) healthcare utilization. Across all studies, 23 evaluated symptom management, 17 assessed quality of life, 14 examined psychosocial aspects, 14 assessed patient or caregiver experience, and 16 analyzed healthcare utilization.

Symptom management and quality of life were most frequently measured using validated instruments such as the Integrated Palliative Care Outcome Scale, the Edmonton Symptom Assessment System, and the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire. These outcomes were quantitatively synthesized in the meta-analyses. Beyond these, several studies also assessed psychosocial and emotional outcomes (e.g. mood, anxiety, depression, sense of safety, and self-efficacy), patient and caregiver experience (e.g. satisfaction, perceived usefulness, emotional distress, caregiver burden), and healthcare utilization (e.g. emergency visits, hospital admissions, and readmissions). Additionally, four studies evaluated survival outcomes (e.g. 1-year survival), and 18 studies assessed feasibility and usability, including patient engagement and treatment adherence.

Discussion

A significant improvement was observed in quality of life and symptom burden, whereas no statistically significant effect was found for depression. Furthermore, trained multiprofessional teams, accessible digital infrastructure, sustainable reimbursement mechanisms, and standardized outcome measurements were found to be the key requirements for implementing telehealth in the palliative care of patients with advanced cancer.

There was substantial heterogeneity among the palliative care delivery models. The lack of sensitivity analyses limited to low-risk studies highlights the need for cautious interpretation of pooled estimates. Nevertheless, in line with findings from previous meta-analyses of face-to-face palliative care, 26 , 29 our analysis demonstrated that telehealth interventions significantly improved quality of life in patients with advanced cancer. These results suggest that telehealth can be an effective modality for delivering palliative care, offering outcomes comparable to in-person care. Such findings support the integration of telehealth into routine palliative care, particularly when timely in-person access is limited.

The finding that telehealth in palliative care significantly reduced symptom burden at 2- to 3-month follow-up aligns with the results of previous meta-analyses of face-to-face palliative care, 26 which demonstrated improved symptom burden at both 1- to 3-month and 4- to 6-month follow-ups. Routine symptom surveillance via electronic patient-reported outcomes (ePRO) may support the effectiveness of telehealth in palliative care by reducing symptom burden. 74 When an ePRO score exceeds a pre-specified threshold, an automated alert is sent to the clinical team, prompting timely supportive interventions; this rapid feedback may help alleviate symptoms. In addition, encouraging patients to self-monitor their symptoms may enhance engagement and adherence to treatment, both of which could be associated with a reduction in symptom burden. 75 However, survey data indicate that patients experiencing dyspnea are significantly less willing to substitute video consultations for in-person encounters, 3 demonstrating that different symptoms vary in their applicability for telehealth interventions.

The implementation of telehealth in palliative care requires careful coordination of both human and technological infrastructures. Although the review emphasizes the importance of multiprofessional teams (as in in-person care), delivering such care via telehealth may involve greater complexity. 76 However, previous studies have shown that multiprofessional care can be effectively delivered—even in remote settings—through user-centered design, clear multiprofessional guidelines, stable IT infrastructure, and appropriate telecommunication tools. 77 , 78 To support these efforts, it may be essential to develop an online telehealth education resource for palliative care providers. 25

Access to and usability of technology were also identified as key facilitators, as many studies recruited participants who already owned digital devices, which likely contributed to higher feasibility. Yet, palliative care populations often include older adults with serious illnesses and limited familiarity with technology. 79 To ensure inclusive access, systems should incorporate user-friendly interfaces designed for individuals with physical or cognitive impairments. There is also a need to consider data privacy and security concerns, particularly when enabling communication between institutions and home-based patients. Although international telemedicine guidelines exist, 25 , 80 guidelines tailored to the unique needs of palliative care populations remain limited. Given the high proportion of older adults with serious illnesses, palliative-care-specific telehealth guidelines that comprehensively address accessibility, usability, and data security are urgently required.

Future implications

In terms of future research, it is essential to identify which populations in palliative care, not only cancer patients, benefit most from telehealth. To satisfy the needs of diverse populations, studies should evaluate telehealth across different models such as specialist-led, outpatient, and community-based approaches. 81 , 82 Given the heterogeneity of existing trials, meta-analyses will provide clearer estimates of telehealth’s impact when based on high-quality studies with consistent comparators and designs.

For implementation, applying structured frameworks such as the Consolidated Framework for Implementation Research can help systematically evaluate how organizational, technological, and individual-level factors influence the adoption and sustainability of telehealth interventions. 83 Research should also broaden its scope to include rural and underserved populations and address cultural and linguistic diversity, as most of the existing evidence is based on racially homogeneous urban groups. 84 , 85 From a policy perspective, the sustainability and equity of telehealth in palliative care depend on reimbursement mechanisms and regulations that recognize remote care as an equivalent alternative to in-person services. Policy support for telehealth, strengthened during the pandemic but now being scaled back, remains essential for sustaining telehealth in palliative care.

Looking ahead, ongoing clinical trials in Europe are testing remote palliative care models in intensive care settings. These initiatives highlight the potential of telehealth not only to support patients but also to address the needs of families and to support non-specialist healthcare providers. This indicates that telehealth may also expand palliative care across specialties. 86

Limitations

The strengths of this review include the use of diverse study designs, a dual focus on effectiveness and implementation, and a restriction to patients with advanced cancer to ensure clinical homogeneity. This focus enhances the internal validity of our findings and allows for more precise estimation of intervention effects, consistent with current trends in implementation science.

However, this study had several limitations. First, the small number of trials eligible for meta-analysis limited the robustness of the pooled estimates. Second, many included studies had methodological limitations, particularly related to the risk of bias due to lack of blinding of subjective outcomes. While blinding is a key methodological safeguard, it is often infeasible in palliative care trials. Third, this review did not stratify the findings based on delivery modality (e.g. video- vs telephone-based telehealth), follow-up duration (e.g. 1- to 3-month window vs 6- to 12-month window), timing (e.g. early use vs delayed use), or the degree of risk of bias, all of which may have influenced the outcomes. Post hoc subgroup analyses were not possible because of the limited number of studies. Fourth, there was a conceptual overlap between symptom burden and depression because some composite symptom burden scales included items related to depression. We addressed this by treating depression as a distinct outcome to allow for a clearer interpretation of its psychological impact. Finally, although all interventions met the prespecified definition of palliative care, substantial heterogeneity was observed. While variations in the delivery model, team composition, intervention intensity, modality, and timing of the outcome assessment were plausible contributors, their influence could not be verified in this review. Future studies should perform meta-regression or subgroup analyses to clarify potential sources of heterogeneity.

Conclusions

Using telehealth in palliative care is a feasible approach for patients with advanced cancer and may help improve quality of life and alleviate the symptom burden. The key requirements for telehealth use include trained multiprofessional teams, accessible digital infrastructure, sustainable reimbursement mechanisms, and standardized outcome measurements. Future research should clarify optimal care delivery models and implementation strategies. It should also examine equity-related barriers to support wider implementation and policy development.

Supplemental Material

sj-docx-1-pmj-10.1177_02692163251403395 – Supplemental material for Effectiveness of and implementation requirements for telehealth in palliative care patients with advanced cancer: A systematic review and meta-analysis

Supplemental material, sj-docx-1-pmj-10.1177_02692163251403395 for Effectiveness of and implementation requirements for telehealth in palliative care patients with advanced cancer: A systematic review and meta-analysis by Arisa Kawashima, Taiji Noguchi, Taiki Furukawa, Akiko Unesoko, Shintaro Togashi and Kazuki Sato in Palliative Medicine

We extend our gratitude to Dr. Yuki Sugihara, Ms. Chihiro Yamashita, Ms. Mika Onodera, Ms. Rina Hasebe, Ms. Rin Matsushita, Ms. Sakiho Miyamoto, Ms. Reika Yamamoto, and Ms. Mizuki Furukawa, who conducted the abstract screening. This study was supported by the Industry-University Collaborative Project for Human Resource Development to Accelerate AI R&D in the Health and Medical Fields (MEXT). This work is partially supported by Nagoya University Research Fund.

ORCID iDs: Arisa Kawashima https://orcid.org/0000-0001-7864-9289

Taiji Noguchi https://orcid.org/0000-0001-9165-5501

Taiki Furukawa https://orcid.org/0000-0002-3522-1845

Akiko Unesoko https://orcid.org/0000-0002-2540-148X

Ethical considerations: This study did not require ethical approval because we used only publicly available data.

Author contributions: Arisa Kawashima: Study design, data collection, screening, and data analysis, writing—original draft, and writing—review and editing. Taiji Noguchi: Study design, data analysis, writing, review, and editing. Taiki Furukawa: Study design, writing, review, and editing. Akiko Unesoko: Study design, screening, and writing, review, and editing. Shintaro Togashi: Data collection, screening, data analysis, writing, review, and editing. Kazuki Sato: Study design, writing, review, and editing.

Funding: The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was supported by AMED under Grant Number 24uk1024009h0001 and JSPS KAKENHI under Grant Number 25K20696.

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Data availability statement: Data supporting the findings of this study are available from the corresponding author upon request.

Supplemental material: Supplemental material for this article is available online.

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