Review Article| Volume 24, ISSUE 3, P356-367.e2, March 2023

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Telehealth Palliative Care in Nursing Homes: A Scoping Review

Published:February 06, 2023DOI:



      Many adults older than 65 spend time in a nursing home (NH) at the end of life where specialist palliative care is limited. However, telehealth may improve access to palliative care services. A review of the literature was conducted to synthesize the evidence for telehealth palliative care in NHs to provide recommendations for practice, research, and policy.


      Joanna Briggs Institute guidance for scoping reviews, and Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews frameworks were used to guide this literature review.

      Settings and Participants

      Reviewed articles focused on residents in NHs with telehealth palliative care interventionists operating remotely. Participants included NH residents, care partner(s), and NH staff/clinicians.


      We searched Medline (Ovid), Embase (Elsevier), Cochrane Library (WileyOnline), Scopus (Elsevier), CINHAL (EBSCOhost), Trip PRO, and Dissertations & Theses Global (ProQuest) in June 2021, with an update in January 2022. We included observational and qualitative studies, clinical trials, quality improvement projects, and case and clinical reports that self-identified as telehealth palliative care for NH residents.


      The review yielded 11 eligible articles published in the United States and internationally from 2008 to 2020. Articles described live video as the preferred telehealth delivery modality with goals of care and physical aspects of care being most commonly addressed. Findings in the articles focused on 5 patient and family-centered outcomes: symptom management, quality of life, advance care planning, health care use, and evaluation of care. Consistent benefits of telehealth palliative care included increased documentation of goals of care and decrease in acute care use. Disadvantages included technological difficulties and increased NH financial burden.

      Conclusions and Implications

      Although limited in scope and quality, the current evidence for telehealth palliative care interventions shows promise for improving quality and outcomes of serious illness care in NHs. Future empirical studies should focus on intervention effectiveness, implementation outcomes (eg, managing technology), stakeholders’ experience, and costs.


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        • Aldridge M.D.
        • Ornstein K.A.
        • McKendrick K.
        • Moreno J.
        • Reckrey J.M.
        • Li L.
        Trends in residential setting and hospice use at the end of life for medicare decedents.
        Health Aff. 2020; 39: 1060-1064
        • Aragon K.
        • Covinsky K.
        • Miao Y.
        • Boscardin W.J.
        • Flint L.
        • Smith A.K.
        Use of the Medicare posthospitalization skilled nursing benefit in the last 6 months of life.
        Arch Intern Med. 2012; 172: 1573-1579
        • Jones A.L.
        • Dwyer L.L.
        • Bercovitz A.R.
        • Strahan G.W.
        The national nursing home survey: 2004 overview.
        Vital Health Stat. 2009; 13: 1-155
        • Regier N.G.
        • Cotter V.T.
        • Hansen B.R.
        • Taylor J.L.
        • Wright R.J.
        Place of death for persons with and without cognitive impairment in the United States.
        J Am Geriatr Soc. 2021; 69: 924-931
        • Lima J.C.
        • Miller S.C.
        Palliative care consults in U.S. nursing homes: not just for the dying.
        J Palliat Med. 2018; 21: 188-193
        • Miller S.C.
        • Lima J.C.
        • Intrator O.
        • Martin E.
        • Bull J.
        • Hanson L.C.
        Palliative care consultations in nursing homes and reductions in acute care use and potentially burdensome end-of-life transitions.
        J Am Geriatr Soc. 2016; 64: 2280-2287
        • Carpenter J.G.
        • Lam K.
        • Ritter A.Z.
        • Ersek M.
        A systematic review of nursing home palliative care interventions: characteristics and outcomes.
        J Am Med Dir Assoc. 2020; 21: 583-596
        • Giuffrida J.
        Palliative care in your nursing home: program development and innovation in transitional care.
        J Soc Work End Life Palliat Care. 2015; 11: 167-177
        • Meier D.E.
        • Back A.L.
        • Berman A.
        • Block S.D.
        • Corrigan J.M.
        • Morrison R.S.
        A national strategy for palliative care.
        Health Aff. 2017; 36: 1265-1273
        • Casarett D.
        • Pickard A.
        • Bailey F.A.
        • et al.
        Do palliative consultations improve patient outcomes?.
        J Am Geriatr Soc. 2008; 56: 593-599
        • Cassel J.B.
        • Kerr K.M.
        • Kalman N.S.
        • Smith T.J.
        The business case for palliative care: translating research into program development in the U.S.
        J Pain Symptom Manage. 2015; 50: 741-749
        • Courtright K.R.
        • Cassel J.B.
        • Halpern S.D.
        A research agenda for high-value palliative care.
        Ann Intern Med. 2018; 168: 71-72
        • Parikh R.B.
        • Kirch R.A.
        • Smith T.J.
        • Temel J.S.
        Early specialty palliative care--translating data in oncology into practice.
        N Engl J Med. 2013; 369: 2347-2351
        • Kamal A.H.
        • Wolf S.P.
        • Troy J.
        • et al.
        Policy changes key to promoting sustainability and growth of the specialty palliative care workforce.
        Health Aff. 2019; 38: 910-918
        • Carpenter J.G.
        • Berry P.H.
        • Ersek M.
        Care in nursing facilities after palliative consult.
        J Hosp Palliat Nurs. 2018; 20: 153-159
        • Lupu D.
        • Quigley L.
        • Mehfoud N.
        • Salsberg E.S.
        The growing demand for hospice and palliative medicine physicians: will the supply keep up?.
        J Pain Symptom Manage. 2018; 55: 1216-1223
        • Kamal A.H.
        • Bull J.H.
        • Swetz K.M.
        • Wolf S.P.
        • Shanafelt T.D.
        • Myers E.R.
        Future of the palliative care workforce: preview to an impending crisis.
        Am J Med. 2017; 130: 113-114
        • Worster B.
        • Swartz K.
        Telemedicine and palliative care: an increasing role in supportive oncology.
        Curr Oncol Rep. 2017; 19: 37
        • Calton B.A.
        • Rabow M.W.
        • Branagan L.
        • et al.
        Top ten tips palliative care clinicians should know about telepalliative care.
        J Palliat Med. 2019; 22: 981-985
        • Ankuda C.
        • Woodrell C.D.
        • Meirer D.E.
        • Morrison R.S.
        • Chai E.
        A beacon for dark times: palliativecare support during the coronavirus pandemic.
        NEJM Cat. 2020;
        • Ritchey K.C.
        • Foy A.
        • McArdel E.
        • Gruenewald D.A.
        Reinventing palliative care delivery in the era of covid-19: how telemedicine can support end of life care.
        Am J Hosp Palliat Care. 2020; 37: 992-997
        • Centers for Medicare & Medicaid Services
        Medicare telemedicine health care provider fact sheet.
        • Hamadi H.Y.
        • Zhao M.
        • Haley D.R.
        • Dunn A.
        • Paryani S.
        • Spaulding A.
        Medicare and telehealth: the impact of COVID-19 pandemic.
        J Eval Clin Pract. 2022; 28: 43-48
        • Groom L.L.
        • McCarthy M.M.
        • Stimpfel A.W.
        • Brody A.A.
        Telemedicine and telehealth in nursing homes: an integrative review.
        J Am Med Dir Assoc. 2021; 22: 1784-1801
        • Centers for Medicare and Medicaid Services
        Telehealth for providers: What you need to know.
        • U.S. Department of Health & Human Services
        New hhs study shows 63-fold increase in medicare telehealth utilization during the pandemic.
        • Tan A.J.
        • Rusli K.D.
        • McKenna L.
        • Tan L.L.
        • Liaw S.Y.
        Telemedicine experiences and perspectives of healthcare providers in long-term care: A scoping review.
        J Telemed Telecare. 2021; (1357633X211049206)
        • Peters M.D.J.
        • Marnie C.
        • Tricco A.C.
        • et al.
        Updated methodological guidance for the conduct of scoping reviews.
        JBI Evid Implement. 2021; 19: 3-10
        • Tricco A.C.
        • Lillie E.
        • Zarin W.
        • et al.
        Prisma extension for scoping reviews (prisma-scr): checklist and explanation.
        Ann Intern Med. 2018; 169: 467-473
        • Covidence
        Covidence systematic review software. Veritas Health Innovation.
        Date accessed: April 24, 2022
        • National Consensus Project for Quality Palliative Care
        Clinical practice guidelines for quality palliative care, 4th edition.
        Date accessed: September 20, 2022
        • Baxter K.E.
        • Kochar S.
        • Williams C.
        • Blackman C.
        • Himmelvo J.
        Development of a palliative telehealth pilot to meet the needs of the nursing home population.
        J Hosp Palliat Nurs. 2021; 23: 478-483
        • Canales F.J.
        • Rios C.
        • Peck T.
        • et al.
        End-of-life discussions using emergency telemedicine in skilled nursing facilities.
        AEM. 2018; 2(S1): 173
        • Fu E.
        • Rubenstein C.
        Virtual end-of-life care during COVID-19 outbreak in a nursing home.
        J Am Geriatr Soc. 2021; 69(S1): 167
        • Mayahara M.
        • Miller A.M.
        • O'Mahony S.
        Components of the advance care planning process in the nursing home setting.
        J Hosp Palliat Nurs. 2018; 20: 95-102
        • O’Mahony S.
        • Marthone P.
        • Santoro G.
        • et al.
        Preliminary report of a pilot tele-health palliative care and bioethics program for residents in skilled nursing facilities.
        Palliat Care. 2009; 3: 13-27
        • Stephens C.
        • David D.
        • Wertz V.
        • et al.
        Improving palliative care access through technology (impactt): preliminary findings from a pilot study.
        Innov Aging. 2018; 2: 776-2018
        • Ho P.
        • Lim Y.
        • Tan L.L.C.
        • et al.
        Does an integrated palliative care program reduce emergency department transfers for nursing home palliative residents?.
        J Palliat Med. 2022; 25: 361-367
        • Low J.A.
        • Beins G.
        • Lee K.K.
        • Koh E.
        Last moments of life: can telemedicine play a role?.
        Palliat Support Care. 2013; 11: 353-355
        • Samara J.
        • Liu W.-M.
        • Kroon W.
        • Harvie B.
        • Hingeley R.
        • Johnston N.
        Telehealth palliative care needs rounds during a pandemic.
        J Nurse Pract. 2021; 17: 335-338
        • Perri G.A.
        • Abdel-Malek N.
        • Bandali A.
        • Grosbein H.
        • Gardner S.
        Early integration of palliative care in a long-term care home: a telemedicine feasibility pilot study.
        Palliat Support Care. 2020; 18: 460-467
        • Salles N.
        • Lafargue A.
        • Cressot V.
        • et al.
        Global geriatric evaluation is feasible during interactive telemedicine in nursing homes.
        Eur Res Telemed. 2017; 6: 59-65
        • Kruse C.S.
        • Karem P.
        • Shifflett K.
        • Vegi L.
        • Ravi K.
        • Brooks M.
        Evaluating barriers to adopting telemedicine worldwide: a systematic review.
        J Telemed Telecare. 2018; 24: 4-12
        • Stephens C.
        Improving palliative care access through technology (impactt).
        • Murtagh F.E.
        • Ramsenthaler C.
        • Firth A.
        • et al.
        A brief, patient- and proxy-reported outcome measure in advanced illness: validity, reliability and responsiveness of the integrated palliative care outcome scale (ipos).
        Palliat Med. 2019; 33: 1045-1057
      1. Palliative Care Outcome Scale (POS).
        Date accessed: August 8, 2022
        • Steinhauser K.E.
        • Voils C.I.
        • Bosworth H.B.
        • Tulsky J.A.
        Validation of a measure of family experience of patients with serious illness: the QUAL-E (Fam).
        J Pain Symptom Manage. 2014; 48: 1168-1181
        • Carnahan J.L.
        • Unroe K.T.
        • Torke A.M.
        Hospital readmission penalties: coming soon to a nursing home near you.
        J Am Geriatr Soc. 2016; 64: 614-618
        • Baughman A.W.
        • Cain G.
        • Ruopp M.D.
        • et al.
        Improving access to care by admission process redesign in a veterans affairs skilled nursing facility.
        Jt Comm J Qual Patient Saf. 2018; 44: 454-462
        • Burke R.E.
        • Canamucio A.
        • Glorioso T.J.
        • Baron A.E.
        • Ryskina K.L.
        Transitional care outcomes in veterans receiving post-acute care in a skilled nursing facility.
        J Am Geriatr Soc. 2019; 67: 1820-1826
        • The American Bar Association
        House passed bill extending pandemic telehealth flexibilities beyond COVID-19 through 2024.
        • Johnson K.S.
        Racial and ethnic disparities in palliative care.
        J Palliat Med. 2013; 16: 1329-1334
        • Estrada L.V.
        • Agarwal M.
        • Stone P.W.
        Racial/ethnic disparities in nursing home end-of-life care: a systematic review.
        J Am Med Dir Assoc. 2021; 22: 279-290
        • Estrada L.V.
        • Harrison J.M.
        • Dick A.W.
        • Luchsinger J.A.
        • Dhingra L.
        • Stone P.W.
        Examining regional differences in nursing home palliative care for black and hispanic residents.
        J Palliat Med. 2022; 25: 1228-1235
        • Noel K.
        • Ellison B.
        Inclusive innovation in telehealth.
        NPJ Digit Med. 2020; 3
        • Valdez R.S.
        • Rogers C.C.
        • Claypool H.
        • et al.
        Ensuring full participation of people with disabilities in an era of telehealth.
        J Am Med Inform Assoc. 2021; 28: 389-392