Digital health interventions in home-based palliative care: a systematic review and narrative synthesis of randomised controlled trials

Aging populations and rising chronic disease burdens increase demand for home-based palliative care, yet traditional care is limited by resource shortages, regional disparities, and low follow-up efficiency. Digital health interventions are increasingly used, but their overall effectiveness and optimal models remain unclear. To systematically evaluate the effects of digital health interventions in home-based palliative care on patients, caregivers, and healthcare utilization, and to characterize the features of different intervention models. Following the Cochrane Handbook and PRISMA guidelines, a narrative synthesis was conducted. Databases were searched from January 2016 to January 2026 for randomized controlled trials of digital health interventions in home-based palliative care for adults with terminal illnesses. Two researchers independently performed screening, quality assessment, and data extraction. Six randomized controlled trials were included (589 patients, 367 caregivers). Digital interventions included active digital education, telemedicine/video consultations, and digital quality of life (QoL) monitoring. Active digital education interventions (n = 2) significantly improved patients’ health-related quality of life, overall functional status, and individual physical symptoms (pain, fatigue, nausea). Findings regarding telemedicine and video consultation interventions (n = 3) were heterogeneous: short-term symptom non-inferiority was demonstrated in one study (n = 1), while inconsistent or non-significant quality-of-life trajectories were reported across others (n = 2), with one study (n = 1) observing increased pain and anxiety scores at 12 weeks. A passive digital quality-of-life monitoring platform (n = 1) did not yield measurable clinical benefits, primarily due to low clinical utilization. Direct evidence regarding caregiver-specific outcomes remains very limited (n = 1); the Canadian QPSS study found no statistically significant effect on caregiver quality of life. Regarding healthcare resource utilization (n = 3), flexible telemedicine integrated with clinical care reduced in-person contacts (n = 1), whereas fixed-frequency teleconsultations (n = 1) and passive monitoring (n = 1) did not demonstrate resource-reduction benefits. The impact of digital health interventions in home-based palliative care varies by intervention structure and delivery model. Active digital education shows consistent benefits for patient outcomes, whereas evidence for telemedicine, caregiver-specific endpoints, and healthcare resource reduction remains limited, mixed, or inconclusive. Future research requires practical multi-center randomized controlled trials with standardized reporting and workflow-integrated designs. 1. The effectiveness of digital palliative care does not depend on the technology itself, but rather on the presence of proactive education, behavioral activation, and caregiver involvement. 2. Video-based education and integrated apps can significantly improve patients’ quality of life, functional status, and symptoms such as anxiety, pain, and fatigue. 3. Scheduled, supply-driven once-weekly telemedicine consultations may increase symptom burden and anxiety (a nocebo effect), which remains to be verified in further studies. 4. Systems that provide assessment data without behavioral guidance fail to generate clinical benefits due to extremely low usage rates.