Ma Cong, Fang Yifan, Zhang Hui, Zheng Ying, Zhang Ying, Zhao Wanchen, Yan Ge, Zeng Yaoxin, Zhang Yanwu, Ning Xiaohong, Jia Zhimeng, Guo Na
School of Nursing, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
Department of Nursing, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
J Med Internet Res. 2025 May 5;27:e73024. doi: 10.2196/73024.
Telehealth technologies can enhance patients' and their families' access to high-quality resources in home-based palliative care. Nurses are deeply involved in delivering telehealth in home-based palliative care. However, no previous integrative systematic reviews have synthesized evidence on nurses' roles, facilitators, and barriers to implementing nurse-delivered telehealth in home-based palliative care.
This integrative systematic review aimed to provide a comprehensive understanding of the roles of nurses and the multilevel facilitators and barriers to implementing nurse-delivered telehealth in home-based palliative care, which could inform future policy development, research, and clinical practice.
This integrative systematic review was conducted using Joanna Briggs Institute methodological guidance. We followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines. We systematically searched articles published from January 1, 2014, to May 2024 in PubMed, Embase, Web of Science, CINAHL, and Cochrane Library. We included English-language; peer-reviewed; original; and qualitative, quantitative, and mixed methods studies that centered on nurse-delivered telehealth in home-based palliative care. We used the Mixed Methods Appraisal Tool to assess the quality of the included articles. Furthermore, 3 authors independently assessed eligibility, extracted data, and assessed the quality of articles. The entities to extract were identified by research questions of interest regardless of the type of study. We applied a convergent synthesis approach to integrate quantitative and qualitative data. Guided by the updated Consolidated Framework for Implementation Research (CFIR) 2.0, we synthesized the facilitators and barriers to implementing nurse-delivered telehealth in home-based palliative care.
This integrative systematic review identified 4819 unique articles, including 34 papers encompassing 29 unique primary research studies. Innovations were mainly delivered by nurses (n=8) and nurse-involved multiprofessional teams (n=18). The roles of nurses in telehealth home-based palliative care involve palliative care nurses, community nurses, nurse coordinators, nurse coaches or nurse navigators, and nurse case managers. Guided by CFIR 2.0, facilitators and barriers to implementing nurse-delivered, telehealth, home-based palliative care were identified to 6 implementation levels and 20 constructs. The key facilitators included the COVID-19 pandemic, cost avoidance to the health care system, engagement of patients and their family caregivers, and so on. The barriers included a lack of reimbursement and payment mechanisms, technical problems, insufficiently trained health care providers, and so on.
This integrative systematic review synthesizes evidence on nurses' evolving roles in telehealth home-based palliative care and identifies multilevel facilitators and barriers to nurse-delivered, home-based palliative care implementation. With the empowerment of telehealth technologies, nurses could establish a stronger professional identity and develop leadership in home-based palliative care. Nurses should leverage influence to promote nursing practice, clinical management, and policy support in the implementation of telehealth home-based palliative care.
PROSPERO CRD42024541038; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024541038.
远程医疗技术可以增强患者及其家属在家居姑息治疗中获取高质量资源的机会。护士深度参与到家居姑息治疗的远程医疗服务中。然而，以往尚无综合性系统评价对护士在家居姑息治疗中提供远程医疗服务的角色、促进因素和障碍进行证据整合。
本综合性系统评价旨在全面了解护士的角色以及在家居姑息治疗中实施护士主导的远程医疗服务的多层次促进因素和障碍，为未来的政策制定、研究和临床实践提供参考。
本综合性系统评价依据乔安娜·布里格斯循证卫生保健中心的方法学指南开展。遵循PRISMA（系统评价与Meta分析优先报告条目）指南。我们系统检索了2014年1月1日至2024年5月在PubMed、Embase、Web of Science、CINAHL和Cochrane图书馆发表的文章。纳入英文、经同行评审、原创的定性、定量和混合方法研究，这些研究聚焦于护士在家居姑息治疗中提供的远程医疗服务。我们使用混合方法评估工具评估纳入文章的质量。此外，3位作者独立评估纳入标准、提取数据并评估文章质量。提取的实体由感兴趣的研究问题确定，而不考虑研究类型。我们采用聚合性综合方法整合定量和定性数据。在更新后的实施研究综合框架（CFIR）2.0的指导下，我们综合了在家居姑息治疗中实施护士主导的远程医疗服务的促进因素和障碍。
本综合性系统评价共识别出4819篇独特文章，其中包括34篇论文，涵盖29项独特的原始研究。创新服务主要由护士（n = 8）和有护士参与的多专业团队（n = 18）提供。护士在家居姑息治疗远程医疗服务中的角色包括姑息治疗护士、社区护士、护士协调员、护士教练或护士导航员以及护士个案管理员。在CFIR 2.0的指导下，确定了在家居姑息治疗中实施护士主导的远程医疗服务的促进因素和障碍，涉及6个实施层面和20个构建模块。关键促进因素包括新冠疫情、医疗系统成本节约、患者及其家庭照护者的参与等。障碍包括缺乏报销和支付机制、技术问题、医护人员培训不足等。
本综合性系统评价整合了护士在家居姑息治疗远程医疗服务中不断演变的角色的证据，并识别了护士主导的家居姑息治疗实施的多层次促进因素和障碍。借助远程医疗技术的赋能，护士可以在家居姑息治疗中建立更强的专业身份并发挥领导作用。护士应利用自身影响力，促进远程医疗家居姑息治疗实施中的护理实践、临床管理和政策支持。
PROSPERO CRD42024541038；https://www.crd.york.ac.uk/PROSPERO/view/CRD42024541038
