Background: Telehealth is growing and its application in palliative care is seen as a solution to pressures on\npalliative care services. A 2010 UK review reported growing awareness of telehealth in palliative care but a lack of\nevidence-based research to support its use. The primary aim of this review was to describe the current use of\ntelehealth in palliative care in the UK and evaluate telehealth initiatives against a digital service standard. The\nsecondary aim was to explore whether telehealth results in a reduction in emergency care access.\nMethods: Systematic review of the literature with thematic synthesis. Records were screened and data extracted by\ntwo reviewers. EMBASE, MEDLINE, CINAHL, Psychinfo and Cochrane central register for controlled trials were\nsearched using pre-defined terms. Hand searching of conference literature, thesis databases and citation tracking\nwas also conducted. The protocol for this systematic review was registered with PROSPERO and can be found at\nhttp://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42017080038.\nResults: The search identified 3807 titles and 30 studies were included in the review. Telehealth was used to\nsupport patients and carers, electronic record keeping and professional education. Notably, the number of home\ntelemonitoring initiatives for patients had increased from the 2010 review. Despite this variety, many studies were\nsmall scale, descriptive and provided little evidence of evaluation of the service. Ten papers were sufficiently\ndetailed to allow appraisal against the digital service standard and only one of these met all of the criteria to some\nextent. Seven studies made reference to emergency care access.\nConclusions: Although there is growth of telehealth services, there remains a lack of evaluation and robust study\ndesign meaning conclusions regarding the clinical application of telehealth in palliative care cannot be drawn.\nThere is insufficient evidence to appreciate any benefit of telehealth on access to emergency care. Future work is\nneeded to evaluate the use of telehealth in palliative care and improve telehealth design in line with digital service\nstandards.
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