Community Health Workers and Technology Interventions' Impact on Palliative Support Globally: A Scoping Review of Randomized Controlled Trials.

Abstract

Background: Palliative care has the potential to relieve burdened global health systems but is in short supply in many low-resource settings. Community health workers (CHWs) and digital health tools/telephonic support have the potential to scale scarce palliative care resources and improve outcomes for seriously ill adults in home/community settings. Aim: To describe the utilization of CHWs and digital health/telephony in the palliative care of seriously ill adults in these settings. Design: We conducted a scoping review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews guidelines. Search terms were developed with a health sciences librarian. Data Sources: The databases PubMed, EMBASE, LILACS, and CINAHL were searched for articles published from January 1, 2012, to December 30, 2023. Results: A total of 31 articles out of 7518 screened were included in the final analysis. Studies were mostly conducted in the United States. Most interventions were remote, with only four addressing rural or minority populations. Nineteen targeted advanced cancer, with others focusing on chronic obstructive pulmonary disease, heart failure, renal disease, and hospice care. CHWs and digital health/telephony were commonly used for physical and psychological care. Culturally tailored interventions with CHWs were few but effective. Patient quality of life, health care utilization, and caregiver outcomes were significantly impacted. Conclusions: CHWs and digital health/telephony can improve quality of life, health care use, and caregiver support. Most research focuses on physical and psychological aspects of care instead of cultural aspects of care. Future research is needed to explore culturally tailored interventions in minority populations and low- and middle-income countries, as well as investigate emerging remote technologies to allow for scaling palliative care into home/community settings.