Effectiveness of telehealth interventions for palliative care in patients with kidney failure: a systematic review.

Abstract

Background: Kidney failure affects a substantial proportion of the global population, and is associated with high morbidity and mortality. These patients require high-quality palliative care to manage symptoms and enhance quality of life. With advances in technology, telehealth offers potentially convenient and scalable means to provide this integral aspect of care. This systematic review assessed the effectiveness of telehealth interventions for providing palliative care in patients with kidney failure.

Methods: A comprehensive search of PubMed (32), Cochrane (1), Google Scholar (938) and HINARI (25) yielded 1039 articles. Following the removal of duplicates, 1013 articles remained. Screening questions were developed in relation to the use of telehealth-based interventions among patients with kidney failure for palliative care. Studies on patients with stages 1-4 of chronic kidney disease, telehealth interventions related to improving renal replacement therapy, interventions focused on optimization of medical complications or drug adherence and caregiver-directed interventions were excluded. Articles were screened by two independent reviewers, with conflicts settled by a third. Risk of bias was assessed using the RoB2 tool for randomized controlled trials (RCTs). Meta-analysis was not performed following heterogeneity assessments. Registration was done in PROSPERO registry with the ID CRD42024582255.

Results: Four RCTs were included in the final review. Two had low risk of bias while the other two had moderate risk. Three of the interventions were nurse-led telehealth interventions that focused on post-discharge follow up with outcomes related to quality of life and symptom control. The other focused on cognitive behavioral therapy (CBT) delivered via telehealth. All post-discharge follow-up telehealth interventions showed significant improvements in symptom control and quality of life. The CBT intervention also demonstrated significant improvement in symptom control.

Conclusions: Telehealth interventions for provision of palliative care in patients with kidney failure seem promising for improvement of symptom control and quality of life.