Specialist palliative care remains highly uneven in rural and remote settings for patients with life-limiting illness and their families. This review aimed to examine the implementation characteristics, clinical and service-level outcomes, and patient experiences of tele-palliative care interventions for individuals living in rural or remote settings with limited access to specialist palliative care.
Methods
A systematic review was conducted in accordance with the PRISMA 2020 guidelines across PubMed, Scopus, CINAHL, and Google Scholar (August-October 2025). Eligible studies were published within the past 20 years and evaluated tele-palliative care interventions among rural populations. Data were extracted and outcomes were narratively synthesized.
Results
Thirteen primary studies were included, conducted in the United States (n = 8), Australia (n = 2), Canada (n = 1), Japan (n = 1), and England (n = 1). Interventions included video consultations, hybrid tele-palliative programs, and remote symptom monitoring. Across studies, reported outcomes included implementation and process outcomes, patient and caregiver experiences and communication outcomes, clinical and care-process outcomes and health service utilization and economic outcomes. Challenges included technological instability, internet access limitations and inconsistent implementation fidelity.
Conclusions
Tele-palliative care can extend specialist palliative care to rural and remote communities by reducing travel burden and supporting continuity, particularly when delivered through hybrid models embedded in local care pathways. However, the evidence base remains limited and concentrated in high-income settings, with heterogeneity in intervention models and outcome reporting. Future studies should use standardized implementation outcomes, evaluate equity impacts, and compare hybrid tele-palliative models with usual care in diverse rural contexts.
World Health Organization. Palliative Care. Geneva: WHO; 2023.
2.
RadbruchLDe LimaLKnaulF, et al.Redefining palliative care—A new consensus-based definition. J Pain Symptom Manag. 2020;60(4):754-764. doi:10.1016/j.jpainsymman.2020.04.027.
3.
HawleyPH. The bow tie model of 21st century palliative care. J Pain Symptom Manag. 2014;47(1):e2-e5. doi:10.1016/j.jpainsymman.2013.10.009.
4.
SpahoRSUhrenfeldtLFotisTBjerkanJGåre KymreI. Healthcare professionals’ experiences of eHealth in palliative care for older people: challenges, compromises and the price of dignity. Int J Qual Stud Health Well-Being. 2024;19(1):2374733. doi:10.1080/17482631.2024.2374733.
5.
RatcliffeMBurdCHolderKFieldsA. Defining rural at the US Census Bureau. ACSGEO-1. U.S. Census Bureau, Washington, DC, 2016;1(8):1-8.
6.
BonsignoreLBloomNSteinhauserK, et al.Evaluating the feasibility and acceptability of a telehealth program in a rural palliative care population: tapcloud for palliative care. J Pain Symptom Manag. 2018;56(1):7-14. doi:10.1016/j.jpainsymman.2018.03.013.
7.
GordonBMasonBSmithSLH. Leveraging telehealth for delivery of palliative care to remote communities: a rapid review. J Palliat Care. 2022;37(2):213-225. doi:10.1177/08258597211001184.
8.
AokiNOhtaSYamamotoHKikuchiNDunnK. Triangulation analysis of tele-palliative care implementation in a rural community area in Japan. Telemed J E Health. 2006;12(6):655-662. doi:10.1089/tmj.2006.12.655.
9.
Hayes BauerESchultzANØBrandtFSmithACBolligGDieperinkKB. Patient and families’ perspectives on telepalliative care: a systematic integrative review. Palliat Med. 2024;38(1):42-56. doi:10.1177/02692163231217146.
10.
CaltonBAbediniNFratkinM. Telemedicine in the time of coronavirus. J Pain Symptom Manag. 2020;60(1):e12-e14. doi:10.1016/j.jpainsymman.2020.03.019.
11.
TiemanJJSwetenhamKMorganDDToTHCurrowDC. Using telehealth to support end of life care in the community: a feasibility study. BMC Palliat Care. 2016;15(1):94. doi:10.1186/s12904-016-0167-7.
12.
FunderskovKFRaunkiærMDanbjørgDB, et al.Experiences with video consultations in specialized palliative home-care: Qualitative study of patient and relative perspectives. J Med Internet Res. 2019;21(3):e10208. doi:10.2196/10208.
13.
CoombsNCCampbellDGCaringiJ. A qualitative study of rural healthcare providers’ views of social, cultural, and programmatic barriers to healthcare access. BMC Health Serv Res. 2022;22(1):438. doi:10.1186/s12913-022-07829-2.
14.
MaitaKCManiaciMJHaiderCR, et al.The impact of digital health solutions on bridging the health care gap in rural areas: a scoping review. Perm J. 2024;28(3):130-143. doi:10.7812/TPP/23.134.
15.
BarryRGreenERobsonKNottM. Factors critical for the successful delivery of telehealth to rural populations: a descriptive qualitative study. BMC Health Serv Res. 2024;24(1):908. doi:10.1186/s12913-024-11233-3.
16.
Bin Abdul BatenRZohoraFTSiddiquiMUH. Disparities in telehealth utilization between US rural and urban areas during the COVID‐19 pandemic. J Rural Health. 2025;41(1):e12910. doi:10.1111/jrh.12910.
17.
OlsonKPhillipsASmythJDStengerR. The urban–rural digital divide in internet access and online activities during the COVID‐19 pandemic. Rural Sociol. 2025;90(3):e70012. doi:10.1111/ruso.70012.
18.
EllK. Social networks, social support and coping with serious illness: the family connection. Soc Sci Med. 1996;42(2):173-183. doi:10.1016/0277-9536(95)00100-X.
19.
GolicsCJBasraMKAFinlayAYSalekS. The impact of disease on family members: a critical aspect of medical care. J R Soc Med. 2013;106(10):399-407. doi:10.1177/0141076812472616.
20.
MystakidouKTsilikaEParpaEPathiakiMGalanosAVlahosL. The relationship between quality of life and levels of hopelessness and depression in palliative care. Depress Anxiety. 2008;25(9):730-736. doi:10.1002/da.20319.
21.
PitisADiamantopoulouMPanagiotouAPapageorgiouDTzavellaF. Financial toxicity and its association with the quality of life of Greek patients with cancer: a cross-sectional study. Nurs Rep. 2025;15(2):67.
22.
PitisADiamantopoulouMPanagiotouAPapageorgiouDTzavellaF. Social capital as a determinant of quality of life in Greek cancer patients: a cross-sectional study. Front Public Health. 2025;13:1602804. doi:10.3389/fpubh.2025.1602804.
23.
NikoloudiMKalogeridiMATsatsouIMystakidouK. Comprehensive assessment of quality of life and preservation of dignity in cancer patients undergoing radiotherapy treatment. Indian J Palliat Care. 2025;31:221-226. doi:10.25259/IJPC_309_2024.
24.
AldanaGLEvohOVReddyA. Best practices for providing patient-centered tele-palliative care to cancer patients. Cancers. 2023;15(6):1809. doi:10.3390/cancers15061809.
25.
HancockSPrestonNJonesHGadoudA. Telehealth in palliative care is being described but not evaluated: a systematic review. BMC Palliat Care. 2019;18(1):114. doi:10.1186/s12904-019-0495-5.
26.
JessMTimmHDieperinkKB. Video consultations in palliative care: a systematic integrative review. Palliat Med. 2019;33(8):942-958. doi:10.1177/0269216319854938.
27.
RoganteMGiacomozziCGrigioniMKairyD. Telemedicine in palliative care: a review of systematic reviews. Ann Ist Super Sanita. 2016;52(3):434-442. doi:10.4415/ANN_16_03_16.
28.
PageMJMcKenzieJEBossuytPM, et al.The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. doi:10.1136/bmj.n71. Published online March 29.
29.
HaddawayNRPageMJPritchardCCMcGuinnessLA. PRISMA2020: an R package and shiny app for producing PRISMA 2020-compliant flow diagrams, with interactivity for optimised digital transparency and open synthesis. Campbell Syst Rev. 2022;18(2):e1230. doi:10.1002/cl2.1230.
30.
ChandlerJCumpstonMLiTPageMJWelchV. Cochrane Handbook for Systematic Reviews of Interventions. Hoboken: Wiley; 2019, vol. 4(1002), p. 14651858.
31.
HaddawayNRCollinsAMCoughlinDKirkS. The role of google scholar in evidence reviews and its applicability to grey literature searching. Wray KB, ed. PLoS One. 2015;10(9):e0138237. doi:10.1371/journal.pone.0138237.
32.
HongQNFàbreguesSBartlettG, et al.The mixed methods appraisal tool (MMAT) version 2018 for information professionals and researchers. EFI. 2018;34(4):285-291. doi:10.3233/EFI-180221.
33.
PaceRPluyePBartlettG, et al.Testing the reliability and efficiency of the pilot mixed methods appraisal tool (MMAT) for systematic mixed studies review. Int J Nurs Stud. 2012;49(1):47-53. doi:10.1016/j.ijnurstu.2011.07.002.
34.
BakitasMAGazawaySUnderwoodF, et al.Palliative video consultation and symptom distress among rural inpatients: a randomized clinical trial. JAMA Netw Open. 2025;8(7):e2519426. doi:10.1001/jamanetworkopen.2025.19426.
35.
CheungKLTamuraMKStapletonRDRabinowitzTLaMantiaMAGramlingR. Feasibility and acceptability of telemedicine-facilitated palliative care consultations in rural dialysis units. J Palliat Med. 2021;24(9):1307-1313. doi:10.1089/jpm.2020.0647.
36.
WatanabeSMFairchildAPituskinEBorgersenPHansonJFassbenderK. Improving access to specialist multidisciplinary palliative care consultation for rural cancer patients by videoconferencing: report of a pilot project. Support Care Cancer. 2013;21(4):1201-1207. doi:10.1007/s00520-012-1649-7.
37.
MenonPRStapletonRDMcVeighURabinowitzT. Telemedicine as a tool to provide family conferences and palliative care consultations in critically ill patients at rural health care institutions: a pilot study. Am J Hops Palliat Care. 2015;32(4):448-453. doi:10.1177/1049909114537110.
38.
SnoswellCLSmithACGroveG, et al.A cost-consequence analysis of the Queensland specialist palliative rural telehealth (SPaRTa) service. Prog Palliat Care. 2024;32(5):326-333. doi:10.1080/09699260.2024.2374601.
39.
HartzSGarbinAMcGuireCSteagallJMcCauliffJNearingKA. Establishing first age-friendly health system tele-palliative care clinic – facilitators, challenges, lessons learned to improve care for rural, older veterans. Inquiry. 2025;62:00469580251352727. doi:10.1177/00469580251352727.
40.
HutchinsonRAndersonEGramlingRHanP. A multi-method pilot study to explore the acceptability and feasibility of tele-palliative care. J Pain Symptom Manag. 2022;63(5):881. doi:10.1016/j.jpainsymman.2022.02.081.
41.
CheungKLSmogerSTamuraMK, et al.Content of tele-palliative care consultations with patients receiving dialysis. J Palliat Med. 2022;25(8):1208-1214. doi:10.1089/jpm.2021.0539.
42.
CollierAMorganDDSwetenhamKToTHCurrowDCTiemanJJ. Implementation of a pilot telehealth programme in community palliative care: a qualitative study of clinicians’ perspectives. Palliat Med. 2016;30(4):409-417. doi:10.1177/0269216315600113.
43.
TarbiECAmbroseNAndersonEC, et al.“It’s hard to talk to a computer, I get it”: an exploratory analysis of clinician connection-building communication practices in rural telepalliative care encounters. PEC Innovation. 2025;6:100377. doi:10.1016/j.pecinn.2025.100377.
44.
DismoreLFrewKWakefieldDBryanCSwainstonK. Remote and rural communities face inequalities in access to specialist palliative care, could telemedicine enhance care? A qualitative study of patient, carer and healthcare professionals’ experiences of video consultation. Palliat Care Soc Pract. 2025;19:26323524251380632. doi:10.1177/26323524251380632.
45.
HutchinsonRNAndersonECRubenMA, et al.A formative mixed-methods study of emotional responsiveness in telepalliative care. J Palliat Med. 2022;25(8):1258-1267. doi:10.1089/jpm.2021.0589.
46.
KirbyAGriffinDHeavinCDrummondFJMcGrathCKielyF. Telehealth adoption in palliative care: a systematic review of patient barriers and facilitators. BMC Palliat Care. 2025;24(1):52. doi:10.1186/s12904-025-01698-2.
47.
HeadBASchapmireTJZhengY. Telehealth in palliative care: a systematic review of patient-reported outcomes. J Hospice Palliat Nurs. 2017;19(2):130-139. doi:10.1097/NJH.0000000000000319.
48.
ZhengYHeadBASchapmireTJ. A systematic review of telehealth in palliative care: caregiver outcomes. Telemed J E Health. 2016;22(4):288-294. doi:10.1089/tmj.2015.0090.
49.
FasolinoTMayfieldMEValentineKRosaWEKociA. Palliative care in rural communities. Am J Nurs. 2024;124(8):50-55. doi:10.1097/01.NAJ.0001027716.70431.35.
50.
MaoATamLXuA, et al.Barriers to telemedicine video visits for older adults in independent living facilities: mixed methods cross-sectional needs assessment. JMIR Aging. 2022;5(2):e34326. doi:10.2196/34326.
51.
MarshallCVirdunCPhillipsJL. Patient and family perspectives on rural palliative care models: a systematic review and meta-synthesis. Palliat Med. 2024;38(9):935-950. doi:10.1177/02692163241269796.
52.
HollandDEVanderboomCEIngramCJ, et al.The feasibility of using technology to enhance the transition of palliative care for rural patients. Comput Inf Nurs. 2014;32(6):257-266. doi:10.1097/CIN.0000000000000066.
