# How, when and why is emotional support delivered using videoconferencing by adult palliative care services successful? A realist synthesis

## TL;DR

This study explores how and why video calls can successfully provide emotional support in palliative care, finding that it works best when addressing isolation and supported by proper resources and leadership.

## Contribution

The study provides a realist synthesis framework to understand the success factors of videoconferencing in delivering emotional support in palliative care.

## Key findings

- Emotional support via videoconferencing is feasible when it addresses social isolation and maintains engagement.
- Success depends on stakeholder motivation, resource allocation, and organizational support for staff.
- Leadership and inter-agency collaboration are crucial for mitigating digital exclusion and enhancing outcomes.

## Abstract

Videoconferencing (also known as telehealth) is part of digitally enabled healthcare provision (‘eHealth’) and its use in palliative care practice is increasing. There is uncertainty and limited evidence to guide organisations in how to use this technology to provide emotional support for patients, caregivers and the bereaved.

How, why, and in which circumstances can videoconferencing be used to successfully meet the emotional support needs of adults receiving palliative care?

Realist synthesis of literature was conducted according to RAMESES guidelines.

Evidence of research studies and practice descriptions about successful emotional support interventions in palliative care by videoconferencing were identified from six databases (AMED, Medline, PsycINFO, SCOPUS, TRIP, Overton.io) and Google searching on16th January 2023. Normalisation Process Theory guided analysis and synthesis proceeded iteratively through retroductive reasoning.

Synthesis of 13 eligible sources (9 empirical studies and 4 practitioners’ perspectives) generated 10 context-mechanism-outcome configurations and 5 hypothetical explanations for successful videoconferencing interventions. Potential causative links were made connecting social isolation, financial, educational and relational resourcing, and feelings of self-confidence, fear, or desires for belonging.

Emotional support by videoconferencing in adult palliative care is feasible when it addresses feelings of isolation and maintains patient/carer engagement with services. It depends on stakeholders being motivated and resourced to adapt and innovate interventions appropriate for those with least familiarity or access to technology. To be successful staff need leadership and organisational cultures that enhance their professional self-worth and technical competencies, that foster inter-agency collaborations and mitigate digital exclusion of service users.

How, when and why is emotional support delivered by video calls to adult patients, caregivers and the bereaved by palliative care organisations successful? A systematically conducted realist literature review

Connecting patients with healthcare providers by video technology (videoconferencing) claims to extend the reach of palliative care by overcoming barriers of geographical distance and limited time, energy and financial resources. Research in this area has focused on physical aspects of care. However, little is known about circumstances leading to successful emotional support by video call for palliative care service users provided by counsellors, arts therapists, chaplains, psychologists, social workers or medical and nursing professionals. To understand how, when and why videoconferencing is used successfully for emotional support in palliative care a systematically conducted review of literature was undertaken. Thirteen sources met the inclusion criteria and comprised research studies and practitioner accounts. These were appraised using Normalisation Process Theory, which offers ways to explain individual and collective efforts in getting new interventions underway in healthcare. A realist approach was used to analyse retrieved sources and build potential explanations to answer the review question. Five explanations were generated and labelled: 1/Shifting balance of power and agency; 2/All in this together; 3/Follow the leader or money; 4/Comply or die; 5/Fear of missing out. These suggest reasons for using videoconferencing for emotional support in palliative care. In circumstances of social isolation people seek new ways to stay connected with those who matter to them. With organisational support through the provision of material and educational resources patients and staff can adopt new interventions and be motivated to take account of folk with least familiarity or access to technology. Success requires leadership and organisational cultures that foster collaborations, professional development and technical competencies. This article may help organisations make best use of staff and technology to add virtual interventions to their palliative care provision.