Death in the digital age: A systematic review of information and communication technologies in end-of-life care

Kirsten Anne Ostherr, The University of Texas School of Public Health


Background: The first baby boomers turned 65 in the year 2011. As this population ages and approaches death, it will place increasing demands on an overburdened healthcare system that already provides inadequate end-of-life care to many patients. Information and communication technologies (ICTs) may offer a means to address the needs of this generation, particularly for the growing numbers of tech-savvy seniors who are already accustomed to using smartphones, the internet and other digital devices as part of their daily lives. However, few resources exist to guide the use of ICTs in end-of-life care. Methods: A systematic review of the literature was conducted using Medline, PubMed PsycINFO, Sociological Abstracts, Communication Abstracts, CINAHL, and Embase. Cross-sectional, case-control, cohort studies, and clinical trials were included. Only articles published in English between the dates of 1997 and 2013 were included in the final review. Concepts that made up the search included end-of-life, doctor-patient communication, and technology. Aims: The primary aim was to identify the information and communication technologies being used in end-of-life communication. The secondary aim was to compare the effectiveness of different information and communication technologies being used in end-of-life communication. Results: Two thousand two hundred and forty eight (2248) publications were identified, twenty-nine of which met the inclusion criteria for the review. Fifteen of the studies were randomized, controlled trials, thirteen were quasi-experimental pre-intervention post-intervention studies, and one was an interrupted time series study. The study populations were approximately evenly distributed between two primary patient groups: 48% were cancer patients (n=14) and 52% were non-cancer patients (n=15). Eight different types of technology were identified: the majority (59%, n=17) used video as the intervention technology; 14% (n=4) developed a prototype website; 14% (n=4) used a telephone; and the remaining technologies—videoconferencing, email prompt, telemonitoring, Internet search, and Compact Disc (CD)—were used once each. Of the twenty-nine studies included in this review, 45% ( n=13) were published between 2011-2013, with 28% (n=8) published in the year 2013 alone. Eight different purposes of ICT use were identified. The most common purposes for using technology in these interventions were to provide information/education and to serve as decision aids, followed by promoting Advance Care Planning (ACP), and relieving physical symptom distress. Conclusions: The use of ICTs in end-of-life care is a small, but growing, field of research. Early results show promise for further applications, but additional research is needed to adapt older, analogue technologies for use in the digital age. Many of the interventions discussed in this review do not take full advantage of the affordances of mobile, connected health ICTs. The growing evidence base for mHealth and eHealth applications in related fields should guide future interventions in end-of-life care.

Subject Area

Communication|Information Technology|Public health

Recommended Citation

Ostherr, Kirsten Anne, "Death in the digital age: A systematic review of information and communication technologies in end-of-life care" (2014). Texas Medical Center Dissertations (via ProQuest). AAI1568492.