Using Complex Interventions to Develop Programme Theory for a Family‐Focused Model of Telepalliative Care

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BACKGROUND: Patients and families find telepalliative care to be a valuable and convenient supplement to conventional palliative care services. However, challenges persist in sustaining meaningful telepalliative care beyond the initial implementation. Developing structured models that are culturally and contextually aligned may be the key to sustainability. AIM: To develop programme theory for a family-focused model of telepalliative care for adult patients and their families. METHODS: Guided by the British Medical Research Council's framework for developing and evaluating complex interventions, data were collected through workshops with key stakeholders, participant observations and ethnographic interviews. Reflexive thematic and secondary data analyses were performed to develop programme theory and identify key uncertainties. RESULTS: Six workshops were held at two Danish locations with 49 participants. Three themes were generated. (1) Virtual care in palliative settings: Adapting to new norms and evolving practices in telepalliative care. This theme explores how professionals, patients and families adapted to new norms in virtual interactions without structured guidance. (2) Balancing trust and technology: The role of face-to-face consultations in telepalliative care. This theme examines the balance between face-to-face consultations and telepalliative care. (3) Governance and equity in telepalliative care: Ensuring access, sustainability and quality. This theme explores factors affecting the implementation, sustainability and equitable access to telepalliative care services. CONCLUSION: The programme theory highlighted the link between clinicians' level of digital competency and benefits to patients and families in telepalliative care, emphasising the need to enhance clinicians' skills. Further exploration is needed to identify the specific digital skills required for delivering effective telepalliative care. Key considerations include the importance of face-to-face first visits to establish relationships and the concern that technology may overshadow palliative care.

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