As we emerge from the coronavirus disease 2019 (COVID-19) pandemic, it is time for us to reflect on what we have learned from the pandemic, which we endured for over 2 years. The COVID-19 pandemic has highlighted and exacerbated global health disparities. The pandemic has affected the most vulnerable groups such as older adults, children, and low-income countries. Furthermore, the pandemic has accelerated the use of digital health. Digital health can advance health equity because it contributes to reducing the existing physical barriers of traditional healthcare. However, whether digital health can close the health equity gap in palliative care remains unclear.

In palliative care, a strand of digital health widely implemented during COVID-19 is telehealth, defined as “the use of two-way telecommunication technologies to provide clinical health care through a variety of remote methods.”1 Primarily, telehealth enables healthcare professionals to provide virtual care and treatment to patients without the risk of infection, which is essential during a pandemic, owing to the vulnerability of palliative care patients to transmissible infections.2 In addition, telehealth contributes to access to care, both in terms of availability and affordability as telehealth is available regardless of distance, and travel costs are at times unnecessary for the service.3 Particularly, in palliative care, telehealth promotes family members’ engagement in the patient’s end-of-life communication regardless of their geographical location, which is an important element of the patient’s quality of life and dignified death.4 Increased access can contribute to diversity and to the inclusiveness of care and treatment. Considering the limited access to palliative care worldwide, the contribution of digital health in reducing disparities in palliative care is evident.

Despite these advantages, digital health raises ethical concerns regarding health disparities. Digital health has brought changes in access to healthcare services and subsequently marginalized populations, from regional and physical vulnerability to technological infrastructure, language barriers, and digital literacy. Infrastructure, such as Internet connections and suitable devices, significantly influences the availability of telehealth services.5 A high proportion of telehealth studies are conducted in high-income regions, indicating potential inequity in the implementation of digital health.4 In addition, the quality of conversation via voice or video calls is not as high as that of in-person delivery because of the lack of nonverbal language.4 Patients and family members with insufficient language proficiency can be marginalized by rapidly increasing digital health deliveries.3 Furthermore, digital health requires digital literacy of patients and family members to access healthcare services, which marginalizes populations according to age, educational attainment, residency, and race. Palliative care patients share vulnerabilities in digital health access which can hinder the reach of digital health for patients in need.

Although digital health contributes to closing the health equity gap through the unprecedented development of technology and subsequent health access, some groups or populations are potentially at risk of marginalization. To maximize the impact of digital health on reducing health disparities, digital health in palliative care should be carefully designed and implemented, considering the characteristics of patients and family members. The design and implementation of care should consider the diversity of patients and their family members. In addition, up-to-date training and education for healthcare professionals will play a significant role in delivering person-centered and family-centered palliative care via digital health.

Yours sincerely,

Hye Ri Choi, PhD, RN
School of Nursing, Li Ka Shing Faculty of Medicine
The University of Hong Kong, Hong Kong SAR
Chia-Chin Lin, PhD, FAAN, RN
Editorial Board Member, Cancer Nursing Professor and Head
School of Nursing, Li Ka Shing Faculty of Medicine
The University of Hong Kong, Hong Kong SAR;
Alice Ho Miu Ling Nethersole Charity Foundation Professor in Nursing
The University of Hong Kong, Hong Kong

1. Koonin LM, Hoots B, Tsang CA, et al. Trends in the use of telehealth during the emergence of the COVID-19 pandemic—United States, January-March 2020. MMWR Morb Mortal Wkly Rep. 2020;69(43):1595–1599. 2. The Lancet. Palliative care and the COVID-19 pandemic. Lancet. 2020;395(10231):1168. 3. Broglio K, Kirkland KB. Rural palliative care patients' attitudes toward telemedicine visits during the COVID-19 pandemic: a descriptive study. J Palliat Med. 2021;24(8):1126–1127. 4. Xu X, Ho MH, Lin CC. Telehealth in palliative care during the COVID-19 pandemic: a systematic mixed studies review. Worldviews Evid Based Nurs. 2023. doi:10.1111/wvn.12637. 5. Kaihlanen AM, Virtanen L, Buchert U, et al. Towards digital health equity—a qualitative study of the challenges experienced by vulnerable groups in using digital health services in the COVID-19 era. BMC Health Serv Res. 2022;22(1):188.