Background: The exponential growth of telehealth is revolutionizing health care delivery, but its evaluation has not matched the pace of its uptake. Various forms of assessment, from single-item to more extensive questionnaires, have been used to assess telehealth and digital therapeutics and their usability. The most frequently used questionnaire is the “Telehealth Usability Questionnaire” (TUQ). The use of the TUQ is limited by its restricted availability in languages other than English and its feasibility. Objective: The aims of this study were to create a translated German TUQ version and to derive a short questionnaire for patients—“Telehealth Usability and Perceived Usefulness Short Questionnaire for patients” (TUUSQ). Methods: As a first step, the original 21-item TUQ was forward and back-translated twice. In the second step, 13 TUQ items were selected for their suitability for the general evaluation of telehealth on the basis of expert opinion. These 13 items were surveyed between July 2022 and September 2023 in 4 studies with patients and family members of palliative care, as well as patients with chronic autoimmune diseases, evaluating 13 health care apps, including digital therapeutics and a telehealth system (n1=128, n2=220, n3=30, and n4=12). Psychometric exploratory factor analysis was conducted. Results: The analysis revealed that a parsimonious factor structure with 2 factors (“perceived usefulness in health care” and “usability”) is sufficient to describe the patient’s perception. Consequently, the questionnaire could be shortened to 6 items without compromising its informativeness. Conclusions: We provide a linguistically precise German version of the TUQ for assessing the usability and perceived usefulness of telehealth. Beyond that, we supply a highly feasible shortened version that is versatile for general use in telehealth, mobile health, and digital therapeutics, which distinguishes between the 2 factors “perceived usefulness in health care” and “usability” in patients. Trial Registration: German Clinical Trials Register DRKS00030546; https://drks.de/search/de/trial/DRKS00030546

Pediatric palliative home care (PPHC) provides care for children, adolescents, and young adults with life-limiting illnesses in their own homes. Home care often requires long travel times for the PPHC team, which is available to the families 24/7 during crises. The complementary use of telehealth may improve the quality of care. In this pilot study we identify the needs and concerns of patients, teams, and other stakeholders regarding the introduction of telehealth. As a first step, focus groups were conducted in three teams. For the second step, semi-structured interviews were conducted with patients and their families (n = 15). Both steps were accompanied by quantitative surveys (mixed methods approach). The qualitative data were analyzed using content analysis. A total of 11 needs were identified, which were prioritized differently. Highest priority was given to: data transmission, video consultation, access to patient records, symptom questionnaires, and communication support. The concerns identified were related to the assumption of deterioration of the status quo. Potential causes of deterioration were thought to be the negative impact on patient care, inappropriate user behavior, or a high level of technical requirements. As a conclusion, we define six recommendations for telehealth in PPHC.

Background: Specialized outpatient palliative care (SOPC) provides home-based care for terminally ill patients and is associated with improved quality of life and prolonged survival. Due to its decentralized structure and growing demand, SOPC is a key target for digital transformation. Telehealth, mobile health, and AI offer considerable potential benefits but also present challenges, particularly with regard to user acceptance. Although both children and adults receive SOPC under the German statutory health insurance system, services differ in terms of patient characteristics, duration of care, and geographic coverage. Moreover, there is limited knowledge regarding the extent to which digital health applications are transferable across different areas of palliative care. Objective: This study assesses the extent to which needs and concerns regarding digitalization in SOPC for children are transferable to adult SOPC, using the PalliDoc Mobile app as a case example. Methods: Two adult SOPC teams using the PalliDoc Mobile app (a pediatric-origin mobile app) were surveyed between March 2022 and March 2025 using an embedded mixed methods design to assess digitalization needs and concerns. Therefore, a focus group study took place in the respective offices of the included teams. Twenty-five members from both teams, who were recruited via the personal network of the authors, participated, representing urban and rural care areas in Germany. Using an open-ended interview guide, the needs and concerns were first discussed with all participating members of each team. In a second step, the participants were allocated to profession-specific subgroups to further explore and prioritize the identified needs using a quantitative voting format. The focus group discussions were analyzed using qualitative content analysis, while the analysis of the prioritization votes was performed using descriptive statistics. Results: The triangulation of qualitative and quantitative findings revealed a total of 13 needs within the examined care teams for adults, with functions focusing on voice control being the highest priority (n=8 positive votes and no negative votes for voice input; n=6 positive votes and no negative votes for voice output). Additionally, functions relating to digitization and organizational tasks were viewed as predominantly helpful. Unlike in pediatrics, telehealth functions like video contacts, telemetry, and electronic patient-reported outcome measures are neither used here now nor intended to be used in the future. The identified concerns predominantly addressed the potential risk of AI-assisted documentation (n=2 positive votes and n=7 negative votes) altering or distorting health care professionals’ perception of information related to patients. Conclusions: Cross-setting telehealth applications may work, but they are no “plug-and-play solution.” Needs and concerns in each setting should be addressed to guarantee customized services.

(Electronic) patient reported outcome measures ((e)PROMs) enable the systematic assessment of patients' health status and treatment needs. However, their targeted use in pediatric palliative home care (PPHC) remains limited, as existing instruments are largely derived from adult care and have not adequately addressed the needs of this specific field. This study aims to develop a child-specific (e)PROM tool to assess and monitor symptom burden in children and young people receiving PPHC. Following the COSMIN Practical Guide for Measurement in Medicine, we first gathered the experiences of n=3 German PPHC teams using a questionnaire survey and expert panel. Secondly, a systematic literature review was conducted based on PRISMA statement to refine the tool. A field test involving n=63 patients was subsequently carried out to evaluate the practical implementation of the tool. The expert panel established 37 symptom categories, which formed the Pediatric Palliative Symptom Categories (PPSC). The comparison with instruments from literature review showed high consistency, yet the PPSC covers a wider range of symptoms specifically relevant for PPHC. The field test confirmed the accuracy of the PPSC but also revealed some necessary adjustments regarding the language and scope of the symptoms based on user responses. Providing tailored instruments is essential for precisely and effectively assessing symptom burden in PPHC, as transferring instruments from adult care has proven insufficient. The PPSC offers the potential to enhance patient care and research in PPHC. Further research is needed to customize, validate, and determine long-term effectiveness of the tool.

Background: Digital health technologies may support communication, symptom management, continuity of care, and access to services in hospice and palliative care. National data on their adoption, on professionals’ attitudes, and on perceived barriers are scarce. We examined digital health adoption, attitudes towards digital health, perceived suitability, perceived barriers, and self-rated eHealth literacy among hospice and palliative care professionals in Germany. Methods: We conducted a national cross-sectional web-based survey among all members of the German Society for Palliative Medicine (DGP) between 15 August and 28 September 2024. The questionnaire covered current use of digital devices and services, perceived suitability and impact of digital health, perceived usefulness across care domains, perceived barriers, use of and willingness to use artificial intelligence (AI), and self-rated eHealth literacy using the German Revised eHealth Literacy Scale (GR-eHEALS). We analyzed data descriptively and with bivariate tests. We report the study according to the CHERRIES and CROSS checklists. Results: In total, 618 professionals completed the survey (completion rate 88%; 9.6% of all invited members). Established tools were used by most respondents (computers 99%, email 98%, electronic patient documentation 73%), whereas patient-facing and newer technologies were used less often (electronic health card 39%, mobile health apps 29%, video consultation 20%). In 2024, 69% reported no regular AI use; 12.7% selected the maximum score for willingness to use AI regularly at work. Respondents rated digital health as less suitable for hospice and palliative care than for general healthcare (M = 3.53 vs. 4.00 on a 1–5 scale; Cohen’s d = 0.59). Digital tools were rated as most useful for coordination with external professionals, advance care planning, and communication with relatives, and as least useful for nursing care, therapies, and pastoral care. The most frequently perceived barriers were inadequate technical infrastructure (75%) and perceived limited digital literacy among patients (67%) and relatives (62%). Self-rated eHealth literacy was high (GR-eHEALS M = 4.31 on a 1–5 scale). Conclusions: Hospice and palliative care professionals in Germany broadly use established digital tools, whereas patient-facing technologies are used less. Acceptance is context-specific: digital support is welcomed for coordination, advance care planning, and communication, and viewed more cautiously where personal presence is central to care. Implementation should prioritize technical infrastructure and context-sensitive design that preserves relational, person-centered care.

BACKGROUND The exponential growth of telehealth is revolutionizing health care delivery, but its evaluation has not matched the pace of its uptake. Various forms of assessment, from single-item to more extensive questionnaires, have been used to assess telehealth and digital therapeutics and their usability. The most frequently used questionnaire is the “Telehealth Usability Questionnaire” (TUQ). The use of the TUQ is limited by its restricted availability in languages other than English and its feasibility. OBJECTIVE The aims of this study were to create a translated German TUQ version and to derive a short questionnaire for patients—“Telehealth Usability and Perceived Usefulness Short Questionnaire for patients” (TUUSQ). METHODS As a first step, the original 21-item TUQ was forward and back-translated twice. In the second step, 13 TUQ items were selected for their suitability for the general evaluation of telehealth on the basis of expert opinion. These 13 items were surveyed between July 2022 and September 2023 in 4 studies with patients and family members of palliative care, as well as patients with chronic autoimmune diseases, evaluating 13 health care apps, including digital therapeutics and a telehealth system (n1=128, n2=220, n3=30, and n4=12). Psychometric exploratory factor analysis was conducted. RESULTS The analysis revealed that a parsimonious factor structure with 2 factors (“perceived usefulness in health care” and “usability”) is sufficient to describe the patient’s perception. Consequently, the questionnaire could be shortened to 6 items without compromising its informativeness. CONCLUSIONS We provide a linguistically precise German version of the TUQ for assessing the usability and perceived usefulness of telehealth. Beyond that, we supply a highly feasible shortened version that is versatile for general use in telehealth, mobile health, and digital therapeutics, which distinguishes between the 2 factors “perceived usefulness in health care” and “usability” in patients. CLINICALTRIAL German Clinical Trials Register DRKS00030546; https://drks.de/search/de/trial/DRKS00030546