Adoption of, attitudes towards, and perceived challenges of digital health in hospice and palliative care among professionals in Germany: a national cross-sectional web-based survey

Abstract

Abstract 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.