Evaluation of Hospice@Home for Home-Based Palliative Care: Development and Usability Pilot Study.

Background: The demand for palliative care is rising due to population aging and increased chronic illness. However, access to timely palliative care remains limited, particularly for patients receiving home-based hospice care in rural areas. Digital health technologies present an opportunity to enhance care delivery and communication at home. Objective: This pilot study aimed to (1) develop the Hospice@Home system, a digital in-home hospice care solution; (2) explore preliminary indications of usability and feasibility among patients with terminal cancer and their caregivers; and (3) identify challenges for future implementation. Methods: Hospice@Home was developed following the human-centered, evidence-driven Adaptive Health Experience and Application Design approach. After the prototype was developed, alpha testing was conducted with 2 simulated patients to assess system functionality and identify technical issues. Usability was measured through structured observation and task completion success during these sessions. Feasibility was evaluated during a 3-week beta test involving 5 dyads of patients with terminal cancer and caregiver, recruited through a home-based palliative care agency. Challenges were identified through user feedback, field notes, and technical logs collected throughout the testing period. Results: Hospice@Home is a web app optimized for Android devices. It integrates wearable biosignal data-blood pressure, pulse rate, sleep patterns, and oxygen saturation-measured via the Samsung Galaxy Watch 6. It also allows self-reporting of body temperature, pain levels, bowel movements, and the severity of symptoms tailored to individual patients. Medication compliance, including scheduled and pro re nata analgesics, was recorded in a smart medication box and automatically transmitted to Hospice@Home. Over 3 weeks, 5 patients (aged 53-93 y) with terminal cancer and their caregivers (aged 38-63 y) explored the system. Both patients and caregivers appreciated the consolidated symptom reporting and real-time data sharing, noting that the system helped them feel more reassured and connected to clinical support. Usability was assessed via satisfaction ratings, averaging 3.3 (SD 0.5) for patients and 4.0 (SD 0.7) for caregivers (5-point scale). Feasibility was evaluated through task compliance; dyads completed ≥13 of 18 tasks during stable periods. No major technical issues were reported. Challenges to consistent system use included data entry fatigue, psychological barriers to using technology, fluctuations in cognitive and physical functioning, and a general preference among patients and caregivers for phone calls rather than using the in-app communication. Conclusions: Hospice@Home showed early signals of usability and feasibility among patients with terminal cancer and caregivers, but these preliminary observations require cautious interpretation given the pilot design. The findings highlight potential value in supporting home-based palliative care, while underscoring the need for ongoing refinement and iterative testing before making broader claims about effectiveness or clinical impact.