TY  - JOUR
T1  - When Digital Silence Does Not Mean Symptom Stability: A Methodological Framework for Interpreting Missing Patient-Reported Data in Remote Palliative Nursing Assessment and Follow-Up
A1  - Freja Nielsen
A1  - Lars Holm
A1  - Mette Sørensen
JF  - Journal of Integrative Nursing and Palliative Care
JO  - J Integr Nurs Palliat Care
SN  - 3006-5550
Y1  - 2026
VL  - 7
IS  - 2
DO  - 10.51847/hUeCbQ6nZG
SP  - 92
EP  - 101
N2  - To develop a method for interpreting missing patient-reported symptom data during remote palliative nursing assessment without treating digital nonresponse as evidence of clinical stability. Remote symptom monitoring can extend palliative assessment beyond scheduled encounters, but it also creates an interpretive problem when an expected patient report is absent. Advanced illness, fluctuating capacity, respondent burden, language, technology access, service workflow and patient preference can all influence whether a report becomes observable. Original non-empirical methodological framework informed by selected palliative-care outcome-measurement research, remote symptom-monitoring studies, implementation evidence, digital-equity literature and missing-data methodology. Evidence published between 2017 and 2025 was used to distinguish measurement of observed symptoms from the interpretation of unobserved patient states and to identify circumstances in which missingness may be clinically or methodologically informative. The approach treats the expected assessment opportunity, rather than a fixed patient category of “responder” or “nonresponder,” as the unit of analysis. It separates observed patient reports from unobserved symptom states and requires the reason for missingness to remain provisional when inability to report, failed contact, refusal or nonparticipation, and technical or access failure cannot be distinguished. Digital silence is an information gap, not a symptom value. Remote palliative nursing systems should preserve uncertainty until the source and meaning of a missing report can be sufficiently established.
UR  - https://journalinpc.com/article/when-digital-silence-does-not-mean-symptom-stability-a-methodological-framework-for-interpreting-mi-leu9knq8u7ros5j
ER  -