This study adheres to the COREQ (Consolidated Criteria for Reporting Qualitative Research) to enhance transparency, credibility, and completeness in qualitative reporting. A completed COREQ checklist is provided in Checklist 1. The COREQ checklist was used as a guiding framework during the preparation and reporting stages. Before data collection, the checklist was instrumental in informing the study design, ensuring that all pertinent aspects—including the composition and reflexivity of the research team, participant selection strategy, and detailed data collection procedures—were meticulously planned and documented in advance. During the process of manuscript development, the COREQ items were systematically reviewed to verify that each relevant element was transparently reported in the Methods and Results sections. This process ensured completeness and facilitated reproducibility.

The focus group (FG) and interviews included family caregivers selected through purposive sampling. The sampling was used, with participants being purposively recruited to ensure a diverse range of experiences relevant to the study’s objective. The selection of participants was conducted by the SOPC teams of the “Anhaltische Hospiz- und Palliativgesellschaft” in Dessau-Roßlau, Germany, and the “Leipziger Palliativgesellschaft” in Torgau, Germany. Participants were approached by telephone or via email. The SOPC teams identified potential participants who met the inclusion criterion of having provided care for a palliative patient within the past 6 months in rural regions. Within this sample, variation in relationship to the patient (spouse and other relative) and gender was sought to capture a range of perspectives. Although the data collection process did not entail the application of formal stratification criteria, such as age, caregiving burden, or technology literacy, the SOPC teams were encouraged to extend invitations to individuals with a range of backgrounds, thereby fostering heterogeneity in the ensuing discussions. Group effects were minimized, and no strict exclusion criteria were applied, reflecting the open, cocreative nature of the development process. There was no relationship to participants before the study.

A German-language FG and interview guide was developed through a systematic, multistage process informed by qualitative research principles rooted in a constructivist paradigm by AL and FF [30,39]. This method was chosen due to existing theoretical assumptions, with the aim of exploring a wide range of perspectives rather than reaching consensus. The guide focused on eliciting argumentative patterns, that is, the reasoning and justification underlying participants’ views, rather than collecting biographical narratives [40]. The stepwise procedure (collecting, checking, sorting, and subsuming) ensured systematic coverage of relevant themes while maintaining openness to emergent issues [39]. First, potentially relevant questions were collected without concern for their final usability (collecting). Next, the questions were evaluated against qualitative guideline criteria (checking). Then, the content was sorted into thematic areas (sorting). Finally, these were subsumed into question blocks, each beginning with an open introductory question. The sequence of these blocks was also determined (subsuming). Critical review and feedback were provided by PJ, MG, and members of the PalliDrone project team (peer group). Feedback aimed to assess the clarity and relevance of items. No fixed instructions were given, and the guide was refined after each feedback round.

In terms of content, the guide development was informed by established models of technology acceptance, particularly the technology acceptance model (TAM 1‐3) [41-43]. TAM proposes that technology adoption is primarily driven by perceived usefulness and perceived ease of use, complemented in later extensions by factors such as social, cognitive, and psychological factors. These factors collectively shape the intention to use. The Technology Usage Inventory expands upon the traditional technology acceptance factors of the TAM, such as perceived usability, usefulness, immersion, and accessibility (technology-specific), by incorporating key psychological constructs, including interest, curiosity, technology-related anxiety, and skepticism [44,45]. The guide built on these theoretical foundations and on instruments from previous research on cocreative development of drone-assisted delivery and mobile app [30]. Thus, the final guide includes four categories: (1) processes and problem situations in palliative care (is-state), (2) specification of the process flow and communication (usability), (3) possibilities for realizing technical integration (usefulness), and (4) concerns regarding the implementation and integration (concerns). The guide began with a narrative stimulus (description) to initiate the conversation, followed by open-ended thematic question blocks. These were built on previous responses (immanent) and introduced new themes (exmanent). Transitions between blocks were deliberately soft to encourage storytelling. Evaluative questions were asked at the end. The complete FG and interview guide is available in Multimedia Appendix 1.

All FG and interview discussions were conducted in German. The FG was conducted at “Leipziger Palliativgesellschaft” in Torgau, Germany. With the help of the “Anhalt-Hospiz Dessau”, interviews were conducted at the homes of caregivers. Two moderators (M) guided both formats: M1 (AL, female, research associate, experienced in mixed methods) actively led the sessions using an inductive questioning approach (starting with immanent before exmanent questions), while M2 (FF, female, postdoc, experienced in FG and interviews) remained more passive and managed the input setting. M1 moderated the discussion, asked questions, and encouraged participants to elaborate, drawing out a range of views. M2 documented interactions, atmosphere, and key statements through an ad-hoc protocol, which was later made available for participants to verify the accuracy of their contributions. Before the data collection, M1 received interview training from M2. Both moderators were familiar with the subject matter and guided their actions using the principle of “methodological understanding of others” [46].

At the beginning of each session, moderators introduced themselves and explained the procedure. A detailed overview of drone-based medication delivery was presented, followed by an open discussion about possible applications in palliative care. Participants reflected on urgency, expected relief for caregivers, and situations where traditional courier delivery would suffice.

Sessions were audio-recorded. Data validation was ensured through member checking. Participants received summaries of their respective FG discussions or interviews and were invited to provide feedback or corrections. This process helped to confirm the accuracy and credibility of the data while respecting participants’ time and availability.

Participants were informed in writing and verbally about the recording and their right to withdraw consent at any time.

The FG lasted about 90 minutes; interviews lasted around 30 minutes, depending on the situation. In interviews, 1 member of the SOPC team was present, and in the FG, 2 members were present. This was done deliberately to provide emotional support for participants, given that recruitment targeted caregivers within 6 months of bereavement, which could evoke distress.

All collected statements during the FG and interviews were repeated and discussed with participants. All participants confirmed for correctness. The participants’ responses were transcribed and coded by 1 researcher in German (AL). Transcripts were not returned to participants. A simple transcription system was used, that is, only manifest content was analyzed [47,48]. The data analysis was conducted according to the content analysis method from Elo and Kyngäs [47] and was coded using a deductive approach moving from general to specific [49]. All data were coded with the MAXQDA 2022 program (VERBI Software GmbH). The unit of analysis (event) was defined as words and as one or several sentences that contain one theme of the guideline-based questions [50]. Thus, aspects that would fit the matrix were chosen from the data. The categories were formed along the guideline-based question complexes [30,44] (see Table 1).

To validate the concept, a second researcher (FF), familiar with the analyses, independently coded 20% of the transcripts to calculate the interrater reliability. In case of discrepancies, discussions were held between the 2 researchers until a consensus was reached. Cohen Kappa was computed for all variables [51]. The interrater reliability was κ=0.71 (P<.001) with a substantial agreement [51,52].

For reporting purposes, illustrative quotes and examples were translated into English. Translations were iteratively cross-checked by FF and AL of the research team to ensure that the original meaning, tone, and context were preserved.

The PalliDrone project was reviewed and approved by the Ethics Committee of Martin-Luther-University Halle-Wittenberg (case number 2024‐038, date of approval April 18, 2024) for the conduct of the PalliDrone study. All participants gave their informed written consent before the FG and semistructured interviews and were informed about the procedure, the general aim, and the reasons for the discussion or interview. Participants were informed of their right to withdraw at any time without any consequences. For participants who were approached for qualitative interviews following recent bereavement, special care was taken to ensure they had the opportunity to ask questions and receive adequate explanations before consenting. All data were anonymized before analysis. All personal identifiers (eg, names and locations) were removed during transcription. Transcripts and coded data were stored on secure, password-protected servers accessible only to the research team. Participants did not receive financial compensation for their participation but were offered reimbursement of travel expenses where applicable. No identifiable images or other identifying information about participants are presented in this manuscript or in the supplementary materials.

Between June and July 2024, we collected data from 10 participants. Six participants took part in the FG, and 4 participants were part of individually conducted interviews. No one dropped out during the discussions or interviews. All caregivers (n=10; mean age 68.6, SD 12.3) lacked knowledge and skills in using drones, and only 30% (3/10) were familiar with using medication apps. Of the 10 participants, 30% (n=3) care for their relatives while they are still working. Additional findings are reported in Table 2.

This study aimed to explore the practical requirements, opportunities, and challenges associated with drone-based medication delivery in palliative care for family caregivers by addressing their needs, relief, and requirements. FG and interview results revealed that family caregivers face challenges in assessing the usefulness of drone delivery, largely due to unfamiliarity with such technologies and generally low eHealth literacy [53]. Caregivers highlighted frequent delays in medication access, especially during evenings and weekends, which often led to emergency interventions and increased stress. They expressed a need for reliable and fast delivery solutions that operate beyond regular hours, while emphasizing the importance of maintaining human contact and trusted communication channels, particularly with SOPC teams.

This study revealed that family caregivers face persistent challenges in accessing medications in a timely manner, particularly during evenings and weekends. These delivery gaps often result in emergency interventions or unplanned hospital admissions, increasing stress and contradicting patients’ wishes to remain at home [5,6]. Such problems are especially acute during early stages of palliative care, before SOPC teams are established [3,8-10]. This highlights the need for a reliable, fast delivery system that operates even during off-hours, where conventional courier services may fail. Studies in rural medicine and emergency supply delivery have demonstrated drones’ ability to overcome logistical and geographic barriers and reduce delivery times, especially in areas with limited infrastructure [15-24,32]. For example, the usage of drones for the delivery of defibrillators has led to a notable enhancement in accessibility to essential lifesaving equipment [21-23,32]. Consistent with the findings of our study, these investigations underscore the value of drones as a useful addition to existing logistics, rather than a replacement. They demonstrate the potential of drones to facilitate access to critical medical supplies through faster delivery [54]. However, there is a paucity of studies that have used drones within the framework of a living lab design to substantiate their effectiveness and practicality within a particular context. Moreover, palliative care differs from emergency contexts in its ongoing, sensitive care relationships where continuity and human interaction are paramount.

However, the family caregivers also highlighted a limited familiarity with drones and generally low eHealth literacy, making it difficult to assess the usefulness of the technology. The technological gap makes it difficult to assess what caregivers truly need in this context. This gap necessitates empowering both individuals through skill development and adapting social and technical infrastructures accordingly, because digital health literacy is an interplay between user competence, system readiness, and their interaction [55]. At the same time, the likelihood of requiring palliative care increases with age, raising concerns about a mismatch between technical competence and care needs. Although the most common palliative care services are symptom management (88%) and psychological support (81%), which often require face-to-face contact, eHealth can complement traditional support to some extent [56]. However, concerns regarding a potential loss of trusted human contact, particularly with SOPC teams, privacy risks, and the possibility that digital ordering systems could exclude those with limited technical competence were faced in this context. These concerns align with previous studies reporting that palliative care users value face-to-face relationships and clear communication as part of care delivery [53,57]. This indicates that the loss of human connection is a key concern, mirroring previous research [31,53,58]. Given disparities in access to palliative care globally, alternative delivery models that help patients and families communicate needs are essential [59]. This is particularly important for family caregivers, who frequently report feelings of helplessness in managing complex care situations [8,60].

Despite these concerns, caregivers acknowledged the potential benefits of drones, especially for logistical relief and emergency access. Participants described how delivery delays often required them to travel long distances to pharmacies, leaving patients unattended. These situations were particularly stressful for older adult caregivers, many of whom had limited mobility or transport options [61,62]. A reliable drone delivery system was perceived as potentially reducing such logistical burdens by shortening delivery times and enabling rapid response during urgent situations, especially in rural or poorly connected areas [15-24,32]. Although most participants had no previous experience with drones, they acknowledged that faster access to medication could improve symptom control and help maintain patient comfort, which in turn might reduce caregivers’ stress levels. Previous studies have demonstrated strong links between patient well-being and caregiver quality of life [3,7,10,62,63]. Managing pain effectively is a priority in palliative care, and fears related to pain, particularly fear of patients dying in pain, can exacerbate caregiver distress [63]. Faster access to medications via drones could reduce these fears and feelings of helplessness [21-23,32]. However, these anticipated benefits remain hypothetical and require further empirical testing in real-world palliative care contexts.

Several conditions emerged as critical for successful implementation. Integration into established SOPC workflows was considered essential to maintain trusted communication channels and ensure that drones complemented rather than replaced conventional courier services [53,57]. Strengthening collaboration with SOPC teams is crucial, as caregivers view these professionals as trusted partners for both emotional and technical support. Participants emphasized that the ordering process should be as clear and simple as possible, ideally with the SOPC team initiating medication orders and individual orders placed only when necessary. They valued having a single point of contact for all medication-related information (eg, within the app) and suggested that drones could also transport essential documents, such as transport tickets. Direct communication options, particularly via telephone, with SOPC teams, general practitioners, and pharmacies were seen as indispensable, while chat functions were dismissed as impersonal and lacking advisory value. Direct communication was also the most important aspect of the cocreative process for developing a delivery app for drone-assisted systems [31]. However, in the present study, participants were, on average, 18 years older (mean age 68.6,SD 12.3) and preferred not to communicate with the SOPC via app or chat. Moreover, multilingual app interfaces were recommended to accommodate caregivers with limited German proficiency.

In terms of logistics, caregivers expressed a preference for having the option to choose between courier and drone delivery, with flexible time slots (eg, 30-minute windows) for urgent deliveries. Involving nursing services and enabling direct delivery to SOPC facilities were seen as beneficial. While many participants found it difficult to imagine the operational aspects of drones, they recognized their potential for rural areas with limited infrastructure.

Environmental and technical challenges, such as weather conditions, potential mechanical failure, and flight range limitations, were viewed as possible constraints. Data protection, noise disturbance, and regulatory and liability issues were additional concerns that would need to be resolved before deployment [26,31]. Moreover, unequal access to necessary digital tools could exacerbate disparities among caregivers and patients from different socio-economic or geographic backgrounds [31]. These findings highlight that technological readiness alone is insufficient; social, infrastructural, and regulatory readiness must also be addressed before implementation [25,55].

Although the sample reflects typical age and gender distributions, it is not representative due to the small number of participants. The recruitment process, conducted by SOPC staff, may have introduced a positive selection bias. Caregivers with an established trust relationship with the SOPC teams may have been more inclined to participate and potentially more open to innovative care concepts, including drone delivery. This could have led to an overrepresentation of participants who were generally supportive of new interventions. We also note that such participants may have been more motivated to engage in research activities, which could have influenced the generally positive reception of the concept. While drones in medical delivery were largely unknown to all participants, reducing the likelihood that only technology enthusiasts were included, clear rejections of drone use were rare. However, limited knowledge restricted the depth of the discussion. Nevertheless, data saturation can be assumed, as previous studies have also shown low awareness of drones in health care, likely due to the novelty of the technology and lack of discourse [31]. Despite this, the discussions revealed a clear need for drone delivery, particularly through the detailed accounts of caregivers’ challenges. This supports the relevance of the topic, even with limited previous knowledge. Another limitation concerns the presence of SOPC team members during data collection, one in the interviews and 2 in the focus group. Their involvement was intended to provide emotional support for participants, who were within 6 months of bereavement. However, the SPOC involvement may have introduced social desirability bias, as SOPC staff were also involved in recruitment. Participants might have felt inclined to provide answers they believed aligned with SOPC expectations. To minimize this risk, SOPC staff did not actively contribute to the discussions, and all facilitation was conducted by the research team. However, the possibility that their presence influenced participants’ responses cannot be fully excluded. All FGs were conducted in German; to preserve meaning, translations were cross-checked. Minor linguistic shifts were adjusted through a process of iterative translation.

This study reveals several clinical implications. First, integrating eHealth can help ensure timely medication supply during critical care gaps, such as evenings and weekends. Drone-based delivery could reduce unnecessary hospitalizations and support patients’ preference to remain at home. Second, SOPC teams play a central role in facilitating eHealth use. Caregivers view them as essential for technical guidance, emotional support, and confidence in using new technologies. Their involvement in training and communication is therefore crucial. Third, strengthening digital health literacy should be a structural task. The study shows that a lack of eHealth literacy is a key obstacle to accepting and effectively using drone-based health care solutions. Therefore, empowerment measures should focus not only on individual training but also on structural adjustments that better adapt technological offerings to the abilities and needs of target groups, such as older relatives and people with little affinity for technology. Fourth, technology must not replace human connection. Concerns about losing personal interaction in palliative care remain significant. Digital tools should complement in-person care and include communication features that maintain links with SOPC teams. Fifth, improving the quality of life through faster access to medication may ease pain and reduce caregiver stress. Drone delivery may help close critical supply gaps, a potential that future research should explore further. Ultimately, to foster acceptance, caregivers need hands-on experience with drone-based services to understand their practical value.

This study highlights both opportunities and challenges in implementing drone-based medication delivery in palliative care. Caregivers perceived drones as a promising solution for timely access to essential medication, particularly during critical care gaps such as evenings and weekends. It remains open for further research whether the integration of eHealth solutions like drone-assisted delivery could help reduce unnecessary hospitalizations to support patients’ preference to remain at home.

Successful adoption; however, requires more than technical feasibility. Low digital health literacy, especially among older caregivers, remains a key barrier. Effective eHealth must align with users’ abilities, offering simple interfaces and integration into trusted systems like SOPC teams, who play a central role in providing technical guidance, emotional support, and confidence in new technologies. Their involvement in both communication and training processes is therefore critical for successful adoption. Strengthening digital health literacy should be addressed not only through individual training but also via structural adjustments that better adapt technology to the needs of older caregivers and those with limited affinity for digital tools.

Improving timely medication access could also reduce caregiver stress and improve patients’ quality of life by supporting symptom control at home, which remains open for further research. Ultimately, to foster acceptance, caregivers need hands-on experience with drone-based services to understand their practical value. Future research should focus on real-world testing in living lab environments, evaluating feasibility, effectiveness, and integration into existing clinical workflows while ensuring that technological, psychological, and social needs are equally addressed.