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Abstract

Introduction

Palliative care aims to enhance the quality of life (QoL) of individuals with serious or life-limiting illnesses through holistic physical, psychological, and social support. Nurses play a central role in delivering palliative care; however, the specific contribution of nurse-led interventions to improving patient outcomes remains insufficiently clarified in the literature.

Aim

This systematic review aimed to examine the effectiveness of nurse-led palliative care interventions in improving patient-reported quality of life among adults with advanced or life-limiting illnesses.

Methods

A systematic review was conducted following the PRISMA 2020 guidelines. Six electronic databases were searched to identify empirical studies published between 2020 and 2025 that evaluated nurse-led palliative care interventions. Eligible studies included randomized controlled trials, quasi-experimental studies, and cohort designs that reported patient-reported QoL outcomes. Study selection and data extraction were performed independently by two reviewers. Due to heterogeneity in study designs, intervention characteristics, and outcome measures, the findings were synthesized using a narrative approach.

Results

Twenty studies met the inclusion criteria and represented diverse health-system contexts and clinical settings. Overall, nurse-led interventions demonstrated positive trends in several QoL domains. Improvements were frequently reported in symptom management, emotional well-being, communication quality, and family engagement. Multi-component and sustained interventions showed more consistent benefits, particularly in community and home-based care settings. Some studies also indicated reductions in healthcare utilization and improved patient–family communication.

Conclusion

Nurse-led palliative care interventions may enhance patient-centered outcomes when implemented as comprehensive and contextually integrated care models. Further research is needed to standardize intervention definitions, evaluate long-term effectiveness, and expand evidence beyond oncology populations.

Keywords

leadership business concepts palliative care hospitals

Introduction

Palliative care is increasingly recognized as an essential component of modern healthcare systems, aiming to improve the quality of life (QoL) of individuals living with serious or life-limiting illnesses. The World Health Organization (WHO) defines palliative care as an approach that prevents and relieves suffering through early identification, comprehensive assessment, and management of physical, psychological, social, and spiritual needs (World Health Organization [WHO], 2022). Despite global recognition of its importance, access to high-quality palliative care remains uneven, particularly in low- and middle-income countries where healthcare systems face structural constraints, workforce shortages, and limited integration of services.

The global burden of advanced chronic illnesses including cancer, chronic obstructive pulmonary disease (COPD), heart failure, and neurodegenerative conditions continues to rise, increasing the demand for scalable and sustainable palliative care models (Abdel-Aziz et al., 2025; Hassan et al., 2023). Traditional physician-led models often encounter challenges related to limited time, fragmented care pathways, and insufficient continuity, particularly in resource-constrained environments. These limitations have prompted increasing interest in alternative care delivery approaches, particularly nurse-led models that can enhance accessibility and continuity of care across clinical and community settings.

Nurses are uniquely positioned to lead palliative care interventions due to their continuous presence at the point of care, advanced clinical assessment competencies, and ability to address the multidimensional needs of patients and families. Their role extends beyond symptom management to include psychosocial support, patient education, care coordination, and facilitation of communication and shared decision-making (Kim et al., 2024; Rosa et al., 2023). Emerging evidence from regional and international contexts further highlights the expanding role of nurses as primary providers in palliative care delivery, particularly in settings with limited specialist resources (Alqaissi et al., 2025; Qtait & Alqaissi, 2025). These findings underscore the potential of nurse-led models to improve accessibility, patient engagement, and continuity of care.

Despite the growing implementation of nurse-led palliative care interventions, substantial variability exists in how these interventions are defined and operationalized. The term nurse-led encompasses a wide range of models differing in levels of autonomy, clinical responsibility, and integration within multidisciplinary teams. In this review, nurse-led palliative care interventions are conceptualized as structured approaches in which nurses assume primary responsibility for key components of care, including symptom assessment and management, psychosocial support, patient and caregiver education, care coordination, and advance care planning. These interventions may be delivered across diverse settings, including hospitals, community services, home-based care, hospice programs, and telehealth platforms (Haun et al., 2023; Qian et al., 2024; White et al., 2022).

Empirical findings regarding the effectiveness of nurse-led palliative care interventions remain heterogeneous. Several studies have reported significant improvements in QoL domains, including symptom control, emotional well-being, communication, and patient satisfaction following nurse-led interventions (Jaber & Qumsieh, 2023; Nasser et al., 2025; Tang et al., 2025). Conversely, other studies have found no significant differences compared with usual or multidisciplinary care, particularly in high-resource settings where comprehensive palliative services are already established (Haun et al., 2023; McCorkle et al., 2022). This inconsistency suggests that intervention effectiveness may depend on multiple factors, including intervention complexity, duration, care setting, and the degree of integration within existing healthcare systems.

Recent developments in healthcare delivery including the expansion of telehealth, increased emphasis on community-based care, and the evolving scope of nursing practice following the COVID-19 pandemic have further transformed palliative care models. Contemporary nurse-led interventions increasingly incorporate digital health technologies, remote monitoring, and family-centered approaches, reflecting a shift toward more integrated and adaptive models of care (Choi et al., 2025; Thompson & Zhou, 2025). These developments highlight the need for an updated synthesis of the literature to identify which components of nurse-led interventions are most effective in improving patient-centered outcomes.

Quality of life (QoL) remains the most comprehensive and patient-centered outcome in palliative care research, encompassing physical, emotional, social, and functional dimensions of well-being. As a multidimensional construct, QoL reflects the cumulative impact of disease burden and healthcare interventions on patients’ lived experiences (Li et al., 2024; Saleh et al., 2022). While secondary outcomes such as symptom burden, healthcare utilization, and caregiver outcomes provide important complementary insights, QoL is widely regarded as the gold-standard outcome for evaluating the effectiveness of palliative care interventions.

Therefore, this systematic review aims to synthesize recent evidence on the effectiveness of nurse-led palliative care interventions in improving QoL among adults with advanced or life-limiting illnesses. By clarifying conceptual definitions, examining variations in intervention design, and identifying key components associated with improved outcomes, this review seeks to inform clinical practice, support evidence-based policy development, and guide future research in palliative care.

Methods

Design

This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines (Page et al., 2021). The aim of the review was to synthesize empirical evidence on the effectiveness of nurse-led palliative care interventions in improving patient-reported quality of life (QoL) among adults with advanced or life-limiting illnesses.

Ethical Considerations

Ethical approval was not required for this study because it involved the analysis of data from previously published research and did not include direct interaction with human participants or access to identifiable personal information. All included studies were assumed to have obtained ethical approval from their respective institutional review boards in accordance with national and international ethical standards.

Search Strategy

A comprehensive literature search was conducted across five electronic databases: PubMed, CINAHL, Scopus, Web of Science, and Google Scholar. The search covered studies published between January 2020 and March 2025 to capture recent developments in palliative care, including the expansion of telehealth and evolving nursing roles. The search strategy combined Medical Subject Headings (MeSH) and free-text terms using Boolean operators. Key search concepts included nurse-led care (e.g., nurse-led, nurse-managed, nursing intervention), palliative care (e.g., hospice care, end-of-life care), quality of life (e.g., well-being, patient-reported outcomes), and advanced illness conditions (e.g., cancer, chronic obstructive pulmonary disease, heart failure, renal disease, and neurodegenerative disorders). To ensure comprehensive coverage, the reference lists of included studies and relevant reviews were manually screened. Detailed search strategies for each database are provided in the supplementary material.

Eligibility Criteria

Population

Studies involving adults aged 18 years or older with advanced, chronic, or life-limiting illnesses were included. These conditions included cancer, chronic obstructive pulmonary disease, heart failure, renal disease, and neurodegenerative disorders.

Intervention

Eligible studies examined nurse-led palliative care interventions in which nurses held primary responsibility for at least one core component of care. These components included clinical assessment, symptom management, psychosocial support, patient or caregiver education, care coordination, or advance care planning. Interventions delivered in hospital, community, home-based, hospice, or telehealth settings were considered.

Comparator

Comparators included usual care, multidisciplinary or physician-led care, or no comparator in quasi-experimental designs.

Outcomes

Studies were included if they reported patient-reported QoL using validated instruments such as the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30), Functional Assessment of Cancer Therapy–General (FACT-G), McGill Quality of Life Questionnaire, or the Short Form Health Survey (SF-36). Secondary outcomes, including symptom burden, patient satisfaction, and healthcare utilization, were also extracted when available.

Study Design

Eligible study designs included randomized controlled trials, quasi-experimental studies, cohort studies, and controlled before–after studies. Peer-reviewed articles published in English between January 2020 and March 2025 were included.

Exclusion Criteria

Studies were excluded if they involved pediatric populations, lacked a clearly defined nurse-led intervention, were non-empirical (e.g., editorials, commentaries, protocols, or dissertations), or did not report patient-reported QoL outcomes.

Study Selection

All identified records were imported into EndNote 20 for reference management and duplicate removal. Two reviewers independently screened titles and abstracts, followed by full-text screening based on predefined eligibility criteria. Any disagreements were resolved through discussion or consultation with a third reviewer. The study selection process is illustrated in Figure 1.

Figure 1.

PRISMA 2020 flow diagram describing study selection for systematic review

Data Extraction

Data extraction was performed independently by two reviewers using a standardized and pilot-tested extraction form. Extracted information included study characteristics (author, year, country, and design), participant characteristics, details of the nurse-led intervention and comparator, outcome measures, and key findings. A third reviewer verified the accuracy and completeness of the extracted data. Discrepancies were resolved through consensus.

Quality Appraisal

Methodological quality was assessed using validated, design-specific appraisal tools. Randomized controlled trials were evaluated using the Cochrane Risk of Bias 2.0 tool, while quasi-experimental and cohort studies were assessed using the Joanna Briggs Institute (JBI) critical appraisal checklists. These tools evaluate key domains such as selection bias, confounding, outcome measurement validity, and completeness of follow-up. All studies were appraised independently by two reviewers, and disagreements were resolved through discussion.

Quality Rating

Based on appraisal outcomes, studies were categorized as high quality (≥80% of criteria met), moderate quality (50%–79%), or low quality (<50% or high risk of bias). Final quality ratings were determined through reviewer consensus.

Data Synthesis

Due to substantial heterogeneity in study designs, populations, interventions, and outcome measures, a meta-analysis was not feasible. Therefore, a narrative synthesis approach was employed in accordance with established methodological guidance and the Synthesis Without Meta-analysis (SWiM) framework (Campbell et al., 2020; Popay et al., 2006). Studies were grouped based on design, clinical population, and intervention characteristics. Patterns in QoL outcomes were identified and interpreted, with particular attention to contextual and methodological factors influencing variability.

Results

Study Selection

The database search identified 3,852 records. After removing 1,231 duplicates, 2,621 records were screened based on titles and abstracts, resulting in the exclusion of 2,471 records. A total of 150 full-text articles were assessed for eligibility, of which 130 were excluded for the following reasons: absence of a nurse-led intervention (n = 33), lack of quality-of-life (QoL) outcomes (n = 36), non-empirical study design (n = 31), and ineligible population or methodology (n = 30). Ultimately, 20 studies met the inclusion criteria. The study selection process is presented in Figure 1.

Study Characteristics

The characteristics of the included studies are summarized in Table 1. The studies were published between 2020 and 2025 and included 10 randomized controlled trials, 6 quasi-experimental studies, and 4 cohort studies. Sample sizes ranged from 64 to 380 participants. The studies were conducted across diverse geographical contexts, including high-income and middle-income or resource-limited settings. Most studies focused on oncology populations (n = 12), while others included patients with chronic respiratory disease, heart failure, renal disease, neurological disorders, and other advanced conditions. Interventions were implemented across various care settings, including hospitals, community programs, home-based services, hospice care, and telehealth platforms. Overall, the included studies demonstrate variability in intervention design and implementation.

Table 1.

Characteristics of Included Studies (n = 20)

Author & year	Country	Design	Sample size	Intervention	Comparator	Key QoL findings	Quality rating
McCorkle et al. (2022)	USA	RCT	300	Nurse-led primary palliative care	Usual care	No significant QoL change	Moderate
Kim et al. (2024)	South Korea	Cohort	120	Nurse-led counseling and advance care planning	Standard care	Improved emotional and social QoL	Moderate
Abdel-Aziz et al. (2025)	Saudi Arabia	Quasi-experimental	210	Community nurse-led palliative program	None	Improved QoL and reduced emergency visits	High
Al-Hroub et al. (2024)	Palestine	Quasi-experimental	150	Hospital-based nurse-led palliative care	Oncology care	Improved pain and emotional QoL	Moderate
Jaber & Qumsieh (2023)	Palestine	RCT	110	Nurse-led home-based care	Nephrology care	Improved QoL and reduced hospitalizations	High
Al-Khalidi et al. (2023)	Jordan	Cohort	180	Nurse-led telehealth follow-up	Usual care	Improved QoL and reduced anxiety	Moderate
Saleh et al. (2022)	Egypt	RCT	200	Nurse-led education and counseling	Usual care	Significant QoL improvement	High
Tang et al. (2025)	United Kingdom	RCT	380	Nurse-led home-based program	Usual care	Improved physical and functional QoL	High
Qian et al. (2024)	China	Cohort	200	Nurse-led telehealth support	Usual care	Improved QoL and reduced depression	Moderate
Haun et al. (2023)	Germany	RCT	220	Nurse-led advance care planning and education	Multidisciplinary care	No significant QoL differences	Moderate
HPNA (2023)	USA	Quasi-experimental	85	Nurse-led hospice care	Traditional hospice	Improved symptom management	Moderate
Farah et al. (2024)	Lebanon	Cohort	140	Nurse-led supportive counseling	Usual care	Improved emotional QoL	Moderate
Barakat et al. (2025)	UAE	Quasi-experimental	160	Nurse-led outpatient program	Usual care	Improved social and role functioning	High
Hassan et al. (2023)	Egypt	RCT	240	Nurse-led palliative rehabilitation	Usual care	Improved symptom control and mobility	High
Al-Qudah et al. (2024)	Jordan	RCT	130	Nurse-led family education	Neurology care	Improved QoL for patients and caregivers	High
Ali et al. (2022)	United Kingdom	RCT	250	Nurse-led supportive care	Usual care	Improved QoL	High
Nasser et al. (2025)	Qatar	Cohort	100	Nurse-led home visits	Hospice care	Increased satisfaction and QoL	Moderate
White et al. (2022)	Canada	RCT	200	Nurse-led tele-palliative care	Usual care	Improved QoL	High
Müller et al. (2024)	Germany	Quasi-experimental	95	Nurse-led symptom monitoring	Oncology care	Reduced symptoms and improved QoL	Moderate
Lindell et al. (2021)	USA	RCT	64	Nurse-led palliative care with caregiver education	Usual care	Improved caregiver preparedness and confidence	High

Methodological Quality

The methodological quality of the included studies was generally moderate to high (see Table 1). Most randomized controlled trials demonstrated low to moderate risk of bias, supported by appropriate randomization procedures and the use of validated QoL measurement instruments. Quasi-experimental and cohort studies met most appraisal criteria but were occasionally limited by non-randomized designs, smaller sample sizes, and potential confounding factors.

Quality-of-Life Outcomes

Symptom Management and Physical Functioning

Nurse-led palliative care interventions were frequently associated with improvements in symptom burden, including pain, dyspnea, and fatigue. Interventions incorporating structured symptom monitoring, rehabilitation components, or proactive follow-up demonstrated more consistent improvements in physical functioning. However, some studies reported no statistically significant differences compared with usual care, particularly when interventions were short in duration or limited to a single component.

Emotional and Psychological Well-Being

Several studies reported reductions in anxiety, depressive symptoms, and emotional distress following nurse-led interventions, particularly those incorporating supportive counseling and continuous follow-up. These improvements were more evident in community and home-based settings. Nevertheless, the effects on psychological outcomes were not consistent across all studies, particularly in interventions with limited duration or scope.

Communication, Decision-Making, and Family Engagement

Nurse-led interventions were associated with improvements in communication processes, including clarification of treatment goals, facilitation of advance care planning, and enhancement of patient and family understanding. In studies involving family members, participants reported increased confidence in managing care-related decisions. Improvements in relational continuity and trust were more evident in interventions with sustained patient contact.

Healthcare Utilization

Several studies reported reductions in emergency department visits and hospitalizations following nurse-led interventions, particularly in community and home-based care models. These reductions were associated with early symptom identification and improved care coordination. In contrast, some studies reported no significant changes in healthcare utilization, particularly in settings with established multidisciplinary care systems.

Variability of Outcomes

Although most studies demonstrated positive trends in at least one QoL domain, findings were not uniform. Interventions reporting limited or no improvement were often characterized by short duration, single-component design, insufficient integration within healthcare systems, or small sample sizes.

Overall, nurse-led palliative care interventions were associated with improvements in multiple QoL domains, particularly symptom management, emotional support, and communication. However, the magnitude and consistency of these effects varied depending on intervention characteristics, care setting, and healthcare system context.

Discussion

This systematic review synthesized evidence from 20 studies published between 2020 and 2025 examining nurse-led palliative care interventions and their impact on patient-reported quality of life (QoL). Overall, the findings indicate that many nurse-led interventions were associated with favorable trends in physical, emotional, and communication-related outcomes. However, the magnitude and consistency of these effects varied considerably across studies, reflecting differences in intervention design, intensity, delivery setting, and health-system context. Rather than demonstrating uniform effectiveness, the evidence highlights specific patterns that clarify where nurse-led approaches may be most beneficial and where further refinement is required.

The findings are broadly consistent with previous reviews emphasizing the contribution of nurses to holistic assessment, symptom management, psychosocial support, and care coordination in palliative care settings (Kim et al., 2024; Lindell et al., 2021; Rosa et al., 2023). Similar to earlier syntheses, interventions incorporating continuous assessment, structured follow-up, and psychosocial counseling tended to yield more favorable QoL outcomes, particularly in emotional and symptom-related domains. Importantly, this review extends existing knowledge by focusing on studies published from 2020 onward, thereby capturing recent expansions in tele-palliative care and the evolution of nursing roles following the COVID-19 pandemic.

Conversely, this review also aligns with evidence indicating that nurse-led interventions do not consistently outperform multidisciplinary or physician-led models (Haun et al., 2023; McCorkle et al., 2022; Reinke, L. F. (2025).). In well-resourced health systems where usual palliative care already includes comprehensive interdisciplinary services, the incremental benefit of nurse-led programs may be limited. This variability underscores the importance of contextual factors, including baseline care structures and the specific components integrated into each intervention.

A central issue emerging from the included studies—and reflecting concerns raised during review is the lack of a consistent operational definition of nurse-led palliative care. Although nurses were identified as primary providers across studies, the scope of autonomy, leadership responsibility, and clinical decision-making varied substantially. In some interventions, nurses independently delivered comprehensive care encompassing assessment, counseling, and advance care planning (Jaber & Qumsieh, 2023; Tang et al., 2025). In others, nurses operated within multidisciplinary teams where leadership roles were less clearly articulated. This heterogeneity complicates cross-study comparisons and highlights the need for clearer conceptual and operational frameworks.

Although nurse-led interventions were initially conceptualized as comprising symptom assessment, psychosocial counseling, education, care coordination, and advance care planning, this review identified additional influential components. Tele monitoring and telehealth follow-up emerged as prominent features in several studies conducted in China, Qatar, Canada, and the United States (Qtait et al., 2025). Family-centered decision support was particularly influential in neurological and hospice settings, contributing to improved caregiver preparedness and satisfaction (Al-Qudah et al., 2024; Nasser et al., 2025). Furthermore, structured rehabilitation elements especially in COPD and cancer populations were associated with meaningful improvements in physical functioning (Hassan et al., 2023; Lindell et al., 2021). These findings suggest that effectiveness is more strongly associated with comprehensive, multi-component models than with isolated intervention elements.

Notable contextual differences were observed across healthcare systems. Nurse-led interventions implemented in resource-limited or middle-income settings tended to demonstrate more pronounced improvements in QoL, symptom burden, and healthcare utilization, including reductions in emergency department visits and hospitalizations in countries such as Palestine, Egypt, and Saudi Arabia. These effects may reflect gaps in baseline palliative care services that nurse-led models are particularly well positioned to address. In contrast, studies from high-income countries—where usual care is often multidisciplinary—reported more modest or inconsistent benefits.

One of the most consistent findings across studies was the positive influence of nurse-led interventions on communication quality, patient empowerment, and relational continuity. Interventions incorporating structured conversations, advance care planning discussions, and repeated contact through home visits or telehealth were associated with clearer communication and strengthened trust among patients and families. Importantly, this trust extended beyond the nurse–patient relationship to include confidence in the care plan and the broader healthcare system, particularly in hospice and home-based contexts.

Interpretation of Variability in Outcomes

The observed variability in QoL outcomes across studies appears to be influenced by several factors, including intervention duration, complexity, integration within existing care pathways, and timing of outcome measurement. Short-term or single-component interventions rarely produced sustained improvements, whereas multi-component, integrated programs demonstrated more consistent benefits. These findings emphasize the importance of designing nurse-led palliative care interventions that are sustained, comprehensive, and embedded within broader healthcare systems.

Strengths and Limitations

This review provides a contemporary synthesis of nurse-led palliative care interventions using studies published between 2020 and 2025. Strengths include adherence to PRISMA guidelines, use of validated quality appraisal tools, and inclusion of diverse geographic and clinical contexts. However, limitations include heterogeneity in intervention components, outcome measures, and definitions of nurse-led care, which limited comparability. Short follow-up periods and the predominance of oncology-focused studies further constrain generalizability. Narrative synthesis was necessary due to methodological variability, precluding meta-analysis.

Implications for Practice and Research

The findings indicate that nurse-led palliative care interventions can enhance symptom management, communication, and psychosocial support, particularly in resource-limited settings. Health systems should consider integrating comprehensive nurse-led models supported by clear role definitions and regulatory frameworks. Future research should examine long-term outcomes, cost-effectiveness, and expand beyond oncology populations to strengthen the evidence base.

Conclusion

In conclusion, nurse-led palliative care interventions frequently contribute to improvements across multiple QoL domains, particularly when interventions are comprehensive, sustained, and contextually aligned. Nevertheless, heterogeneity in definitions, components, and outcome measurement limits direct comparison across studies. Strengthening conceptual clarity and methodological rigor will be essential to support the integration of nurse-led palliative care models across diverse healthcare systems.

Supplemental Material

Supplemental Material - Effectiveness of Nurse-Led Palliative Care Interventions on Patient Quality of Life: A Systematic Review

Supplemental Material for Effectiveness of Nurse-Led Palliative Care Interventions on Patient Quality of Life: A Systematic Review by Mohammad Qtait, Nesreen Alqaissi, Yousef Jaradat, Mohammad Faisal AlAli and Zenat Mesk in Sage Open Nursing.

Footnotes

ORCID iDs

Mohammad Qtait

Yousef Jaradat

Author Contributions

Mohammad Qtait: Conceptualization, Methodology, Investigation, Writing – Original Draft, Project Administration. Nesreen Alqaissi: Formal Analysis, Validation, Writing – Review & Editing, Supervision. Yousef Jaradat: Data Curation, Software, Visualization, Writing – Review & Editing. Mohammad Faisal AlAli, Resources, Methodology, Writing – Review & Editing, Funding Acquisition. Zeenat Mesk: Investigation, Data Curation, Writing – Review & Editing, Project Administration. All authors contributed to the final manuscript, approved the submitted version, and agree to be accountable for all aspects of the work.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Supplemental Material

Supplemental material for this article is available online.

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