Clinical effectiveness of nurse-led palliative care interventions for patients with advanced cancer: A systematic review and meta-analysis.

Résumé

BACKGROUND: Advanced cancer impacts physical, emotional, social, and spiritual well-being of a person's life. While palliative care is known to alleviate suffering for patients and families, its availability remains limited, especially in resource-constrained settings. Nurses play a vital role in healthcare, with their leadership and interventions significantly impacting patient outcomes; however, synthesised evidence on nurse-led palliative care for patients with advanced cancer is limited.AIM: To evaluate the available evidence on the clinical effectiveness of nurse-led palliative care interventions for patients with advanced cancer.DESIGN: A systematic review and meta-analysis.METHODS: Six international databases, including MEDLINE, CINAHL, Cochrane Library, Embase, PsycINFO, and ProQuest Dissertations, were systematically searched from inception to May 2025. Randomised controlled trials and quasi-experimental studies were included. Studies were eligible if the interventions fell within the scope of palliative care and led by nurses, regardless of the use of palliative care terminology or care setting. Data were extracted, and Hedges' g was calculated as the effect estimate for meta-analysis. Studies with insufficient data were synthesised narratively. Sensitivity and post hoc subgroup analyses were also performed. Methodological quality was assessed using the revised JBI checklists for risk of bias assessment in randomised controlled trials and quasi-experimental studies.RESULTS: A total of 51 studies (n = 6152) were included in this review, with 35 studies (n = 4623) included in the meta-analysis. Most studies originated from high-income countries (n = 43). Notable improvements were observed in the nurse-led palliative care group compared to the control group, including quality of life (Hedges' g = 0.26, 95 % CI: 0.04 to 0.49), total pain score (Hedges' g = -0.53, 95 % CI: -0.71 to -0.35), symptom burden (Hedges' g = -0.14, 95 % CI: -0.28 to 0.00), fatigue (Hedges' g = -0.23, 95 % CI: -0.43 to -0.06), functional capacity (Hedges' g = 0.25, 95 % CI: 0.07 to 0.43), and well-being (Hedges' g = 0.50, 95 % CI: 0.01 to 1.00, from correlation coefficient of 0.9 for a pre-posttest study). Nurse-led palliative care interventions varied, covering symptom monitoring, follow-up, education, patient consultation, pain management, and multidisciplinary coordination.CONCLUSION: Nurse-led palliative care has a potential effect to improve quality of life, total pain score, symptom burden, fatigue, functional capacity, and well-being for patients with advanced cancer. Future research is needed to evaluate the effectiveness of nurse-led palliative care, particularly in resource-constrained settings, enhancing access to quality palliative care.REGISTRATION NUMBER: CRD42023471413.