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Nurse-Led Advance Care Planning Interventions for Patients with Advanced Cancer: A Systematic Review
Shaomin Wu1, Zhuangli Zhu2, Chun Li1
1Department of Medical Oncology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, Hainan, China.
The American Journal of Hospice & Palliative Care
|June 30, 2026
Summary
Nurse-led advance care planning (ACP) interventions effectively increase advance directive completion and end-of-life conversations for advanced cancer patients. These interventions are feasible and improve patient engagement.
Area of Science:
- Oncology
- Palliative Care
- Nursing Research
Background:
- Advance care planning (ACP) is crucial for patients with advanced cancer.
- Nurse-led interventions may improve ACP engagement and outcomes.
Purpose of the Study:
- To systematically review randomized controlled trials (RCTs) on nurse-led ACP interventions for advanced cancer patients.
- To synthesize evidence on the effectiveness of these interventions.
Main Methods:
- Searched multiple databases (PubMed, Embase, CINAHL, Web of Science, Cochrane) up to January 2026.
- Included RCTs evaluating nurse-led ACP in adults with advanced/metastatic cancer.
- Conducted narrative synthesis due to heterogeneity; assessed risk of bias using RoB 2 tool.
Main Results:
- Six studies (N=2816) met inclusion criteria.
- Nurse-led ACP interventions significantly increased advance directive completion (aOR 2.5-5.3) and end-of-life conversations.
- Quality of life outcomes were mixed; higher intensity interventions showed trends toward greater benefit.
Conclusions:
- Nurse-led ACP interventions are feasible and effective for improving ACP engagement and end-of-life outcomes in advanced cancer.
- Successful implementation requires standardized training, adequate intensity, and systematic follow-up.
- Future research should focus on validated patient-reported measures and optimal delivery methods.
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