Applications of episodic future thinking in patients with chronic diseases: a scoping review

Patients with chronic diseases require long-term self-management, but adherence and sustained behavior change remain major challenges in nursing practice. Episodic future thinking (EFT) is a cognitive strategy that may influence intertemporal decision-making and health-related behaviors by increasing the salience of future outcomes. However, its application, implementation, and clinical translation across chronic disease populations have not been comprehensively synthesized. Therefore, this scoping review aimed to map the use of EFT among adults with chronic diseases, characterize its intervention components and delivery models, and examine the extent to which existing evidence extends beyond short-term cognitive and decision-making outcomes to include health behaviors and clinically relevant outcomes, thereby informing future research and clinical translation.

This scoping review was conducted following PRISMA-ScR reporting guidelines. We searched PubMed, Web of Science, Embase, CINAHL, PsycINFO, The Cochrane Library, CNKI, WANFANG DATA, VIP, and SinoMed from database inception through October 2025. The methodological quality of the included studies was appraised using the 2018 Mixed Methods Appraisal Tool (MMAT).

Twenty studies were included, primarily involving populations with metabolic conditions; few focused on breast cancer, heart failure, or chronic pain. EFT interventions were grouped into two types: general EFT and goal-oriented EFT. Most intervention protocols included three core components: cue generation, cue appraisal, and episodic imagery training. Cue design, intervention duration, training frequency, and delivery modality varied considerably. Outcomes were categorized into four domains: decision-making and cognitive function, health-related behaviors, psychological well-being and motivation, and clinical and physiological outcomes. Evidence was strongest for proximal cognitive outcomes, particularly delay discounting, whereas behavioral outcomes were examined primarily in relation to dietary behaviors. Evidence regarding other self-management behaviors and clinically relevant outcomes was comparatively limited.

Existing evidence suggests that EFT has potential for application in populations with metabolic conditions, but its applicability to other chronic diseases requires further validation. Overall, the field remains in transition from experimental exploration to clinical translation. Future research should focus on optimizing intervention protocols for specific diseases and populations, identifying essential intervention components, extending intervention and follow-up durations, and evaluating the feasibility and effectiveness of digital delivery approaches within chronic disease management.

OSF registration: https://osf.io/rq9z7/.