Models of palliative care for malignant disease in rural settings: Systematic review

Access to palliative care for people with advanced cancer in rural settings remains inequitable due to workforce shortages, geographic isolation, and limited formalised care structures. This review synthesised evidence on rural palliative care models for people with malignant disease.

Systematic review of rural palliative care models for malignant disease published since January 2000; four databases were searched on 30 May 2024 and updated 30 May 2026. Predefined domains included: model/population characteristics, Health related quality of life (HRQoL), symptom burden, healthcare utilisation, model evaluation/experience, and health professional education. Study quality was appraised and findings synthesised narratively.

22 publications representing 18 studies were included. Models varied in leadership and delivery and were predominantly community-based (13/18); nine were specialist palliative care-led, six oncology-, generalist- or primary care-led, and three lay navigator-led with specialist support. Telehealth or hybrid delivery was used in 11/18. Outcomes were heterogeneous. Symptom burden (6/18) and location of death (5/18) were commonly reported. Several specialist- and generalist-led observational studies reported improvements in selected symptoms and health care use, while the two randomised controlled trials showed mixed HRQoL findings. Model acceptability and experience were frequently assessed (15/18), with continuity, flexible delivery, telehealth support and workforce development commonly valued, although infrastructure and resource constraints moderated implementation.

Rural palliative care models may support symptom management, access and care closer to home, with specialist palliative care expertise commonly embedded within local services. Comparative and economic evaluation of scalable rural models remains limited.

PROSPERO CRD42022303861.