Abstract
Objective
This systematic review synthesizes randomized controlled trial evidence on the effectiveness of nurse-led ACP interventions for patients with advanced cancer.
Methods
We searched PubMed, Embase, CINAHL, Web of Science, and the Cochrane Central Register from inception to January 2026. Eligible studies were randomized controlled trials (RCTs) evaluating nurse-led ACP interventions in adults with advanced or metastatic cancer. Two reviewers independently screened records, extracted data, and assessed risk of bias using the Cochrane Risk of Bias 2 (RoB 2) tool. A narrative synthesis was performed due to clinical and methodological heterogeneity precluding meta-analysis.
Results
Six studies (7 publications; N = 2816) met inclusion criteria, conducted in the United States, South Korea, and six European countries. Nurse-led ACP interventions consistently increased advance directive completion (adjusted odds ratios 2.5-5.3) and end-of-life conversation rates vs usual care. One trial showed facilitated nurse-led ACP outperformed patient-directed approaches in ACP engagement (adjusted difference 0.25; 95% CI 0.10-0.40; P = .001). Quality of life outcomes were mixed; most trials showed no significant difference at 3 months, though higher-intensity interventions trended toward greater benefit. Overall risk of bias was low to moderate.
Conclusions
Nurse-led ACP interventions are feasible and effective in improving ACP engagement and end-of-life outcomes for patients with advanced cancer. Successful implementation requires standardized training, adequate intervention intensity, and systematic follow-up. Future trials should use validated patient-reported ACP measures and explore optimal timing and delivery methods.
Keywords
Get full access to this article
View all access options for this article.