Nurse-led tele-palliative care for symptom management and family support: A hybrid umbrella review of reviews and primary studies.

BACKGROUND

The use of telehealth in palliative care has expanded rapidly, offering opportunities to enhance symptom management and provide psychosocial support to patients and families. Nurse-led virtual interventions play a critical role in improving access to care, particularly for those facing geographic or logistical barriers.

OBJECTIVES

To systematically synthesize global evidence on the effectiveness of tele-palliative nursing interventions in improving symptom management and family support for adults with life-limiting illnesses.

METHODS

This study was conducted as a hybrid umbrella review in accordance with PRISMA 2020 guidelines. Six databases and two trial registries were searched through September 2025. Eligible evidence included (a) systematic reviews, scoping reviews, integrative reviews, and mixed-methods reviews, and (b) primary studies such as randomized controlled trials (RCTs), quasi-experiments, observational studies, and pilot/feasibility studies. Systematic reviews were appraised using AMSTAR-2; primary studies using RoB 2, ROBINS-I, or CASP, as appropriate. A narrative synthesis was employed, with review-level evidence prioritized and primary studies used to contextualize effect directions. Potential overlap of primary studies across included reviews was assessed conceptually to avoid double counting. This approach was selected to integrate both review-level and primary evidence within a unified synthesis framework.

RESULTS

Twenty-eight studies (≈2,500 participants from primary studies only) from North America, Europe, Asia, and Australia were included. Interventions included video consultations, structured telephone follow-ups, remote symptom monitoring, and caregiver education programs delivered by nurses. Across studies, nurse-led telehealth interventions were associated with improvements in access to care, symptom monitoring, patient satisfaction, and aspects of family support. Evidence for symptom severity reduction and caregiver burden was mixed, with moderate heterogeneity. Risk of bias was generally low to moderate, with RCTs offering the strongest evidence.

SIGNIFICANCE OF

RESULTS

Tele-palliative nursing is a promising model for delivering symptom management and family support remotely. It demonstrates feasibility and acceptability across diverse settings. However, findings should be interpreted cautiously due to heterogeneity in study designs, reliance on secondary evidence, and variable methodological quality. Further large-scale trials with standardized outcome measures are needed to strengthen the evidence base.