Determinants of palliative care implementation in the end-of-life phase: A systematic literature review
DOI: https://doi.org/10.33024/min.v9i7.4267
Determinants End-of-Life Care Health Personnel Palliative Care Social Cognitive Theory
Abstract
Background: End-of-life palliative care depends on interacting determinants that have not been examined within a single theoretical framework.
Purpose: To identify and synthesize the determinants of end-of-life palliative care implementation and to interpret them using Social Cognitive Theory.
Method: This systematic literature review (PRISMA 2020; PEO framework) searched PubMed, Scopus, Web of Science, CINAHL, and Google Scholar, supplemented by Cochrane CENTRAL and PROSPERO, on 12 July 2026 for English-language original research published from 2020. Study quality was appraised with JBI, CASP, or MMAT tools, and findings were synthesized narratively (SWiM).
Results: Of 420 records, 17 studies (16 independent samples) were included. Knowledge was suboptimal (64.5%–75% correct). Core competence was the strongest predictor of practice in one multicenter study (β = 0.656), in-service training was associated with better practice (β = 0.26, p = .006), and 73%–82% of professionals in four studies lacked formal training. In one Dutch study, 44% of patients and 24% of families had not discussed stopping curative treatment. Confidence in the findings was low to moderate.
Conclusion: Individual, educational, and communication determinants appear to interact within organizational and family contexts, but the evidence is small and largely cross-sectional; longitudinal and interventional studies are needed.
Downloads
References
Agustini, N. L. P. I. B., Israfil, I., Swarjana, I. K., & Suyasa, I. G. P. D. (2025). Development of a palliative end of life care (PEOLC) model based on transcultural nursing for patients in need of long-term care. Jurnal Ners, 20(2), 164–172. https://doi.org/10.20473/jn.v20i2.65544
Agustini, N. L. P. I. B., Satriani, N. L. A., Dewi, N. P. A. R., Yulistina, P. D., Dewi, P. S., Putra, P. A. S., Wijayanatha, I. P. A., & Yudha, G. K. E. (2023). Philosophy of Science on The Development of Palliative Nursing Practice in The Implementation of Long-Term Care for The Elderly: A Literature Review. Jurnal Info Kesehatan, 21(2), 226–238. https://doi.org/10.31965/infokes.Vol21.Iss2.1064
Arantzamendi, M., Sapeta, P., Belar, A., & Centeno, C. (2024). How palliative care professionals develop coping competence through their career: A grounded theory. Palliative Medicine, 38(3), 284–296. https://doi.org/10.1177/02692163241229961
Bandura, A. (2001). Social Cognitive Theory: An Agentic Perspective. Annual Review of Psychology, 52(1), 1–26. https://doi.org/10.1146/annurev.psych.52.1.1
Barker, R., Wilson, P., & Butler, C. (2021). How does English national end-of-life care policy impact on the experience of older people at the end of life? Findings from a realist evaluation. Primary Health Care Research & Development, 22, e57. https://doi.org/10.1017/S1463423621000621
Bergenholtz, H., Kragh, C., Ziebell, M., Hølge-Hazelton, B., & Gaardboe, O. (2025). A joint hospital initiative to strengthen general palliative care in the hospital: an action research study on challenges and facilitators. BMC Palliative Care, 24(1), 121. https://doi.org/10.1186/s12904-025-01764-9
Berhanu, R. D., Tesema, A. A., Deme, M. B., & Kanfe, S. G. (2021). Perceived transcultural self-efficacy and its associated factors among nurses in Ethiopia: A cross-sectional study. Plos One, 16(7), e0254643. https://doi.org/10.1371/journal.pone.0254643
Besselaar, B. N. van den, Hof, K. S. van, Sewnaik, A., de Jong, Robert. J. B., & Offerman, M. P. J. (2023). Experience with eHealth in the palliative care pathway for head and neck cancer patients – a mixed-methods study. https://doi.org/10.21203/rs.3.rs-3314403/v1
Campbell, M., McKenzie, J. E., Sowden, A., Katikireddi, S. V., Brennan, S. E., Ellis, S., Hartmann-Boyce, J., Ryan, R., Shepperd, S., Thomas, J., Welch, V., & Thomson, H. (2020). Synthesis without meta-analysis (SWiM) in systematic reviews: reporting guideline. BMJ, l6890. https://doi.org/10.1136/bmj.l6890
Chamorro, I. M. U., & Miangolarra Page, J. C. (2025). Health-related quality of life in palliative care: determinants identified in a hospital-based observational study. BMC Palliative Care, 25(1), 32. https://doi.org/10.1186/s12904-025-01974-1
Eng, V., Hewitt, V., & Kekalih, A. (2022). Preference for initiation of end-of-life care discussion in Indonesia: a quantitative study. BMC Palliative Care, 21(1), 6. https://doi.org/10.1186/s12904-021-00894-0
Hansen, M. I. T., Haugen, D. F., Sigurdardottir, K. R., Kvikstad, A., Mayland, C. R., Schaufel, M. A., Haugen, D. F., Sigurdardottir, K. R., Hansen, M. I. T., Hufthammer, K. O., Leppert, W., Wolszczak, K., Yanneo, E. G., Tripodoro, V., Goldraij, G., Weber, M., Gerlach, C., Zambon, L., Passarini, J. N., & Guldhav, K. V. (2020). Factors affecting quality of end-of-life hospital care - a qualitative analysis of free text comments from the i-CODE survey in Norway. BMC Palliative Care, 19(1), 98. https://doi.org/10.1186/s12904-020-00609-x
Hasni, N. Al, Yahyaei, A. Al, Omari, O. Al, Muliira, J., Lazarus, E. R., Riyami, N. Al, Musalami, A. Al, Al-Harrasi, A., Mahyijari, N. Al, Ayaad, O., & Sivankutty, N. (2025). Oncology nurses at the frontline of palliative care: knowledge, attitudes, and factors associated with palliative care practice. BMC Health Services Research, 25(1), 1634. https://doi.org/10.1186/s12913-025-13763-w
Israfil, I., Agustini, N. L. P. I. B., & Swarjana, I. K. (2025). Developing a culture-based palliative nursing care model in hospitals: a phenomenological study. Healthcare in Low-Resource Settings. https://doi.org/10.4081/hls.2025.13398
Jia, J., Lv, F. F., Cai, Z. H., Li, L. T., & Nie, X. F. (2024). Self-reported pain assessment, core competence and practice ability for palliative care among Chinese oncology nurses: a multicenter cross-sectional study. BMC Nursing, 23(1), 806. https://doi.org/10.1186/s12912-024-02471-1
Khessairi, N., Bacha, D., Aouadi, R., Ennaifer, R., Lahmar, A., & Ben Slama, S. (2024). Knowledge and Perceptions of the End of Life among Tunisian Medical and Paramedical Staff. Journal of Hospice and Palliative Care, 27(2), 64–76. https://doi.org/10.14475/jhpc.2024.27.2.64
Kodama, K., Kanke, S., & Kassai, R. (2024). Palliative care practices and their relationship to training: A cross-sectional study of community-oriented physicians. FUKUSHIMA JOURNAL OF MEDICAL SCIENCE, 70(3), 23–00007. https://doi.org/10.5387/fms.23-00007
Lazarus, E., Muliira, J., Al-Zaabi, O., Al-Khabori, M., Al Adawi, M., & Al Mamari, Q. (2025). Palliative care knowledge and attitudes towards end-of-life care of nurses in tertiary hospitals. Curationis. https://doi.org/10.4102/curationis.v48i1.2734
Martins, M., Rodrigues, A., Marques, C., & Carvalho, R. (2024). Level of knowledge in palliative care, preparation and capacity to provide care at the end of life by health professionals. Riage - Revista Ibero-Americana de Gerontologia, 5. https://doi.org/10.61415/riage.244
Moola, S., Muun, N., Lissy, K., & Rittano. (2020). Chapter 7: Systematic reviews of etiology and risk. In JBI Manual for Evidence Synthesis. JBI. https://doi.org/10.46658/JBIMES-20-08
Nie, X., Lv, F., Li, L., & Jia, J. (2025). Current situation and influencing factors of palliative care practice ability among oncology nurses: A multicenter cross-sectional study. International Journal of Nursing Sciences, 12(1), 35–41. https://doi.org/10.1016/j.ijnss.2024.12.006
Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S., … Moher, D. (2021). The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ, n71. https://doi.org/10.1136/bmj.n71
Pask, S., Okwuosa, C., Mohamed, A., Price, R., Young, J., Curtis, T., Henderson, S., Winter-Luke, I., Sunny, A., Chambers, R. L., Greenley, S., Johansson, T., Bone, A. E., Barclay, S., Higginson, I. J., Sleeman, K. E., & Murtagh, F. E. (2025). Models, components and outcomes of palliative and end-of-life care provided to adults living at home: A systematic umbrella review of reviews. Palliative Medicine, 39(10), 1037–1062. https://doi.org/10.1177/02692163251362567
Septianata, V., Afriani, T., Pujasari, H., Wildani, A. A., & Mutiasari, H. (2025). Development of Advance Care Planning-Based Discharge Planning to Enhance the Continuity of Palliative Care. Indonesian Journal of Global Health Research, 8(1), 385–392. https://doi.org/10.37287/ijghr.v8i1.662
Sharma, K., Prathipati, R. P., Agrawal, A., & Shah, K. (2023). A review on determinants and barriers affecting the transition from curative care to palliative care in patients suffering from terminal cancer. International Journal of Research in Medical Sciences, 11(6), 2333–2337. https://doi.org/10.18203/2320-6012.ijrms20231667.
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Kadek Leni, Ni Luh Putu Inca Buntari Agustini, I Nyoman Arya Maha Putra, Ni Kadek Sriasih
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
