A Systematic Review of United States-Based Interventions to Explain Community-Based Palliative Care.

Abstract

The prevalence of serious illness has increased significantly, yet palliative care uptake remains limited, particularly in community settings. In the United States, misconceptions equating palliative care with hospice or limiting it to end-of-life care create barriers to uptake. This systematic review examines interventions focused on how community-based palliative care is explained to seriously ill individuals and caregivers. A systematic review was conducted between March 4 and August 20, 2025, for articles published after January 1, 2006, across seven databases, and supplemented by hand searches. Included studies were peer-reviewed, in English, and described interventions that explained community-based palliative care to seriously ill adults or caregivers directly or by training clinicians and other providers to do so. Data extraction followed predefined criteria and the Cochrane Checklist, with study quality assessed using the 26-item CONSORT checklist. Of 4328 unique studies identified, twelve met the inclusion criteria. Included studies targeted 1) seriously ill adults or their caregivers, 2) healthcare professionals responsible for explaining palliative care, or 3) a combination thereof. Interventions were delivered by analog, virtual, in-person, or combined methods. Ten studies assessed knowledge, and three assessed attitudes toward palliative care. Five evaluated intervention acceptability and usability, and one addressed communication outcomes. Overall, study quality reflected early-phase intervention development. Interventions focused on how community-based palliative care is explained to patients and caregivers are in the early stages of development. Future research should prioritize rigorous designs, larger samples, and outcomes that evaluate receptivity towards palliative care to increase eventual uptake.