Provision of palliative and end-of-life care by community health nurses: a scoping review on the challenges and potential solutions

Background The demand for home-based palliative care is increasing, driven by ageing populations and a rise in multiple long-term conditions. Community health nurses are pivotal to enabling patients to be cared for and die at home, yet their contributions to palliative and end-of-life care remain under-recognised and poorly understood. Previous international reviews have focused on specific themes but in-depth synthesis of evidence from one national health system has not been undertaken. Aim To identify, map and synthesise evidence within a single national health system on the community health nursing workforce in palliative and end-of-life care provision for adults living at home (including their role and responsibilities, and identifying challenges and potential solutions). Method This scoping review followed the Joanna Briggs Institute methodology and the PRISMA-Scoping Review checklist statement. We systematically searched thirteen electronic databases and grey literature sources, from 2009 to 2025. UK-evidence reporting on community health nurses’ provision of palliative and end-of-life care to adults living at home was included. Data were charted using a structured data extraction form and grouped thematically to understand the nature of their roles and responsibilities, the challenges faced in providing such care, and potential solutions to mitigate these challenges. Results A total of 250 items/reports reflecting 239 included items/reports (11 merged as same project) were included. The main challenges community health nurses are facing in palliative and end-of-life care provision are driven by the rising demand and increasing complexity of the needs of patients dying at home. This requires rapid role evolvement, expertise, and effective integration with multiple providers and services, and impacts on staff wellbeing and morale. To mitigate these challenges, requires recognition of and training to support their rapidly evolving roles in palliative and end-of-life care and to meet the increasingly complex needs of patients and their families. There is limited understanding of safe caseloads and data to demonstrate the extent of palliative and end-of-life care provided by community health nurses. Conclusions Community health nurses are essential to the delivery of palliative and end-of-life care at home. Addressing workforce capacity, role clarity, and training gaps is critical to meeting future demand and ensuring equitable, high-quality care. This review highlights the urgent need for these challenges in community health nursing to be addressed to support sustainable palliative and end-of-life care delivery.