Effectiveness of palliative care integrated with digital health interventions on nursing-sensitive outcomes among family caregivers: a systematic review and meta-analysis

Abstract Family caregivers play a central role in palliative care, yet they often experience high burden and reduced quality of life. Palliative care is essential for addressing the holistic needs of patients with life-limiting illnesses and their families; however, access to timely support remains a challenge, particularly for caregivers managing complex care responsibilities at home. Nurse-led digital health interventions integrated into palliative care models have emerged as a promising strategy to bridge this gap by providing accessible education, remote monitoring, and psychosocial support to empower caregivers and support holistic nursing care delivery. However, their effectiveness has not been systematically synthesized from a nursing perspective. This study aimed to systematically review and meta-analyze the effectiveness of nursing-informed palliative care models integrated with digital health interventions on family caregiver empowerment, burden, and quality of life. Following PRISMA guidelines, we conducted a comprehensive search of Scopus, Medline via PubMed, CINAHL via EBSCOhost, and Cochrane from database inception to 18 May 2026, yielding 4,706 records. Study quality was assessed using the Cochrane Risk of Bias 2.0 tool. Pooled effect sizes were calculated as standardized mean differences (SMDs) with 95% confidence intervals using the DerSimonian–Laird random-effects model. Sixteen studies involving family caregivers in palliative care settings were included in the qualitative synthesis and meta-analysis. Our pooled analysis found that digital health interventions, delivered or facilitated by nursing professionals, significantly improved caregiver readiness (SMD = 5.07, 95% CI: 3.90–6.25, p < 0.00001) and certain aspects of caregiver burden, including the Caregiver Strain Index (SMD = − 0.60, 95% CI: −1.20 to − 0.01, p = 0.05) and the Bakas Caregiver Outcomes Scale (SMD = 1.56, 95% CI: 1.20–1.91, p < 0.00001). However, the interventions did not consistently improve caregiver self-efficacy, psychological well-being (including depression, anxiety, and stress), or overall quality of life in RCT-based analyses. Non-randomized studies showed significant QoL improvements, but these findings should be interpreted cautiously given the inherent limitations of uncontrolled designs. These findings highlight the role of nurses in coordinating, educating, and sustaining digital-based supportive care for families. Digital health interventions integrated into nurse-led palliative care models show selective effectiveness, enhancing caregiver readiness and specific burden domains, while broader psychosocial and quality of life outcomes require further investigation. Findings underscore the pivotal role of nursing in designing, implementing, and evaluating technology-based caregiver support, and highlight the need for hybrid models that combine digital tools with psychological support.