The effect of simulation-based training on palliative care competence: A systematic review and meta-analysis

BACKGROUND: Palliative care and end-of-life care training are increasingly recognized as essential components of nursing education worldwide. Comprehensive training in general palliative care can prepare nurses for handling complex challenges. Simulation-based training offers an innovative approach to prepare nurses and nursing students for the demands of palliative and end-of-life care. OBJECTIVES: To examine the effect of simulation-based training in improving nursing students' and nurses' knowledge, attitudes, skills, and confidence in palliative care compared to conventional education or no intervention. DATA SOURCES: Five databases, including PubMed, MEDLINE, EMBASE, CINAHL PLUS, and Cochrane CENTRAL, were searched from inception to May 8, 2025. METHODS: statistics and Cochran's Q test. RESULT: Eleven studies (3 randomized controlled trials and 8 quasi-experimental studies) involving 909 participants (588 nurses [64.7%] and 321 nursing students [35.3%]) were included, with 9 studies contributing to the meta-analysis. Simulation-based training showed statistically significant improvements in knowledge (SMD = 1.49; 95% CI: 1.12 to 1.86, Z = 7.91, p < 0.00001) and skill performance (SMD = 1.29; 95% CI: 0.79 to 1.78, Z = 5.08, p < 0.00001) for both nurses and nursing students. Subgroup analysis revealed that nursing students experienced significant gains in confidence (SMD = 1.39; 95% CI: 0.51 to 2.28, Z = 3.10, p = 0.002) compared to non-simulation settings. However, the effect of simulation-based training on improving nurses' and nursing students' attitudes remains inconclusive. CONCLUSION AND IMPLICATIONS: Simulation-based training significantly enhances nursing students' confidence, as well as nurses' and nursing students' knowledge and skill performance in palliative and end-of-life care. However, its effect on attitudes remains uncertain, and high-quality randomized controlled trials are needed. Future research should focus on robust trials to assess the long-term effects, address cultural and psychological factors, accommodate the diverse needs of nurses and students, and incorporate patient outcome assessments.