Objectives Social and therapeutic horticulture (STH) is little known in palliative care. This evaluation sets out to explore the effectiveness of STH in relieving distress, managing symptoms and supporting people with advanced and terminal illness to live well throughout each stage of the disease trajectory.

Methods STH was provided for 218 patients in an indoor hospice setting during a 2-year period (April 2018 to March 2020). Nature-based interventions, such as potting up plants, floristry and creating miniature gardens, were adapted for all participants to create a nature connection experience while indoors. The Distress Thermometer (DT) was used to measure perceived distress before and after each session, and patients’ reports of their subjective experience were recorded verbatim.

Results Results showed a statistically significant reduction in DT scores of between 54% and 60%. Patients also self-reported an improvement in quality of life and well-being and in management of symptoms including a reduction in pain.

Conclusions This evaluation shows that STH is effective in relieving distress in palliative care and may be considered a valued therapeutic intervention. The findings can inform planning within hospices and palliative care settings to enhance the care of patients and their family members.