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Regional hospice and palliative care networks worldwide: scoping review
  1. Hanna A A Röwer,
  2. Franziska A Herbst and
  3. Sven Schwabe
  1. Institute for General Practice and Palliative Care, Hanover Medical School, Hanover, Germany
  1. Correspondence to Ms Hanna A A Röwer, Institute for General Practice and Palliative Care, Hannover Medical School, Hannover, Germany; roewer.hanna{at}


Background Regional hospice and palliative care networks (RHPCNs) are increasingly being established to improve integrative care for patients with life-limiting illnesses. This scoping review aimed at identifying and synthesising international literature on RHPCNs, focusing on structures, outcomes, benefits, success factors and good practices.

Method Following Arksey and O’Malley’s (2005) framework, a search of four electronic databases (CINAHL, Google Scholar, PubMed, Web of Science Core Collection) was conducted on 7 July 2023. Additionally, a manual search of reference lists of the identified articles was performed. Original research, qualification theses and descriptive reports on RHPCNs at a structural level were included.

Findings Two researchers analysed 777 article abstracts, screened 104 full texts and selected 24 articles. The included studies predominantly used qualitative designs. RHPCNs self-identify as local stakeholders, employ coordination offices and steering committees, and actively recruit network partners. Outcomes included improved professional practices, enhanced quality of care, increased patient utilisation of regional care offerings and improved patient transitions between care providers. Success factors included clear coordination, transparent communication, strategic planning and resource-securing strategies.

Conclusions The analysis identified key RHPCN success factors such as effective communication and adaptive leadership. Despite the need for further research, the findings emphasise RHPCNs’ potential to improve palliative care and encourage policymaker support.

Other This scoping review is part of the research project HOPAN, which aims at assessing and analysing RHPCNs in Germany. The project is funded by the German Innovation Fund of the Federal Joint Committee (G-BA) (Grant N° 01VSF22042; funding period: 01/2023–12/2024).

  • Hospice care
  • Palliative Care
  • Case Management
  • Supportive care
  • Communication

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  • The existing literature recognises regional hospice and palliative care networks (RHPCNs) as promising structural approaches for optimising end-of-life care. A comprehensive overview of RHPCN structures and benefits is lacking. A scoping review was considered appropriate to synthesise the literature and address research gaps.


  • The present review provided an understanding of RHPCNs’ nuanced organisational structures, multifaceted outcomes and benefits (eg, improved professional practices, enhanced client services), and specific success factors (eg, transparent communication, strategic planning, resource securing strategies for sustainability).


  • The findings may guide efforts to refine and strengthen RHPCN structures and activities, thereby bolstering the ability of RHPCNs to provide effective and integrated end-of-life care. Policymakers and stakeholders may use the findings to improve the structural frameworks and funding conditions of RHPCNs.


Effective palliative care requires collaboration and coordination among various healthcare professionals, organisations and community resources.1 2 Thus, the emergence of regional hospice and palliative care networks (RHPCNs) shows promise for enhancing the delivery of comprehensive and integrated care for patients with life-limiting illnesses at a structural level.


An RHPCN is a structured collaborative system encompassing a wide array of stakeholders in a specific geographic region. RHPCNs bring together various healthcare providers, organisations and services to address the complex and interconnected healthcare challenges faced by patients and communities. Unlike isolated cases of provider cooperation, RHPCNs collaborate at a structural level, with key stakeholders working together to improve healthcare delivery in palliative and hospice settings in their local region. RHPCNs aim at facilitating the sharing of expertise, resources and good practices, ultimately optimising the delivery of palliative care across different contexts, including hospitals, long-term care facilities and outpatient care settings.3 4

Given the increasing implementation of RHPCNs,5–8 a comprehensive understanding of their structures, benefits and success factors is crucial to guide their continued development and refinement. A scoping review may help to achieve this by mapping and synthesising the literature on RHPCNs, exploring the range of evidence available to identify key themes and research gaps.


The present scoping review aimed at generating an overview of the current knowledge and understanding of RHPCNs. Specifically, it addressed the following question: What is known about RHPCNs worldwide, with regard to (a) their structure, (b) their benefits and outcomes, and (c) their success factors and good practices?

Through this systematic scoping review, the study sought to inform both current and prospective RHPCN providers and funders about the state of knowledge on RHPCNs, while also drawing researchers’ attention to gaps in the scientific data. Additionally, the results aimed at guiding the further development of RHPCNS through recommendations and evaluation frameworks to improve network maturity. The work comprised part of the broader HOPAN research project.9


The research question necessitated a methodology that would offer a comprehensive overview of the existing literature. Scoping reviews are designed to capture a wide range of information, allowing for a broad and diverse collection of knowledge. Consequently, for the present study, a scoping review was preferred to a systematic review, as the research question called for an open, exploratory approach.

The scoping review followed the five-step methodological framework of Arksey and O’Malley10: (1) identifying the research question(s), (2) identifying the relevant studies, (3) selecting the studies, (4) charting the data, and (5) collecting, summarising and reporting the results.

Protocol and registration

The present scoping review has not been registered. To enable transparent documentation and to ensure replicability, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist11 and a review protocol were used to both plan and conduct the review, as well as to guide the reporting of the results.

Eligibility criteria

Articles were assessed and selected on the basis of the study population and setting, as well as the publication language and article type. As RHPCNs are a rather recent phenomenon, the review search period was left open. Publications in both German and English were included in the review. English contributions were accepted in order to capture results from around the world, while German articles were included to generate additional insights into the authors’ local context.

The review considered original research, scientific qualification theses and descriptive reports, as these types of publications typically follow rigorous methodologies, ensuring systematic and thorough investigation. Limiting the review to these types of publications also aimed at ensuring the credibility, validity and relevance of the included literature. Congress abstracts were excluded because these often lack sufficient detail on methodology and results to guarantee scientific quality.

Information sources

A comprehensive search of the electronic databases CINAHL, Google Scholar, PubMed and Web of Science Core Collection was conducted on 7 July 2023. These databases were selected to provide broad coverage of different disciplines. Additional databases were considered redundant or irrelevant. The compilation of full texts relied on the resources of the Hannover Medical School library.

Search strategy

The search strategy was developed by HR, with support from SvS and FH. The initial approach involved compiling a list of key articles deemed essential for answering the research question.5 12–16 The search strategy was then iteratively adjusted until it included all of the identified key articles. Additional grey literature was sought via Google Scholar. Reference lists of the full texts were hand-searched to identify further relevant studies.

The following search strategy was used in PubMed:

(network[Tiab] OR networks[Tiab] OR networking[Tiab] AND rural[Tiab] OR regional[Tiab] OR local[Tiab] AND ‘palliative care’[MeSH Terms] OR ‘hospice care’[MeSH Terms] OR ‘terminal care’[MeSH Terms] OR palliative[Tiab] OR ‘terminally ill’[Tiab] OR ‘terminal illness’[Tiab] OR ‘terminal illnesses’[Tiab] OR ‘terminal disease’[Tiab] OR ‘terminal diseases’[Tiab] OR hospice[Tiab] OR hospices[Tiab] OR ‘end of life’[Tiab] OR eol[Tiab] OR ‘life’s end’[Tiab] OR ‘advanced care planning’[Tiab] OR ‘advanced illness’[Tiab] OR ‘advanced illnesses’[Tiab] OR ‘end stage disease’[Tiab] OR ‘end stage illness’[Tiab] OR ‘end stage illnesses’[Tiab] OR ‘end stage diseases’[Tiab])

This search strategy was adapted for the other databases according to the individual database standards, and retested to ensure that key articles in the respective databases were identified.

Selection of sources of evidence

To be included in the review, studies were required to focus specifically on RHPCNs comprised of interdisciplinary providers in hospice and palliative care settings, working at a structural level. Additionally, studies were only included if their population was a regional healthcare network promoting collaboration and coordination among different healthcare service providers in a specific geographic region. These networks were required to involve care providers from various health professions and disciplines, such as physicians, nurses, social workers, therapists and other experts from outpatient and/or inpatient facilities. Studies focused solely on specific cases of collaboration between individual providers were excluded, given the research objective to analyse structurally operating networks, rather than isolated instances of collaborative effort. Finally, studies were included only if they related to hospice or palliative care settings (ie, networks addressing the care of individuals with life-limiting illnesses at the end-of-life and their families).

Data charting

All of the retrieved articles were imported into EndNote 20 reference management software (Clarivate, Philadelphia, USA). After screening for duplicates, two researchers (HR and SvS) independently reviewed the titles and abstracts of the remaining studies. Documentation of the main reasons for exclusion was used to reach consensus. Both researchers independently moved excluded studies to separate EndNote groups according to the exclusion criteria: (1) other population, (2) other research setting, (3) other publication type or (4) other language. Researcher decisions were subsequently compared. In the event of disagreement, consensus was sought. Where consensus was not reached, a third researcher (FH) was consulted for clarification. In the next step, two researchers (HR and SvS) independently reviewed the full text of the remaining studies, according to the aforementioned criteria.

Data items

All of the included articles provided information on at least one of the three aspects covered by the research question. The analysis of RHPCN structures relied on data regarding their organisation and operational framework. The examination of benefits and outcomes referred to studies describing the effects of RHPCNs on patients and their families, as well as local professionals. Finally, the identification of RHPCN good practices and success factors relied on studies highlighting established and recognised methods and processes leading to optimal RHPCN conditions. Benefits, outcomes, good practices and success factors that were listed in articles as potentially significant but not actually observed were not included.

Critical appraisal of individual sources of evidence

No quality assessment of the reported evidence was conducted, due to the chosen form of review and the immediate need for evidence to support an ongoing research project.

Synthesis of results

Studies were included if they provided information on at least one of the following three topics: (1) structures, (2) benefits and outcomes, and (3) success factors and good practices. Information on these topics was compiled in a table.


The search resulted in 24 articles for the final review, including one article identified through a hand search.

Selection of sources of evidence

A total of 1089 records were identified from CINAHL (n=248), Google Scholar (n=30), PubMed (n=362) and Web of Science Core Collection (n=449) (see figure 1). Prior to the screening process, 313 duplicate records were removed, leaving 776 unique records for further assessment. During the screening phase, the abstracts and titles of each of the 776 records were reviewed for study eligibility. This resulted in the exclusion of 670 records for the following reasons: study population other than structural networks (n=644), study setting other than hospice and palliative care settings (n=23), other publication type (n=2), or published in a language other than English or German (n=2). Following the initial screening, the full texts of 105 potentially relevant articles were sought for retrieval. However, two of these articles could not be retrieved. Hence, a total of 103 full texts were assessed for eligibility. From these articles, further exclusions were made based on the following criteria: study population other than structural networks (n=51), study setting other than hospice and palliative care settings (n=2), other publication type (n=15), or published in a language other than English or German (n=12). A hand search of the reference lists of the chosen full texts resulted in the inclusion of one further paper. Ultimately, 24 studies were included in the systematic review.

Characteristics of sources of evidence

The included 24 studies focused on RHPCNs in different countries, with the majority (n=10) based in Canada.3 17–25 Five articles provided insights into RHPCNs in different regions of Australia,16 26–29 five originated from Germany12–15 30 and two were based in the USA.31 32 One article explored the formation and evaluation of RHPCNs in the Netherlands.5 Finally, one article focused on the experiences of community nurses in RHPCNs based in the UK.8 The earliest study was published in 198031 and only a small number of articles (n=6) were published in the last 10 years since the database search.12–15 24 30 These more recent studies primarily stemmed from Germany.12–15 Most articles were published in 2001,8 28 between 2005 and 2007,3 5 10 21 26 29 between 2009 and 2011,16–20 22 and in 201712 13 (see figure 2).

Figure 2

Publications (full texts) by year and country of origin.

Thirteen studies drew on qualitative research in the form of interviews and focus groups.3 5 8 12–14 19 21 22 26 27 29 30 Document analysis was applied in five studies,3 5 16 18 19 mainly describing the establishment and structural composition of RHPCNs. While the use of surveys was noted in seven studies,5 12 14 18 20–22 only one study used a survey as their sole data source.20 The number of network participants varied across studies, from 115 19 23–25 27 30 32 to 13.20 The number of interviewees in studies reporting this information ranged from 117 to 20,19 with an average of 11. The number of focus group or workshop participants in studies reporting this data ranged from 832 to 106,28 with an average of 42. The number of survey participants in studies reporting this data ranged from 1226 to 61,20 with an average of 25. Additionally, two studies23 30 analysed a total of n=43 012 patient data sets.

Results of individual sources of evidence

In the following tables present the principal data pertaining to the articles and their content in relation to the research questions (see tables 1–6).

Table 1

Summarised characteristics of the included studies (part 1)

Table 2

Summarised characteristics of the included studies (part 2)

Table 3

Summarised characteristics of the included studies (part 3)

Table 4

Summarised characteristics of the included studies (part 4)

Table 5

Summarised characteristics of the included studies (part 5)

Table 6

Summarised characteristics of the included studies (part 6)


The findings of the scoping review are presented in accordance with the three topics covered by the research question.


Seventeen articles5 8 12 13 15 17–20 22 23 25 28–32 addressed RHPCN structures. Taken together, these articles provided a comprehensive overview of two central RHPCN themes: network role and organisational structure. In more detail, 14 articles5 8 12 13 15 17 19 23 28–32 addressed network role and 14 articles5 8 12 13 15 17–20 25 29–32 addressed organisational structure.

Network role

RHPCNs were found to contribute to collaboration and the efficient delivery of patient-centred care. Some studies emphasised the central role played by RHPCNs in sustaining interprofessional collaboration and cooperation.17 21 30 Two studies described RHPCNs as a central point of information exchange between regional providers,25 29 while other studies showed that RHPCNs aim at improving the flow of information through centralised information platforms.19 Some articles positioned RHPCNs as strategic management tools within health systems, describing them as multi-institutional systems for coordination or consolidation, involved in planning and evaluation, rather than policy.8 31 Several authors further indicated that RHPCNs act as catalysts for sustained collaboration,20 engage in advocacy through coordination and programme evaluation,32 and expand to new target groups, fostering diverse partnerships.12 The included studies varied in their descriptions of the extended functions of RHPCNs, which included establishing new provider facilities (eg, branch offices) or completely new regional offerings,15 and serving as catalysts for organisational and stakeholder organisation.23 28 Several authors also indicated that RHPCNs may play a governance role,19 highlighting diverse functions ranging from coordinating volunteers to exerting political influence,28 29 while also suggesting the importance of formal structures to facilitate commitment and alignment.

Overall, the included studies showed that RHPCNs facilitate interprofessional collaboration through team-based approaches emphasising ethical awareness.17 In addition, several authors argued that RHPCNs align with larger healthcare strategies, recognising their evolving nature.8 12 15

Organisational structure

The included studies identified differing RHPCN organisational models, based on various forms of cooperation. These included cooperation agreements,13 20 cooperation via coordination offices or steering committees,13 15 and cooperation with no formal agreement in place but the intention to share costs.32 This highlights the adaptive nature of these networks. A qualitative study of n=10 network coordinators described partnerships within RHPCNs as expansive, including hospitals, general practitioners, specialised doctors, outpatient care services, inpatient care homes, local authorities, pharmacies and aid suppliers.12 One study found that some RHPCNs had approximately 100 member organisations.18 The authors of three other papers described that RHPCNs focus on expanding local educational services, adapting to external policy frameworks and accommodating different palliative care service models.15 23 28 One publication noted that local stakeholder-driven networks adopt inclusive structures, uniting leaders from numerous organisations.21

Another study described that RHPCN organisational structures vary in accordance with internal and external factors, such as structural disparities and funding challenges. Variations in interorganisational cooperation may pose further complexities.19 Two studies described RHPCNs as constantly evolving in response to government guidance.8 29 These same studies also described how the influence of external policy frameworks on service models8 29 can challenge structural uniformity. Furthermore, two studies reported structural inequalities within RHPCNs due to inadequate funding, variable palliative care capacity, and a lack of standardised information systems.5 19

In summary, the investigated studies suggest that RHPCNs are remarkably adaptable to local contexts. Furthermore, they navigate challenges through diverse structures, promote interprofessional collaboration and contribute to strategic health priorities.

Outcomes and benefits

Eighteen articles3 5 8 13 15 17–23 25–27 30–32 addressed the outcomes and benefits of RHPCNs, underlining two main themes: professional practice benefits and client service benefits. Both of these categories were covered by all of the 18 articles, with consistent themes emerging.

Professional practice benefits

Various studies described that interdisciplinary collaboration and a team-based approach could improve coordination and communication at an interdisciplinary level.5 8 17 27 31 Some of the publications noted that the integration of comprehensive pain and bereavement management skills through networking could also contribute significantly to holistic patient care.3 17 26–28 Two studies based in Australia and Canada, respectively, identified that networking improved both ethical awareness and knowledge of legislation, promoting greater compliance with legislation and models of ethical healthcare.17 27 In addition, some authors argued that networking could facilitate greater collaboration between healthcare professionals and ensure a consistently high quality of patient care.5 8 19–21 26 Professional practice was also described as being strengthened through the exchange of valuable information and further training within the network.26 28 32

Studies also identified that improvements in symptom management and the introduction of regional standardised assessment procedures, both associated with RHPCNs, could significantly improve the effectiveness of patient care.20 22 23 30 31 Four studies described that networking could promote the efficient use of resources, knowledge sharing and interdisciplinary cooperation, enabling the optimal use of healthcare resources.13 15 23 30 In addition, three studies showed how the culture of collaboration fostered by RHPCNs, as evidenced by their greater transparency and promotion of effective conflict resolution, had a positive impact on primary caregiver satisfaction.5 19 21

Client service benefits

In addition to the client benefits derived from the improved professional practice associated with RHPCNs, studies also identified a number of concrete benefits to local communities. As an example, six papers described that RHPCNs facilitate better communication and coordination among healthcare professionals, leading to improved access to healthcare services and continuity of care for their respective populations.5 13 15 19 21 23 In addition, two studies identified a reduction in emergency visits and the introduction of evidence-based practices in RHPCNs as a result of networking.22 31 Two further articles explained that bereavement support and strong ethical awareness among professionals may significantly contribute to the expansion of holistic end-of-life care offerings.17 This outcome could also be promoted by more effective pain management skills in RHPCNs.17 27 Studies also revealed that RHPCNs can increase public awareness and political influence with respect to local end-of-life issues. Increased public awareness of such issues could facilitate access and increase support from current or prospective funders.18 19 23 32

Success factors and good practices

Twenty-four articles addressed RHPCN success factors and good practices. The articles strongly advocated for interdisciplinary collaboration and team-based approaches to improve patient care and coordination across healthcare providers.8 13 16–19 21 25 Six studies also highlighted effective leadership and governance structures as crucial to the success of RHPCNs, ensuring clear direction, commitment and the ability to navigate complex dynamics.8 13 16 17 19 21 Moreover, several authors argued that effective coordination is a crucial success factor for overall healthcare delivery, encompassing streamlined care coordination, standardised practices and centralised capacities.13 15 20 21 30 Seven studies indicated that the establishment of robust networks and open communication are pivotal in facilitating collaboration, knowledge sharing and overall effectiveness in RHPCNs.8 13 15 17 22 26 30 Four studies identified transparency and trust as critical factors for fostering effective relationships between stakeholders, healthcare providers and the community, thereby increasing a network’s impact.15 21 22 30 Flexibility and adaptability were also emphasised, in recognition of the dynamic nature of healthcare environments and the need for RHPCNs to evolve in response to changing circumstances.8 15 19 21

Seven articles stressed the need for sustainable resource management, including financial considerations and incentives, to ensure long-term viability and effectiveness.5 8 17 18 22 30 In particular, sustainable healthcare practices, including efficient resource use, were highlighted as essential for the long-term success and impact of RHPCNs.15 17 22

The provision of bereavement support was noted as an integral aspect of RHPCNs, underlining the importance of addressing the emotional and psychological needs of patients and their family caregivers.17 22 28 Various articles3 14 17–20 26 32 emphasised the importance of comprehensive patient care, including thorough pain management and bereavement support. In addition, four studies highlighted the implementation of patient-centred care, prioritising patient needs and preferences and ensuring more personalised and effective healthcare.8 14 18 25 Continuous quality improvement and rigorous evaluation processes were also advocated to ensure the continued success and effectiveness of RHPCNs in meeting the evolving needs of patients and communities.8 14 15 17 21 22 30 One study showed that the common language used within RHPCNs may help patients understand the procedures and implications across different settings, enabling them to make more informed decisions.23

Seven studies identified education and training programmes as essential for healthcare professionals within these networks, promoting continuous learning, skills development, and the integration of innovative approaches, as well as professional confidence.14 15 17 26 28 29 In this context, collaborative resource utilisation was emphasised as an effective strategy, encouraging the pooling of expertise and resources to optimise service delivery and improve overall healthcare outcomes.26 28 32 One study showed that agreement over the sharing of medical aids (eg, diffusers, walking aids) across all RHPCN providers could simplify patient transfers between facilities.23

Six studies recognised community engagement as another RHPCN success factor, emphasising public involvement in, awareness of, and support for healthcare initiatives.17 18 20 21 29 32 In this vein, community outreach and the promotion of public awareness were highlighted as key strategies for fostering community involvement and understanding, while promoting the central role played by RHPCNs.29 31 32 One paper identified political support and advocacy as influential for shaping favourable policies and creating environments conducive to the effective operation of healthcare networks.17


Summary of the evidence

The results of the scoping review highlight the crucial role played by RHPCNs in fostering collaboration, enhancing patient care and contributing to the sustainability of the healthcare system. The identified success factors and good practices provide a roadmap for optimising the effectiveness and impact of RHPCNs in delivering quality, accessible and sustainable palliative care services to patients and communities in need. The geographical diversity of the studies—encompassing full texts from six countries across three continents, plus abstracts from seven other countries (including one from a fourth continent)—and nearly 40-year range of publication (ie, from 1980 to 2019), reflect the global importance and ongoing development of RHPCNs.

The findings can be compared with those of previous systematic reviews and meta-analyses on healthcare networks, particularly in terms of good practices and success factors. In line with the present review, these studies have underlined that healthcare networks are most effective when they have structural features that promote connection and communication, and when they are well managed with effective leadership.33–36 One scoping review identified success factors such as clearly defined responsibilities and tasks, alongside a coordinating position where possible. Although effective leadership emerged as key to network performance in the present scoping review and other studies of health networks,33–36 some studies have also shown that tensions can arise in healthcare networks between the moderating mechanisms of collaboration and control, due to the confluence of different structures, ways of working, and objectives.37 38 The simultaneous use and development of new structures, behaviours and goals has been suggested as a way to manage these tensions.37 This approach may also be relevant to RHPCNs, though it was not explicitly identified in the present review.

The ability to connect with other stakeholders based on commonly agreed standards is essential for the collaborative delivery of patient-centred and cost-effective services in healthcare networks.39 Findings from qualitative studies of healthcare networks33 suggest that networks with access to adequate funding and effective leadership and governance, combined with effective communication strategies and trust-based collaborative relationships, exhibit greater quality of care and patient outcomes. This is consistent with the results of the present scoping review, which identified intersections between good practices and success factors for healthcare networks in general, as well as those focused on end-of-life care.

Two systematic reviews on this topic have revealed some evidence that clinical networks can improve quality of care, network efficiency and patient outcomes,33 40 based on a small number of studies. The present scoping review aligned with these previous works, as most of the studies, it investigated on the benefits and outcomes of networks emphasised improved patient outcomes and greater network effectiveness. However, the subjective experiences of professionals and patients have rarely been considered in studies of general networks33 or RHPCNs, more specifically (as shown by the present results).

Strengths and limitations

The present scoping review used a robust methodological framework based on Arksey and O’Malley,10 conducting a thorough search of multiple electronic databases (CINAHL, Google Scholar, PubMed, Web of Science) to ensure comprehensive coverage of the relevant literature. Clear inclusion criteria were established, focused on studies of networks in hospice and palliative care settings, including original research and reports of projects and initiatives. This ensured the relevance and applicability of the included studies. To minimise bias, two researchers independently reviewed abstracts and full texts to identify relevant articles. This transparent process helped to ensure the reliability of the review findings.

Overall, these strengths contribute to the credibility and reliability of the scoping review, making it a valuable resource for understanding the current landscape of RHPCNs and identifying areas for future research and practice.

At the same time, it is important to acknowledge certain limitations due to the inclusion criteria related to language. Some articles may have been excluded from the analysis because they were not available in the language(s) specified for the review. This language limitation may have led to the omission of valuable research and insights published in other languages. As a result, the findings and conclusions of this review may not fully represent the global landscape of RHPCNs.

It is also important to note the challenges involved in distinguishing between care and case networks, as many care structures work collaboratively or interprofessionally (eg, those funded by health insurance funds in Germany), without being active at a structural level. The types of networks included in the reviewed studies were not always clear. Thus, when the relevance of the network type was in doubt, the relevant article was excluded from the analysis. This may have influenced the final selection of studies. Furthermore, it was not always clear how the different conceptualizations of networks—which included varying degrees of formalisation—could be compared between studies. Consequently, it was not possible to establish a relationship between benefits/outcomes and degree of network organisation.


The present scoping review explored the structures, outcomes, benefits, success factors and good practices of healthcare networks in hospice and palliative care contexts. The investigated studies applied different research methods without time limitations, providing a broad overview of the research field.

Nevertheless, certain research gaps emerged from the review. While numerous qualitative studies have identified success factors, the lack of quantitative studies precludes any analysis of the relative importance and strength of these factors in facilitating effective networking. The RHPCN structures reported in this scoping review varied from loose collaboration to contractual relationships headed by a fully funded coordinating office. However, it is unclear which of these structures best supports good networking. It would also be useful to determine whether the financial participation of network members contributes to determining their commitment to network collaboration. Overall, there are no established quality criteria or reference points for determining RHPCN quality. Studies aimed at filling these gaps through comprehensive research and a balanced representation of perspectives would contribute significantly to our understanding of the functioning and impact of RHPCNs.

Furthermore, the present scoping review suggests potential implications not only for RHPNs but also for policymakers, encouraging them to support and invest in these networks to ensure long-term sustainability and facilitate moderation and coordination.

Ethics statements

Patient consent for publication

Ethics approval

Not applicable.


The authors thank Nilab Kamandi, the student assistant involved in the research project HOPAN, for their support in testing the search strategy and obtaining the full texts. The authors also acknowledge Valerie Appleby’s professional copyediting of the manuscript.



  • FAH and SS are joint senior authors.

  • Contributors HAAR and SvS conceived of the scoping review. HAAR, SvS and FAH designed and coordinated the review study. HAAR conducted the database search. HAAR and SvS screened the search results and extracted the data. FAH supervised the data screening process. HAAR wrote the first draft of the manuscript. SvS and FAH revised the manuscript critically for important intellectual content and contributed to the draft. All authors approved the final version of the manuscript. All contributors are responsible for the overall content, as guarantors.

  • Funding The present scoping review comprised part of the research project HOPAN, which aims at assessing and analyzing RHPCNs in Germany. The project is funded by the German Innovation Fund of the Federal Joint Committee (G-BA) (Grant N° 01VSF22042; funding period: 01/2023–12/2024). The funding body was not involved in the study design, the preparation of this paper, or the decision to submit the paper for publication.

  • Competing interests Non competing interests.

  • Provenance and peer review Not commissioned; internally peer reviewed.