Palliative Care Educational Intervention Versus Cognitive Behavioral Therapy for Health-Related Quality of Life in Patients with Incurable Cancer: a Protocol for a Systematic Review and Network Meta-Analysis

Patients with incurable cancer prioritize health-related quality of life (HRQoL)—a key target of palliative care. But shortages of palliative care professionals create critical access barriers, leaving patients with unmet HRQoL needs. In addition to palliative care provided by professionals, non-pharmacological strategies such as palliative care educational intervention (PEI) and cognitive behavioral therapy (CBT) have been proposed to address these gaps. Recent studies about PEI have shown promise in improving HRQoL for patients with incurable cancer. However, it remains an emerging approach that has not been thoroughly and systematically evaluated, especially compared with CBT—an intervention with extensive systematic reviews. Furthermore, due to the scarcity of head-to-head comparisons between PEI and CBT, a network meta-analysis (NMA) is needed to clarify their relative effectiveness. This systematic review and NMA will include randomized controlled trials evaluating PEI and/or CBT in adults (≥ 18 years) with incurable cancer. Electronic databases (MEDLINE, EMBASE, the Cochrane Library, PsycINFO, and CINAHL) and trial registers (ClinicalTrials.gov) will be searched from inception. The primary outcome is HRQoL (measured via validated scales such as the European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire [EORTC QLQ-C30]); secondary outcomes include symptoms (pain, fatigue, anxiety, depression) assessed by validated scales. Effect sizes (standardized mean differences [SMD]) will be calculated, and SMDs will be re-expressed to the EORTC QLQ-C30 global health/quality of life scale. NMA will estimate relative effects, with subgroup analyses (based on delivery setting, mode, etc.) and sensitivity analyses. The GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) will assess evidence quality. Comparing PEI with CBT will offer evidence for palliative care professionals and policymakers. Clear PEI definition and comprehensive literature retrieval are foundational to this systematic review and NMA, while analyzing study and intervention details may address heterogeneity in HRQoL outcomes and guide development of more effective interventions. PROSPERO CRD420251146822.