Optimizing hospice care: A scoping review of staffing strategies to enhance practice

Background: Strategic hospice staffing is essential to optimize patient care and strengthen workforce performance and retention, particularly as aging populations and rising rates of life-limiting illnesses increase the demand for end-of-life care. Despite growing recognition of staffing challenges in hospice care, there is limited synthesis of evidence on effective models and practices that support high-quality, sustainable care delivery. Objective: This scoping review aimed to synthesize evidence on workforce characteristics and strategies that support sustainable, high-quality hospice care. Information sources: Literature published after 2013 was searched in Ovid MEDLINE, EBSCOhost CINAHL, Ovid Embase, and Google Scholar to capture both peer-reviewed and grey literature sources relevant to hospice staffing and care quality. Methods: The review followed the PRISMA-ScR framework and was guided by the Arksey and O'Malley five-stage methodology. Search terms reflected three dimensions: 1) adult hospice care, 2) hospice staffing, and 3) the quality and effectiveness of care. Articles were included if they discussed hospice or palliative care staffing models, workforce characteristics, or operational performance metrics. Results: Forty-seven articles were included (33 peer-reviewed publications and 14 grey literature sources), representing hospice and palliative care settings across 11 countries, with the United States most frequently studied. Core strategies to enhance workforce sustainability and patient care included staffing composition and competency, key care approaches, and volunteer integration Findings highlighted that having an appropriately structured and well-prepared workforce is critical for ensuring quality care, while strategies that promote staff well-being and streamline processes further enhance service delivery. Collectively, these themes point to guiding principles for hospice staffing: adaptable, patient-responsive models; strong interdisciplinary collaboration; ongoing training and support; and the strategic use of volunteers and technology. Conclusions: This review synthesizes international evidence on hospice staffing and identifies common principles that can guide practice. Taken together, these practical insights highlight an urgent need for rigorous evaluation to move beyond fragmented approaches and establish sustainable, equitable, and patient-centred staffing standards. Developing and implementing such standards is essential not only for workforce stability, but also for ensuring high-quality, compassionate care for patients and families at the end of life. Registration: Not registered. Social media abstract: Interdisciplinary, flexible staffing models improve hospice care quality and support workforce sustainability.