Systematic review reveals significant compassion fatigue differences between high and middle income country palliative care nurses

BACKGROUND: Palliative care nurses face a high risk of compassion fatigue due to chronic exposure to suffering and death. However, synthesized evidence regarding its prevalence and key determinants remains scarce. This meta-analysis aims to inform targeted support strategies for safeguarding the well-being of nurses and maintaining the quality of care. PURPOSE: To systematically quantify the levels of compassion fatigue among palliative care nurses and synthesize the key influencing factors. METHODS: We systematically searched 11 electronic databases from their inception to April 2025. Studies were included if they met the following criteria: (1) cross-sectional design; (2) palliative care nurses as participants; (3) assessment of compassion fatigue levels or associated factors; (4) publication in Chinese or English. Random-effects meta-analyses and pre-specified subgroup analyses were conducted in Stata. RESULTS: Twelve cross-sectional studies involving 3515 palliative care nurses from high- and middle-income countries were included (no eligible low-income country studies). Pooled analysis showed moderate mean scores of compassion satisfaction (34.64), burnout (25.24), and secondary traumatic stress (26.76). Subgroup analyses indicated that nurses in high-income countries reported significantly better outcomes than their counterparts in middle-income countries. Secondary traumatic stress increased in post-2020 (COVID-19 pandemic) studies. Key influencing factors spanned demographic, work-related, psychological, and social domains, with psychological resilience and strong social support being the most prominent protective factors for nurse well-being. CONCLUSIONS: This meta-analysis indicates that palliative care nurses encounter moderate compassion fatigue, and secondary traumatic stress has deteriorated in recent years. Multilevel interventions (which prioritize resilience training, strengthening support systems, and optimizing the work environment) are recommended to alleviate compassion fatigue and protect the well-being of palliative care nurses.