The role of emotional intelligence in end-of-life care: a scoping review of studies involving healthcare professionals

Abstract

Background

The capacity to recognize, label, comprehend, manage, and apply emotions, known as Emotional Intelligence (EI), is pivotal for health outcomes, especially within the emotionally charged context of end-of-life (EOL) care. Although a growing body of research examines EI within the realm of EOL care, a comprehensive synthesis of the results has yet to be conducted.

Aim

This scoping review synthesizes evidence to explore the role of EI in EOL care by healthcare professionals, focusing on its associated factors and the effectiveness of interventions aimed at enhancing EI.

Objectives

(1) To synthesize evidence on the predictors and outcomes associated with healthcare professionals' EI in EOL care, (2) the effect of interventions on improving EI in the EOL setting.

Methods

Following PRISMA-ScR guidelines, the study searched six databases (PubMed, MEDLINE, Cochrane Library, Scopus, CINAHL, and Web of Science) for studies published between 2014 and 2024.

Results

Of 256 articles screened, 12 studies were included. In the EOL context, these studies demonstrated significant influence of EI on attitudes towards EOL care, learning satisfaction, coping styles, death anxiety, fear of death, empathy, perception of palliative care, attitudes towards death, self-efficacy and EOL care ability. The differences in position, degree, and EOL training status significantly affect EI levels. Additionally, EOL simulation and EOL psychodrama interventions were proven effective in enhancing EI.

Conclusions

This review summarizes the influencing factors and intervention effects of EI among hospice healthcare professionals. The included studies indicate that EI is associated with multidimensional variables such as attitudes, mental states, professional competence, cognitive levels, and learning coping behaviors. Furthermore, specific interventions targeting hospice care demonstrate the malleability of EI and provide practical pathways for enhancing clinical outcomes related to EI. These findings point to future research directions: developing specialized EI training to improve the EI levels of hospice healthcare professionals and optimize their capabilities in palliative care.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12904-025-01928-7.

Background

With the rapid aging of the global demographic, the emphasis on improving the quality of life during the final phases of life has become increasingly significant. Studies underscore that there is a growing preference for palliative care, which prioritizes comfort and quality of life, over aggressive, life-extending treatments that may not align with the individual’s wishes or needs [1]. Consequently, the demand for effective end-of-life (EOL) care delivery is increasing [2]. End-of-life care refers to a multidisciplinary approach aimed at improving the quality of life for individuals with advanced, life-limiting illnesses. It includes the management of physical symptoms, emotional and spiritual support, and psychosocial care. While palliative care ideally begins at the time of diagnosis to alleviate suffering and improve well-being throughout the course of illness, EOL care typically becomes more prominent in the final months of life. It continues through the dying process and involves both patients and their families in care planning, decision-making and support [3].

Thorndike, in his 1920 work, initially introduced the notion of social intelligence, characterizing it as an individual’s capacity to comprehend and adeptly handle interpersonal dynamics, a precursor to the contemporary understanding of emotional intelligence (EI) [4]. Subsequently, the concept of emotional intelligence was first formally introduced by Salovey and Mayer in 1990 [5], who defined it as the ability to perceive, understand, and manage one’s own emotions as well as those of others. Their model positioned EI as a distinct form of intelligence that plays a crucial role in guiding thought and behavior. This foundational definition has since underpinned a wide range of research into the role of emotional competencies in professional settings, including healthcare and nursing. Building upon earlier conceptualizations, Mayer and his colleagues in 2000 refined the definition of EI, characterizing it as encompassing the capacities to accurately perceive and articulate emotions, integrate these emotions into cognitive processes, comprehend and deduce emotional states, and adeptly regulate both individual and collective emotional responses [6, 7]. In the field of nursing, EI forms the core component of professional competence, underpinning critical attributes such as empathic capacity, clinical decision-making skills, and psychological resilience. These elements play a decisive role in managing complex emotional and physical needs of patients’ multifaceted health issues, while also helping nurses navigate the inherent stressors and ethical challenges of EOL care [8].

Recent studies suggest that EI is crucial in palliative and EOL care, where healthcare providers must manage sensitive and emotionally charged situations. Effective understanding and management of emotions can significantly guide caregivers’ behavior in nursing [9]. For example, healthcare professionals with high EI demonstrate heightened self-awareness, enabling them to recognize their emotional triggers and biases when confronted with death. This self-awareness fosters emotional resilience, allowing them to maintain composure and provide compassionate care in the face of adversity. Moreover, those with high EI possess strong empathic abilities, enabling them to connect deeply with grieving families and offer meaningful support tailored to individual needs [10, 11]. Additionally, other research highlights that EI correlates with various factors (e.g., psychology, attitude), functioning as both a predictor and an outcome across various contexts [12–14]. In particular, studies have explored the role of EI among healthcare professionals, shedding light on how EI can influence them [12–14]. Specifically, aspects of EI, such as emotional attention, have been identified as risk factors that can adversely affect these psychological variables [15]. In contrast, emotional repair and emotional clarity serve as protective factors that mitigate the negative impacts of death anxiety and fear among nursing students [16, 17]. However, there are also studies that suggest appropriate emotional attention is a facilitator. Moreover, some studies have highlighted the beneficial indirect effects of EI on the capability to provide effective EOL care [18]. This underscores the importance of fostering EI within nursing education and practice, as it can serve as a vital resource in addressing the emotional challenges students face in EOL scenarios.

Within the realm of EOL care, research has increasingly focused on the psychological dimensions associated with EI, investigating interventions that aim to foster more positive attitudes towards EOL care and enhance empathy among healthcare professionals [9, 15]. Furthermore, findings reveal that EI is correlated with several critical variables in the context of EOL care, including death anxiety, fear of death, attitudes towards EOL care, and general self-efficacy [11, 16–18]. These relationships underscore the complex interplay between EI and various psychological outcomes, suggesting that EI can affect these outcomes both directly and indirectly.

Considering EOL care involves complex emotional dynamics, requiring healthcare professionals to demonstrate empathy, effective communication, and psychological resilience. EI has emerged as a critical factor in navigating these challenges. Despite the increasing emphasis on EI in clinical settings, no scoping review has synthesized evidence on its role in shaping EOL care outcomes. This review addresses this gap by examining EI’s impact on healthcare professionals in EOL contexts.

Research questions

1. What factors are associated with the EI of healthcare professionals in EOL care?

2. What interventions are effective in enhancing EI in EOL settings?

Methods

This scoping review adhered to the PRISMA Extension for Scoping Reviews [19].

Search strategy

A scoping review of the published literature was conducted from September 4, 2024, through October 30,2024. An extensive investigation was carried out in six different databases: PubMed, MEDLINE, Cochrane Library, Scopus, CINAHL, and Web of Science. The search strategy combined the terms “end-of-life care,” “hospice care,” “palliative care,” OR “terminal care” AND “emotional intelligence” OR “emotional competence.” MeSH terms such as “terminal care” and “emotional intelligence” were applied to ensure comprehensive coverage. The search included publications from 2014 to 2024. The specific search query is provided in Supplementary file 1.

Eligibility criteria

The research question was developed using the population, concept, and context (PCC) framework. This study aims to examine the role of EI in EOL care among healthcare professionals by synthesizing available evidence on its measurement, associated factors, and effect of intervention on EI. Specifically, the objectives are to: (1) To identify and describe the tools used to evaluate EI in EOL care, (2) to summarize the predictors and outcomes associated with EI in this setting, and (3) to evaluate the effectiveness of interventions aimed at enhancing EI in EOL situations. Table 1 summarizes the PCC-based eligibility criteria:

Table 1.

PCC criteria for the selection of the studies

Population	Concept	Context
Healthcare Professional	EI and variables related to EI	End of life care context

Study selection

Upon conducting preliminary searches, a total of 256 studies were found to be possibly fitting the criteria; distributed across various databases as follows: 66 from Web of Science (WOS), 23 from PubMed,19 from CINAHL, 30 from the Cochrane Library, 53 from Scopus, and 65 from Medline. After eliminating 112 duplicate records, 144 relevant reports remained. Three authors (HS, KT and YL) conducted the initial search in the identified databases. Duplicate records were identified and removed using Endnote. Two reviewers (HS and KT) independently screened the titles and abstracts of the remaining studies to identify potentially eligible full-text articles. The final inclusion was determined using standardized screening criteria. Disagreements were resolved through discussion, and when necessary, with input from a third reviewer (YL). After selection, data extraction was performed, and the results were summarized collaboratively by HS and KT. Any discrepancies during data analysis were again resolved in consultation with YL. For the topic chosen, inclusion criteria were: (1) any clinical trial evaluating EI in the context of EOL care and (2) no restrictions on country, age, race and gender, (3) research articles published between 2014 and 2024, and (4) research articles assessing EI in EOL scenarios published in reference databases were taken into account.

Exclusion criteria: (1) studies with data that cannot be reliably extracted, including duplicate or overlapping data; (2) abstract-only papers, such as preceding studies, editorials or author responses, theses, and books; (3) articles lacking full text availability; (4) articles not written in English; (5) qualitative studies and reviews; (6) articles unrelated to EI or EOL care; (7) studies that did not employ an EI instrument; and (8) studies involving populations that do not meet eligibility criteria.

Critical appraisal

For the studies selected according to the above criteria, critical appraisal tools were used to assess the quality of the studies. Depending on the study design, the Joanna Briggs Institute tools were used [20], and in the case of mixed methods, the Mixed Methods Assessment Tool (MMAT) were used [21].

Results

The comprehensive search yielded 256 articles. From the initial investigation, 112 duplicate articles were excluded. A total of 78 studies were excluded through the title and abstract screening and 66 papers were selected for full-text screening, 1 article was not found in its entirety. After the assessment of 65 full-text articles, 53 articles were excluded based on specific reasons: qualitative research or reviews (n = 27); not English (n = 3); conference proceedings or author response (n = 12); instrument do not measure EI (n = 9); The measured population is not eligible (n = 2). The final 12 articles were analyzed and discussed in the scoping review paper (Fig. 1).

Fig. 1.

Flow Diagram of the selection process of included studies

This scoping review incorporated a total of 12 studies. Supplementary file 2 presents the characteristics of the selected studies, which includes details about the authors, publication year, country of origin, study design, participants, sample sizes, the presence of any intervention or treatment, tools utilized for EI assessment, variables studied, statistical analyses employed, and the key findings.

The studies were primarily conducted in Spain (41.6%), followed by South Korea (16.6%), the United States (16.6%), Greece (8.3%), Portugal (8.3%), Australia (8.3%), and Singapore (8.3%).

Analysis

The scoping review incorporates data from mixed studies, cross-sectional studies, and intervention studies. The data collected from the listed papers were organized and analyzed using Microsoft Excel. Following that, The screening as well as charting was interchangeably done by both the researchers (HS and KT). Discrepancies between reviewers were resolved through consultation among the reviewers (HS, KT and YL) in the team.

Design of the studies

The reviewed studies employed both quantitative and mixed-method approaches, with 66.7% [15, 16, 18, 22–25] adopting non-experimental designs and 33.3% [9, 26–28] employing experimental designs. Among the non-experimental studies, six (75%) [15–17, 22–24] were cross-sectional, one (12.5%) was a comprehensive quantitative study, and one (12.5%) used a sequential mixed-methods approach [18, 25]. The experimental studies included four studies (30%). Three of these followed a one-group pre-test/post-test design, where participants were assessed before and after the intervention [9, 26, 28]. The remaining study was a Randomized Controlled-Trial (RCT) that involved participants being randomly assigned to either a control or experimental group, with pre-test and post-test measures conducted to evaluate the intervention’s effects [27].

Participants

The samples in the included studies consisted of nursing students, nurses and doctors, totaling 3,425 participants (min.=56; max.=760). Participants were primarily nursing students [9, 15–17, 23, 26–28], nurses [18, 22, 25], midwives [24] as well as doctors [18] also recruited.

Studies methodological quality assessment

Quality assessment was performed for all 12 papers. The Mixed-Methods Appraisal Tool (MMAT) [21] was used for the mixed methods study, and the JBI Critical Appraisal Tools Checklist [20] was used for the cross-sectional studies and the intervention study. Each paper was independently assessed and given an overall rating. Furthermore, all studies used an adequate sampling frame to address the target population. All provided a detailed description of their sample and context. All studies included used appropriate research methods to answer the research question, validated scales to measure the different variables, and used appropriate statistical analysis. The results of the assessment are presented in Supplementary file 3.

Instruments assessing EI

A total of five EI scales were used in EOL situations: Trait Meta-Mood Scale 24 (n = 5, 41.6%) [15–17, 26, 27], Wong and Law Emotional Intelligence Scale (n = 3, 25%) [18, 22, 23], Mayer-Salovey-Caruso Emotional Intelligence Test (n = 2, 16.6%) [9, 28], Trait Emotional Intelligence Questionnaire-Short Form (n = 1, 8.3%) [24], Brief Emotional Intelligence Scale (n = 1, 8.3%) [25]. Table 3 demonstrates the result summary, which include country, EI instrument, EI dimension, EI scores, intervention, effect on EI/EI correlate with others variables, demographic variables, population and study number.

Table 2.

Result summary

Country	Instrument	EI Dimension	EI scores	Intervention	Effect on EI/ EI Correlate with others variables	Demographic Variables	Population	Study
US	MSCEIT	PE, UEFT, UE, ME	97.2 ± 12.5	EOL simulations	↑EI, ↑Attitude to EOL care, ↑Empathy	N/A	Nursing students	[9]
Spain	TMMS-24	EA, EC, ER	N/A	N/A	EA ↑Learning satisfaction, ↑Coping styles: Problem-focused coping and Open emotional expression	N/A	Nursing students	[15]
Spain	TMMS-24	EA, EC, ER	N/A	N/A	EA ↑DA and FOD, EC, ER ↑Attitude to EOL care ↓DA and FOD	N/A	Nursing students	[16]
Spain	TMMS-24	EA, EC, ER	86.93 ± 9.75	N/A	EA ↑DA and FOD, EC, ER ↓DA and FOD	Years of PC training	Nursing students	[17]
Portugal	WLEIS	SEA, OEA, RE, UE	3.88 ± 0.83	N/A	OEA, RE ↑Self-efficacy and ↗Ability to provide EOL care	N/A	Doctors and nurses	[18]
Korea	WLEIS	SEA, OEA, RE, UE	4.66 ± 0.70	N/A	↑EI, Attitudes toward EOL care	Position, Degree, EOL education	Nurses	[22]
Korea	WLEIS	SEA, OEA, RE, UE	4.94 ± 0.78	N/A	EI ↑Palliative care perception and Empathy	N/A	Nursing students	[23]
Greece	TEIQue-SF	Emotionality, Self-control, Sociability, Well-being	5 ± 0.6	N/A	EI ↑Attitudes toward death: Avoidance acceptance	N/A	Midwives	[24]
Australia	BEIS-10	Appraisal of one’s own emotion, Appraisal of other’s emotion, Regulation of one’s own emotion, Regulation of other’s emotion Utilization of emotion	N/A	N/A	↑Emotional skills	N/A	Nurses	[25]
Singapore	TMMS-24	EA, EC, ER	90.14 ± 11.40	EOL simulations	↑EI	N/A	Nursing students	[26]
Spain	TMMS-24	EA, EC, ER	N/A	EOL Psychodrama	↑EC and ER	N/A	Nursing students	[27]
US	MSCEIT	PE, UEFT, UE, ME	N/A	EOL simulations	↑UE	N/A	Nursing students	[28]

TMMS-24 Trait Meta-Mood Scale 24, WLEIS Wong and Law Emotional Intelligence Scale, MSCEIT Mayer-Salovey-Caruso Emotional Intelligence Test, TEIQue-SF Trait Emotional Intelligence Questionnaire-Short Form, BEIS-10 Brief Emotional Intelligence Scale, PE Perceiving emotions, UEFT Using emotions to facilitate thought, UE Understanding emotions, ME Managing emotions, SEA Self-emotion appraisal, OEA Others’ emotion appraisal, RE Regulation of emotion, UE Use of emotion, DA Death anxiety, FOD Fear of death,

↑ Positive correlation, ↓ Negative correlation, ↗ Indirect positive correlation

EI’s impact on EOL care-related factors

As shown in Table 2, the studies included in this review demonstrate a close connection between EI and various domains in the context of EOL, including attitude, psychological, capability, and learning and coping strategies. Specifically, these studies demonstrated significant influence of EI on attitudes towards EOL care [9, 16, 22], learning satisfaction [15], coping styles [15], death anxiety [16, 17], fear of death [16, 17], empathy [9, 23], perception of palliative care [23], attitudes towards death [24] and self-efficacy [18]. Although EI was not found to have a direct effect on the ability to provide EOL care, it showed an indirect effect through self-efficacy [18]. Beyond that, one study shows that those who possess greater EI might be more inclined to offer emotional support and are more capable of handling emotional stress [25].

Attitudinal domains

Four studies have shown that EI is correlated with attitude towards EOL care and attitudes toward death [9, 16, 22, 24]. Specifically, Three studies demonstrated that positive attitudes toward EOL care were associated with higher levels of EI, particularly EC and ER in health professionals [9, 16, 22]. In addition, one study on midwives found a significant association between higher levels of EI and scores on the death attitude avoidance acceptance subscale [24].

Psychological domains

As shown in Table 3, two studies indicated an association between EI and death anxiety as well as fear of death [16, 17]. In the EOL context, increased levels of EI correlate with lower levels of death anxiety and fear [17]. Notably, EC and ER were found to act as protective factors against death-related anxiety and fear, whereas EA enhanced levels of death anxiety and fear [16, 17].

Domains of competence

One study indicates that higher EI levels correlate with better performance and competence in providing EOL care, as well as greater self-efficacy in healthcare professionals [18]. In particular, within the dimensions of emotional regulation and recognizing others’ emotions, positively impacted self-efficacy, thereby enhancing EOL care capabilities among healthcare professionals.

Domains of cognition

Two studies indicate that EI is positively correlated with cognitive-related variables [9, 23]. Specifically, EI is positively correlated with higher levels of cognition regarding palliative care and empathy [9, 23].

Learning and coping styles

As shown in Table 2, one study indicates that EI is correlated with learning satisfaction in palliative care simulation [15]. Two studies reveal that EI is associated with coping styles [15, 26]. Specifically, elevated EA was notably correlated with higher levels of focus on problem-solving and open emotional expression in coping strategies, in addition to increased learning satisfaction [15]. Similarly, other mixed-methods research found that higher EI was more likely to have a higher level of emotional skills to offer emotional support and manage emotional stress more efficiently [25].

Effect of EOL care simulations and psychodrama on the EI of nursing students

Four studies demonstrated the effect of the intervention on nursing students’ EI [9, 26–28]. Table 2 shows that all EOL-based interventions, EOL simulation and EOL psychodrama, had a positive impact on EI.

EI and demographics

Two studies demonstrated an association between EI and general demographics in EOL care simulations. Specifically, Edo-Gual et al., [17] study showed that the EI levels of nursing students varied significantly in the years of training for palliative care. In addition, Park and Oh study showed that the emotional intelligence of nurses varied significantly depending on their position, academic degree, and whether they were trained in EOL care [22]. No differences were found in other studies with other general demographic factors.

In addition, Table 2 synthesizes country, EI scores, population, study, and measurement tools. Notably, this illustrates the variation in EI scores among participants from different countries. Based on the EI levels of healthcare professionals measured by TMMS-24, the results indicate that nursing students in Singapore [26] exhibit higher EI levels than their counterparts in Spain [15, 17]. Using WLEIS to measure the EI levels of healthcare professionals, participants from Korea [22, 23] demonstrated higher levels compared to those from Portugal [18].

Discussion

Over the past few years, a growing body of research has focused on the impact of EI within the realm of EOL care, with EI being acknowledged as a significant personal asset in this context. To our knowledge, this review is the first to synthesize the existing literature on EI specifically within the EOL care. EI is now seen as a crucial element in improving not only the psychological health of healthcare providers but also the standard of care for patients at the EOL [13, 29, 30], there is a pressing need for scoping reviews that bring together research outcomes related to EI in EOL settings.

Predictors and outcomes associated with EI in EOL care

The research encompassed in this review underscored the immediate and mediated impacts of EI on a spectrum of predictor and outcome variables. Findings indicated that elevated EI, along with its constituent elements, correlated with more favorable attitudes and enhanced psychological well-being [9, 18].

Attitudinal domains

Four studies have shown that emotional intelligence is positively correlated with a positive attitude towards EOL care and attitudes toward death [9, 16, 22, 24]. The reason for this may be that healthcare professionals with high EI are better able to control their emotions correctly in the face of unexpected events [22]. By keenly observing the emotional changes of patients and their caregivers, they can deeply perceive their emotional needs, thereby establishing a solid bridge for communication between nurses and patients [31], which is more conducive to the implementation of palliative care.

Psychological domains

In the EOL context, increased levels of EI, correlate with lower levels of death anxiety and fear [17]. Notably, EC and ER were found to act as protective factors against death-related anxiety and fear, whereas EA may act as a risk factor [16, 17]. Other research indicates that while EA may be beneficial in some contexts, it may also be maladaptive when associated with heightened fear and anxiety around death [11]. Consistent with these findings, individuals with strong abilities to understand and manage their emotions were more likely to demonstrate proactive behaviors in EOL care [24]. Elevated levels of death anxiety can compromise the quality of care, diminish effective communication between patients and their caregivers regarding EOL preferences, impede the progress of palliative care initiatives, and ultimately hinder improvements in both the quality of life and death for patients [32, 33]. This is attributed to nurses who possess strong emotional management skills and are adept at utilizing others’ emotions being better equipped to assist patients in managing their own emotions during the nursing process [31]. Thus, these nurses have a greater capacity to positively influence patients, leading them toward increased satisfaction and finding meaning in their work [34].

Domains of competence

Moreover, research indicates that higher EI levels correlate with better performance and competence in providing EOL care and greater self-efficacy in healthcare professionals [18]. This finding aligns with broader research supporting a strong positive relationship between EI and self-efficacy [35]. Specifically, EI significantly influences individuals’ emotions, thoughts, and behaviors, which in turn mediate productivity and competence in professionals settings [36–38]. Furthermore, EI also influences EOL care competence indirectly. An increase in EI is associated with heightened self-efficacy, which subsequently improves competency in providing EOL care [18]. This finding aligns with existing research that indicates a strong correlation between higher levels of clinical care competency and elevated EI among healthcare professionals. The underlying rationale for this connection appears to be that professionals who possess greater EI are more adept at identifying and addressing the emotional needs of their patients. This heightened awareness allows them to deliver care that is not only more personalized but also imbued with compassion, ultimately enhancing the overall patients who are dying experience [38].

Domains of cognition

Additionally, EI is positively correlated with higher levels of cognition regarding palliative care and empathy [9, 23]. Enhanced EI supports better emotional regulation in high-stress situations, helping caregivers avoid moral distress, maintain empathy, and deeply understand patients’ emotions. This facilitates effective empathetic relationships with patients and their families at EOL. Consequently, healthcare professionals require high EI levels to manage the impact of death, dying, and loss. Without adequate emotional control, they may struggle to develop positive recognition of palliative care caring.

Learning and coping styles

Furthermore, elevated EI was linked to greater satisfaction in learning and more positive coping strategies [15, 16]. Similarly, Another study found that higher EI more likely to offer emotional support and manage emotional stress more efficiently, even in advocacy-related situations outside routine clinical tasks [25]. These results seem to support other studies indicating that high levels of EI help minimize the negative effects of stress, effectively improving coping styles. People who presented only moderate EA levels also more frequently used more adaptive regulation strategies as they were able to use the information obtained by their emotions more with greater efficiency [16]. This aligns with current literature linking EI with adaptive coping mechanisms, reduced stress, and improved care quality [39]. Clinical nurses with higher EI and greater psychological resilience are better equipped to manage challenges and pressure, maintain emotional balance, and resolve problems effectively through interpersonal awareness and emotional regulation [40].

Ultimately, EI contributes to a more supportive, emotionally intelligent environment for patients and families facing the end of life [41].While this research reveals a range of EI-related outcomes in EOL contexts, it does not explore underlying mechanisms. As noted in previous reviews [42], personal history, mental health, and physical conditions may also mediate the role of EI. By mapping these associations, this present review lays the groundwork for future research to examine and clarify the complex pathways and mediators that account for the relationships between EI and different outcomes, especially in the realm of EOL care.

Effectiveness of interventions to enhance EI

In this review, four intervention studies were involved, three using EOL care simulations [9, 26, 27] and one employing psychodrama [28]. These interventions generally yielded positive results:

EOL care simulations

Studies utilizing simulations with standardized patients demonstrated significant positive effects on EI. Esteban-Burgos et al. [27] found enhancements in coping with death, EA, and EC, particularly for students actively participating in scenarios. This aligns with other simulation research showing overall EI improvement [26]. Alghamdi et al. [9] reported that simulations targeting EI competencies effectively enhanced EI, empathy, and attitudes towards caring for patients who are dying among nursing students. To be more specific, clinical simulations offer several advantages, such as gaining clinical knowledge and concepts, developing and applying cognitive and psychomotor abilities, enhancing communication skills, and fostering clinical reasoning and problem-solving, all while ensuring the safety of actual patients [43].Thus, integrate EI skill development into simulation-based EOL training enriches the educational experience and fosters emotional competence [26].

EOL care psychodrama

In EOL context, psychodrama includes dramatizations, role-playing, and self-presentation [44]. One study [28] found that while psychodrama did not significantly improve overall EI scores, it led to task-specific improvements in skills like emotional awareness and regulation. This suggests that psychodrama can target particular aspects of EI that are crucial for navigating emotionally charged situations in EOL care. The approach further enhances empathy, as noted by Ozcan et al. [45], who discovered that psychodrama increased empathetic understanding in nursing students. Through facilitating the processing and expression of emotions via structured dramatic activities, psychodrama can assist healthcare professionals in gaining insight into and managing their emotional reactions [44], which in turn improves the quality of care delivered to patients and their families during EOL situations. Further research is warranted to explore its full potential as a targeted EI intervention in EOL care.

Overall, interventions, particularly active simulations, showed promise in enhancing specific EI dimensions like EA, EC and ER [26, 27], fostering self-awareness and the ability to process emotions after intense experiences [9]. This supports the notion that EI competencies can be developed through targeted training relevant to EOL care [9, 12, 17, 25].

EI and general demographics

This review reveals a selective pattern of demographic associations with EI in EOL contexts. Crucially, only two studies demonstrated statistically significant relationships: Edo-Gual et al. [17] identified progressive EI enhancement in nursing students correlated with whether one has received PC training, while Park and Oh [22] observed EI variations among nurses tied to professional position, academic credentials, and specialized EOL training completion. These isolated findings suggest that profession-specific developmental factors, particularly structured clinical education and career advancement, may exert stronger influence on EI than inherent demographic traits. The consistent absence of correlations with common demographic variables (e.g., age, gender) across other studies implies that conventional population characteristics become secondary when healthcare professionals engage with terminal care scenarios. This phenomenon may reflect the unique emotional demands of EOL contexts, where role-specific competencies override baseline attributes. Scores measured by the same tool indicate that South Korea outranks Spain, and Singapore outranks Portugal, possibly due to participants from wealthier nations being better able to express their emotions compared to those from less developed countries [46]. The remaining countries, due to differing measurement tools, are not comparable. Overall findings from this study suggest that the impact of general demographic data on the EI of healthcare professionals warrants further investigation through additional research.

Study limitations

This review has the following limitations: Firstly, the search was confined to literature from PubMed, MEDLINE, the Cochrane Library, Scopus, CINAHL, and Web of Science. Secondly, the inclusion of only English-language studies published after 2014 may result in underrepresentation of pre-2014 literature and non-English publications. Furthermore, the exclusion of grey literature and other unpublished research types potentially introduces publication bias. Finally, the predominant reliance on cross-sectional designs in included studies precludes causal inferences.

Implication

The purpose of this review was to identify and synthesize the available evidence on the relationship between EI and other variables. In addition, findings from both observational and experimental studies highlight the pivotal role that EI plays in EOL care. High levels of EI are consistently linked to positive attitudes, improved perceptions, and more adaptive coping mechanisms related to EOL care. Furthermore, targeted interventions have been shown to effectively enhance specific components of EI. To elaborate, this review supports integrating EI-focused simulations into palliative care education for curriculum design. Evidence demonstrates that standardized patient scenarios and psychodrama significantly improve emotional competencies while ensuring clinical safety, making them ideal for pre-licensure training. Consequently, for professional development, healthcare systems should increase EI-boosting simulations and psychodrama workshops during clinical onboarding and bachelor curricula to refine emotion-regulation in high-stress EOL contexts. Targeting these variables early would allow the promotion of mental health in healthcare professionals from the formative stages of their education. Finally, the importance of longitudinal studies on EI should be emphasized. Such studies are needed to explore the long-term mechanisms through which EI impacts hospice care professionals. This will enable them to develop protective psychological factors, adopt effective coping strategies for managing stress, and reduce risks to their physical health in emotionally demanding EOL contexts. Thus, by identifying the benefits of the relationships between these variables and the most effective intervention strategies, we can lay the foundation for designing, implementing, and evaluating future mental health interventions for healthcare professionals in EOL care settings.

Conclusion

This review summaries the influencing factors, related outcomes, and intervention effects of EI among hospice healthcare professionals population. The included studies indicate that EI is significantly associated with multidimensional variables such as attitudes, mental states, professional competence, cognitive levels, and learning and coping behaviors. Furthermore, specific interventions for hospice care (e.g., situational simulations, psychodrama) have been proven effective in enhancing EI levels, demonstrating the malleability of EI and providing practical pathways for improving clinical outcomes related to EI. These findings point to future research directions: developing specialized EI training to enhance the EI levels of hospice healthcare staff and optimize their capabilities in palliative care.

Abbreviations

EI

Emotional intelligence

PC

Palliative care

PRISMA-ScR

Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews

PCC

Population, concept, and context

EA

Emotional attention

EC

Emotional clarity

ER

Emotional repair

EOL

End-of-life

Authors’ contributions

The author KT conceived the review and oversight for all stages of the review. HS, KT and YL undertook the initial database search, data extraction was undertaken by HS and KT. HS and KT screened the included papers and conducted the quality appraisal and analyzed the data, HS and KT wrote the first draft of the manuscript. All authors revised the manuscript and provided substantial contributions, and all authors approved the final version of the manuscript.

Funding

The review study has received no funding.

Data availability

The data used in this scoping review were obtained from published studies available through PubMed, MEDLINE, Cochrane Library, Scopus, CINAHL, and Web of Science, as outlined in the methods section. All references are included in the manuscript. No additional datasets were generated or analyzed during this study.

Declarations

Ethics approval and consent to participate

Not applicable to this study.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.