Background: Forty-five percent of the world’s population lives in rural areas. Providing palliative care to people in rural communities continues to be challenging. Identifying key care elements that rural populations with palliative care needs require is critical to improving care outcomes.

Aim: To identify the key care elements that optimise palliative care for people in rural communities.

Design and Data Sources: A systematic review of articles studying the impact of novel rural model of care interventions was undertaken in May 2022. This study was reported using the PRISMA Statement and was registered with Prospero (CRD42020154273). Three databases were systematically searched, with the data generated from the included papers analysed according to Popay’s narrative synthesis, and elements classified according to the WHO Innovative Care for Chronic Conditions (ICCC) Framework.  

Results: Of the 9508 identified papers, 15 met the inclusion criteria, reporting on 14 studies involving 1820 rural patients.  Care received spanned 12/18 of the WHO ICCC Framework elements, with wide variability in how these 12 elements were operationalised.  The five elements that signal improved outcomes were: 1) Promote continuity and coordination; 2) Prepared, informed, and motivated health care teams; 3) Prepared, informed, and motivated patients and families; 4) Organize and equip health care teams; 5) Promote consistent financing. 

Conclusions: A well-coordinated multidisciplinary team approach, led by clinicians with specialist palliative care expertise, integrated across local healthcare settings, using information systems and care planning, is critical to optimising rural palliative care patient outcomes. Rural patients and their families require timely input from specialist palliative care clinicians and information to address their palliative care needs. Rural sites need to be connected with specialist centres, academic institutions and governance structures to maximise a population-based approach to care; conduct funded, robust translational research; and actively inform policy. Further research using more robust designs is required.