Primary palliative care in low- and middle-income countries: A systematic review and thematic synthesis of the evidence for models and outcomes

IF 3.6 2区 医学 Q1 HEALTH CARE SCIENCES & SERVICES
Anna Peeler, Oladayo Afolabi, Michael Adcock, Catherine Evans, Kennedy Nkhoma, Dorothee van Breevoort, Lindsay Farrant, Richard Harding
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Abstract

Background:Serious health-related suffering is predicted to double in low- and middle-income countries by 2060. Primary care offers the best opportunity to meet Universal Health Coverage in an equitable way. Primary palliative care growth should be evidence-based to ensure provision is feasible, acceptable and culturally congruent.Aim:To identify the current evidence related to primary palliative care and to describe how primary palliative is defined in this setting, dominant typologies of care and meaningful outcome measures in LMICs.Design:A systematic review and thematic synthesis was conducted. We described the nature, extent and distribution of published literature on primary palliative care in low- and middle-income countries, use thematic synthesis to characterize typologies of primary palliative care and design a process model for care delivery in low- and middle-income countries.Data sources:Medline, Psychinfo, Global Health, Embase and CINAHL.Results:Thirty-five publications were included. Nearly half took place in Asia ( n = 16, 45.7%). We identified five dominant typologies of primary palliative care, including delivery in primary care clinics by multidisciplinary healthcare teams and palliative care specialists, in people’s homes by healthcare professionals and volunteers and in tertiary healthcare facilities by generalists. We designed a process model for how these models operate within larger health systems and identified barriers and facilitators to implementing primary palliative care in this context.Conclusion:Evidence supporting primary palliative care in low- and middle-income countries is limited, and much of the published literature comes from Asia and southern Africa. Health systems in low- and middle-income countries have unique strengths and needs that affect primary palliative care services that should guide how services evolve to meet future need.
中低收入国家的初级姑息关怀:对模式和成果证据的系统性审查和专题综述
背景:据预测,到 2060 年,低收入和中等收入国家与健康有关的严重痛苦将增加一倍。初级医疗服务为以公平的方式实现全民医保提供了最佳机会。目的:确定目前与初级姑息关怀相关的证据,并描述在这种情况下如何定义初级姑息关怀、主流的关怀类型以及在低收入和中等收入国家有意义的结果测量。数据来源:Medline、Psychinfo、Global Health、Embase 和 CINAHL。结果:共纳入 35 篇文献。其中近一半发生在亚洲(16 篇,占 45.7%)。我们确定了初级姑息关怀的五种主要类型,包括由多学科医疗团队和姑息关怀专家在初级医疗诊所提供的服务、由医疗专业人员和志愿者在居民家中提供的服务以及由全科医生在三级医疗机构提供的服务。我们为这些模式如何在更大的医疗系统中运作设计了一个流程模型,并确定了在这种情况下实施初级姑息关怀的障碍和促进因素。结论:支持中低收入国家开展初级姑息关怀的证据有限,已发表的文献大多来自亚洲和南部非洲。中低收入国家的卫生系统具有影响初级姑息关怀服务的独特优势和需求,这些优势和需求应指导服务如何发展以满足未来的需求。
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来源期刊
Palliative Medicine
Palliative Medicine 医学-公共卫生、环境卫生与职业卫生
CiteScore
7.60
自引率
9.10%
发文量
125
审稿时长
6-12 weeks
期刊介绍: Palliative Medicine is a highly ranked, peer reviewed scholarly journal dedicated to improving knowledge and clinical practice in the palliative care of patients with far advanced disease. This outstanding journal features editorials, original papers, review articles, case reports, correspondence and book reviews. Essential reading for all members of the palliative care team. This journal is a member of the Committee on Publication Ethics (COPE).
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