Strengthening Capacity in Primary Palliative Care: A Scoping Review from Latin America and the Caribbean.

Abstract

Introduction: Primary palliative care (PPC) is widely recognized as essential for equitable palliative care access, yet evidence on its integration across Latin America and the Caribbean (LAC) remains limited. This scoping review synthesized evidence on strategies, opportunities, and challenges shaping PPC integration throughout the region.

Methods: Guided by the PRISMA Extension for Scoping Reviews and Joanna Briggs Institute methodology, peer-reviewed and gray literature published from 2014 to February 2025 were searched across eight databases and relevant sources. Using population-concept-context criteria, articles addressing PPC integration within primary health care (PHC) in LAC were included. Directed content analysis was framed by the World Health Organization (WHO) Conceptual Model of Palliative Care Development.

Results: Forty-six articles representing 30 LAC countries met inclusion criteria. Available evidence suggested uneven progress in PPC integration across settings. Common strategies included workforce development and task-sharing approaches; nurse- and community health worker-led care models; incorporation of PPC into chronic disease management and home-based care pathways; and evolving policy frameworks supporting PHC-based delivery. Persistent barriers involved limited workforce capacity; fragmentation between primary and specialist services; restricted availability of essential palliative medicines, particularly opioids; and sociocultural and regulatory constraints. Although findings mapped onto all domains of the WHO model, several region-specific subcomponents emerged: (a) tailored and structured caregiver engagement, (b) academic-policy partnerships and benchmarking mechanisms, (c) telehealth-enabled and networked PPC models, (d) advanced practice nurse- and nurse-led mentoring structures, (e) standardized screening linked to actionable PHC responses, and (f) early PPC pathways adapted to regional disease burden.

Conclusions: Integration of PPC is progressing yet remains constrained by structural, regulatory, and implementation gaps. Bridging policy commitments with routine PHC delivery requires strengthened workforce capacity, improved access to essential medicines, and implementation-focused research to inform scalable, context-sensitive, and equitable PPC models across diverse LAC health systems.