{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T17:58:50Z","timestamp":1793123930580,"version":"4.5.0"},"reference-count":60,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,12,29]],"date-time":"2025-12-29T00:00:00Z","timestamp":1766966400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T00:00:00Z","timestamp":1769731200000},"content-version":"vor","delay-in-days":32,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Prim. Care"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Primary care physicians play a crucial role in delivering palliative care, particularly in low-and middle-income countries, where access to specialist services is often limited. However, various facilitators and barriers influence their ability to provide effective palliative care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This systematic review aimed to identify and synthesise the facilitators and barriers experienced by primary care physicians in low- and middle-income countries when providing palliative care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A convergent integrated mixed-methods review adhered to PRISMA guidelines. Seven databases (MEDLINE, CINAHL, PsycINFO, Scopus, Google Scholar, Policy Commons, and ProQuest) were searched. Data were synthesised using reflexive thematic analysis and narrative synthesis, and quantitative findings were summarised descriptively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Twelve studies met the inclusion criteria. Five overarching themes were identified: (1) health system organisation, (2) coordinating and sharing care responsibilities, (3) primary care physicians\u2019 disposition, (4) effects on physicians and their regulation, and (5) interacting with patients and families. Key barriers included poor infrastructure, shortages in staff, medicines and funding, lack of clear referral systems, insufficient training, emotional burden, legal uncertainties and cultural or religious resistance to palliative care. Facilitators included supportive health reforms, interdisciplinary teamwork, integration with specialist services, home-based care models, motivated clinicians and opportunities for practical, ongoing education.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The findings highlight the urgent need for targeted interventions, including enhanced training, policy reforms, and improved resource allocation, to strengthen the role of primary care physicians in palliative care in low- and middle-income countries. Future research should focus on context-specific solutions to address these barriers and improve palliative care accessibility in resource-limited settings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12875-025-03023-5","type":"journal-article","created":{"date-parts":[[2025,12,29]],"date-time":"2025-12-29T21:03:17Z","timestamp":1767042197000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Facilitators and barriers primary care physicians face in providing palliative care in low- and middle-income countries: a mixed methods systematic review"],"prefix":"10.1186","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2689-7306","authenticated-orcid":false,"given":"GVC","family":"Fernando","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2942-0880","authenticated-orcid":false,"given":"L","family":"Athauda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4945-2203","authenticated-orcid":false,"given":"TK","family":"Perdamaian","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0174-9462","authenticated-orcid":false,"given":"JS","family":"Kondasinghe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6503-0396","authenticated-orcid":false,"given":"S","family":"Prathapan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,12,29]]},"reference":[{"key":"3023_CR1","volume-title":"World Health Organization definition of palliative care","author":"WH Organization","year":"2014","unstructured":"Organization WH. World Health Organization definition of palliative care. World Health Organ Website Available Online Httpwww Who Intcancerpalliativedefinitionen; 2014."},{"issue":"4","key":"3023_CR2","first-page":"704","volume":"14","author":"CL Ahia","year":"2014","unstructured":"Ahia CL, Blais CM. Primary palliative care for the general internist: integrating goals of care discussions into the outpatient setting. Ochsner J. 2014;14(4):704\u201311.","journal-title":"Ochsner J"},{"issue":"1","key":"3023_CR3","doi-asserted-by":"publisher","first-page":"357","DOI":"10.1146\/annurev-publhealth-032315-021448","volume":"37","author":"L De Lima","year":"2016","unstructured":"De Lima L, Pastrana T. Opportunities for palliative care in public health. Annu Rev Public Health. 2016;37(1):357\u201374.","journal-title":"Annu Rev Public Health"},{"key":"3023_CR4","doi-asserted-by":"publisher","DOI":"10.1177\/02692163241270915","author":"D Munday","year":"2024","unstructured":"Munday D, Pastrana T, Murray SA. Defining and developing primary palliative care as an essential element of primary health care. Palliat Med. 2024. https:\/\/doi.org\/10.1177\/02692163241270915.","journal-title":"Palliat Med"},{"issue":"1","key":"3023_CR5","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1186\/s12904-020-00558-5","volume":"19","author":"H Abu-Odah","year":"2020","unstructured":"Abu-Odah H, Molassiotis A, Liu J. Challenges on the provision of palliative care for patients with cancer in low- and middle-income countries: a systematic review of reviews. BMC Palliat Care. 2020;19(1):55.","journal-title":"BMC Palliat Care"},{"issue":"9","key":"3023_CR6","doi-asserted-by":"publisher","first-page":"2877","DOI":"10.4103\/jfmpc.jfmpc_653_19","volume":"8","author":"S Atreya","year":"2019","unstructured":"Atreya S, Patil C, Kumar R. Integrated primary palliative care model; facilitators and challenges of primary care\/family physicians providing community-based palliative care. J Fam Med Prim Care. 2019;8(9):2877\u201381.","journal-title":"J Fam Med Prim Care"},{"key":"3023_CR7","doi-asserted-by":"publisher","first-page":"1","DOI":"10.7189\/jogh.09.020309","volume":"9","author":"A Poudel","year":"2019","unstructured":"Poudel A, Kc B, Shrestha S, Nissen L. Access to palliative care: discrepancy among low-income and high-income countries. J Glob Health. 2019;9:1\u20135.","journal-title":"J Glob Health"},{"issue":"5","key":"3023_CR8","doi-asserted-by":"publisher","first-page":"637","DOI":"10.1002\/jso.24585","volume":"115","author":"M Are","year":"2017","unstructured":"Are M, McIntyre A, Reddy S. Global disparities in cancer pain management and palliative care. J Surg Oncol. 2017;115(5):637\u201341.","journal-title":"J Surg Oncol"},{"key":"3023_CR9","unstructured":"Givler A, Bhatt H, Maani-Fogelman PA. The Importance of Cultural Competence in Pain and Palliative Care. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2023 Cited 10 Sep 2023. Available from: http:\/\/www.ncbi.nlm.nih.gov\/books\/NBK493154\/."},{"issue":"3","key":"3023_CR10","doi-asserted-by":"publisher","first-page":"399","DOI":"10.1016\/j.pop.2019.05.006","volume":"46","author":"SE Mathew-Geevarughese","year":"2019","unstructured":"Mathew-Geevarughese SE, Corzo O, Figuracion E. Cultural, religious, and spiritual issues in palliative care. Prim Care. 2019;46(3):399\u2013413.","journal-title":"Prim Care"},{"issue":"10341","key":"3023_CR11","doi-asserted-by":"publisher","first-page":"2129","DOI":"10.1016\/S0140-6736(22)00532-3","volume":"399","author":"A Haakenstad","year":"2022","unstructured":"Haakenstad A, Irvine CMS, Knight M, Bintz C, Aravkin AY, Zheng P, et al. Measuring the availability of human resources for health and its relationship to universal health coverage for 204 countries and territories from 1990 to 2019: a systematic analysis for the global burden of disease study 2019. Lancet. 2022;399(10341):2129\u201354.","journal-title":"Lancet"},{"key":"3023_CR12","doi-asserted-by":"publisher","unstructured":"Wiggins L, Sohail M. The Shortage of Healthcare Workers in Low Resource Countries. In: Fiander A, Fry G, editors. A Healthcare Students Introduction to Global Health: Low- and Middle Income Countries [Internet]. Cham: Springer Nature Switzerland; 2024 [cited 2025 Aug 7]. pp. 219\u201329. Available from: https:\/\/doi.org\/10.1007\/978-3-031-66563-9_22.","DOI":"10.1007\/978-3-031-66563-9_22"},{"issue":"3","key":"3023_CR13","doi-asserted-by":"publisher","first-page":"229","DOI":"10.25259\/IJPC_9_2022","volume":"28","author":"S Atreya","year":"2022","unstructured":"Atreya S, Datta S, Salins N. Public health perspective of primary palliative care: a review through the lenses of general practitioners. Indian J Palliat Care. 2022;28(3):229\u201335.","journal-title":"Indian J Palliat Care"},{"issue":"1","key":"3023_CR14","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1191\/0269216303pm665oa","volume":"17","author":"S Barclay","year":"2003","unstructured":"Barclay S, Wyatt P, Shore S, Finlay I, Grande G, Todd C. Caring for the dying: how well prepared are general practitioners? A questionnaire study in Wales. Palliat Med. 2003;17(1):27\u201339.","journal-title":"Palliat Med"},{"key":"3023_CR15","doi-asserted-by":"publisher","DOI":"10.1177\/02692163241248324","author":"A Peeler","year":"2024","unstructured":"Peeler A, Afolabi O, Adcock M, Evans C, Nkhoma K, van Breevoort D, et al. Primary palliative care in low- and middle-income countries: a systematic review and thematic synthesis of the evidence for models and outcomes. Palliat Med. 2024. https:\/\/doi.org\/10.1177\/02692163241248324.","journal-title":"Palliat Med"},{"issue":"1","key":"3023_CR16","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1186\/s13643-017-0454-2","volume":"6","author":"QN Hong","year":"2017","unstructured":"Hong QN, Pluye P, Bujold M, Wassef M. Convergent and sequential synthesis designs: implications for conducting and reporting systematic reviews of qualitative and quantitative evidence. Syst Rev. 2017;6(1):61.","journal-title":"Syst Rev"},{"key":"3023_CR17","first-page":"434","volume-title":"Researching Health: Qualitative, Quantitative and Mixed Methods","author":"M Saks","year":"2007","unstructured":"Saks M, Allsop J. Researching Health: Qualitative, Quantitative and Mixed Methods. SAGE; 2007. p. 434."},{"issue":"4","key":"3023_CR18","doi-asserted-by":"publisher","first-page":"589","DOI":"10.1080\/2159676X.2019.1628806","volume":"11","author":"V Braun","year":"2019","unstructured":"Braun V, Clarke V. Reflecting on reflexive thematic analysis. Qual Res Sport Exerc Health. 2019;11(4):589\u201397.","journal-title":"Qual Res Sport Exerc Health"},{"key":"3023_CR19","doi-asserted-by":"publisher","DOI":"10.1111\/nin.12080","author":"M Sandelowski","year":"2014","unstructured":"Sandelowski M. A matter of taste: evaluating the quality of qualitative research. Nurs Inq. 2014. https:\/\/doi.org\/10.1111\/nin.12080.","journal-title":"Nurs Inq"},{"issue":"5","key":"3023_CR20","doi-asserted-by":"publisher","first-page":"546","DOI":"10.1111\/j.1365-2648.2005.03621.x","volume":"52","author":"R Whittemore","year":"2005","unstructured":"Whittemore R, Knafl K. The integrative review: updated methodology. J Adv Nurs. 2005;52(5):546\u201353.","journal-title":"J Adv Nurs"},{"key":"3023_CR21","first-page":"457","volume-title":"Qualitative Research Practice: A Guide for Social Science Students and Researchers","author":"J Ritchie","year":"2013","unstructured":"Ritchie J, Lewis J, Nicholls CM, Ormston R. Qualitative Research Practice: A Guide for Social Science Students and Researchers. SAGE; 2013. p. 457."},{"issue":"1","key":"3023_CR22","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1186\/1471-2288-6-35","volume":"6","author":"M Dixon-Woods","year":"2006","unstructured":"Dixon-Woods M, Cavers D, Agarwal S, Annandale E, Arthur A, Harvey J, et al. Conducting a critical interpretive synthesis of the literature on access to healthcare by vulnerable groups. BMC Med Res Methodol. 2006;6(1):35.","journal-title":"BMC Med Res Methodol"},{"key":"3023_CR23","doi-asserted-by":"publisher","first-page":"103","DOI":"10.1016\/j.jclinepi.2021.02.003","volume":"134","author":"MJ Page","year":"2021","unstructured":"Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. Updating guidance for reporting systematic reviews: development of the PRISMA 2020 statement. J Clin Epidemiol. 2021;134:103\u201312.","journal-title":"J Clin Epidemiol"},{"issue":"2","key":"3023_CR24","doi-asserted-by":"publisher","first-page":"68","DOI":"10.5596\/c14-016","volume":"35","author":"J Babineau","year":"2014","unstructured":"Babineau J. Product review: covidence (systematic review software). J Can Health Libr Assoc J Assoc Bibl Sante Can. 2014;35(2):68\u201371.","journal-title":"J Can Health Libr Assoc J Assoc Bibl Sante Can"},{"issue":"4","key":"3023_CR25","first-page":"285","volume":"34","author":"QN Hong","year":"2018","unstructured":"Hong QN, F\u00e0bregues S, Bartlett G, Boardman F, Cargo M, Dagenais P, et al. The mixed methods appraisal tool (MMAT) version 2018 for information professionals and researchers. Educ Inf. 2018;34(4):285\u201391.","journal-title":"Educ Inf"},{"issue":"1","key":"3023_CR26","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1016\/j.ijnurstu.2011.07.002","volume":"49","author":"R Pace","year":"2012","unstructured":"Pace R, Pluye P, Bartlett G, Macaulay AC, Salsberg J, Jagosh J, et al. Testing the reliability and efficiency of the pilot mixed methods appraisal tool (MMAT) for systematic mixed studies review. Int J Nurs Stud. 2012;49(1):47\u201353.","journal-title":"Int J Nurs Stud"},{"key":"3023_CR27","doi-asserted-by":"publisher","first-page":"e20170279","DOI":"10.1590\/1980-265x-tce-2017-0279","volume":"28","author":"V Cardoso","year":"2019","unstructured":"Cardoso V, Trevisan I, Cicolella D, de Waterkemper A, SYSTEMATIC R, REVIEW OF MIXED METHODS: METHOD OF RESEARCH FOR THE INCORPORATION OF EVIDENCE IN NURSING. Texto Contexto - Enferm. 2019;28:e20170279.","journal-title":"Texto Contexto - Enferm"},{"issue":"1","key":"3023_CR28","doi-asserted-by":"publisher","first-page":"13","DOI":"10.4314\/mmj.v27i1.4","volume":"27","author":"FC Zamawe","year":"2015","unstructured":"Zamawe FC. The implication of using NVivo software in qualitative data analysis: evidence-based reflections. Malawi Med J. 2015;27(1):13\u20135.","journal-title":"Malawi Med J"},{"issue":"2","key":"3023_CR29","doi-asserted-by":"publisher","first-page":"120","DOI":"10.1097\/XEB.0000000000000282","volume":"19","author":"C Stern","year":"2021","unstructured":"Stern C, Lizarondo L, Carrier J, Godfrey C, Rieger K, Salmond S, et al. Methodological guidance for the conduct of mixed methods systematic reviews. JBI Evid Implement. 2021;19(2):120.","journal-title":"JBI Evid Implement"},{"issue":"6","key":"3023_CR30","doi-asserted-by":"publisher","first-page":"472","DOI":"10.1071\/PY20111","volume":"26","author":"NS Hertanti","year":"2020","unstructured":"Hertanti NS, Huang MC, Chang CM, Fetzer SJ, Kao CY. Knowledge and comfort related to palliative care among Indonesian primary health care providers. Aust J Prim Health. 2020;26(6):472\u20138.","journal-title":"Aust J Prim Health"},{"issue":"4","key":"3023_CR31","doi-asserted-by":"publisher","first-page":"319","DOI":"10.1016\/j.jpainsymman.2022.06.019","volume":"64","author":"OA Afolabi","year":"2022","unstructured":"Afolabi OA, Nkhoma K, Soyannwo O, Aje A, Ogunniyi A, Harding R, et al. Integrated primary palliative care in Nigeria- perspectives of patients, families and providers. J Pain Symptom Manage. 2022;64(4):319\u201329.","journal-title":"J Pain Symptom Manage"},{"key":"3023_CR32","first-page":"111","volume":"2","author":"M Asadi-Lari","year":"2009","unstructured":"Asadi-Lari M, Madjd Z, Afkari ME, Goushegir A, Baradaran HR. The concept of palliative care practice among Iranian general practitioners. Iran J Cancer Prev. 2009;2:111\u20136.","journal-title":"Iran J Cancer Prev"},{"issue":"3","key":"3023_CR33","doi-asserted-by":"publisher","first-page":"160","DOI":"10.1080\/09699260.2024.2339097","volume":"32","author":"S Atreya","year":"2024","unstructured":"Atreya S, Mondal S. Healthcare professional\u2019s perspectives on factors influencing integration of primary palliative care into mainstream health service: an exploratory focus group study. Prog Palliat Care. 2024;32(3):160\u20138.","journal-title":"Prog Palliat Care"},{"issue":"2","key":"3023_CR34","doi-asserted-by":"publisher","first-page":"139","DOI":"10.4103\/IJPC.IJPC_216_17","volume":"24","author":"A Damani","year":"2018","unstructured":"Damani A, Ghoshal A, Dighe M, Dhiliwal S, Muckaden M. Exploring education and training needs in palliative care among family physicians in Mumbai: a qualitative study. Indian J Palliat Care. 2018;24(2):139\u201344.","journal-title":"Indian J Palliat Care"},{"issue":"2","key":"3023_CR35","first-page":"121","volume":"10","author":"M Dehi","year":"2021","unstructured":"Dehi M, Norouzi K, Mohammadi F, Negarandeh R. Barriers to end-of-life care delivery to home-dwelling terminally-ill older patients: a qualitative content analysis. Nurs Midwifery Stud. 2021;10(2):121.","journal-title":"Nurs Midwifery Stud"},{"issue":"1","key":"3023_CR36","doi-asserted-by":"publisher","first-page":"226","DOI":"10.1186\/s12875-022-01835-3","volume":"23","author":"S Hojjat-Assari","year":"2022","unstructured":"Hojjat-Assari S, Rassouli M, Kaveh V, Heydari H. Explaining health care providers\u2019 perceptions about the integration of palliative care with primary health care; a qualitative study. BMC Prim Care. 2022;23(1):226.","journal-title":"BMC Prim Care"},{"key":"3023_CR37","doi-asserted-by":"publisher","first-page":"17","DOI":"10.2147\/JPR.S178103","volume":"12","author":"H Jabbari","year":"2018","unstructured":"Jabbari H, Azami-Aghdash S, Piri R, Naghavi-Behzad M, Sullman MJ, Safiri S. Organizing palliative care in the rural areas of Iran: are family physician-based approaches suitable? J Pain Res. 2018;12:17\u201327.","journal-title":"J Pain Res"},{"issue":"1","key":"3023_CR38","doi-asserted-by":"publisher","first-page":"116","DOI":"10.1186\/s12904-018-0372-7","volume":"17","author":"XB Lai","year":"2018","unstructured":"Lai XB, Wong FKY, Ching SSY. The experience of caring for patients at the end-of-life stage in non-palliative care settings: a qualitative study. BMC Palliat Care. 2018;17(1):116.","journal-title":"BMC Palliat Care"},{"issue":"1","key":"3023_CR39","doi-asserted-by":"publisher","first-page":"62","DOI":"10.1186\/s12960-019-0399-8","volume":"17","author":"D Lertrattananon","year":"2019","unstructured":"Lertrattananon D, Limsawart W, Dellow A, Pugsley H. Does medical training in Thailand prepare doctors for work in community hospitals? An analysis of critical incidents. Hum Resour Health. 2019;17(1):62.","journal-title":"Hum Resour Health"},{"issue":"7","key":"3023_CR40","doi-asserted-by":"publisher","first-page":"758","DOI":"10.1089\/jpm.2012.0514","volume":"16","author":"A Xhixha","year":"2013","unstructured":"Xhixha A, Rama R, Radbruch L. Reducing the barriers to pain management in Albania: results from an educational seminar with family doctors. J Palliat Med. 2013;16(7):758\u201361.","journal-title":"J Palliat Med"},{"issue":"10128","key":"3023_CR41","doi-asserted-by":"publisher","first-page":"1391","DOI":"10.1016\/S0140-6736(17)32513-8","volume":"391","author":"FM Knaul","year":"2018","unstructured":"Knaul FM, Farmer PE, Krakauer EL, De Lima L, Bhadelia A, Jiang Kwete X, et al. Alleviating the access abyss in palliative care and pain relief-an imperative of universal health coverage: the lancet commission report. Lancet. 2018;391(10128):1391\u2013454.","journal-title":"Lancet"},{"key":"3023_CR42","doi-asserted-by":"publisher","DOI":"10.1136\/bmjspcare-2019-002109","author":"JJ Rhee","year":"2020","unstructured":"Rhee JJ, Grant M, Senior H, Monterosso L, McVey P, Johnson C, et al. Facilitators and barriers to general practitioner and general practice nurse participation in end-of-life care: systematic review. BMJ Support Palliat Care. 2020. https:\/\/doi.org\/10.1136\/bmjspcare-2019-002109.","journal-title":"BMJ Support Palliat Care"},{"issue":"9","key":"3023_CR43","doi-asserted-by":"publisher","first-page":"1131","DOI":"10.1177\/0269216319865414","volume":"33","author":"ML Carey","year":"2019","unstructured":"Carey ML, Zucca AC, Freund MA, Bryant J, Herrmann A, Roberts BJ. Systematic review of barriers and enablers to the delivery of palliative care by primary care practitioners. Palliat Med. 2019;33(9):1131\u201345.","journal-title":"Palliat Med"},{"issue":"1","key":"3023_CR44","doi-asserted-by":"publisher","first-page":"e20201335","DOI":"10.1590\/0034-7167-2020-1335","volume":"75","author":"TC da Silva","year":"2021","unstructured":"da Silva TC, Nietsche EA, Cogo SB. Palliative care in primary health care: an integrative literature review. Rev Bras Enferm. 2021;75(1):e20201335.","journal-title":"Rev Bras Enferm"},{"issue":"4","key":"3023_CR45","doi-asserted-by":"publisher","first-page":"411","DOI":"10.1136\/bmjspcare-2017-001374","volume":"8","author":"GK Mitchell","year":"2018","unstructured":"Mitchell GK, Senior HE, Johnson CE, Fallon-Ferguson J, Williams B, Monterosso L, et al. Systematic review of general practice end-of-life symptom control. BMJ Support Palliat Care. 2018;8(4):411\u201320.","journal-title":"BMJ Support Palliat Care"},{"key":"3023_CR46","doi-asserted-by":"publisher","first-page":"143","DOI":"10.1186\/s12904-023-01265-7","volume":"22","author":"M Matthew","year":"2023","unstructured":"Matthew M, Bainbridge D, Bishop V, Sinding C, Winemaker S, Kilbertus F, et al. Implementing palliative care education into primary care practice: a qualitative case study of the CAPACITI pilot program. BMC Palliat Care. 2023;22:143.","journal-title":"BMC Palliat Care"},{"key":"3023_CR47","doi-asserted-by":"crossref","unstructured":"Yennurajalingam S, Soyannwo O, Weru J, Addo Opare-Lokko VND, Burger EB, Nafulah H. E, Extension for community healthcare Outcomes-Palliative care in Africa and quality of life, symptoms, patient experience, and caregiver distress among patients with cancer. JCO Glob Oncol. 2025;(11):e2400236. https:\/\/ascopubs.org\/doi\/full\/10.1200\/GO.24.00236.","DOI":"10.1200\/GO.24.00236"},{"key":"3023_CR48","doi-asserted-by":"publisher","first-page":"61","DOI":"10.51866\/cm0007","volume":"19","author":"GVC Fernando","year":"2024","unstructured":"Fernando GVC, Perdamaian TK. Integrating palliative care into primary healthcare systems: advocacy efforts, milestones and challenges in Asia. Malays Fam Physician Off J Acad Fam Physicians Malays. 2024;19:61.","journal-title":"Malays Fam Physician Off J Acad Fam Physicians Malays"},{"issue":"6","key":"3023_CR49","doi-asserted-by":"publisher","first-page":"720","DOI":"10.1200\/JGO.2016.007872","volume":"3","author":"MR Rajagopal","year":"2017","unstructured":"Rajagopal MR, Karim S, Booth CM. Oral morphine use in South India: a population-based study. J Glob Oncol. 2017;3(6):720\u20137.","journal-title":"J Glob Oncol"},{"key":"3023_CR50","unstructured":"Rosa WE, Knaul FM, Touchton M, Bhadelia A, Humphreys K, Radbruch L, et al. Towards opioid access without excess. Lancet Public Health. 2025;0(0). Available from: https:\/\/www.thelancet.com\/journals\/lanpub\/article\/PIIS2468-2667(25)00035-0\/fulltext. Accessed 2 Mar 2025."},{"issue":"1","key":"3023_CR51","doi-asserted-by":"publisher","first-page":"2","DOI":"10.4103\/0973-1075.53485","volume":"15","author":"SK Chaturvedi","year":"2009","unstructured":"Chaturvedi SK, Loiselle CG, Chandra PS. Communication with relatives and collusion in palliative care: a cross-cultural perspective. Indian J Palliat Care. 2009;15(1):2\u20139.","journal-title":"Indian J Palliat Care"},{"issue":"1","key":"3023_CR52","doi-asserted-by":"publisher","first-page":"176","DOI":"10.1080\/13576275.2022.2136515","volume":"29","author":"E Wilson","year":"2024","unstructured":"Wilson E, Caswell G, Turner N, Pollock K. Talking about death and dying: findings from deliberative discussion groups with members of the public. Mortality. 2024;29(1):176\u201392.","journal-title":"Mortality"},{"key":"3023_CR53","doi-asserted-by":"publisher","first-page":"96","DOI":"10.1016\/j.puhe.2021.02.033","volume":"194","author":"WW Li","year":"2021","unstructured":"Li WW, Chhabra J, Singh S. Palliative care education and its effectiveness: a systematic review. Public Health. 2021;194:96\u2013108.","journal-title":"Public Health"},{"key":"3023_CR54","unstructured":"Yongpraderm S, Inpithuk P, Wongprom I. Resilience-building in palliative care professionals: scoping review. BMJ Support Palliat Care. 2025. Available from: https:\/\/spcare.bmj.com\/content\/early\/2025\/01\/27\/spcare-2024-005144. Accessed 2 Mar 2025."},{"issue":"3","key":"3023_CR55","first-page":"971","volume":"28","author":"F Zanatta","year":"2020","unstructured":"Zanatta F, Maffoni M, Giardini A. Resilience in palliative healthcare professionals: a systematic review. Support Care Cancer. 2020;28(3):971\u20138.","journal-title":"Support Care Cancer"},{"issue":"8","key":"3023_CR56","doi-asserted-by":"publisher","first-page":"776","DOI":"10.1177\/02692163241248324","volume":"38","author":"A Peeler","year":"2024","unstructured":"Peeler A, Afolabi O, Adcock M, Evans C, Nkhoma K, van Breevoort D, et al. Primary palliative care in low- and middle-income countries: a systematic review and thematic synthesis of the evidence for models and outcomes. Palliat Med. 2024;38(8):776\u201389.","journal-title":"Palliat Med"},{"issue":"e1","key":"3023_CR57","doi-asserted-by":"publisher","first-page":"e1","DOI":"10.1136\/bmjspcare-2019-001852","volume":"14","author":"H Senior","year":"2024","unstructured":"Senior H, Grant M, Rhee JJ, Aubin M, McVey P, Johnson C, et al. General practice physicians\u2019 and nurses\u2019 self-reported multidisciplinary end-of-life care: a systematic review. BMJ Support Palliat Care. 2024;14(e1):e1\u201311.","journal-title":"BMJ Support Palliat Care"},{"issue":"6","key":"3023_CR58","doi-asserted-by":"publisher","DOI":"10.1016\/j.outlook.2024.102273","volume":"72","author":"K Kuebler","year":"2024","unstructured":"Kuebler K, Monroe T, Ricciardi R, Westlake C, Sorenson M, Pederson J, et al. Integration of palliative care in the management of multiple chronic conditions: an expert consensus paper with policy implications. Nurs Outlook. 2024;72(6):102273.","journal-title":"Nurs Outlook"},{"issue":"1","key":"3023_CR59","doi-asserted-by":"publisher","first-page":"102","DOI":"10.1186\/s12916-017-0860-2","volume":"15","author":"SN Etkind","year":"2017","unstructured":"Etkind SN, Bone AE, Gomes B, Lovell N, Evans CJ, Higginson IJ, et al. How many people will need palliative care in 2040? Past trends, future projections and implications for services. BMC Med. 2017;15(1):102.","journal-title":"BMC Med"},{"issue":"1","key":"3023_CR60","doi-asserted-by":"publisher","first-page":"106","DOI":"10.1016\/j.jpainsymman.2025.03.018","volume":"70","author":"O Afolabi","year":"2025","unstructured":"Afolabi O, Peeler A, Nkhoma K, Evans C, Abboah-Offei M, Namisango E, et al. A logic model and multinational consensus definition of primary palliative care in sub-Saharan Africa. J Pain Symptom Manage. 2025;70(1):106\u201314.","journal-title":"J Pain Symptom Manage"}],"container-title":["BMC Primary Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12875-025-03023-5","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12875-025-03023-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12875-025-03023-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T15:05:49Z","timestamp":1769785549000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s12875-025-03023-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,29]]},"references-count":60,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["3023"],"URL":"https:\/\/doi.org\/10.1186\/s12875-025-03023-5","relation":{},"ISSN":["2731-4553"],"issn-type":[{"value":"2731-4553","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,29]]},"assertion":[{"value":"11 May 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"3 September 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"29 December 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"No primary participants were involved in this systematic review. However, since an empirical research project follows the systematic review, the project obtained ethical approval from the Research Ethics Committee of the Faculty of Medical Sciences of the University of Sri Jayewardenepura in Sri Lanka (ERC 54\/24).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"<!--Emphasis Type='Bold' removed-->Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"34"}}