# Facilitators and barriers primary care physicians face in providing palliative care in low- and middle-income countries: a mixed methods systematic review

## TL;DR

This paper reviews what helps and hinders primary care doctors in low- and middle-income countries when providing palliative care.

## Contribution

It synthesizes facilitators and barriers through a mixed-methods systematic review, focusing on primary care physicians in resource-limited settings.

## Key findings

- Key barriers include poor infrastructure, staff shortages, and lack of training.
- Facilitators include health reforms, interdisciplinary teamwork, and home-based care models.
- The study highlights the need for policy and resource improvements to support palliative care delivery.

## Abstract

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.

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.

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.

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’ 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.

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.

The online version contains supplementary material available at 10.1186/s12875-025-03023-5.