Nurse-led adult palliative care models in low- and middle-income countries: A scoping review

Abstract

Aims: To map evidence on the nature and extent of use of nurse-led palliative care models in low- and middle-income countries serving adults with life-limiting conditions.

Design: A scoping review of the literature was undertaken.

Data sources: A systematic search was performed from database inception to March 2022 in: Medline, EMBASE, CINAHL, Wiley Cochrane Library, SCOPUS, Web of Science, SciELO and Global Health. Main search terms included: Nurse-led AND Palliative care AND Low-and middle-income countries. Grey literature was searched from Proquest Dissertations and Theses Global, the World Health Organization and selected palliative care websites. We searched the reference list of included articles for additional studies.

Review methods: We used the framework by Arksey and O'Malley and the PRISMA-ScR guidelines. Titles and abstracts were screened by one reviewer and full text by two reviewers. Thematic analysis was used to synthesize data and results are presented descriptively using themes and categories.

Results: Eighteen studies were included, with majority from Sub-Saharan Africa (10/20). Three nurse-led palliative care models emerged: nurse-led empowering care, nurse-led symptom control and nurse-led multicomponent palliative care. They served particularly cancer and HIV patients and were delivered in person or by telehealth care. Reported outcomes were adherence to therapy, improved self-care ability, improved quality of life and increased access to palliative.

Conclusions: The use of nurse-led palliative care in low- and middle-income countries is in its developing stages and seems feasible. Nursing roles in in low- and middle-income countries need to be expanded by developing advanced practice nurses and nurse practitioner programmes, with palliative care content. More impact evaluation studies on the use of nurse-led palliative care models in these countries are needed.

Impact: This review highlights nurse-led care models that can enhance access and quality of life of patients with life-limiting conditions in low- and middle-income countries.

Keywords: access to care; adult; end-of-life care; life-limiting conditions; low- and middle-income countries; models of care; nurse-led; nursing; palliative care; scoping review.