title: The needs, models of care, interventions and outcomes of palliative care in the Caribbean: a systematic review of the evidence.
abstract: BACKGROUND
  Palliative care provision is expanding in low and middle income countries. Services are developing in the Caribbean in response to the region's ageing population, the significant burden of cancer, non-communicable diseases and HIV/AIDS. Appraisal of the existing evidence on palliative care needs, models of care, interventions and outcomes in the Caribbean is essential to inform emerging practice and future research.
  
  
  METHODS
  Systematic review and narrative synthesis. Following implementation of a search strategy, titles, abstracts and full texts were screened. Data from nine studies were synthesized. The Qualsyst tools were used to assess the quality of quantitative and qualitative studies. Data were extracted into a common table, and themes were generated from the available peer review evidence using narrative synthesis.
  
  
  RESULTS
  Nine papers were retained for appraisal. Eight papers described palliative care needs in the Caribbean. The needs for analgesia, support for patients, education and training of staff in palliative care and palliative care services were identified in the literature. Models of care for palliative care in the Caribbean were not described in great depth (n = 2 papers) and no intervention studies were found. Outcomes of palliative care such as quality of life, quality of care, and patient's preferred place of care and death were identified from six papers. Quantitative methodology was used in seven of the nine papers in this review. One paper used a mixed methodology design, and one a qualitative approach.
  
  
  CONCLUSIONS
  Research from the Caribbean highlights the need for health care policy, training of staff, education, and access to analgesia and palliative care support services in this region. This sparse evidence must be taken into consideration with cultural beliefs and preferences of the Caribbean population in order to achieve improved outcomes for patients, their caregivers and health care professionals. This underscores the importance for more research in the field of palliative care in the Caribbean.
authors.affiliation: Caura Palliative Care Unit, Caura Hospital, El Dorado, Trinidad and Tobago. sandhyamaharaj1@yahoo.com.
authors.forename: Sandhya
authors.initials: S
authors.lastname: Maharaj
authors.affiliation: Department of Palliative Care,Policy and Rehabilitation, Cicely Saunders Institute, King's College London, Bessemer Road, London, SE59PJ, UK. richard.harding@kcl.ac.uk.
authors.forename: Richard
authors.initials: R
authors.lastname: Harding
mesh_terms: D000700:Analgesics / Q000627:therapeutic use; D017028:Caregivers / Q000592:standards; D017691:Caribbean Region; D006291:Health Policy / Q000639:trends; D006801:Humans; D020380:Needs Assessment; D010166:Palliative Care / Q000379:methods* / Q000592:standards*; D063868:Patient Outcome Assessment; D011788:Quality of Life
chemical_list: D000700:Analgesics