1 Health Services Management, Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

2 Health Information Technology Research Center, Student Research Committee, Department of Medical Library and Information Sciences, School of Management and Medical Information Sciences, Isfahan University of Medical Sciences, Isfahan, Iran


Palliative care has been proposed as a multidisciplinary method for providing patients with care. The
present study proposes to discuss the necessary principles required for any country to successfully
implement a palliative medicine program. The present study was a systematic review conducted in
January 2019, and the articles related to palliative care requirements on the databases of Web of
Science, PubMed, Scopus, Science Direct, Ovid, ProQuest, Wiley, and Google Scholar from January
1, 2009, to January 20, 2019, were searched. Strategy for searching and selecting the articles was
Preferred Reporting Items for Systematic Reviews and Meta‑Analyses Guidelines. The findings
showed that the World Health Organization has introduced for main phases for increasing these types
of services including: defining and developing a national policy, training and educating healthcare
employees and general public, as well as pain relief. In general, two scenarios are described in the
development of palliative medicine: bottom‑up and top‑down approaches. In conclusion, although
there seem to be progressing activities regarding the issue of making palliative medicine accessible,
there are still many obstacles including lack of adequate knowledge and political support, social and
cultural problems, inadequate training and education of physicians and nurses, fixed and biased
attitude in medical professions, and low priority of palliative medicine among policymakers. Therefore,
it could be said that implementing palliative medicine programs requires an overall change in culture,
public and individual education, political support, and appropriate policies.


1. Santos Garcia JB, Rodrigues RF, Lima SF. Structuring a palliative
care service in Brazil: Experience report. Rev Bras Anestesiol
2. Hauser J, Sileo M, Araneta N, Kirk R, Martinez J, Finn K, et al.
Navigation and palliative care. Cancer 2011;117 15 Suppl: 3585‑91.
3. Plu I, Moutel G, Purssell‑Franc I. Ethical issues arising from the
requirement to provide written information in palliative care.
Palliat Med 2007;21:55, 57.
4. Twaddle ML. The impact of a home‑based palliative care program
in an accountable care organization. J Palliat Med 2016;19:1‑4.
5. Ddungu H. Palliative care: What approaches are suitable in
developing countries? Br J Haematol 2011;154:728‑35.
6. Juth N, Lindblad A, Lynöe N, Sjöstrand M, Helgesson G.
European Association for Palliative Care (EAPC) framework
for palliative sedation: An ethical discussion. BMC Palliat Care
7. Lucas S. Palliative Care: Issues and Challenges. World Health
Organization; 2002. Available from:
en/palliativecare_en.pdf. [Last accessed on 2010 May 18].
8. Witkamp FE, Lv Z, Maas PJ, Hv D, Rijt CC, Heide A. Improving
the quality of palliative and terminal care in the hospital by a
network of palliative care nurse champions: The study protocol
of the PalTeC‑H project. BMC Health Serv Res 2013;13:115.
9. Schneider N, Lueckmann SL, Kuehne F, Klindtworth K,
Behmann M. Developing targets for public health initiatives to
improve palliative care. BMC Public Health 2010;10:222.
10. Beek KV, Woitha K, Ahmed N, Menten J, Jaspers B, Engels Y,
et al. Comparison of legislation, regulations and national health
strategies for palliative care in seven European countries (Results
from the Europall Research Group): A descriptive study. BMC
Health Serv Res 2013;13:275.
11. Sagin A, Kirkpatrick JN, Pisani BA, Fahlberg B, Sundlof AL,
O’Connor NR. Emerging collaboration between palliative
care specialists and mechanical circulatory support teams:
A qualitative study. J Pain Symptom Manag 2016;52(4):4‑9.
12. Knaul FM, Richard A. Provision of palliative care in low‑ and
middle‑income countries: Overcoming obstacles for effective
treatment delivery. J Clin Oncol 2015;62:1615.
13. Rukhadze T, Kezeli T, Lekashvili T, Kordzaia D. Georgian national
palliative care strategic plan – Achievements, challenges and
perspectives in implementation palliative care in Georgia. EPMA
J 2014;5 Suppl 1:A106.
14. Marrelli TM. Hospice and Palliative Care Handbook: Quality,
Compliance, and Rembursment. 3rd ed. Indianapolis, IN: Sigma
Theta Tau; 2018. p. 20‑5.
15. Cassileth BR. Palliative care: Progress, needs, and challenges.
Cassileth J Health Policy Res 2012;1:10.
16. Gwyther L, Brennan F, Harding R. Advancing palliative care as
a human right. J Pain Symptom Manag 2009;38(5):767‑74.
17. A Provincial Framework for End‑of‑Life Care. British Columbia:
Ministry of Health; May, 2006.