Background: In low- and middle-income countries (LMICs), access to palliative care for cancer patients remains highly unequal, constrained by workforce shortages, hospital-centered care models, and limited support for family caregivers. Strengthening home-based palliative care within public health systems is a priority recommended by the World Health Organization to improve equity and quality of end-of-life care. Brazil’s Unified Health System (SUS), through the national Melhor em Casa home care program, offers a unique setting to examine scalable palliative care models based on nursing teams coordinated by registered nurses in resource-constrained contexts.
Objectives: To describe the organization, workforce roles, and caregiver training strategies of a nursing team–based, home-based palliative care program for cancer patients implemented within the Melhor em Casa program of the Brazilian public health system.
Methods: We conducted a retrospective observational study of 471 consecutive cancer patients assisted by a Home-Based Palliative Care Service operating under the Melhor em Casa program between 2013 and 2023 in a Brazilian municipality. Sociodemographic, clinical, functional, and service delivery data were extracted from medical records. The scope of practice of registered nurses, task-sharing with nursing technicians, and structured family caregiver training, mandatory for program enrollment, were analyzed descriptively.
Results: The cohort comprised 471 cancer patients with advanced disease, high symptom burden, and significant functional impairment, reflecting typical palliative care needs in LMIC public health settings. Pain (94.7%) and dyspnea (77.1%) were the most prevalent symptoms at admission, followed by fatigue and functional dependence. Registered nurses assumed a central coordinating role, conducting comprehensive clinical assessments, developing individualized care plans, supervising nursing technicians, and leading structured training of family caregivers, which was mandatory for enrollment in the Melhor em Casa program. Nursing technicians provided routine and continuous care under nurse supervision, enabling effective task-sharing and service continuity. Caregiver training focused on symptom control, medication administration, basic clinical monitoring, and end-of-life care. Most patients (99.4%) died at home, indicating strong alignment with patient-centered goals, continuity of care, and reduced reliance on hospital-based services.
Conclusions and Implications for Public Health: This nursing team–based, home palliative care model coordinated by registered nurses demonstrates how workforce optimization and caregiver capacity-building within an existing public health program can expand equitable access to quality cancer palliative care in an LMIC. The findings provide actionable, system-level evidence to inform policy development, workforce planning, and scaling of palliative care services within SUS and comparable health systems globally.