Title: Family Caregivers' Experience in the Provision of Palliative Care for Adult Cancer Patients in Low and Lower-Middle-Income Countries: A Qualitative Systematic Review Protocol

IntroductionIn contrast to high-income countries, palliative care services are limited and largely undertaken by informal caregivers, often family members, in low- and lower-middle-income countries (LMICs). This review aims to explore the family caregiver experience in providing palliative care to adult cancer patients in LMICs. Methods and AnalysisThis qualitative systematic review will be conducted using a comprehensive search strategy on PubMed (MEDLINE), EMBASE, CINAHL, and PsycINFO without language or date restrictions. Open Universitys CORE database will be searched for grey literature. Review questions will follow the PICo framework (population, phenomena of interest, and contexts). Qualitative or mixed-method studies on the experience of family caregivers of adult cancer patients (above 18 years) receiving palliative care in LMICs will be included. Study quality will be assessed using the Joanna Briggs Institute (JBI) critical appraisal tools. Findings will be synthesized using meta-aggregation, or with a narrative synthesis if pooling is not feasible. Review process will follow the JBI methodology for systematic reviews of qualitative evidence and will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework. Ethics and DisseminationNo ethical approval is required as the study involves secondary data analysis of published literature. Ethical principles of accurate reporting and transparency will be upheld. Findings will be published in peer-reviewed open-access journals and presented at academic conferences. Recommendations will be shared with policymakers and healthcare organizations responsible for the provision of palliative care for cancer patients in LMICs. PROSPERO registration numberCRD420251010556 Article SummaryO_ST_ABSStrengths and Limitations of this studyC_ST_ABSO_LIFour databases, as well as grey literature, will be searched using the extensive search strategy by a multidisciplinary team with expertise in systematic reviews and cancer care in LMICs. C_LIO_LIA rigorous methodology will be adhered to throughout the study as per the JBI guidelines for qualitative systematic reviews. C_LIO_LIWhile language was not limited in the search, due to translation constraints, only selected non-English articles will be reviewed. This limitation may introduce language bias through the exclusion of some non-English qualitative study articles. C_LIO_LIDue to the limited number of qualitative studies on cancer palliative care in LMICs and possible low quality of available studies, the certainty of evidence generated through this systematic review may be limited. C_LI