This report presents an initial examination of palliative care across the Pacific region. There is scarce literature on palliative care in Pacific island countries and territories, but the documented disease profile shows a need for expanded palliative care. Through a small number of individual interviews, this initial research builds an overview of what is occurring at the regional level and in some Pacific island countries. There is scant attention to palliative care at the regional level. Multilateral and regional agencies, and key donors, do not have focused programs of support for palliative care. The main drivers of action to date have been local champions, supported through collegial, cross-border clinical engagement and networks. Some civil society organisations are active, such as the Fiji and Samoa Cancer Societies. Country snapshots of action are included in Appendix 2. This report draws out some common themes related to palliative care, alongside selected lessons from elsewhere. Suggestions for regional agencies and donors are offered, based on key principles for action. These suggestions include the need to: provide funding; foster leadership; support training, coaching and mentoring; nurture networks; and conduct further research.