Implementation and knowledge of the clinical practice guide for palliative care in the Ecuadorian primary care level

Tamara Rodríguez Quintana, Viviana Dávalos-Batallas, Ana Magdalena Vargas-Martínez, Lucelly López, Patricia Bonilla-Sierra, María De Las Mercedes Lomas-Campos, Fatima Leon-Larios

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    2 Scopus citations


    Ecuador assumed the commitment of including Palliative Care (PC) in its health policies. In 2014, the Ministry of Public Health (Ministerio de Salud Pública, MSP) approved the Clinical Practice Guide for Palliative Care (Guía de Práctica Clínica sobre Cuidados Paliativos, GPCCP), with application at the national level, as a mandatory internal regulation in all institutions belonging to the National Health System. In 2021, there is no evidence about the degree of implementation. The objective was to evaluate the implementation (I) of the GPCCP guide and the knowledge (C) of the health personnel working in the Zone 7 Health Centers (HCs). This is a cross-sectional, descriptive, and prospective study. A total of 292 professionals were interviewed: managers (38), physicians (150), and nurses (104). Three surveys based on the GPCCP guide were elaborated: one for the implementation, which was applied to the individuals in charge, and the others to assess the health professionals’ knowledge. The SPSS program was used, version 25. In the three groups, more than half of the participants had no training in PC, 91.2% of the HCs have the GPCCP guide, there is PC medical history (MH) in 38.2%, and morphine is used in 14.7%. The implementation of the GPCCP guide was inadequate in 52.9% of the cases. Only 25% treat the agony symptoms and 30%, delirium; 4.4% acknowledge the use of morphine in dyspnea, and 13.3% identify the subcutaneous route as the first choice for hydration at the end-of-life phase. Strategies to implement the GPCCP guide and to improve the health personnel’s knowledge must be implemented in Zone 7 centers.

    Original languageEnglish
    Article number11573
    JournalInternational Journal of Environmental Research and Public Health
    Issue number21
    StatePublished - 1 Nov 2021

    Bibliographical note

    Publisher Copyright:
    © 2021 by the authors. Licensee MDPI, Basel, Switzerland.


    • Clinical practice guide
    • Knowledge
    • Palliative care

    Types Minciencias

    • Artículos de investigación con calidad A1 / Q1


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