TY - JOUR
T1 - Beyond the Pandemic
T2 - End-of-Life Care Lessons From Latin America to Inform Future Health
AU - Tripodoro, Vilma A
AU - Pérez-Cruz, Pedro
AU - CO-LIVE Latin America research group
AU - Khoury, Marina
AU - León, Martha Ximena
AU - Saca, José Mario López
AU - Veloso, Verónica
AU - Acero, Ángela
AU - Soto-Guerrero, Sebastián
AU - Rodríguez, Marco
AU - Uchida, Michelle
AU - Korfage, Ida
AU - van der Heide, Agnes
N1 - Publisher Copyright:
© 2025 The Authors. Published by Elsevier Inc. on behalf of American Academy of Hospice and Palliative Medicine. This is an open access article under the CC BY-NC-ND license. http://creativecommons.org/licenses/by-nc-nd/4.0/
PY - 2026/2
Y1 - 2026/2
N2 - Context: The COVID-19 pandemic exposed critical weaknesses in end-of-life care (EOLC), particularly in Latin America, where fragmented health systems and inequities intensified suffering. Objectives: To examine bereaved relatives’ perceptions of EOLC during the pandemic in five Latin American countries, identify predictors of perceived adequacy, and assess alignment with the Core Outcome Set (COS) for best care for the dying person, a consensus-based set of patient-centered outcomes for end-of-life care. Methods: A cross-sectional online survey of bereaved relatives was conducted in Argentina, Brazil, Chile, Colombia, and El Salvador (2021–2023) using an adapted iCODE questionnaire (Care of the Dying Evaluation). The primary outcome, perceived “adequate care” in the last 48 hours of life, was based on two iCODE items. Logistic regression identified associated factors. Results: Among 1,125 respondents, 51% perceived care as adequate, varying from 45% in Argentina and Colombia to 81% in El Salvador (P < 0.001). Independent predictors included personal care support (P < 0.001), emotional support (P < 0.001), trust in professionals (P < 0.001), symptom relief (P ≤ 0.001), effective communication (P = 0.012), and family involvement in decision-making (P = 0.045). COVID-19 restrictions were negatively associated with perceived adequacy. Alignment of our findings with the COS domains revealed persistent gaps in spiritual support, shared decision-making, and communication. Conclusion: Perceptions of EOLC adequacy during the pandemic varied across Latin America. Relational, emotional, and physical aspects of care strongly influenced relatives’ assessments. The COS offers a practical framework to identify and address care gaps. Its adoption could promote holistic, culturally sensitive EOLC, essential to improving care in the region.
AB - Context: The COVID-19 pandemic exposed critical weaknesses in end-of-life care (EOLC), particularly in Latin America, where fragmented health systems and inequities intensified suffering. Objectives: To examine bereaved relatives’ perceptions of EOLC during the pandemic in five Latin American countries, identify predictors of perceived adequacy, and assess alignment with the Core Outcome Set (COS) for best care for the dying person, a consensus-based set of patient-centered outcomes for end-of-life care. Methods: A cross-sectional online survey of bereaved relatives was conducted in Argentina, Brazil, Chile, Colombia, and El Salvador (2021–2023) using an adapted iCODE questionnaire (Care of the Dying Evaluation). The primary outcome, perceived “adequate care” in the last 48 hours of life, was based on two iCODE items. Logistic regression identified associated factors. Results: Among 1,125 respondents, 51% perceived care as adequate, varying from 45% in Argentina and Colombia to 81% in El Salvador (P < 0.001). Independent predictors included personal care support (P < 0.001), emotional support (P < 0.001), trust in professionals (P < 0.001), symptom relief (P ≤ 0.001), effective communication (P = 0.012), and family involvement in decision-making (P = 0.045). COVID-19 restrictions were negatively associated with perceived adequacy. Alignment of our findings with the COS domains revealed persistent gaps in spiritual support, shared decision-making, and communication. Conclusion: Perceptions of EOLC adequacy during the pandemic varied across Latin America. Relational, emotional, and physical aspects of care strongly influenced relatives’ assessments. The COS offers a practical framework to identify and address care gaps. Its adoption could promote holistic, culturally sensitive EOLC, essential to improving care in the region.
UR - https://www.scopus.com/pages/publications/105025261396
U2 - 10.1016/j.jpainsymman.2025.10.016
DO - 10.1016/j.jpainsymman.2025.10.016
M3 - Article
C2 - 41173064
SN - 0885-3924
JO - Journal of Pain and Symptom Management
JF - Journal of Pain and Symptom Management
ER -