From Compassionate Intuition to Clinical Competence: Spiritual Care Among Palliative Care Professionals in Ecuador

Abstract

Highlights What are the main findings? Among the professionals interviewed, spiritual care was often supported by compassionate intuition, clinical sensitivity, and individual commitment, despite limited formal training, time constraints, and insufficient documentation tools. Participants described ethical tension related to family involvement, paternalism, intercultural communication, language barriers, and traditional or ancestral health practices. What are the implications of the main findings? The findings point to possible areas for future development, including structured education in spiritual care, clearer documentation processes, and staff support strategies within palliative care settings. Future studies could further examine culturally sensitive mediation and collaboration with community or spiritual references as potential strategies to support respectful spiritual care in diverse contexts. Abstract Background/Objectives: Spiritual care is essential for alleviating multidimensional suffering at the end of life. However, its clinical integration in Latin America faces cultural, linguistic, and religious complexities. These complexities also challenge the traditional biomedical model. This study addresses the gap between international theoretical frameworks and empirical reality in a diverse context by examining how healthcare professionals in Ecuador perceive, understand, and apply palliative spiritual care, using three competencies from the Latin American Association of Palliative Care (ALCP). Methods: This was a qualitative, exploratory, and descriptive study. We conducted in-depth, semi-structured interviews with 20 professionals (physicians, nurses, and psychologists) with experience in palliative care. We analyzed the data using inductive–deductive thematic analysis. Results: Spirituality was conceived as an existential dimension of purpose and transcendence. Clinical empathy drew upon the professional’s personal vulnerability and was channeled through nonverbal communication and informal interdisciplinary support. However, this approach faced critical institutional (time constraints and lack of clinical records), sociocultural (language barriers and clashes with traditional Andean medicine), and ethical–familial (paternalism and familism) barriers. Conclusions: Among the professionals interviewed, palliative spiritual care relied primarily on compassionate intuition, clinical sensitivity, and professional commitment, within a context marked by limited formal training and institutional, sociocultural, and ethical–familial barriers. These findings suggest possible areas for future development, including spiritual literacy, institutional self-care, and intercultural mediation, which should be examined in broader and more diverse contexts before being translated into practice or policy recommendations.