Identificación de necesidades paliativas con el instrumento NECPAL 4.0 en pacientes de un hospital oncológico.

Abstract

This study addressed the challenge of the late identification of palliative care needs in oncology, a situation that limits patients' quality of life and timely access to comprehensive care. The main objective was to identify palliative care needs using the NECPAL 4.0 instrument in patients treated at SOLCA Hospital–Guayaquil between August and September 2025. A quantitative approach was adopted using a non-experimental, cross-sectional design with an analytical scope. The study included 470 adult oncology patients who were assessed using the NECPAL 4.0 instrument, which was completed by the treating physician during routine outpatient consultations. Sociodemographic, clinical, and functional information was additionally obtained from institutional clinical records to support the analysis of the study variables. The results showed that 27.02% of the patients (127 individuals) were identified as NECPAL positive, indicating a substantial burden of palliative care needs even among patients with relatively preserved functional status (mean Karnofsky Performance Status: 80.38). A statistically significant association was found between a positive NECPAL result and stage IV disease (50.68%), as well as with digestive tract malignancies (47.62%). Furthermore, NECPAL-positive patients were 4.3 times more likely to be referred to specialized palliative care services. It is concluded that NECPAL 4.0 is a valid and sensitive tool for identifying palliative care needs in oncology patients. Nevertheless, a care gap remains, as 30.71% of NECPAL-positive patients were not referred to specialized palliative care services. These findings highlight the need to strengthen institutional referral pathways in order to ensure timely, comprehensive, and patient-centered oncological care.