{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T21:13:05Z","timestamp":1768597985474,"version":"3.49.0"},"reference-count":25,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T00:00:00Z","timestamp":1767916800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"ANID FONDAP","award":["152220002"],"award-info":[{"award-number":["152220002"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nursing Reports"],"abstract":"<jats:p>Background: Integrating palliative care (PC) into primary health care (PHC) is essential for achieving Universal Health Coverage and reducing avoidable suffering. Despite global progress in PC development, the extent to which PC is effectively embedded within PHC systems remains unclear, particularly in low- and middle-income countries. Colombia illustrates this gap, with an advanced legal framework but persistent territorial inequities. This study explored how national experts conceptualize PC integration into PHC to inform the development of context-sensitive indicators. Methods: A directed thematic analysis was conducted using qualitative comments from a modified Delphi process (pre-Delphi, Round 1, Round 2). Coding was guided by the WHO model for PC development and the WHO\u2013UNICEF Operational Framework for PHC, combining deductive and inductive approaches to identify recurrent themes. Results: A total of 230 qualitative comments from experts in PC, PHC, and public health were analyzed. Experts described integration as the alignment of policy, education, service delivery, and community participation within PHC structures. They emphasized that laws and training programs alone are insufficient; integration depends on implementation capacity, equitable access, and locally responsive systems. Rural areas were identified as facing the greatest barriers, including limited trained staff, restricted medicine availability, and weak referral pathways. Conclusions: Experts understood PC integration into PHC as a dynamic and ethical process linking system design with human experience. Strengthening equity, workforce preparation, and community engagement is essential to translate policy into practice and to develop meaningful indicators for health system improvement.<\/jats:p>","DOI":"10.3390\/nursrep16010020","type":"journal-article","created":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T12:52:17Z","timestamp":1767963137000},"page":"20","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Expert Perspectives on Integrating Palliative Care into Primary Health Care: A Qualitative Analysis of a Modified Delphi Study"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4064-0120","authenticated-orcid":false,"given":"Carolina","family":"Mu\u00f1oz Olivar","sequence":"first","affiliation":[{"name":"Health Sciences, Faculty of Medicine, Antonio Nari\u00f1o University, Bogot\u00e1 111321, Colombia"},{"name":"Center for Cancer Prevention and Control (CECAN), Santiago 8331150, Chile"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8093-4687","authenticated-orcid":false,"given":"Francisca","family":"Marquez-Doren","sequence":"additional","affiliation":[{"name":"Escuela de Enfermer\u00eda, Facultad de Medicina, Pontificia Universidad Cat\u00f3lica de Chile, Cap\u00edtulo Alpha Beta Omicron de Sigma, Santiago 7820436, Chile"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6507-1462","authenticated-orcid":false,"given":"Juan Sebasti\u00e1n","family":"G\u00f3mez Quintero","sequence":"additional","affiliation":[{"name":"Faculty of Engineering, Andr\u00e9s Bello University, Santiago 8370211, Chile"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8318-4201","authenticated-orcid":false,"given":"Carla Taramasco","family":"Toro","sequence":"additional","affiliation":[{"name":"Center for Cancer Prevention and Control (CECAN), Santiago 8331150, Chile"},{"name":"Institute of Technologies for Innovation in Health and Well-Being, Faculty of Engineering, Andr\u00e9s Bello University, Vi\u00f1a del Mar 8370211, Chile"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1487-4537","authenticated-orcid":false,"given":"Carlos Javier","family":"Avenda\u00f1o-V\u00e1squez","sequence":"additional","affiliation":[{"name":"Escuela de Enfermer\u00eda, Universidad Industrial de Santander, Bucaramanga 680001, Colombia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,9]]},"reference":[{"key":"ref_1","unstructured":"Tripodoro, V.A., Su\u00e1rez, D., Bejar-Alban, A.C., Montero-Calero, l., Ruiz-Ospina, P.M., Lopez-Saca, M., Stoltenberg, M., Connor, S., Garralda-Domezain, E., and Bastos, F. (2025, September 22). Palliative Care Atlas of the Americas. Available online: https:\/\/hdl.handle.net\/10171\/117222."},{"key":"ref_2","unstructured":"WHO, and UNICEF (2025, March 15). Global Conference on Primary Health Care, Astana, Available online: https:\/\/www.who.int\/publications-detail-redirect\/WHO-HIS-SDS-2018.61."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1391","DOI":"10.1016\/S0140-6736(17)32513-8","article-title":"Alleviating the access abyss in palliative care and pain relief\u2014An imperative of universal health coverage: The Lancet Commission report","volume":"391","author":"Knaul","year":"2018","journal-title":"Lancet"},{"key":"ref_4","unstructured":"World Health Organization (2025, January 10). Assessing the Development of Palliative Care Worldwide: A Set of Actionable Indicators. Geneva, Available online: https:\/\/www.who.int\/publications\/i\/item\/9789240033351."},{"key":"ref_5","unstructured":"Arias-Casais, N., Garralda-Domezain, E., L\u00f3pez-Fidalgo, J.F., Lima, L., de Rhee, J.Y., Pons-Izquierdo, J.J., and Centeno, C. (2019). Brief Manual on Health Indicators Monitoring Global Palliative Care Development, IAHPC Press."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"794","DOI":"10.1016\/j.jpainsymman.2019.11.009","article-title":"Mapping Levels of Palliative Care Development in 198 Countries: The Situation in 2017","volume":"59","author":"Clark","year":"2020","journal-title":"J. Pain Symptom Manag."},{"key":"ref_7","unstructured":"World Health Organization and the United Nations Children\u2019s Fund (UNICEF) (2025, January 10). Primary Health Care Measurement Framework and Indicators: Monitoring Health Systems Through a Primary Health Care Lens, Available online: https:\/\/www.who.int\/publications\/i\/item\/9789240044210."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1016\/j.jpainsymman.2025.07.026","article-title":"First-Ever Global Ranking of Palliative Care: 2025 World Map Under the New WHO Framework","volume":"70","author":"Tripodoro","year":"2025","journal-title":"J. Pain Symptom Manag."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1016\/j.jpainsymman.2020.12.010","article-title":"The Development of Palliative Care in Colombia: An Analysis of Geographical Inequalities Through the Application of International Indicators","volume":"62","author":"Garralda","year":"2021","journal-title":"J. Pain Symptom Manag."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1277","DOI":"10.1177\/1049732305276687","article-title":"Three Approaches to Qualitative Content Analysis","volume":"15","author":"Hsieh","year":"2005","journal-title":"Qual. Health Res."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"461","DOI":"10.1016\/0260-6917(91)90009-Y","article-title":"A method of analysing interview transcripts in qualitative research","volume":"11","author":"Burnard","year":"1991","journal-title":"Nurse Educ. Today"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1093\/intqhc\/mzm042","article-title":"Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups","volume":"19","author":"Tong","year":"2007","journal-title":"Int. J. Qual. Health Care"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"26323524251328036","DOI":"10.1177\/26323524251328036","article-title":"Colombia\u2019s 5-year public health strategy for palliative care: Implementation protocol","volume":"19","author":"Umbacia","year":"2025","journal-title":"Palliat. Care Soc. Pract."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"621","DOI":"10.1016\/S0140-6736(19)31830-6","article-title":"Defining primary palliative care for universal health coverage","volume":"394","author":"Munday","year":"2019","journal-title":"Lancet"},{"key":"ref_15","unstructured":"European Association for Palliative Care EAPC (2025, July 15). Toolkit for the Development of Palliative Primary Care, Available online: https:\/\/www.globalfamilydoctor.com\/site\/DefaultSite\/filesystem\/documents\/Groups\/Palliative%20Care\/EAPC%20Toolkit%202019.pdf."},{"key":"ref_16","first-page":"e00130222","article-title":"Palliative care: Pathway in primary health care in Brazil","volume":"38","author":"Rodrigues","year":"2022","journal-title":"Cad. Sa\u00fade P\u00faBlica"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"776","DOI":"10.1177\/02692163241248324","article-title":"Primary palliative care in low- and middle-income countries: A systematic review and thematic synthesis of the evidence for models and outcomes","volume":"38","author":"Peeler","year":"2024","journal-title":"Palliat. Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e3324","DOI":"10.1590\/1518-8345.3858.3324","article-title":"Palliative care in primary health care: Scoping review","volume":"28","author":"Justino","year":"2020","journal-title":"Rev. Lat. Am. Enferm."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"486","DOI":"10.1016\/j.jpainsymman.2007.02.016","article-title":"The Public Health Strategy for Palliative Care","volume":"33","author":"Foley","year":"2007","journal-title":"J. Pain Symptom Manag."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e1092","DOI":"10.1016\/S2214-109X(22)00280-7","article-title":"Primary health care is not just a service delivery platform","volume":"10","author":"Allen","year":"2022","journal-title":"Lancet Glob. Health"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1461","DOI":"10.1016\/S0140-6736(18)31829-4","article-title":"Revisiting Alma-Ata: What is the role of primary health care in achieving the Sustainable Development Goals?","volume":"392","author":"Hone","year":"2018","journal-title":"Lancet"},{"key":"ref_22","unstructured":"Pan American Health Organization (PAHO) (2025, July 15). The Compact 30\u202230\u202230 PHC for Universal Health. PAHO\u2014WHO, Available online: https:\/\/www.paho.org\/sites\/default\/files\/2019-12\/brochure-30-30-30-eng2019.pdf."},{"key":"ref_23","unstructured":"Charlton, R. (2002). Primary Palliative Care, Radcliffe Medical. Available online: https:\/\/archive.org\/details\/primarypalliativ0000unse\/page\/n9\/mode\/2up."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e419","DOI":"10.1016\/j.jpainsymman.2021.12.015","article-title":"Cross Country Comparison of Expert Assessments of the Quality of Death and Dying 2021","volume":"63","author":"Finkelstein","year":"2022","journal-title":"J. Pain Symptom Manag."},{"key":"ref_25","unstructured":"Economist Intelligence Unit (2010). The quality of death Ranking end-of-life care across the world: A report from the Economist Intelligence Unit. Economist, Available online: https:\/\/www.dgpalliativmedizin.de\/images\/stories\/the_quality_of_death1a.pdf."}],"container-title":["Nursing Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2039-4403\/16\/1\/20\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T09:06:46Z","timestamp":1768554406000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2039-4403\/16\/1\/20"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,9]]},"references-count":25,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1]]}},"alternative-id":["nursrep16010020"],"URL":"https:\/\/doi.org\/10.3390\/nursrep16010020","relation":{},"ISSN":["2039-4403"],"issn-type":[{"value":"2039-4403","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,9]]}}}