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This article delves into understanding suffering as the foundation of spiritual support in palliative care. The authors propose a clinical and anthropological framework to approach suffering beyond the traditional biomedical perspective, emphasizing its multidimensional and existential nature.
It is argued that suffering, from the Latin sufferre (“to bear under”), constitutes an inherent human experience that affects the integrity of the “self” and emerges when life reality challenges the ego’s expectations. Its intensity depends on each person’s biographical history, values, and internal resources. Against the current tendency to medicalize or avoid suffering, this work invites recognition of suffering as an essential part of the human experience and as a potential source of growth and transformation.
Addressing suffering requires sensitivity, presence, and professional training to identify its causes, assess available resources, and accompany the process with authenticity, unconditional acceptance, and empathy (Carl Rogers). These attitudes are embodied in the three principles proposed by SECPAL’s Spirituality group: hospitality, presence, and compassion. It is emphasized that suffering also affects the family and the care team, creating a resonance network that demands awareness and mutual care.
Spiritual support is thus presented as a clinical practice that does not require technical sophistication, but rather human maturity, openness, and inner connection on the part of the professional. Ultimately, one can “die well”: whole, at peace, and with trust, even at the threshold of life.
The article concludes that recognizing, addressing, and accompanying suffering from a holistic perspective not only humanizes medicine but also restores the dignity of both those receiving care and those providing it.

This third article in the series addresses the foundations of spiritual support in palliative care. It explores how to provide spiritual accompaniment to people living with advanced illness or at the end of life.
Spiritual support is understood as a relational process aimed at fostering integration and inner healing, helping individuals find meaning, purpose, and serenity amid suffering. This task is not limited to technique but involves the authentic presence of the professional, who becomes the primary therapeutic tool, as it is the professional’s attitudes that facilitate emotional co-regulation and promote a therapeutic bond that humanizes care.
The article emphasizes the importance of professional self-awareness and self-care as necessary conditions for sustaining a compassionate presence and preventing empathy fatigue or burnout. Cultivating an inner life, reflecting on one’s own relationship with finitude, and caring for one’s spirituality are pillars for the accompanying professional.
Additionally, the article reviews various clinical models and tools useful for spiritual care, all sharing an ethics of accompaniment based on conscious presence, acceptance, and respect for the patient’s process. The GES-SECPAL Spiritual Resources and Needs Assessment Questionnaire is also highlighted, designed to explore intrapersonal, interpersonal, and transpersonal aspects of spiritual experience.
The text concludes by identifying key challenges: integrating spiritual care into healthcare training, clarifying its clinical language, incorporating specific care records, and systematizing its practice within palliative care teams. Beyond being a professional competency, spiritual support is presented as an opportunity for personal transformation and reciprocal healing for both the caregiver and the person being accompanied.

Background: The growing presence of complex chronic patients (CCPs) and frail individuals in Primary Care reflects a demographic and epidemiological shift closely linked to the Global Burden of Disease (GBD). These patients typically present with multiple comorbidities, significant functional impairment, and frequently unmet or unidentified palliative care needs.

Objective: To assess the prevalence of frailty and palliative needs among CCPs and their association with clinical and sociodemographic indicators in a Primary Health Care Area.

Methods: Descriptive cross-sectional study in 401 patients identified as CCPs in a in a southern Spanish Primary Health Care area. Sociodemographic, clinical, and functional variables were analyzed, as well as frailty status and the identification of palliative needs. A bivariate analysis was performed to analyze the association between frailty and the variables collected.

Results: 46.6% of patients were classified as frail, 34.4% as pre-frail, and 19% as robust. 11.5% of patients were NECPAL positive, mostly frail (80.4%)

Conclusions: There is a high prevalence of frailty and palliative care needs in CCPs in PC, representing a hidden burden on the healthcare system. There is a clear need to identify these patients early and adapt comprehensive strategies to optimize care, improve quality of life, and reduce overload.