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Introduction: The perspective of families caring at home for children with life-limiting illnesses, who are attended by a paediatric palliative care team 24 hours a day, 365 days a year (24/7), has been little explored.
Objective: To know families’ experiences regarding the care received at home (24/7) by a Paediatric Palliative Care Team.
Patients and Method: Interpretative phenomenological study. Intentional sampling was conducted among mothers, fathers, and caregivers (families) of children cared for by a specific team in Spain. Data collection was carried out through open-ended online questionnaires, focus groups, and field notes. Thematic analysis was performed following COREQ guidelines and the established norms for qualitative research reporting.
Results: Twenty-nine subjects participated in the study. 86.20% were women, most of them being mothers (89,65%), and 72,41% were dedicated full-time to the child’s care.
Two main topics (Normalizing the extraordinary; and Paediatric Palliative Care saved our lives), and 7 subtopics (difficulties of daily life; the child provides the sense; experience; support; my life before palliative care; the moment I was referred to palliative care; and care in pediatric palliative care) arise.
Discussion - Conclusions: These families expressed their suffering until they were treated by this Paediatric Palliative Care Team. They felt they had arrived there too late. Home hospitalisation 24/7 through a Paediatric Palliative Care Team is a new mode of care in Spain that prevents hospital admissions and improves the lives of these families. "Palliative care has saved our lives" reflects the change that this resource has brought to their lives. Further research is needed to explore the feasibility of implementing this model of care, to improve information-communication processes, and to enhance coordination between care levels.

We present the case of a 71-year-old woman with a complex history of rheumatoid arthritis and interstitial pneumonitis with pulmonary fibrosis receiving palliative care. She consulted our department for the appearance of skin lesions that initially did not improve with antibiotic treatment and corticosteroids. After an exhaustive interdisciplinary assessment, she was given a diagnosis of pellagra, a vitamin B3 deficiency, which was effectively treated with niacinamide and dietary adjustments. This case underlines the importance of early identification of nutritional deficiencies also in palliative patients, as well as the need for close collaboration between medical specialties to optimize comprehensive patient management.

Introduction: Malnutrition is a common problem in cancer patients, affecting up to 80% of those with advanced disease. The European Society for Clinical Nutrition and Metabolism (ESPEN) recommends the use of the MUST (Malnutrition Universal Screening Tool) at the community level for nutritional risk screening.
Objective: To evaluate the risk of malnutrition in oncology outpatients using the MUST.
Methods: This was an observational study with prospective inclusion of cancer patients receiving outpatient treatment at two Day Hospitals in Valladolid, Spain, and Santa Fe, Argentina. Data were collected through anonymous forms. Categorical variables were summarized as frequencies and percentages, and quantitative variables as mean ± standard deviation or median ± interquartile range (IQR), as appropriate. Statistical analysis employed Chi-square tests, Student’s t-test, or Mann-Whitney U test. A binary logistic regression model was constructed with significant variables.
Results: A total of 61 patients were included, 31 from Argentina and 30 from Spain, of whom 55.7% were women. The mean age was 60 ± 13 years. 42.6% had metastatic disease. 93.4% reported symptoms that interfered with eating, with a median of 2 symptoms per patient (IQR 1-4). According to the MUST, 47.5% had a low risk of malnutrition, 29.5% had a medium risk, and 23% had a high risk. Anorexia and scores on the Palliative Performance Scale (PPSv2) were independent predictors of medium or high risk of malnutrition.
Conclusions: The risk of malnutrition in oncology outpatients was medium or high in more than half of the cases. These findings highlight the importance of systematic nutritional screening in cancer patients, especially those with anorexia or low PPSv2 scores.

Introduction: Heart failure (HF) represents a public health challenge, especially in advanced stage, where informal caregivers play a crucial role in obtaining good health outcomes in patients.
Objective: To determine the factors associated with the Quality of Life (QoL) of informal caregivers of patients with advanced HF treated in two high complexity health institutions in Bogota.
Patients and methods: Cross-sectional analytical study that included informal caregivers of patients with advanced HF who were receiving outpatient or home-based care between August 2022 and January 2024. Sociodemographic, clinical variables, level of burden, QoL and caregiving characteristics were analyzed using descriptive statistics. A multiple linear regression model was performed to determine the factors associated with caregiver QoL.
Results: Of the 117 caregivers, the majority were female (87.2%), and 59.8% (70/117) were the children who assumed the caregiving role. Of the caregivers, 55.6% reported a below-average QoL, and 68% had burden (mild or severe). Both intense burden and the number of hours dedicated to daily caregiving were associated with decreased QoL (β -17.05 [-21.80, -12.30]; p=0.000 and β -0.31 [-0.62, -0.00]; p=0.048 respectively). However, intense burden affected all dimensions of QoL (physical well-being β -3.14 [-4.40; -1.88]; p=0.000, psychological well-being β -5.26 [-7.47, -3.04]; p=0.000, social well-being β -8.75 [-10.52, -6. 98]; p=0.000 and spiritual well-being β -1.42 [-2.68, -1.57] p=0.028); while hours dedicated to daily caregiving primarily social (β -0.10 [-0.19, -0.00]; p=0.047) and psychological well-being (β -0.16 [-0.29; -0.02]; p=0.030).
Conclusion: It is evident that a significant proportion of informal caregivers experience burden and deterioration of their QOL. Caregiving hours and overload are associated with reduced QOL. It is crucial to develop strategies or interventions aimed at strengthening training, self-care, community networking and interdisciplinary collaboration that contribute to the caregiver's well-being.

Background: Curricular integration of palliative medicine at the undergraduate level is essential to responding to the growing burden of health-related suffering. EDUPALL is a standardised curriculum in palliative medicine for medical education in Europe. The study aims to translate, adapt, and validate EDUPALL so that it can be integrated into the undergraduate medical curriculum in Chile.
Methods: A sequential exploratory mixed design with three components was used and conducted between October 2023 and August 2024. The process included the following steps: 1) Translation and adaptation of the EDUPALL matrices to the Chilean medical and academic context by the research group using a modified nominal group technique. 2) Validation through an online survey directed at palliative medicine specialists, who evaluated the degree of agreement with the five curricular items and provided comments through an open question. 3) Integration of participants' suggestions into the final version of the EDUPALL-Chile curriculum by the research group using a modified nominal group technique and comparison with the Chilean medical graduate profile competencies. Descriptive statistical analysis and framework analysis were applied.
Results: The EDUPALL matrices were successfully translated and adapted to the Chilean clinical and academic context. Validation with nineteen specialists (42%) resulted in a very high level of agreement in 4 of the 5 curricular items and a high degree of agreement in one. Nine relevant modifications were made. The competencies from EDUPALL-Chile were aligned with those of the Chilean medical graduate profile. Ten recommendations were formulated for curricular integration in undergraduate medicine programs.
Discussion: The EDUPALL-Chile matrices are valid for integration into the undergraduate medical curriculum in Chile. However, integration will require evaluation and future adaptations specific to the local context to ensure successful curricular implementation. This study supports undergraduate curricular development in Latin America.

Objective: To review demoralization syndrome (DS), concept, measurement scales and treatment options.
Methodology: Systematic review of DS between January 2008 and Febreury 2024.
Results: There are different definitions of DS and specialized instruments for its evaluation. Some therapeutic management, group and individual, could be applied to patients with DS. However, no specific treatment for DS was found.
Conclusions: Kissane (2001) proposes a more complete definition of DS. The most widely used instrument for the assessment of DS is the simplified DS-II scale. There are no psychological therapies to address DS, but some intervention techniques may have favorable results in addressing some of the symptoms of DS.

Objectives: This paper aims to describe and assess the frequency of care preferences expression, either through spontaneous expression or through inquiry by health professionals in patients in a palliative care program in home. To approximate the frequency of expression of these preferences, it was proposed to evaluate their registration in the clinical history.
Methods: The present study employs an observational, descriptive and transversal design. The electronic health record of patients in a palliative care program in the home setting in Bogotá and Cundinamarca, Colombia, was reviewed retrospectively, from July to December 2023. No comparison was made with other databases.
Results: The records of 284 patients were included, only 31% had any care preference registered. Patients with non-oncologic diagnosis were less likely to express care preferences while oncologic diagnosis patients were more likely to express them (28% vs. 41%) PR 1,74 (CI 95% 0,98-3,09) without statistical significance. Avoiding Cardiopulmonary Resuscitation was the most frequent preference (69%), followed by avoiding transfers to hospitalization (46%), and avoiding invasive diagnostic procedures (30%).
Conclusions: The results of this investigation show that recording of patient preferences is infrequent. More investigation is required to evaluate the causes of the low frequency of expression of these preferences, considering that they are a fundamental part of the care of patients with palliative needs.

Abstract
Objective: To analyze the knowledge, application, and barriers faced by healthcare professionals regarding Advance Care Planning, as well as to propose a formative and operational intervention model that facilitates its effective implementation across different levels of the healthcare system.
Methods: A search of articles published in the databases PubMed, Dialnet, Google Scholar, Scielo, and Scopus, from the last 10 years was carried out, the search began in November 2023 and ended in January 2024.
Results: 102911 studies were identified, of which 27 were selected according to the inclusion criteria. The findings were analyzed by grouping them into four: Knowledge of healthcare personnel about advance decision planning; Application of advanced decision planning; Barriers in its implementation; and Quality at the end of life. The review evidenced that, although there is an ongoing effort to expand knowledge about advanced decision planning, there are still persistent formative gaps that generate uncertainty in healthcare professionals and hinder its application in clinical practice.
Conclusions: Despite the continuous effort of health professionals to be trained in advance decision planning within palliative care, their knowledge remains limited. Its implementation facilitates decision making, reducing anguish in patients, family members and healthcare team, as well as avoiding unnecessary procedures. It is crucial to strengthen training in this field to improve the quality of end-of-life care.