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Objective: This study describes the utilization patterns of subcutaneous drug administration within the clinical research framework of palliative care focusing on patients treated at the University Hospital of Móstoles.
Patients and method: Conducted as a retrospective observational study, this investigation meticulously analyzed patient records in the admission regime between January 2022 and March 2023. Sociodemographic, clinical and data related to the use of the subcutaneous route were recorded. The data were analyzed using SPSS version 30.0. Global descriptive statistics were stratified according to whether the subcutaneous route was used. Data regarding the use of the subcutaneous route were further stratified based on whether patients had cancer.
Results: 297 patients were included. Subcutaneous route was used in 37.04 % of cases. Subcutaneous route use varied depending on the diagnosis, being more prevalent in patients with dementia (65.5 %), and was associated with non-cancer patients. The main reason was symptomatic control (68.2 % of cases), especially in cancer patients (76.6 %). A different profile of symptoms to be controlled was identified between cancer patients (pain, agitation, dyspnea) and non-cancer patients (dyspnea, agitation, secretions), although no significant differences were found either in the drugs used (mainly morphine chloride, butylscopolamine, midazolam and haloperidol) or in the use of the route (greater use of continuous perfusion).
Conclusions: Our results suggest a low use of the subcutaneous route in palliative patients in hospital settings, despite being considered an effective and safe therapeutic alternative for the management of palliative patients. Its predominant use was observed in non-cancer patients and for symptomatic control. Insufficient records of the location catheter placement and complications associated with the use of the route, as well as the retrospective collection of data, were important limitations of the study. This study lays the groundwork for further research in this field.

Fibrodysplasia ossificans progressiva (FOP) is a rare genetic disease characterized by heterotopic ossification.
The article describes the case of a patient diagnosed at age 7, who exhibited numerous ossifications throughout his body. Despite receiving symptomatic treatment, the patient developed progressive stiffness. He required palliative care at home, but was unable to receive specialized treatment due to difficulties in mobilization.
This article highlights the family support and the care provided by primary and palliative care teams. It emphasizes the importance of comprehensive care for patients with FOP, focusing not only on treating physical symptoms but also on providing emotional support to patients and their families.

Malignant bowel obstruction (MBO) is a common complication in patients with advanced cancer, particularly ovarian cancer. Its management is complex and its prognosis remains poor. We present the case of a patient with stage IV serous carcinoma who developed an intestinal perforation complicated by extensive subcutaneous emphysema.

The end of life is a situation inherent to human beings, it can occur at any time throughout life; secondary to the evolution of chronic diseases that are accompanied by physical and psychological deterioration, which makes it necessary to understand care through competencies in health personal.
Objective: determine the association between the attitudes and knowledge of nursing staff about end-of-life care in Cartagena during the year 2022. Materials and methods: Quantitative, cross-sectional and analytical study. The sample consisted of 163 individuals selected in a non-probabilistic manner. A sociodemographic instrument was applied on knowledge and attitudes towards the terminally ill patient. Results: There were professionals (48.5%) and assistants (51.5%), aged between 19 and 29 years (49.7%), women (72.4%), single (41.7%), low strata (79.1%), who had worked in intensive care (72.4%), for 1 to 2 years (35.6%). Attitudes towards the terminally ill were good among professionals (82.3%) and assistants (81%). Knowledge in this regard was inadequate in professionals (69.6%) and assistants (84.5%). It was found that knowledge was correlated with behavioral attitudes (p <0.05). Conclusion: The Nursing staff had good attitudes and inadequate knowledge in relation to oxygen saturation, opioids and NSAIDs. However, it is worth highlighting the fact that both staff members are aware of issues related to sedation and suffering in the terminal phase.

Introduction
Within Compassionate Communities, "Death Cafés" are organized as community spaces where people gather to talk openly about death in order to normalize dialogue around this topic.
Objective
To assess the effectiveness of "A Coffee with You: Caring and Accompanying Until the End" as a tool for raising awareness about death and the end of life among different population groups and to compare the tool's implementation in different Spanish-speaking contexts.
Materials and Methods
An exploratory quantitative cross-sectional study in which a total of 372 participants in the "A Coffee with You: Caring and Accompanying Until the End" workshops conducted during 2023 (n=22) completed a survey. An ad hoc questionnaire was designed to assess participants' self-esteem and measure their emotional distress using the Distress Thermometer (DT).
Results
Through a factor analysis of all items, three dimensions were identified: 1) the usefulness, relevance, and effectiveness of talking about death, 2) the logistical issues associated with the dynamics, and 3) the management and development of the event. Participants positively rated the “A Coffee with You: Caring and Being with You Until the End” program, with high scores for most items, highlighting its effectiveness in breaking the taboo surrounding death (x̄ Spain = 4.71, x̄ Argentina = 4.92) and the personal resources provided by talking about this topic (x̄ Spain = 4.57, x̄ Argentina = 4.93). A significant but moderate reduction in psychological distress was observed.
Conclusions
The results demonstrate the potential of “A Coffee with You: Caring and Being with You Until the End” as a facilitator of both public awareness and the breaking of the social taboo surrounding death and the end-of-life proces

-Introduction: Neuropathic pain, common in paediatric patients with palliative needs, is difficult to manage, even more, when the enteral route is lost. In recent years, parenteral drugs have been used in the adult population to solve this problem. In Paediatrics there are no standardised indications.
-Main objective: to describe the evidence on the use of parenteral clonidine, lidocaine, ketamine and dexmedetomidine for the control of neuropathic pain in children with palliative needs.
-Materials and methods: Narrative review with systematic methodology of the literature from January 2014 and January 2025. Clinical trials, narrative reviews and descriptive studies in English and Spanish with population <18 years with neuropathic or chronic pain are included. The methodological quality of the included studies was assessed.
-Results: 20 articles were included out of an initial 2326. The unit of analysis consisted of 11 descriptive studies, 8 narrative reviews and 1 systematic review.
-Conclusions: there is insufficient quality evidence on the use of the four drugs for neuropathic pain control in the paediatric population. Neuropathic pain control and opioid sparing are prominent indications. The review has made it possible to suggest safe dosing intervals. Side effects of the drugs were mild and self-limited after dose adjustments. Each of the drugs has particularities to be taken into account in their use.

Introduction: Palliative care coverage in the pediatric population is insufficient. The barriers and facilitators for access to it in Colombia are unknown.
Objective: To determine barriers, facilitators and interaction practices perceived by palliative care and pediatric professionals in Colombia.
Method: Cross-sectional observational quantitative study. Pediatric and palliative care professionals who are members of Colombian associations answered an ad hoc virtual survey. Descriptive and comparative statistics were obtained.
Results: 105 professionals participated (response rate of 10.36%), 66.45% worked in institutions with pediatric and palliative care services. The professionals agree in perceiving barriers from national and health system policies, institutional, from family members/caregivers and some facilitators from palliative care professionals, while they differ in their perceptions of barriers from pediatrics and facilitators for interaction. They consider that palliative care are mainly integrated in the planning of care and end-of- life interventions.
Conclusions: Professionals perceive multiple barriers and some facilitators for interaction, as well as specific situations in which palliative care are integrated, which can serve to establish measures where required. There is an urgent need to improve training, establish national policies and guarantee resources to optimize care and respond appropriately to the needs of children and adolescents and their families.

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.