Salvador Martin Utrilla

Background/Objectives: Palliative sedation may relieve refractory suffering in patients with advanced cancer receiving end-of-life care at home. We aimed to describe patient characteristics, palliative sedation use, refractory symptoms, and sedation-related outcomes in a specialized hospital-at-home unit. Methods: We conducted a retrospective observational study of patients with advanced cancer who died during 2022 while receiving care from the Instituto Valenciano de Oncología hospital-at-home unit, Spain. Admission required clinical and social assessment confirming the need for hospital-level home care, feasibility of care at home, and adequate caregiver support. Sociodemographic, clinical, and sedation-related data were obtained from medical records. Analyses were descriptive and exploratory; associations were unadjusted. Results: The cohort included 113 patients; 80 (70.8%) received palliative sedation. Median age was 76 years (IQR, 19), and 59 patients (52.2%) were men. An elastomeric infuser was used in 74 sedated patients (92.5%). Sedation duration had a median of 1 day (IQR, 2; range, 0–10). Symptom documentation was available for 56 sedated patients (70.0%); dyspnea was documented in 35 (62.5%), delirium in 19 (33.9%), and pain in 14 (25.0%). Symptoms could coexist. The median number of parenteral medications was 4 (IQR, 1). Conclusions: Palliative sedation was frequently used in this selected specialized home-care cohort and generally lasted a short period. The prevalence should not be generalized to other settings. Incomplete documentation and the retrospective, single-centre design limit interpretation. Prospective multi-centre studies are needed.

Hospital at Home (HaH) enables advanced cancer patients to receive end-of-life care in their preferred setting, yet evidence on home-based palliative sedation (PS) remains limited. This retrospective observational study included 113 patients who died in 2022 under the HaH Unit of the Instituto Valenciano de Oncología (Valencia, Spain). Sociodemographic, clinical, and PS-related variables were extracted from medical records. PS was required in 80 patients (70.8%). The median age was 76 years (IQR 19), 52.2% were male, and 77% lived in their own homes. Dyspnoea (43.7%) and delirium (23.7%) were the most frequent refractory symptoms leading to PS. Elastomeric infusers were used in 92.5% of cases. The median duration of PS was 1 day (IQR 2); 46.3% of patients died within 24 hours of initiation. A significant inverse correlation was found between the Barthel Index and PS duration (Spearman’s Rho = −0.226, p = 0.044), indicating shorter survival after sedation in patients with greater functional dependence. No significant associations were observed between PS requirement and multimorbidity, geriatric syndromes, polypharmacy, or prior opioid use. These findings support the feasibility of complex PS at home and highlight functional status as a potential determinant of PS duration, informing protocol optimization for home-based end-of-life care.

Perceived competence is a subject’s perception of being able to interact effectively with the environment. Perceived Competence in the face of death in Nursing degree programs in which the presence of the subject of death and bereavement is key becomes more topical and relevant. The objective of this study is to determine whether this competence is improved through Nursing Studies. This study was designed as paired repeated intrasubject measures, initial measurement at the beginning of the first year and second measurement in the fourth year of the Nursing degree. One hundred and seventeen nursing students were assessed. Significant improvement is evidenced in three of the four dimensions of Perceived Competence in the face of death (Accompaniment and Communication: 25.70/29.34; Self-Confidence: 9.64/12.78; Management of Self-Fear: 13.18/14.66). These results show notable differences with their cross-sectional predecessors, suggesting the need for further studies in this field to consolidate a still developing body of knowledge.

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Welcome to the largest platform for early-stage research