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Resumen: Los cuidados paliativos son «responsabilidad ética de los sistemas de salud». La OMS propone la educación médica de grado y posgrado como una dimensión para evaluar su desarrollo en un país. En Latinoamérica, solo el 15% de las facultades de medicina tienen una asignatura de Cuidados Paliativos. En Argentina no existe aún consenso sobre contenidos básicos en los currículos de grado en Medicina. Método: este estudio buscó consensuar cómo debe ser un currículo de grado en Medicina Paliativa en Argentina utilizando la metodología Delphi. Se recogieron datos sociodemográficos (2019–2020), profesión, años de experiencia, educación universitaria, contenidos temáticos, modalidad pedagógica, plan de estudios y carga horaria. El análisis cuantitativo se realizó utilizando porcentajes y valores medios para indicar el nivel de acuerdo en las escalas de 5 puntos. Los rangos intercuartílicos se calcularon para proporcionar indicadores de acuerdo y consenso. Se realizó el análisis temático de contenidos. Resultados: se convocaron 250 expertos, de los cuales 85 respondieron a 2 rondas de consulta. Se alcanzó un alto grado de acuerdo para proponer 10 recomendaciones generales, dinámicas, flexibles, adaptadas a diferentes contextos. El 98% consideró necesaria la enseñanza de los cuidados paliativos de manera transversal y sugirieron una asignatura específica contextualizada a situaciones de pacientes crónicos y en fin de vida. Sin embargo, se observó una tensión entre el modelo de formación tradicional y la educación basada en competencias. El aprendizaje experiencial es apropiado, pero se recomendó la unión de la teoría con la práctica. Conclusión: por primera vez en Argentina se convocó un consenso de expertos que definió un conjunto de recomendaciones sobre contenidos, metodología de enseñanza, ciclo académico y competencias en cuidados paliativos. Abstract: Palliative care is an “ethical responsibility of healthcare systems”. The WHO proposes undergraduate and postgraduate medical education as one dimension to assess its development in a country. In Latin America, 15% of medical schools have an undergraduate palliative care course. In Argentina, there is still no consensus on the essential content of undergraduate medical curricula. Method: This study sought to reach a consensus on what an undergraduate curriculum in palliative medicine should look like in Argentina using the Delphi methodology (2019–2020). Sociodemographic data, profession, years of experience, university education, thematic content, pedagogical modality, study plan and hourly load were collected. Quantitative analysis was performed using percentages and mean values to indicate the level of agreement on 5-point scales. Interquartile ranges were calculated to provide indicators of agreement and consensus. Thematic content analysis was carried out. Results: Two hundred fifty experts were convened, of whom 85 responded to two rounds of consultation. A high degree of agreement was reached on ten general, dynamic, and flexible recommendations adapted to different contexts. 98% considered it necessary to teach palliative care transversally and suggested a specific course contextualised to chronic patients and end-of-life situations. However, there was a tension between the traditional training model and competency-based education. Experiential learning is appropriate, but linking theory and practice was recommended. Conclusion: For the first time in Argentina, a consensus of experts was reached, which defined a set of recommendations on content, teaching methodology, academic cycle and competencies in palliative care.

Introduction Adequately addressing the needs of patients at the end of life and their relatives is pivotal in preventing unnecessary suffering and optimising their quality of life. The purpose of the iLIVE study is to contribute to high-quality personalised care at the end of life in different countries and cultures, by investigating the experiences, concerns, preferences and use of care of terminally ill patients and their families.Methods and analysis The iLIVE study is an international cohort study in which patients with an estimated life expectancy of 6 months or less are followed up until they die. In total, 2200 patients will be included in 11 countries, that is, 200 per country. In addition, one relative per patient is invited to participate. All participants will be asked to fill in a questionnaire, at baseline and after 4 weeks. If a patient dies within 6 months of follow-up, the relative will be asked to fill in a post-bereavement questionnaire. Healthcare use in the last week of life will be evaluated as well; healthcare staff who attended the patient will be asked to fill in a brief questionnaire to evaluate the care that was provided. Qualitative interviews will be conducted with patients, relatives and healthcare professionals in all countries to gain more in-depth insights.Ethics and dissemination The cohort study has been approved by ethics committees and the institutional review boards (IRBs) of participating institutes in all countries. Results will be disseminated through the project website, publications in scientific journals and at conferences. Within the project, there will be a working group focusing on enhancing the engagement of the community at large with the reality of death and dying.Trial registration number NCT04271085.

Objectives: This study was aimed to analyse the effect of a patient-oriented modality of physical exercise (programmed and directed physical exercise (PDPE)) on cancer-related fatigue (CRF) and quality of life (QoL). The secondary aim was to evaluate changes in body composition and skeletal muscle function during the study in patients with and without PDPE., Methods: A prospective randomised study was conducted to analyse the impact of PDPE on CRF and QoL. Patients were selected before the development of CRF to set the intervention before its appearance. A high probability CRF population was chosen: patients with advanced gastrointestinal cancer undergoing chemotherapy with weight loss (≥5%) over the last 6 months. PDPE consisted of a programme of exercise delivered weekly and adjusted to patients' medical conditions. Four visits were planned (weeks 0, 4, 8 and 12). QoL, CRF, body composition and skeletal muscle function were evaluated in each visit., Results: From 101 patients recruited, 64 were considered evaluable, with three or four visits completed (n=30 control, n=34 PDPE group). Satisfactory compliance of ≥50% to the PDPE programme was seen in 47%. A reduction in the severity of fatigue was detected in the PDPE group (p=0.019), being higher in the subgroup of satisfactory compliance (p<0.001). This latter group showed better results of QoL in comparison with the control group (p=0.0279). A significant increase in endurance was found in the PDPE group (p<0.001)., Conclusion: PDPE reduced the severity of fatigue and improved QoL. The difference in endurance would explain the results seen in the severity of fatigue., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.)

Context: Progress in palliative care (PC) necessarily involves scientific development. However, research conducted in South America (SA) needs to be improved., Objectives: To develop a set of recommendations to advance PC research in SA., Methods: Eighteen international PC experts participated in a Delphi study. In round one, items were developed (open-ended questions); in round two, each expert scored the importance of each item (from 0 to 10); in round three, they selected the 20 most relevant items. Throughout the rounds, the five main priority themes for research in SA were defined. In Round three, consensus was defined as an agreement of ≥75%., Results: 60 potential suggestions for overcoming research barriers in PC were developed in round one. Also in Round one, 88.2% (15 of 17) of the experts agreed to define a priority research agenda. In Round two, the 36 most relevant suggestions were defined and a new one added. Potential research priorities were investigated (open-ended). In Round three, from the 37 items, 10 were considered the most important. Regarding research priorities, symptom control, PC in primary care, public policies, education and prognosis were defined as the most relevant., Conclusion: Potential strategies to improve scientific research on PC in SA were defined, including stimulating the formation of collaborative research networks, offering courses and workshops on research, structuring centers with infrastructure resources and trained researchers, and lobbying governmental organizations to convince about the importance of palliative care. In addition, priority research topics were identified in the region., (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Cancer incidence in the world is predicted to increase in the next decade. While progress has been in diagnosis and treatment, much still remains to be done to improve cancer pain therapy, mainly in underserved communities in low-income countries. Objective: To determine knowledge, beliefs, and barriers regarding pain management in both high- and low-income countries (according to the WHO classification); and to learn about ways to improve the current state of affairs. Design: Descriptive survey. Setting/Subjects: Fifty-six countries worldwide; convenience sample of 1639 consisted of 36.8% physicians; 45.1% nurses, and 4.5% pharmacists employed in varied settings. Results: Improved pain management services are key elements. Top barriers include religion factors, lack of appropriate education and training at all levels, nonadherence to guidelines, patients' reluctance to report on pains, over regulation associated with prescribing and access to opioid analgesics, fear of addiction to opioids, and lack of discussions around prognosis and treatment planning. Conclusion: The majority of patients with cancer in low-income countries are undertreated for their pain. Promoting cancer pain accredited program of training and education on pain management for physicians and nurses is crucial, as well as advocating policymakers and the public at large.

Background: In contrast to typical measures employed to assess outcomes in healthcare such as mortality or recovery rates, it is difficult to define which specific outcomes of care are the most important in caring for dying individuals. Despite a variety of tools employed to assess different dimensions of palliative care, there is no consensus on a set of core outcomes to be measured in the last days of life. In order to optimise decision making in clinical practice and comparability of interventional studies, we aim to identify and propose a set of core outcomes for the care of the dying person., Methods: Following the COMET initiative approach, the proposed study will proceed through four stages to develop a set of core outcomes: In stage 1, a systematic review of the literature will identify outcomes measured in existing peer reviewed literature, as well as outcomes derived through qualitative studies. Grey literature, will also be included. Stage 2 will allow for the identification and determination of patient and proxy defined outcomes of care at the end of life via quantitative and qualitative methods at an international level. In stage 3, from a list of salient outcomes identified through stages 1 and 2, international experts, family members, patients, and patient advocates will be asked to score the importance of the preselected outcomes through a Delphi process. Stage 4 consists of a face-to-face consensus meeting of international experts and patient/family representatives in order to define, endorse, and propose the final Core Outcomes Set., Discussion: Core Outcome Sets aim at promoting uniform assessment of care outcomes in clinical practice as well as research. If consistently employed, a robust set of core outcomes for the end of life, and specifically for the dying phase, defined by relevant stakeholders, can ultimately be translated into best care for the dying person. Patient care will be improved by allowing clinicians to choose effective and meaningful treatments, and research impact will be improved by employing internationally agreed clinically relevant endpoints and enabling accurate comparison between studies in systematic reviews and/or in meta-analyses.

Background: This research presents a short version of the Professional Quality of Life (ProQOL) scale, one of the most frequently used questionnaires in the arena of applied healthcare investigation. It measures burnout (BO), compassion fatigue (CF), and compassion satisfaction (CS)., Methods: A 9-item version of the ProQOL was developed. In Study 1, this short version, which used items from version IV of the ProQOL, was administered to 817 palliative care professionals from Spain, Argentina, and Brazil. In Study 2, the same nine items, but this time from version V of the ProQOL, were administered to 296 Spanish palliative care professionals., Results: Study 1: The Short ProQOL showed an adequate internal structure, and invariance across the countries studied (χ 2 (106) = 185.620 (p < 0.001), CFI = .929, RMSEA = 0.058 [0.044, 0.072], SRMR = 0.081). Argentinians showed higher levels of BO (mean difference = 0.172, p = 0.042, Cohen's d = 0.168), whereas Brazilians showed higher levels of CF (Mean difference = 0.384, p = 0.002, Cohen's d = 0.352). Study 2: the Short ProQOL again showed adequate internal structure and reliability (χ 2 (24) = 134.504 (p < 0.001); CFI = 0.953; RMSEA = 0.126 [0.106, 0.147]; SRMR = 0.063), and was related to coping with death, self-compassion, and self-care., Conclusions: The Short ProQOL could help facilitate the application of harmonizing measurements and its use for cross-cultural comparisons and occupational health monitoring was satisfactory.

Context: The coping with death competence is of great importance for palliative care professionals, who face daily exposure to death. It can keep them from suffering compassion fatigue and burnout, thus enhancing the quality of the care provided. Despite its relevance, there are only two measures of professionals' ability to cope with death. Specifically, the Coping with Death Scale (CDS) has repeatedly shown psychometric problems with some of its items., Objective: The aim of this study was to develop and validate a short version of the CDS., Methods: Nine items from the original CDS were chosen for the short version. Two cross-sectional surveys were conducted in Spanish (N = 385) and Argentinian (N = 273) palliative care professionals. The CDS and the Professional Quality of Life Scale were used in this study. Statistical analyses included two confirmatory factor analyses (CFAs), followed by a standard measurement invariance routine. Reliability estimates and evidence of validity based on relations with other measures were also gathered., Results: CFA models had excellent fit in both the Spanish (χ 2 (27) = 107.043, P < 0.001; Comparative Fit Index [CFI] = 0.978; Tucker-Lewis Index [TLI] = 0.970; Root Mean Square Error of Approximation [RMSEA] = 0.093 [0.075, 0.112]; Standardized Root Mean Square Residual = 0.030) and Argentinian (χ 2 (27) = 102.982, P < 0.001; CFI = 0.963; TLI = 0.950; RMSEA = 0.106 [0.085, 0.128]) samples. A standard measurement invariance routine was carried out. The most parsimonious model (χ 2 (117) = 191.738, P < 0.001; CFI = 0.987; TLI = 0.992; RMSEA = 0.046 [0.034, 0.058]; Standardized Root Mean Square Residual = 0.043) offered evidence of invariance across countries, with no latent mean differences. Evidence of reliability and evidence of validity based on relations with other measures were also appropriate., Conclusion: Results indicated the psychometric boundaries of the short version of the CDS., (Copyright © 2018 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.)

About 75% of population will die from one or more chronic progressive diseases. From this projection WHO urged countries to devise strategies for strengthening palliative treatment as part of comprehensive care. In Catalonia, Spain, direct measurement of the prevalence of these patients with NECPAL CCOMS-ICO© tool was 1.5% of the population. This tool is an indicative, not dichotomous, quali-quantitative multifactorial evaluation to be completed by the treating physician. In Argentina there is no information on these patients. Our goal was to explore and characterize the proportion of chronically ill patients in palliative care needs, by NECPAL CCOMS-ICO© tool, in an accessible population of the City of Buenos Aires. General hospitals of the Health Region 2 (Piñero, álvarez and Santojanni) and its program areas were surveyed. In Health Region 1, we surveyed the Udaondo gastroenterology hospital. A total of 53 physicians (704 patients) were interviewed. It was identified that 29.5% of these patients were affected by advanced chronic diseases; 72.1% of them were NECPAL positive, younger (median 64) than in others studies, and more than 98% presented high levels of comorbidity. Palliative care demand (31.4%) and needs (52.7%) were recorded. Specific indicators of fragility, progression, severity and kind of chronic disease were described. The main finding was to identify, with an instrument not based on mortality that, in Buenos Aires City, 1 in 3 patients with chronic diseases could die in the next year and had palliative care needs.

Background: end-of-life decision making is an important aspect of end-of-life care that can have a significant impact on the process of dying and patients' comfort in the last days of life., Aim: the aim of our study was to identify issues and considerations in end-of-life decision making, and needs for more evidence among palliative care experts, across countries and professions., Participants: 90 palliative care experts from nine countries participated in a modified Delphi study. Participants were asked to identify important issues and considerations in end-of-life decision making and to rate the need for more evidence., Results: experts mentioned 219 issues in end-of-life decision making related to the medical domain, 122 issues related to the patient wishes and 92 related to relatives' wishes, regardless of profession or country (p > 0.05). In accordance, more than 90% of the experts rated the comfort and wishes of the patient and the potential futility of treatment as important considerations in end-of-life decision making, although some variation was present. When asked about issues that are in need of more evidence, 87% mentioned appropriate indications for using sedatives and effects of artificial hydration at the end of life. A total of 83% mentioned adequate communication approaches., Conclusions: palliative care experts from different professions in different countries encounter similar issues in end-of-life decision making. Adequate communication about these issues is universally experienced as a challenge, which might benefit from increased knowledge. This shared experience enables and emphasizes the need for more international research.