Decision Making, Health Services Research, Home Care, Hospital-Based, Palliative Care
Conditions
Keywords
multicriteria decision analysis, Palliative care, Home-based palliative care, Healthcare professionals, Multidisciplinary team, Professional perceptions, Decision making, Priority setting, Quality of care, Health services research, Professional training
Brief summary
This observational cross-sectional study evaluates and compares healthcare professionals' perceptions of key domains of home-based palliative care. Using an anonymous online survey and multicriteria decision analysis (MCDA) methods, the study explores perceived importance, strategic prioritization, and self-assessed performance across five core palliative care domains. The study is conducted across Hospital-at-Home units throughout the Valencian Community (Spain).
Detailed description
MULTIPAL is an observational, analytical, cross-sectional census survey designed to assess healthcare professionals' perceptions of home-based palliative care within Hospital-at-Home units. The study is grounded in international palliative care frameworks, including those promoted by the World Health Organization, which define palliative care as a multidimensional approach encompassing symptom control, psychosocial and spiritual care, communication, coordination, and professional well-being. Differences in professional priorities may influence clinical decision-making, coordination, and care quality. Despite increasing attention to palliative care quality indicators, professionals' perspectives-particularly in home-based settings-remain underexplored. The study applies complementary Multicriteria Decision Analysis methods (TOPSIS, PROMETHEE, Analytic Hierarchy Process) to evaluate and compare professional priorities across five predefined domains: symptom control; communication and shared decision-making; psychosocial and spiritual care; coordination and continuity of care; and support for healthcare professionals. Initially conceived as a single-center study, MULTIPAL was expanded to all Hospital-at-Home units in the Valencian Community to enhance representativeness, external validity, and relevance for system-level quality improvement.
Interventions
None listed
Sponsors
Instituto de Investigacion Sanitaria La Fe
Universitat Politècnica de València
Study design
Observational model
OTHER
Time perspective
CROSS_SECTIONAL
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* Healthcare professionals working in Hospital-at-Home units providing home-based palliative care within the Valencian Community.
Exclusion criteria
* Healthcare professionals without direct clinical or care-related responsibilities (e.g., administrative or non-clinical support staff) within Hospital-at-Home units.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| 1. Multicriteria prioritization of home-based palliative care domains (TOPSIS) | Baseline (single cross-sectional survey) | Relative prioritization of five predefined domains of home-based palliative care based on healthcare professionals' perceived importance and performance (symptom control; communication and shared decision-making; psychosocial and spiritual care; coordination and continuity of care; and support for healthcare professionals) . Measure: TOPSIS closeness coefficient for each domain . Unit of Measure: Closeness coefficient (0-1). Measurement Tool / Method: Multicriteria Decision Analysis using the Technique for Order Preference by Similarity to Ideal Solution (TOPSIS). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| 2. Preference-based ranking of palliative care domains (PROMETHEE) | Baseline (single cross-sectional survey) | Preference-based ranking of palliative care domains according to healthcare professionals' judgments: symptom control; communication and shared decision-making; psychosocial and spiritual care; coordination and continuity of care; and support for healthcare professionals. Measure: Net preference flow for each domain. Unit of Measure: Net preference flow score. Measurement Tool / Method: Preference Ranking Organization Method for Enrichment Evaluations (PROMETHEE). |
| 3. Hierarchical weighting and consistency of each domain importance (AHP) | Baseline (single cross-sectional survey) | Assessment of relative importance and internal consistency of professional judgments for the following domains: symptom control; communication and shared decision-making; psychosocial and spiritual care; coordination and continuity of care; and support for healthcare professionals. Measure: Normalized priority weights and consistency ratio. Unit of Measure: Dimensionless. Measurement Tool / Method: Analytic Hierarchy Process (AHP). At survey completion. |
| 4. Interprofessional consensus on domain prioritization | Baseline (single cross-sectional survey) | Degree of agreement between professional groups regarding domain priorities. Measure: Absolute difference in ranking positions. Unit of Measure: Rank difference. Measurement Tool / Method: Comparison of TOPSIS-derived rankings between groups. At survey completion. |
| 5. Importance-performance gap in palliative care domains | Baseline (single cross-sectional survey) | Difference between perceived importance and perceived performance for each domain. Measure: Importance-performance gap score. Unit of Measure: Likert-scale score difference. Measurement Tool / Method: Direct calculation from survey ratings. |
| Variation in domain prioritization by professional and experiential factors | Baseline (single cross-sectional survey) | Exploratory differences in priorities according to professional role, experience, age, and gender. Measure: Differences in MCDA-derived scores. Unit of Measure: Method-specific. Measurement Tool / Method: Subgroup analyses using TOPSIS, PROMETHEE, and AHP estimators. |
Countries
Spain
Contacts
PRINCIPAL_INVESTIGATORVicente Ruiz Garcia
Hospital at Home Unit - Hospital UiP La Fe, Valencia, Spain
STUDY_CHAIRElisa Soriano Melchor, MD, PhD
Hospital at Home Unit - Hospital UiP La Fe, Valencia, Spain
STUDY_DIRECTORAlberto Muñoz Cano, MD, PhD
Hospital at Home Unit - Hospital UiP La Fe, Valencia, Spain
Outcome results
None listed