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).
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.
Study Type
OBSERVATIONAL
Enrollment
580
Hospital Universitari i Politècnic La Fe
Valencia, Valencia, Spain
1. Multicriteria prioritization of home-based palliative care domains (TOPSIS)
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).
Time frame: Baseline (single cross-sectional survey)
2. Preference-based ranking of palliative care domains (PROMETHEE)
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).
Time frame: Baseline (single cross-sectional survey)
3. Hierarchical weighting and consistency of each domain importance (AHP)
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.
Time frame: Baseline (single cross-sectional survey)
4. Interprofessional consensus on domain prioritization
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.
Time frame: Baseline (single cross-sectional survey)
5. Importance-performance gap in palliative care domains
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.
Time frame: Baseline (single cross-sectional survey)
Variation in domain prioritization by professional and experiential factors
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.
Time frame: Baseline (single cross-sectional survey)
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