Health-Related Quality of Life in Palliative Care: Determinants Identified in a Hospital-Based Observational Study

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Therefore, it is essential to identify which factors contribute most to the perception of well-being to develop timely intervention strategies. The aim of this study was to examine factors associated with health-related quality of life in adults with advanced disease of any etiology. Methods An observational cross-sectional study with a questionnaire based on the Functional Assessment of Chronic Illness Therapy – Palliative Care Spiritual Well-Being scale (FACIT-Sp) and performance status was conducted. Results Forty-two patients with life-threatening illnesses of 71.8 ± 11.29 years, 64.3% diagnosed with oncological disease. The mean Barthel Index was 59.5 ± 24.34, and an estimated survival prognosis of 50–60 days based on the Palliative Performance Scale. The mean FACIT-Sp was 87.9 ± 22.1, the highest scores observed in physical well-being dimension. Patients who engaged in some degree of physical activity the year prior to the study reported higher scores (103.51 ± 15.35 vs. 83.73 ± 21.88 [p = 0.015]). Additionally, participants with a primary caregiver—59.4% of whom were female—had higher scores on FACIT-G subscale (64.09 ± 13.48 vs. 53.38 ± 18.38 [p = 0.05]). The FACIT-Sp scale and its subscales demonstrated high reliability (Cronbach’s alpha = 0.889). Conclusions Engaging in some degree of physical activity and maintaining functional performance may be associated with a better perception of health-related quality of life in palliative care patients. Palliative care quality of life terminal care exercise Physical Functional Performance Spain caregivers Figures Figure 1 Figure 2 Background According to the World Health Organization, palliative care aims to improve the quality of life of patients and their families confronting life-threatening illnesses ( 1 ). While all chronic diseases may benefit from palliative interventions, in practice they are commonly categorized into groups: oncological conditions, which currently represent the largest share of advanced diseases; chronic organ diseases such as pulmonary, cardiac, and renal failure; dementias; neurodegenerative disorders such as multiple sclerosis or Parkinson’s disease; and certain infectious diseases, including HIV. Each condition follows a distinct trajectory. Although they generally share common physical symptoms such as pain, dyspnea, and fatigue, ( 2 , 3 ) certain differences exist. For example, neurological diseases are characterized by predominant functional decline and cognitive manifestations, including insomnia. Psychosocial and advance care planning needs are generally comparable across groups ( 4 ). Advanced disease is well established to negatively affect multiple dimensions of health-related quality of life (HRQoL) simultaneously ( 3 , 5 ). The philosophy of palliative care emphasizes enhancing quality of life for patients and families, as medical interventions cannot alter the underlying disease. Strong evidence supports the benefits of early palliative interventions on HRQoL ( 6 , 7 ), shaping the current model of care, which begins at diagnosis and extends throughout the disease trajectory, with particular attention to the final stages ( 8 ). HRQoL measurement tools for palliative populations should be in line with their care goals and frailty. Ideally, they should be multidimensional, thoug no single tool is universally optimal for all patients ( 9 ). Most available scales are multidimensional, but many omit the spiritual domain, which extends beyond religion and is fundamental in end-of-life care ( 10 , 11 ). Nonetheless, several HRQoL scales have been validated in this setting, with no major differences in outcomes across instruments ( 12 , 13 ). In Spain, it is estimated that 42–79% of individuals at the end of life require palliative care, yet only about 40% actually receive it ( 14 , 15 ). Despite the country’s strong contribution to palliative care research, there remains a pressing need to expand investigations, particularly in advanced non-cancer conditions ( 16 ). Such efforts are essential to meet the demands of an aging population and the rising prevalence of non-communicable chronic diseases. Furthermore, identifying the factors that influence HRQoL in palliative care patients—especially those amenable to intervention—is critical to improving current care strategies. Against this background, the present observational study was designed to explore factors associated with HRQoL and functional status in adult patients with advanced disease of any etiology admitted to a hospital-based palliative care unit. Methods Desing A retrospective observational study was conducted between February 1 of 2023, and February 29 of 2024, in patients with life-threatening illnesses of any etiology admitted to a hospital based palliative care unit in Spain. A cross-sectional measurement of HRQoL and physical function through a questionnaire was performed. A pilot study with five participants (three patients, one volunteer, and one palliative care professional) was conducted to refine the measurement instrument. Also, a self-administration was discarded due to the condition of the patients, and the questionnaire was administered bedside by the principal investigator. These preliminary results were not included in the final analysis. The STROBE Statement checklist for cross-sectional studies was used for this work ( 17 ) Setting/participants Medical records of patient admissions to the palliative care unit over a 12-month period were reviewed. Patients ≥ 18 years or older, diagnosed with an advanced disease of any etiology, and identified as needing palliative care based on the NECPAL tool were included ( 18 ) The following exclusion criteria were, participants with moderate to severe cognitive impairment assessed by Pfeiffer Short Portable Mental State Questionnaire (SPMSQ) ≥ 5 errors ( 19 ), also, patients with advanced dementia or Global Deterioration Scale (GDS) ≥ 6, as well as those in the end-of-life stage or Palliative Performance Status (PPS) ≤ 20. Given the vulnerable nature of the study population, efforts were made to keep data collection brief and eligible participants were already aware of their diagnosis and prognosis; to ensure confidentiality, each questionnaire was coded numerically. Data collection was carried out after a brief explanation of the investigation and the consent of each participant. A study-specific questionnaire was designed, consisting of two sections: The first section collected sociodemographic and clinical variables, including cognitive status assessed by Pfeiffer SPMSQ and functional status evaluated by the Palliative Performance Scale (PPS), a validated tool in palliative care, estimates survival based on functional performance, ranging from 100% (fully ambulatory and healthy) to 0% (death) ( 20 ) and Barthel Index a widely validated instrument in palliative care, was used to assess functional ability in daily activities ( 21 ). The second section contains the FACIT-Sp (Functional Assessment of Chronic Illness Therapy Palliative Care - Spiritual Well-Being version), a 39-item Likert-type scale scored from 0 to 4, that assess HRQoL through two subscales, the general questionnaire (FACIT-G) which is composed of key domains include physical, functional, emotional, and social/family well-being. And the specific questionnaire of palliative care and spiritual Well-Being, (FACIT-Sp-12). The total score can range from 0 to 156, where a higher score indicates a better HRQoL. This scale has been internationally validated and is available for use in Spanish ( 12 , 22 , 23 ). For this study, a license for the scale was obtained. The questionnaire was not administered to participants experiencing pain according to Visual Analog Scale (VAS) ≥ 4 or any other uncontrolled symptoms, in such cases, data collection was divided into two or more sessions to achieving symptomatic control. The final dataset was compiled and stored in a digital database using Microsoft Excel. Data analysis El The analysis of the database was performed using IBM Corp. Statistical Package for the Social Sciences Released 2020 (SPSS) for Windows, Version 29.0. Initially, an exploratory evaluation of the data was carried out, no missing values ​​ were found. A descriptive analysis was performed using measures of central tendency and dispersion for quantitative variables and categorical variables were presented as percentages, graphs, and frequency tables. The results of FACIT-SP scale, as a dependent variable, were compared across different groups. The magnitude of the association was assessed based on the type of independent variable. A t-test was used for quantitative variables in two independent groups, while an ANOVA test was applied for categorical variables with more than two groups. A p value < 0.05 was considered statistically significant. Additionally, a descriptive analysis was performed for each item of the FACIT-Sp scale, along with a reliability analysis of the scale and its main components (FACIT-Sp-12 and FACIT-G) using Cronbach's alpha coefficient. Results Sample characteristics After reviewing the medical records of 287 patients admitted to the palliative care unit between February 1, 2023 and February 29, 2024. 76 patients met the inclusion criteria (Fig. 1), of these, 34 were excluded, due to cognitive impairment (Pfeiffer ≥ 5 errors) or clinical deterioration (PPS ≤ 20). A final sample of 42 participants answered the questionnaire. During the interview only 14.28% had pain ≤ 3 according to the VAS. The sociodemographic and clinical characteristics are presented in Tables 1 and 2 . Most patients were male (61.9%), with a median age of 71.8 years [IQR 51–96]. The main place of medical care was the urban area. Prior to admission to the palliative care unit, 52.4% of patients lived alone and 40.5% lived with their families; nevertheless, most participants had a caregiver, who was female in 59.4% of cases. Table 1 Demographic characteristics All (N = 42) Age (years) Mean + SD 71.8 ± 11.29 Min - Max 51–96 Sex, n (%) Female 16 (38.1) Male 26 (61.9) Employment status, n (%) Currently working 1 (2.4) On medical leave 9 (21.4) Retired 20 (41.6) Not employed 12 (28.6) Place of medical care, n (%) Urban 39 (92.9) Rural 3 (7.1) Living arrangements, n (%) Lives with family 17 (40.5) Care home resident 3 (7.1) Lives alone 22 (52.4) Caregiver, n (%) Have 32 (76.2) Don´t have 10 (23.8) Table 2 Clinical characteristics All (N = 42) Etiology of advanced disease, n (%) Heart 2 (4.8) Lung 4 (9.5) Kidney 4 (9.5) Oncological 27 (64.3) Neurodegenerative 5 (11.9) Physical activity the last year, n(%) ≥ 150 min/week 2 (4.8) < 150 min/week 7 (16.7) None 33 (78.6) Errors on Pfeiffer scale 0 17 (40.5) 1 7 (16.7) 2 8 (19.0) 3 9 (21.4) 4 1 (2.4) Barthel index (0 -100) Mean + SD 59.5 ± 24.3 Range 10–95 Palliative Performance Scale (PPS) (0-100) Mean + SD 52.1 ± 11.4 Range 30–80 FACIT-Sp Total score (0–156) Mean + SD 87.9 ± 22.1 Range 40.5–134.3 In our sample, most patients were admitted for palliative care due to oncological disease (64.3%), mainly of lung origin, followed by colorectal and kidney cancer; 43.3% of these had metastatic disease. The second most common diagnosis was neurodegenerative disease (11.9%), primarily amyotrophic lateral sclerosis and multiple sclerosis. Except for advanced chronic kidney disease, male patients predominated across all groups. Pfeiffer test was normal (≤ 2) in 76.2% of patients, while 23.8% exhibited mild cognitive impairment. Performance status The functional ability to perform activities of daily living according to the Barthel Index (BI) was 59.5 ± 24.34. A total of 54.8% exhibited mild dependence (BI ≥ 60), whereas 14.3% had severe or total dependence (BI ≤ 30). The mean BI was 60.65 ± 21.35 for male participants and 57.56 ± 29.2 for females; however, this difference was not statistically significant (p = 0.69). Regarding etiology, patients with advanced cardiac disease had the highest BI (67 ± 18.39), while those diagnosed with neurodegenerative disease had the lowest (43.4 ± 27.4), with no statistically significant differences (p = 0.6). Respecting the Palliative Performance Scale (PPS), the mean score was 52.14 ± 11.37. Most patients (69%) had a PPS score ≥ 50, which corresponds to an estimated survival prognosis of approximately 50–60 days. No statistically significant differences were found in PPS scores by etiology, although patients with neurodegenerative disease had the lowest values (48 ± 4.47, p = 0.6). Figure 2 illustrates the distribution for both scales according to the diagnosis of advanced disease. A total of 21.4% of participants engaged in some type of physical activity, either regularly or irregularly, during the year preceding the study. Health-related quality of life The mean of HRQoL according the FACIT-SP in all participants was 87.9 ± 22.1 [IQR 40.5–134.33]. Table 3 presents the descriptive statistics for the FACIT-Sp scale and its subscales. The mean score of FACIT-G subscale was 61.54 ± 15.2. Among its dimensions, physical well-being (PWB) had the highest score, followed by emotional well-being (EWB), while functional well-being (FWB) had the lowest scores. The spiritual dimension according to the FACIT Sp-12 subscale had a mean score of 26.43. Table 3 FACIT-Sp results by dimensions All (N = 42) Mean ± SD Range Max possible value Cronbach’s alpha PWB (physical well-being) 17.69 ± 5.15 4–28 28 SWB (social well-being) 15.48 ± 6.19 0–25,6 28 EWB (emotional well-being) 15.05 ± 4.99 5–24 24 FWB (functional well-being) 13.33 ± 3.39 5–24 28 FACIT Sp-12 (Spiritual subscale) 26.43 ± 8.6 9–41 48 0.818 FACIT G score (General subscale) * 61.54 ± 15.2 27.5–93.33 108 0.831 FACIT-SP Total score + 87.9 ± 22.1 40.5–134.43 156 0.889 *FACIT G = SWB + EWB + FWB + FACIT-Sp Total score = SWB + EWB + FWB + FACIT Sp-12 SD: Standard deviation A univariate analysis of factors associated with FACIT-Sp scores is shown in Table 4 . As the main finding, the group of participants who engaged in some degree of physical activity during the year preceding the study had higher HRQoL, these differences were statistically significant across all measures: FACIT-SP Total Score (some degree: 103.51 ± 15.35 vs. none: 83.73 ± 21.88; p = 0.015), and its subscales: general FACIT-G subscale (some degree: 70.96 ± 13.35 vs. none: 58.97 ± 14.90; p = 0.035), and spiritual FACIT-SP-12 subscale (some degree: 32.56 ± 4.90 vs. none: 27.76 ± 8.68; p = 0.002). Also, participants with a primary caregiver exhibited higher scores; however, this was statistically significant only in the FACIT-G subscale (With caregiver: 64.09 ± 13.48 vs. Without caregiver: 53.38 ± 18.38, p = 0.05). Participants with neurodegenerative disease exhibited the lowest HRQoL across all outcomes. However, participants with heart disease, the spiritual dimension had an even lower value, with a statistically significant difference (FACIT Sp-12 subscale: 17 ± 1.41 p = 0.08). Table 4 FACIT Sp scale and subscales by groups FACIT Sp-Total score FACIT-G (General) FACIT Sp-12 (Spiritual) n (%) Mean ± SD CI (95%) Mean ± SD CI (95%) Mean ± SD CI (95%) Sex * p = 0.66 t = -0.44 p = 0.44 t = -0.77 p = 0.82 t = 0.22 Female 16 (38.1) 86.03 ± 20.14 75.90–95.72 59.21 ± 13.48 52.54–65.62 26.81 ± 9.13 22.25–31.18 Male 26 (61.9) 89.16 ± 23.49 80.10–97.88 62.97 ± 16.35 56.43–69.07 26.19 ± 8.44 22.95–29.9 Caregiver * p = 0.10 t = 1.67 p = 0.05 t = 2 p = 0.44 t = 0.76 Present 32 (76.2) 91.09 ± 20.41 84.33–97.67 64.09 ± 13.48 59.92–68.68 27 ± 8.62 23.97–30 Absent 10 (23.8) 77.98 ± 25.27 61.75–92.53 53.38 ± 18.38 41.54–64.09 24.6 ± 8.73 19–29.67 Etiology of advanced disease + p = 0.25 F = 1.39 p = 0.53 F = 0.80 p = 0.08 F = 2.2 Heart 2 (4.8) 73.08 ± 1.76 57.20–88.96 56.08 ± 3.18 27.49–84.67 17 ± 1.41 4.29–2971 Lung 4 (9.5) 95.08 ± 18.07 66.32 -123.83 64.33 ± 14.18 41.75–86.90 30.75 ± 6.39 20.57–40.93 Kidney 4 (9.5) 98.20 ± 23.05 61.51–134.9 67.70 ± 12.39 47.99–87.42 30.5 ± 11.84 11.65–49.35 Oncological 27 (64.3) 89.69 ± 21.60 81.14–98.23 62.46 ± 15.70 56.25–68.68 27.22 ± 7.83 24.12–30.32 Neurodegenerative 5 (11.9) 70.76 ± 25.72 38.82–102.7 51.56 ± 18.03 29.17–73.95 19.2 ± 8.67 8.43–29.97 Engaged in physical activity * p = 0.015 t=-2.53 p = 0.035 t=-2.18 p = 0.002 t=-3.5 Some degree 9 (21.4) 103.51 ± 15.35 92.81 -113.07 70.96 ± 13.35 61.81–79.13 32.56 ± 4.90 28.73–34.80 None 33 (78.6) 83.73 ± 21.88 75.92–91.18 58.97 ± 14.90 53.55–64.06 24.76 ± 8.68 21.84–27.76 Functional impairment + p = 0.33 F = 0.37 p = 0.52 F = 0.64 p = 0.96 F = 0.37 Mild 23 (54.8) 90.54 ± 20.94 81.48–99.59 63.97 ± 14.06 57.89–70.05 26.57 ± 8.44 22.91–30.22 Severe 13 (30.9) 84.97 ± 26.80 68.78 -101.18 59.05 ± 18.39 47.94–70.16 25.92 ± 10.09 19.82–32.02 Total 6 (14.3) 84.64 ± 16.57 67.24 -102.03 57.64 ± 12.98 44.02–71.26 27 ± 6.96 19.70–34.30 *: T test, +: Anova SD: Standard deviation, CI: Confidence interval Lastly, the reliability analysis of the FACIT-SP scale showed a Cronbach’s alpha coefficient of 0.889. Reliability coefficients for the subscales are summarized in Table 3 . Discussion This descriptive study aims to address the growing need to expand knowledge about the perception of well-being in palliative care, particularly in patients with life-threatening non-oncological illnesses, while acknowledging the inherent fragility of the life cycle in which they find themselves. This perspective may explain the relatively small final sample despite the high number of eligible patients after applying selection criteria, a situation already observed in this field, particularly in studies focusing on the final stages of life ( 16 , 24 ). Our sample comprised inpatients with different diagnoses admitted to the palliative care unit, most of whom had an estimated survival of approximately two months according to PPS values. Consistent with this, previous descriptive studies in palliative care units and hospices have shown that survival prognosis is generally limited, with a median survival of only a few weeks or less than three months, and somewhat longer among non-oncological patients ( 25 , 26 ). The overall HRQoL according to the FACIT-SP Total Score scale in our participants was 87.9 ± 22.1. Other studies have reported values for this scale; however, most of them focus on patients with specific diagnoses. For instance, 285 outpatients with advanced cancer reported a mean FACIT-SP Total Score of 99.8 ( 27 ), while in 150 patients with advanced heart failure a mean of 120.6 was recorded ( 28 ). When analysing the results based on the diagnosis of advanced disease, patients with neurodegenerative disease had the lowest HRQoL. This aligns with existing literature, which highlights the negative impact of neurological diseases on HRQoL from the early stages of diagnosis, reinforcing the need for the timely integration of palliative care ( 29 , 30 ). Oncological disease was the predominant diagnosis in our sample, aligning with European palliative care data, where up to 94% of patients had this diagnosis ( 31 ). Similarly, a Spanish study reported 92.1% of 63 patients from a palliative care unit had oncological diagnoses ( 32 ). A principal finding was that HRQoL scores were higher in participants who had undertaken any level of physical activity in the year prior to the study. These differences were statistically significant (p < 0.05) across all scales.. In this regard, it is well documented that physical activity is a non-pharmacological intervention with proven benefits for quality of life and symptom control in palliative care, provided it is adapted to individual needs and limitations. Most existing evidence derives from physiotherapy-guided interventions and rehabilitation groups ( 33 ), whereas our study examined the impact of any degree of activity, whether regular or irregular. Although no universal dose has been defined, in advanced disease the mere practice of physical activity represents a significant achievement given the symptom burden( 34 ). Greater benefits are likely to result from individualised prescriptions that account for functional status, symptom profile, and patient preferences ( 35 ). Furthermore, physical activity plays a crucial role in mitigating or reversing the progressive loss of functionality associated with advanced diseases ( 32 , 33 ), thereby improving HRQoL and reducing the caregiving burden ( 36 , 37 ). Additionally, higher HRQoL values were found in patients with lower levels of functional impairment according to BI, however, this difference was not statistically significant. Yet, this result remains relevant, as functionality, along with morbidity and mortality, is a key indicator for evaluating healthcare strategies, including palliative care ( 38 ). In our results, HRQoL scores across all scales were higher among participants with a primary caregiver. However, this difference was statistical significance only on the general FACIT-G subscale. Caregivers play a crucial role in managing patients with life-threatening illnesses, often performing complex tasks ( 39 ). Thus, their integration into periodic needs assessments is recommended ( 40 ). Studies on advanced cancer patients highlight social support as a key factor of improved HRQoL ( 41 ). Consistent with our findings, the literature reports a predominance of female caregivers, this predominance of women in caregiving role linked to high stress, anxiety, and fatigue ( 42 , 43 ). A local study of 77 caregivers found 66.2% were women, experiencing significant anxiety and fatigue, adversely affecting their well-being, and underscore the need for support strategies to mitigate the adverse effects of caregiving patients with advanced diseases ( 44 ). Despite this, evidence on caregivers' impact on patients' HRQoL and their own well-being remains limited due to scarce and heterogeneous research( 45 ). Among all the dimensions, Physical Well-Being (PWB) recorded the highest score. This result may be attributed to the extensive research on managing physical symptoms prevalent in all advanced diseases, such as pain, dyspnea, fatigue, nausea, and vomiting, in palliative care ( 46 ); consequently, these interventions are widely implemented, and the management of physical symptoms can be considered key to assessing the effectiveness of palliative care. ( 7 , 43 ). Emotional Well-Being (EWB) ranked second. Emotional support enhances HRQoL in patients and their families, alleviates depression and anxiety, and facilitate in disease understanding and end-of-life planning ( 47 , 48 ). In Spain, palliative care units adopt an interdisciplinary approach, including psychologists ( 49 ), which may explain our findings and highlights their crucial role in palliative care teams. Regarding the FACIT-Sp-12 subscale, our results indicate an acceptable level of spiritual well-being, scores above 40 suggest good spiritual well-being consistent with the literature ( 50 ). However, as previously mentioned, other dimensions received higher scores in the overall HRQoL assessment. Although medical literature suggests that spiritual care can improve quality of life in palliative care patients, the effect is generally small and not sustained over the long term ( 51 ). Based on our experience during interviews, we conclude that spirituality is a highly variable dimension that is difficult to quantify using a closed-question questionnaire. Therefore, we agree with other reports emphasizing the need for studies with greater methodological rigor to better understand the effect of spiritual care interventions ( 52 ). It is well established that the integration of palliative care into the treatment of life-threatening illnesses has a positive effect on HRQoL ( 53 , 54 ). However, the magnitude of this effect could be greater if palliative care were guided by the identification of patient-reported outcomes in terms of well-being, which may differ across populations. Additionally, such an approach could serve as a valuable tool for self-assessing the effectiveness of palliative care units. Although Spain ranks among the leading countries in palliative care research( 16 ), further studies, particularly on non-oncological advanced diseases, are needed to address the growing demands driven by increased life expectancy and the rising prevalence of chronic non-communicable diseases. Finally, the high reliability values of the FACIT-Sp scale observed in this study are consistent with findings from previous research ( 55 , 56 ), supporting its potential application in clinical practice. Strengths and limitations To the best of our knowledge, this is the first study in Spain to describe the most relevant aspects of HRQoL in palliative care patients with oncologic and no oncologic conditions, using validated tools to measure outcomes in terms of HRQoL and functional status. The present work provides original observational data supporting a care approach centered on the perceived well-being of patients with life-threatening illnesses. Despite its methodological rigor, certain limitations must be acknowledged. The main limitation of this study is the small final sample size. Despite a high number of annual admissions to the palliative care unit, few patients met the inclusion criteria due to end-of-life status, severe cognitive impairment, or rapid clinical deterioration between screening and intervention. This highlights the frailty of palliative care patients and constrained the scope of statistical analyses. A potential performance bias is also recognized, as the principal investigator was part of the palliative care medical team. Still, to minimize this, patients were informed that their responses would not influence their treatment. Due to the selection process, we acknowledge that our findings may not be fully generalizable to the entire population with palliative care needs. However, owing to its rigorous methodology, this study remains reproducible, its limitations are clearly identified for potential refinement, and it contributes to the advancement of high-quality evidence in related research. Conclusion According to our findings, engaging in some level of physical activity is an important determinant of better perceived HRQoL among patients with life-threatening illnesses. In palliative care, functional capacity is particularly significant, as patients prioritize maintaining independence beyond their illness. This study also sheds light on factors influencing HRQoL in both oncological and non-oncological populations. Although some observed differences did not reach statistical significance, their potential clinical relevance reinforces the importance of a comprehensive, patient-centered approach and the ongoing evaluation of existing care programs. Higher scores in physical well-being reflect the effectiveness of current interventions targeting symptom control, a cornerstone of palliative care. By contrast, the spiritual dimension, widely recognized as essential in clinical practice, remains challenging to quantify, underscoring the need for complementary methodological approaches to assess its contribution. Despite its limitations, we expect that the patient-reported outcomes of this study will contribute to enhancing the integrated approach to palliative care and encourage further research in this field, particularly among populations with advanced non-cancer diseases, while acknowledging their vulnerability and specific needs Declarations Ethical considerations and consent to participate This study adheres to the ethical standards of the Declaration of Helsinki and has been approved by the ethics committees of Hospital Universitario Ramón y Cajal (Reg. No. 311-22 acta 433 CEIM) and Universidad Rey Juan Carlos (Reg. No. 1601202303923). Data collection complied with the EU General Data Protection Regulation (2016/679). The study involved the use of participants' clinical data; therefore, each questionnaire was assigned a numerical code without including any identifying information. Data were handled exclusively by the principal investigator and securely stored, ensuring its use was limited to the research objectives. Given the vulnerable nature of the study population, efforts were made to keep data collection brief. The questionnaire was designed to be clear and accessible, avoiding technical jargon, lengthy phrases, or information overload. People eligible for the study were already aware of their diagnosis and prognosis. Before participation, everyone received an information sheet outlining the study details and the contact information of the principal investigator. Voluntary informed consent was obtained from each participant. No participants were enrolled in the study while experiencing moderate or severe pain or other uncontrolled symptoms. This study did not involve the use of natural or environmental resources, did not affect biodiversity, and did not require the handling of biological materials. Data available The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request. A sample version of the questionnaire developed for this study is also available. Conflict of interest The authors declare that they have no conflicts of interest. Funding The authors declare that no funding was received for this study. Author’s contributions 1 Investigator: Participated in study design, accrual of study participants, data collection through review of medical records and surveys, data analysis, manuscript writing, edition and review, translation to English language. 2 Investigator: Participated in study design, data analysis, review of manuscript and critical revisions for important intellectual content. All authors read and approved the final version of the manuscript. Acknowledgements The authors express their profound gratitude to the patients of the palliative care unit for their generous participation in this study and they kindness, as well as to the healthcare professionals of Hospital Hestia Madrid for their support. The lead author further acknowledges Maria Eugenia Zuluaga Ruiz for her insightful feedback and meticulous review of the manuscript, and extends heartfelt thanks to Dino Ventolini for his patience and dedicated support. Author details Escuela Internacional de Doctorado. 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Assessing quality of life in palliative care settings: head-to-head comparison of four patient-reported outcome measures (EORTC QLQ-C15-PAL, FACT-Pal, FACT-Pal-14, FACT-G7). Support Care Cancer 2020 -01;28(1):141–53. Chiu L, Chiu N, Chow E, Cella D, Beaumont JL, Lam H et al. Comparison of three shortened questionnaires for assessment of quality of life in advanced cancer. J Palliat Med 2014 -08;17(8):918–23. Murtagh FE, Bausewein C, Verne J, Groeneveld EI, Kaloki YE, Higginson IJ. How many people need palliative care? A study developing and comparing methods for population-based estimates. Palliat Med 2014-01-01;28(1):49–58. Morin L, Aubry R, Frova L, MacLeod R, Wilson DM, Loucka M et al. Estimating the need for palliative care at the population level: A cross-national study in 12 countries. Palliat Med 2017 -06;31(6):526–36. Ministerio de Sanidad. Guía de Práctica Clínica sobre atención paliativa al adulto en situación de últimos días. Guías de Práctica Clínica en el SNS; 2021. Sociedad espanola de cuidados paliativos. Guía de Cuidados Paliativos. SECPAL. 2014; Available at: https://www.secpal.org/guia-de-cuidados-paliativos/ . Accessed Nov, 2023. Institute of Social and Preventive Medicine. , University of Bern. STROBE - Strengthening the reporting of observational studies in epidemiology. Available at: https://www.strobe-statement.org/. Accessed Feb 22, 2025. Gómez-Batiste X, Martínez-Muñoz M, Blay C, Amblàs J, Vila L, Costa X et al. Utility of the NECPAL CCOMS-ICO© tool and the Surprise Question as screening tools for early palliative care and to predict mortality in patients with advanced chronic conditions: A cohort study. Palliat Med 2017 -09;31(8):754–63. Patnode CD, Perdue LA, Rossom RC, Rushkin MC, Redmond N, Thomas RG, et al. Screening for Cognitive Impairment in Older Adults: An Evidence Update for the U.S. Preventive Services Task Force. Rockville (MD): Agency for Healthcare Research and Quality (US); 2020. Baik D, Russell D, Jordan L, Dooley F, Bowles KH, Masterson Creber RM. Using the Palliative Performance Scale to Estimate Survival for Patients at the End of Life: A Systematic Review of the Literature. J Palliat Med. 2018;–11(11):1651–61. Hernández-Quiles C, Bernabeu-Wittel M, Pérez-Belmonte LM, Macías-Mir P, Camacho-González D, Massa B, et al. Concordance of Barthel Index, ECOG-PS, and Palliative Performance Scale in the assessment of functional status in patients with advanced medical diseases. BMJ Support Palliat Care. 2017;–09(3):300–7. FACIT Group. Functional Assessment of Chronic Illness Therapy- Pallative Care and Spiritual Well-Being. Available at: https://www.facit.org/measures/FACIT-Sp . Accessed May, 2023. Brintz CE, Birnbaum-Weitzman O, Merz EL, Penedo FJ, Daviglus ML, Fortmann AL et al. Validation of the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being-Expanded (FACIT-Sp-Ex) Across English and Spanish-Speaking Hispanics/Latinos: Results From the Hispanic Community Health Study/Study of Latinos Sociocultural Ancillary Study. Psycholog Relig Spiritual 2017 -11;9(4):337–347. Abu-Odah H, Molassiotis A, Liu JYW. Global palliative care research (2002–2020): bibliometric review and mapping analysis. BMJ Support Palliat Care 2022 -12;12(4):376–87. Tayjasanant S, Bruera E, Hui D. How far along the disease trajectory? An examination of the time-related patient characteristics in the palliative oncology literature. Support Care Cancer. 2016;–09(9):3997–4004. Zimmermann C, Burman D, Swami N, Krzyzanowska MK, Leighl N, Moore M, et al. Determinants of quality of life in patients with advanced cancer. Support Care Cancer. 2011;–05(5):621–9. Rogers JG, Patel CB, Mentz RJ, Granger BB, Steinhauser KE, Fiuzat M et al. Palliative Care in Heart Failure: The PAL-HF Randomized, Controlled Clinical Trial. J Am Coll Cardiol 2017-07-18;70(3):331–41. Chan LML, Yan OY, Lee JJJ, Lam WWT, Lin C, Auyeung M, et al. Effects of Palliative Care for Progressive Neurologic Diseases: A Systematic Review and Meta-Analysis. J Am Med Dir Assoc. 2023;–02(2):171–84. Dawson B, McConvey K, Gofton TE. When to initiate palliative care in neurology. Chapter 8. In: Miyasaki JM, Kluger BM, editors. Handbook of Clinical Neurology. Elsevier; 2022. pp. 105–25. Kaasa S, Torvik K, Cherny N, Hanks G, de Conno F. Patient demographics and centre description in European palliative care units. Palliat Med 2007 -01;21(1):15–22. Navarro-Meléndez A, Gimenez MJ, Robledo-Donascimento Y, Río-González A, Lendínez-Mesa A. Physiotherapy applied to palliative care patients: a descriptive practice-based study. BMC Palliat Care 2023-07-20;22(1):99. Putt K, Faville KA, Lewis D, McAllister K, Pietro M, Radwan A. Role of Physical Therapy Intervention in Patients With Life-Threatening Illnesses: A Systematic Review. Am J Hosp Palliat Care 2017-03-01;34(2):186–96. Santiago-Palma J, Payne R. Palliative care and rehabilitation. Cancer 2001-08-15;92(4 Suppl):1049–52. Montagnini M, Javier NM, Mitchinson A. The Role of Rehabilitation in Patients Receiving Hospice and Palliative Care. Rehabilitation Oncol. 2020 January;38(1):9. Stucki G, Bickenbach J. Functioning: the third health indicator in the health system and the key indicator for rehabilitation. Eur J Phys Rehabil Med 2017 -02;53(1):134–8. Alam S, Hannon B, Zimmermann C. Palliative Care for Family Caregivers. J Clin Oncol 2020-03-20;38(9):926–36. Krug K, Miksch A, Peters-Klimm F, Engeser P, Szecsenyi J. Correlation between patient quality of life in palliative care and burden of their family caregivers: a prospective observational cohort study. BMC Palliat Care 2016-01-15;15:4. Rodríguez AM, Mayo NE, Gagnon B. Independent contributors to overall quality of life in people with advanced cancer. Br J Cancer. 2013;05–14(9):1790–800. Franchini L, Ercolani G, Ostan R, Raccichini M, Samolsky-Dekel A, Malerba MB et al. Caregivers in home palliative care: gender, psychological aspects, and patient's functional status as main predictors for their quality of life. Support Care Cancer 2020 -07;28(7):3227–35. Bajwah S, Oluyase AO, Yi D, Gao W, Evans CJ, Grande G et al. The effectiveness and cost-effectiveness of hospital-based specialist palliative care for adults with advanced illness and their caregivers. Cochrane Database Syst Rev 2020-09-30;9(9):CD012780. Perpiñá-Galvañ J, Orts-Beneito N, Fernández-Alcántara M, García-Sanjuán S, García-Caro MP, Cabañero-Martínez MJ. Level of Burden and Health-Related Quality of Life in Caregivers of Palliative Care Patients. Int J Environ Res Public Health 2019-11-29;16(23). Kavalieratos D, Corbelli J, Zhang D, Dionne-Odom JN, Ernecoff NC, Hanmer J et al. Association Between Palliative Care and Patient and Caregiver Outcomes: A Systematic Review and Meta-analysis. JAMA 2016-11-22;316(20):2104–14. Henson LA, Maddocks M, Evans C, Davidson M, Hicks S, Higginson IJ. Palliative Care and the Management of Common Distressing Symptoms in Advanced Cancer: Pain, Breathlessness, Nausea and Vomiting, and Fatigue. J Clin Oncol 2020-03-20;38(9):905–14. Iannizzi P, Feltrin A, Martino R, De Toni C, Galiano A, Pambuku A, et al. Psychological assessment and the role of the psychologist in early palliative care. Front Psychol. 2024;15:1437191. Greer JA, Applebaum AJ, Jacobsen JC, Temel JS, Jackson VA. Understanding and Addressing the Role of Coping in Palliative Care for Patients With Advanced Cancer. J Clin Oncol 2020-03-20;38(9):915–25. Centeno C, Hernansanz S, Flores LA, Rubiales AS, López-Lara F. Spain: palliative care programs in Spain, 2000: a national survey. J Pain Symptom Manage. 2002;–08(2):245–51. Peterman AH, Fitchett G, Brady MJ, Hernandez L, Cella D. Measuring spiritual well-being in people with cancer: the functional assessment of chronic illness therapy–Spiritual Well-being Scale (FACIT-Sp). Ann Behav Med. 2002;24(1):49–58. Balboni TA, Paulk ME, Balboni MJ, Phelps AC, Loggers ET, Wright AA et al. Provision of spiritual care to patients with advanced cancer: associations with medical care and quality of life near death. J Clin Oncol 2010-01-20;28(3):445–52. Austin PD, Lee W, Keall R, Lovell MR. Efficacy of spiritual interventions in palliative care: An umbrella review of systematic reviews. Palliat Med 2025 -01;39(1):70–85. Quinn KL, Shurrab M, Gitau K, Kavalieratos D, Isenberg SR, Stall NM et al. Association of Receipt of Palliative Care Interventions With Health Care Use, Quality of Life, and Symptom Burden Among Adults With Chronic Noncancer Illness: A Systematic Review and Meta-analysis. JAMA 2020-10-13;324(14):1439–50. Gaertner J, Siemens W, Meerpohl JJ, Antes G, Meffert C, Xander C et al. Effect of specialist palliative care services on quality of life in adults with advanced incurable illness in hospital, hospice, or community settings: systematic review and meta-analysis. BMJ 2017 /07/04;357:j2925. Dapueto JJ, Servente L, Francolino C, Hahn EA. Determinants of quality of life in patients with cancer. Cancer 2005-03-01;103(5):1072–81. Moldón-Ballesteros E, Llamas-Ramos I, Calvo-Arenillas JI, Cusi-Idigoras O, Llamas-Ramos R. Validation of the Spanish Versions of FACIT-PAL and FACIT-PAL-14 in Palliative Patients. Int J Environ Res Public Health 2022-08-29;19(17):10731. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 27 Dec, 2025 Read the published version in BMC Palliative Care → Version 1 posted Editorial decision: Revision requested 10 Nov, 2025 Reviews received at journal 27 Oct, 2025 Reviews received at journal 22 Oct, 2025 Reviews received at journal 22 Oct, 2025 Reviews received at journal 21 Oct, 2025 Reviewers agreed at journal 18 Oct, 2025 Reviewers agreed at journal 18 Oct, 2025 Reviewers agreed at journal 15 Oct, 2025 Reviewers agreed at journal 12 Oct, 2025 Reviewers invited by journal 09 Oct, 2025 Editor invited by journal 16 Sep, 2025 Editor assigned by journal 16 Sep, 2025 Submission checks completed at journal 15 Sep, 2025 First submitted to journal 11 Sep, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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19:34:45","extension":"html","order_by":8,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":150533,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7595021/v1/ad69f6517d6b3ea50922c26c.html"},{"id":94140569,"identity":"51d6f81c-2ef9-4484-ac35-4b7130671239","added_by":"auto","created_at":"2025-10-22 19:42:44","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":206349,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7595021/v1/a71441a866edf47e74ecf12d.png"},{"id":94139643,"identity":"67023393-c113-42fa-8395-2746a19655d9","added_by":"auto","created_at":"2025-10-22 19:34:45","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":153809,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-7595021/v1/f60bfec0c087a85d30e748db.png"},{"id":99172447,"identity":"2e27883b-cbe9-4d1e-a73d-ca83e832bb38","added_by":"auto","created_at":"2025-12-29 16:09:36","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1165096,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7595021/v1/189df190-374d-491c-98eb-a8a9b853563b.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Health-Related Quality of Life in Palliative Care: Determinants Identified in a Hospital-Based Observational Study","fulltext":[{"header":"Background","content":"\u003cp\u003eAccording to the World Health Organization, palliative care aims to improve the quality of life of patients and their families confronting life-threatening illnesses (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). While all chronic diseases may benefit from palliative interventions, in practice they are commonly categorized into groups: oncological conditions, which currently represent the largest share of advanced diseases; chronic organ diseases such as pulmonary, cardiac, and renal failure; dementias; neurodegenerative disorders such as multiple sclerosis or Parkinson\u0026rsquo;s disease; and certain infectious diseases, including HIV. Each condition follows a distinct trajectory. Although they generally share common physical symptoms such as pain, dyspnea, and fatigue, (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) certain differences exist. For example, neurological diseases are characterized by predominant functional decline and cognitive manifestations, including insomnia. Psychosocial and advance care planning needs are generally comparable across groups (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAdvanced disease is well established to negatively affect multiple dimensions of health-related quality of life (HRQoL) simultaneously (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). The philosophy of palliative care emphasizes enhancing quality of life for patients and families, as medical interventions cannot alter the underlying disease. Strong evidence supports the benefits of early palliative interventions on HRQoL (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e), shaping the current model of care, which begins at diagnosis and extends throughout the disease trajectory, with particular attention to the final stages (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eHRQoL measurement tools for palliative populations should be in line with their care goals and frailty. Ideally, they should be multidimensional, thoug no single tool is universally optimal for all patients (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Most available scales are multidimensional, but many omit the spiritual domain, which extends beyond religion and is fundamental in end-of-life care (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Nonetheless, several HRQoL scales have been validated in this setting, with no major differences in outcomes across instruments (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn Spain, it is estimated that 42\u0026ndash;79% of individuals at the end of life require palliative care, yet only about 40% actually receive it (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Despite the country\u0026rsquo;s strong contribution to palliative care research, there remains a pressing need to expand investigations, particularly in advanced non-cancer conditions (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Such efforts are essential to meet the demands of an aging population and the rising prevalence of non-communicable chronic diseases. Furthermore, identifying the factors that influence HRQoL in palliative care patients\u0026mdash;especially those amenable to intervention\u0026mdash;is critical to improving current care strategies. Against this background, the present observational study was designed to explore factors associated with HRQoL and functional status in adult patients with advanced disease of any etiology admitted to a hospital-based palliative care unit.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eDesing\u003c/h2\u003e\u003cp\u003e A retrospective observational study was conducted between February 1 of 2023, and February 29 of 2024, in patients with life-threatening illnesses of any etiology admitted to a hospital based palliative care unit in Spain. A cross-sectional measurement of HRQoL and physical function through a questionnaire was performed.\u003c/p\u003e\u003cp\u003eA pilot study with five participants (three patients, one volunteer, and one palliative care professional) was conducted to refine the measurement instrument. Also, a self-administration was discarded due to the condition of the patients, and the questionnaire was administered bedside by the principal investigator. These preliminary results were not included in the final analysis.\u003c/p\u003e\u003cp\u003eThe STROBE Statement checklist for cross-sectional studies was used for this work (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e)\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eSetting/participants\u003c/h3\u003e\n\u003cp\u003eMedical records of patient admissions to the palliative care unit over a 12-month period were reviewed. Patients\u0026thinsp;\u0026ge;\u0026thinsp;18 years or older, diagnosed with an advanced disease of any etiology, and identified as needing palliative care based on the NECPAL tool were included (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eThe following exclusion criteria were, participants with moderate to severe cognitive impairment assessed by Pfeiffer Short Portable Mental State Questionnaire (SPMSQ)\u0026thinsp;\u0026ge;\u0026thinsp;5 errors (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e), also, patients with advanced dementia or Global Deterioration Scale (GDS)\u0026thinsp;\u0026ge;\u0026thinsp;6, as well as those in the end-of-life stage or Palliative Performance Status (PPS)\u0026thinsp;\u0026le;\u0026thinsp;20. Given the vulnerable nature of the study population, efforts were made to keep data collection brief and eligible participants were already aware of their diagnosis and prognosis; to ensure confidentiality, each questionnaire was coded numerically.\u003c/p\u003e\u003cp\u003eData collection was carried out after a brief explanation of the investigation and the consent of each participant. A study-specific questionnaire was designed, consisting of two sections:\u003c/p\u003e\u003cp\u003eThe first section collected sociodemographic and clinical variables, including cognitive status assessed by Pfeiffer SPMSQ and functional status evaluated by the Palliative Performance Scale (PPS), a validated tool in palliative care, estimates survival based on functional performance, ranging from 100% (fully ambulatory and healthy) to 0% (death) (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e) and Barthel Index a widely validated instrument in palliative care, was used to assess functional ability in daily activities (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe second section contains the FACIT-Sp (Functional Assessment of Chronic Illness Therapy Palliative Care - Spiritual Well-Being version), a 39-item Likert-type scale scored from 0 to 4, that assess HRQoL through two subscales, the general questionnaire (FACIT-G) which is composed of key domains include physical, functional, emotional, and social/family well-being. And the specific questionnaire of palliative care and spiritual Well-Being, (FACIT-Sp-12). The total score can range from 0 to 156, where a higher score indicates a better HRQoL. This scale has been internationally validated and is available for use in Spanish (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). For this study, a license for the scale was obtained.\u003c/p\u003e\u003cp\u003eThe questionnaire was not administered to participants experiencing pain according to Visual Analog Scale (VAS)\u0026thinsp;\u0026ge;\u0026thinsp;4 or any other uncontrolled symptoms, in such cases, data collection was divided into two or more sessions to achieving symptomatic control.\u003c/p\u003e\u003cp\u003eThe final dataset was compiled and stored in a digital database using Microsoft Excel.\u003c/p\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003eData analysis\u003c/h2\u003e\u003cp\u003eEl The analysis of the database was performed using IBM Corp. Statistical Package for the Social Sciences Released 2020 (SPSS) for Windows, Version 29.0. Initially, an exploratory evaluation of the data was carried out, no missing values ​​ were found.\u003c/p\u003e\u003cp\u003eA descriptive analysis was performed using measures of central tendency and dispersion for quantitative variables and categorical variables were presented as percentages, graphs, and frequency tables. The results of FACIT-SP scale, as a dependent variable, were compared across different groups. The magnitude of the association was assessed based on the type of independent variable. A t-test was used for quantitative variables in two independent groups, while an ANOVA test was applied for categorical variables with more than two groups. A p value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant. Additionally, a descriptive analysis was performed for each item of the FACIT-Sp scale, along with a reliability analysis of the scale and its main components (FACIT-Sp-12 and FACIT-G) using Cronbach's alpha coefficient.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003eSample characteristics\u003c/h2\u003e\u003cp\u003eAfter reviewing the medical records of 287 patients admitted to the palliative care unit between February 1, 2023 and February 29, 2024. 76 patients met the inclusion criteria (Fig.\u0026nbsp;1), of these, 34 were excluded, due to cognitive impairment (Pfeiffer\u0026thinsp;\u0026ge;\u0026thinsp;5 errors) or clinical deterioration (PPS\u0026thinsp;\u0026le;\u0026thinsp;20). A final sample of 42 participants answered the questionnaire. During the interview only 14.28% had pain\u0026thinsp;\u0026le;\u0026thinsp;3 according to the VAS.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eThe sociodemographic and clinical characteristics are presented in Tables\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e and \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. Most patients were male (61.9%), with a median age of 71.8 years [IQR 51\u0026ndash;96]. The main place of medical care was the urban area. Prior to admission to the palliative care unit, 52.4% of patients lived alone and 40.5% lived with their families; nevertheless, most participants had a caregiver, who was female in 59.4% of cases.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDemographic characteristics\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eAll (N\u0026thinsp;=\u0026thinsp;42)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge (years)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMean\u0026thinsp;+\u0026thinsp;SD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e71.8\u0026thinsp;\u0026plusmn;\u0026thinsp;11.29\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMin - Max\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e51\u0026ndash;96\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eSex, n (%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e16 (38.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e26 (61.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEmployment status, n (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCurrently working\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (2.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOn medical leave\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9 (21.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRetired\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e20 (41.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNot employed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12 (28.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePlace of medical care, n (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUrban\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e39 (92.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRural\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3 (7.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eLiving arrangements, n (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLives with family\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e17 (40.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCare home resident\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3 (7.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLives alone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e22 (52.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCaregiver, n (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHave\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e32 (76.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDon\u0026acute;t have\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10 (23.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eClinical characteristics\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eAll (N\u0026thinsp;=\u0026thinsp;42)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEtiology of advanced disease, n (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHeart\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2 (4.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLung\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4 (9.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKidney\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4 (9.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOncological\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e27 (64.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNeurodegenerative\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5 (11.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePhysical activity the last year, n(%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;150 min/week\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2 (4.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;150 min/week\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7 (16.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e33 (78.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eErrors on Pfeiffer scale\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e17 (40.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7 (16.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8 (19.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9 (21.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (2.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eBarthel index (0 -100)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMean\u0026thinsp;+\u0026thinsp;SD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e59.5\u0026thinsp;\u0026plusmn;\u0026thinsp;24.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRange\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10\u0026ndash;95\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePalliative Performance Scale (PPS) (0-100)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMean\u0026thinsp;+\u0026thinsp;SD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e52.1\u0026thinsp;\u0026plusmn;\u0026thinsp;11.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRange\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e30\u0026ndash;80\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eFACIT-Sp Total score (0\u0026ndash;156)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMean\u0026thinsp;+\u0026thinsp;SD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e87.9\u0026thinsp;\u0026plusmn;\u0026thinsp;22.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRange\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e40.5\u0026ndash;134.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eIn our sample, most patients were admitted for palliative care due to oncological disease (64.3%), mainly of lung origin, followed by colorectal and kidney cancer; 43.3% of these had metastatic disease. The second most common diagnosis was neurodegenerative disease (11.9%), primarily amyotrophic lateral sclerosis and multiple sclerosis. Except for advanced chronic kidney disease, male patients predominated across all groups. Pfeiffer test was normal (\u0026le;\u0026thinsp;2) in 76.2% of patients, while 23.8% exhibited mild cognitive impairment.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003ePerformance status\u003c/h2\u003e\u003cp\u003eThe functional ability to perform activities of daily living according to the Barthel Index (BI) was 59.5\u0026thinsp;\u0026plusmn;\u0026thinsp;24.34. A total of 54.8% exhibited mild dependence (BI\u0026thinsp;\u0026ge;\u0026thinsp;60), whereas 14.3% had severe or total dependence (BI\u0026thinsp;\u0026le;\u0026thinsp;30).\u003c/p\u003e\u003cp\u003eThe mean BI was 60.65\u0026thinsp;\u0026plusmn;\u0026thinsp;21.35 for male participants and 57.56\u0026thinsp;\u0026plusmn;\u0026thinsp;29.2 for females; however, this difference was not statistically significant (p\u0026thinsp;=\u0026thinsp;0.69). Regarding etiology, patients with advanced cardiac disease had the highest BI (67\u0026thinsp;\u0026plusmn;\u0026thinsp;18.39), while those diagnosed with neurodegenerative disease had the lowest (43.4\u0026thinsp;\u0026plusmn;\u0026thinsp;27.4), with no statistically significant differences (p\u0026thinsp;=\u0026thinsp;0.6).\u003c/p\u003e\u003cp\u003eRespecting the Palliative Performance Scale (PPS), the mean score was 52.14\u0026thinsp;\u0026plusmn;\u0026thinsp;11.37. Most patients (69%) had a PPS score\u0026thinsp;\u0026ge;\u0026thinsp;50, which corresponds to an estimated survival prognosis of approximately 50\u0026ndash;60 days. No statistically significant differences were found in PPS scores by etiology, although patients with neurodegenerative disease had the lowest values (48\u0026thinsp;\u0026plusmn;\u0026thinsp;4.47, p\u0026thinsp;=\u0026thinsp;0.6). Figure\u0026nbsp;2 illustrates the distribution for both scales according to the diagnosis of advanced disease.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eA total of 21.4% of participants engaged in some type of physical activity, either regularly or irregularly, during the year preceding the study.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eHealth-related quality of life\u003c/h3\u003e\n\u003cp\u003eThe mean of HRQoL according the FACIT-SP in all participants was 87.9\u0026thinsp;\u0026plusmn;\u0026thinsp;22.1 [IQR 40.5\u0026ndash;134.33]. Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e presents the descriptive statistics for the FACIT-Sp scale and its subscales. The mean score of FACIT-G subscale was 61.54\u0026thinsp;\u0026plusmn;\u0026thinsp;15.2. Among its dimensions, physical well-being (PWB) had the highest score, followed by emotional well-being (EWB), while functional well-being (FWB) had the lowest scores. The spiritual dimension according to the FACIT Sp-12 subscale had a mean score of 26.43.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eFACIT-Sp results by dimensions\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003eAll (N\u0026thinsp;=\u0026thinsp;42)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRange\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMax possible value\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eCronbach\u0026rsquo;s alpha\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePWB (physical well-being)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e17.69\u0026thinsp;\u0026plusmn;\u0026thinsp;5.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4\u0026ndash;28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSWB (social well-being)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15.48\u0026thinsp;\u0026plusmn;\u0026thinsp;6.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u0026ndash;25,6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEWB (emotional well-being)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15.05\u0026thinsp;\u0026plusmn;\u0026thinsp;4.99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5\u0026ndash;24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFWB (functional well-being)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e13.33\u0026thinsp;\u0026plusmn;\u0026thinsp;3.39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5\u0026ndash;24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFACIT Sp-12 (Spiritual subscale)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e26.43\u0026thinsp;\u0026plusmn;\u0026thinsp;8.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9\u0026ndash;41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.818\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFACIT G score (General subscale) *\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e61.54\u0026thinsp;\u0026plusmn;\u0026thinsp;15.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e27.5\u0026ndash;93.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e108\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.831\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFACIT-SP Total score +\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e87.9\u0026thinsp;\u0026plusmn;\u0026thinsp;22.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e40.5\u0026ndash;134.43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e156\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.889\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003e*FACIT G\u0026thinsp;=\u0026thinsp;SWB\u0026thinsp;+\u0026thinsp;EWB\u0026thinsp;+\u0026thinsp;FWB\u003c/p\u003e\u003cp\u003e+ FACIT-Sp Total score\u0026thinsp;=\u0026thinsp;SWB\u0026thinsp;+\u0026thinsp;EWB\u0026thinsp;+\u0026thinsp;FWB\u0026thinsp;+\u0026thinsp;FACIT Sp-12\u003c/p\u003e \u003cp\u003eSD: Standard deviation\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eA univariate analysis of factors associated with FACIT-Sp scores is shown in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e. As the main finding, the group of participants who engaged in some degree of physical activity during the year preceding the study had higher HRQoL, these differences were statistically significant across all measures: FACIT-SP Total Score (some degree: 103.51\u0026thinsp;\u0026plusmn;\u0026thinsp;15.35 vs. none: 83.73\u0026thinsp;\u0026plusmn;\u0026thinsp;21.88; p\u0026thinsp;=\u0026thinsp;0.015), and its subscales: general FACIT-G subscale (some degree: 70.96\u0026thinsp;\u0026plusmn;\u0026thinsp;13.35 vs. none: 58.97\u0026thinsp;\u0026plusmn;\u0026thinsp;14.90; p\u0026thinsp;=\u0026thinsp;0.035), and spiritual FACIT-SP-12 subscale (some degree: 32.56\u0026thinsp;\u0026plusmn;\u0026thinsp;4.90 vs. none: 27.76\u0026thinsp;\u0026plusmn;\u0026thinsp;8.68; p\u0026thinsp;=\u0026thinsp;0.002). Also, participants with a primary caregiver exhibited higher scores; however, this was statistically significant only in the FACIT-G subscale (With caregiver: 64.09\u0026thinsp;\u0026plusmn;\u0026thinsp;13.48 vs. Without caregiver: 53.38\u0026thinsp;\u0026plusmn;\u0026thinsp;18.38, p\u0026thinsp;=\u0026thinsp;0.05). Participants with neurodegenerative disease exhibited the lowest HRQoL across all outcomes. However, participants with heart disease, the spiritual dimension had an even lower value, with a statistically significant difference (FACIT Sp-12 subscale: 17\u0026thinsp;\u0026plusmn;\u0026thinsp;1.41 p\u0026thinsp;=\u0026thinsp;0.08).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eFACIT Sp scale and subscales by groups\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003eFACIT Sp-Total score\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003eFACIT-G (General)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003eFACIT Sp-12 (Spiritual)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eCI (95%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eCI (95%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eCI (95%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSex *\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.66 t = -0.44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.44 t = -0.77\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.82 t\u0026thinsp;=\u0026thinsp;0.22\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e16 (38.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e86.03\u0026thinsp;\u0026plusmn;\u0026thinsp;20.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e75.90\u0026ndash;95.72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e59.21\u0026thinsp;\u0026plusmn;\u0026thinsp;13.48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e52.54\u0026ndash;65.62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e26.81\u0026thinsp;\u0026plusmn;\u0026thinsp;9.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e22.25\u0026ndash;31.18\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e26 (61.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e89.16\u0026thinsp;\u0026plusmn;\u0026thinsp;23.49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e80.10\u0026ndash;97.88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e62.97\u0026thinsp;\u0026plusmn;\u0026thinsp;16.35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e56.43\u0026ndash;69.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e26.19\u0026thinsp;\u0026plusmn;\u0026thinsp;8.44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e22.95\u0026ndash;29.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCaregiver *\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.10 t\u0026thinsp;=\u0026thinsp;1.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e\u003cb\u003ep\u0026thinsp;=\u0026thinsp;0.05 t\u0026thinsp;=\u0026thinsp;2\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.44 t\u0026thinsp;=\u0026thinsp;0.76\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePresent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e32 (76.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e91.09\u0026thinsp;\u0026plusmn;\u0026thinsp;20.41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e84.33\u0026ndash;97.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e64.09\u0026thinsp;\u0026plusmn;\u0026thinsp;13.48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e59.92\u0026ndash;68.68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e27\u0026thinsp;\u0026plusmn;\u0026thinsp;8.62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e23.97\u0026ndash;30\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAbsent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10 (23.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e77.98\u0026thinsp;\u0026plusmn;\u0026thinsp;25.27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e61.75\u0026ndash;92.53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e53.38\u0026thinsp;\u0026plusmn;\u0026thinsp;18.38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e41.54\u0026ndash;64.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e24.6\u0026thinsp;\u0026plusmn;\u0026thinsp;8.73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e19\u0026ndash;29.67\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEtiology of advanced disease +\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.25 F\u0026thinsp;=\u0026thinsp;1.39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.53 F\u0026thinsp;=\u0026thinsp;0.80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.08 F\u0026thinsp;=\u0026thinsp;2.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHeart\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2 (4.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e73.08\u0026thinsp;\u0026plusmn;\u0026thinsp;1.76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e57.20\u0026ndash;88.96\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e56.08\u0026thinsp;\u0026plusmn;\u0026thinsp;3.18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e27.49\u0026ndash;84.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e17\u0026thinsp;\u0026plusmn;\u0026thinsp;1.41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e4.29\u0026ndash;2971\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLung\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4 (9.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e95.08\u0026thinsp;\u0026plusmn;\u0026thinsp;18.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e66.32 -123.83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e64.33\u0026thinsp;\u0026plusmn;\u0026thinsp;14.18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e41.75\u0026ndash;86.90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e30.75\u0026thinsp;\u0026plusmn;\u0026thinsp;6.39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e20.57\u0026ndash;40.93\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKidney\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4 (9.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e98.20\u0026thinsp;\u0026plusmn;\u0026thinsp;23.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e61.51\u0026ndash;134.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e67.70\u0026thinsp;\u0026plusmn;\u0026thinsp;12.39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e47.99\u0026ndash;87.42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e30.5\u0026thinsp;\u0026plusmn;\u0026thinsp;11.84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e11.65\u0026ndash;49.35\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOncological\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e27 (64.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e89.69\u0026thinsp;\u0026plusmn;\u0026thinsp;21.60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e81.14\u0026ndash;98.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e62.46\u0026thinsp;\u0026plusmn;\u0026thinsp;15.70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e56.25\u0026ndash;68.68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e27.22\u0026thinsp;\u0026plusmn;\u0026thinsp;7.83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e24.12\u0026ndash;30.32\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNeurodegenerative\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5 (11.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e70.76\u0026thinsp;\u0026plusmn;\u0026thinsp;25.72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e38.82\u0026ndash;102.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e51.56\u0026thinsp;\u0026plusmn;\u0026thinsp;18.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e29.17\u0026ndash;73.95\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e19.2\u0026thinsp;\u0026plusmn;\u0026thinsp;8.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e8.43\u0026ndash;29.97\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEngaged in physical activity *\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e\u003cb\u003ep\u0026thinsp;=\u0026thinsp;0.015 t=-2.53\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e\u003cb\u003ep\u0026thinsp;=\u0026thinsp;0.035 t=-2.18\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003e\u003cb\u003ep\u0026thinsp;=\u0026thinsp;0.002 t=-3.5\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSome degree\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9 (21.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e103.51\u0026thinsp;\u0026plusmn;\u0026thinsp;15.35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e92.81 -113.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e70.96\u0026thinsp;\u0026plusmn;\u0026thinsp;13.35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e61.81\u0026ndash;79.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e32.56\u0026thinsp;\u0026plusmn;\u0026thinsp;4.90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e28.73\u0026ndash;34.80\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e33 (78.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e83.73\u0026thinsp;\u0026plusmn;\u0026thinsp;21.88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e75.92\u0026ndash;91.18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e58.97\u0026thinsp;\u0026plusmn;\u0026thinsp;14.90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e53.55\u0026ndash;64.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e24.76\u0026thinsp;\u0026plusmn;\u0026thinsp;8.68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e21.84\u0026ndash;27.76\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eFunctional impairment +\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.33 F\u0026thinsp;=\u0026thinsp;0.37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.52 F\u0026thinsp;=\u0026thinsp;0.64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.96 F\u0026thinsp;=\u0026thinsp;0.37\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMild\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e23 (54.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e90.54\u0026thinsp;\u0026plusmn;\u0026thinsp;20.94\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e81.48\u0026ndash;99.59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e63.97\u0026thinsp;\u0026plusmn;\u0026thinsp;14.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e57.89\u0026ndash;70.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e26.57\u0026thinsp;\u0026plusmn;\u0026thinsp;8.44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e22.91\u0026ndash;30.22\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSevere\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e13 (30.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e84.97\u0026thinsp;\u0026plusmn;\u0026thinsp;26.80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e68.78 -101.18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e59.05\u0026thinsp;\u0026plusmn;\u0026thinsp;18.39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e47.94\u0026ndash;70.16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e25.92\u0026thinsp;\u0026plusmn;\u0026thinsp;10.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e19.82\u0026ndash;32.02\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6 (14.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e84.64\u0026thinsp;\u0026plusmn;\u0026thinsp;16.57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e67.24 -102.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e57.64\u0026thinsp;\u0026plusmn;\u0026thinsp;12.98\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e44.02\u0026ndash;71.26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e27\u0026thinsp;\u0026plusmn;\u0026thinsp;6.96\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e19.70\u0026ndash;34.30\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e\u003cp\u003e*: T test, +: Anova\u003c/p\u003e\u003cp\u003eSD: Standard deviation, CI: Confidence interval\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eLastly, the reliability analysis of the FACIT-SP scale showed a Cronbach\u0026rsquo;s alpha coefficient of 0.889. Reliability coefficients for the subscales are summarized in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis descriptive study aims to address the growing need to expand knowledge about the perception of well-being in palliative care, particularly in patients with life-threatening non-oncological illnesses, while acknowledging the inherent fragility of the life cycle in which they find themselves. This perspective may explain the relatively small final sample despite the high number of eligible patients after applying selection criteria, a situation already observed in this field, particularly in studies focusing on the final stages of life (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). Our sample comprised inpatients with different diagnoses admitted to the palliative care unit, most of whom had an estimated survival of approximately two months according to PPS values. Consistent with this, previous descriptive studies in palliative care units and hospices have shown that survival prognosis is generally limited, with a median survival of only a few weeks or less than three months, and somewhat longer among non-oncological patients (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e The overall HRQoL according to the FACIT-SP Total Score scale in our participants was 87.9\u0026thinsp;\u0026plusmn;\u0026thinsp;22.1. Other studies have reported values for this scale; however, most of them focus on patients with specific diagnoses. For instance, 285 outpatients with advanced cancer reported a mean FACIT-SP Total Score of 99.8 (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e), while in 150 patients with advanced heart failure a mean of 120.6 was recorded (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). When analysing the results based on the diagnosis of advanced disease, patients with neurodegenerative disease had the lowest HRQoL. This aligns with existing literature, which highlights the negative impact of neurological diseases on HRQoL from the early stages of diagnosis, reinforcing the need for the timely integration of palliative care (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). Oncological disease was the predominant diagnosis in our sample, aligning with European palliative care data, where up to 94% of patients had this diagnosis (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). Similarly, a Spanish study reported 92.1% of 63 patients from a palliative care unit had oncological diagnoses (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eA principal finding was that HRQoL scores were higher in participants who had undertaken any level of physical activity in the year prior to the study. These differences were statistically significant (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) across all scales.. In this regard, it is well documented that physical activity is a non-pharmacological intervention with proven benefits for quality of life and symptom control in palliative care, provided it is adapted to individual needs and limitations. Most existing evidence derives from physiotherapy-guided interventions and rehabilitation groups (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e), whereas our study examined the impact of any degree of activity, whether regular or irregular. Although no universal dose has been defined, in advanced disease the mere practice of physical activity represents a significant achievement given the symptom burden(\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). Greater benefits are likely to result from individualised prescriptions that account for functional status, symptom profile, and patient preferences (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e). Furthermore, physical activity plays a crucial role in mitigating or reversing the progressive loss of functionality associated with advanced diseases (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e), thereby improving HRQoL and reducing the caregiving burden (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e). Additionally, higher HRQoL values were found in patients with lower levels of functional impairment according to BI, however, this difference was not statistically significant. Yet, this result remains relevant, as functionality, along with morbidity and mortality, is a key indicator for evaluating healthcare strategies, including palliative care (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e In our results, HRQoL scores across all scales were higher among participants with a primary caregiver. However, this difference was statistical significance only on the general FACIT-G subscale. Caregivers play a crucial role in managing patients with life-threatening illnesses, often performing complex tasks (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e). Thus, their integration into periodic needs assessments is recommended (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e). Studies on advanced cancer patients highlight social support as a key factor of improved HRQoL (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e). Consistent with our findings, the literature reports a predominance of female caregivers, this predominance of women in caregiving role linked to high stress, anxiety, and fatigue (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e). A local study of 77 caregivers found 66.2% were women, experiencing significant anxiety and fatigue, adversely affecting their well-being, and underscore the need for support strategies to mitigate the adverse effects of caregiving patients with advanced diseases (\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e). Despite this, evidence on caregivers' impact on patients' HRQoL and their own well-being remains limited due to scarce and heterogeneous research(\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAmong all the dimensions, Physical Well-Being (PWB) recorded the highest score. This result may be attributed to the extensive research on managing physical symptoms prevalent in all advanced diseases, such as pain, dyspnea, fatigue, nausea, and vomiting, in palliative care (\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e); consequently, these interventions are widely implemented, and the management of physical symptoms can be considered key to assessing the effectiveness of palliative care. (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e). Emotional Well-Being (EWB) ranked second. Emotional support enhances HRQoL in patients and their families, alleviates depression and anxiety, and facilitate in disease understanding and end-of-life planning (\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e). In Spain, palliative care units adopt an interdisciplinary approach, including psychologists (\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e), which may explain our findings and highlights their crucial role in palliative care teams.\u003c/p\u003e\u003cp\u003eRegarding the FACIT-Sp-12 subscale, our results indicate an acceptable level of spiritual well-being, scores above 40 suggest good spiritual well-being consistent with the literature (\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e). However, as previously mentioned, other dimensions received higher scores in the overall HRQoL assessment. Although medical literature suggests that spiritual care can improve quality of life in palliative care patients, the effect is generally small and not sustained over the long term (\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e). Based on our experience during interviews, we conclude that spirituality is a highly variable dimension that is difficult to quantify using a closed-question questionnaire. Therefore, we agree with other reports emphasizing the need for studies with greater methodological rigor to better understand the effect of spiritual care interventions (\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIt is well established that the integration of palliative care into the treatment of life-threatening illnesses has a positive effect on HRQoL (\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e, \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e). However, the magnitude of this effect could be greater if palliative care were guided by the identification of patient-reported outcomes in terms of well-being, which may differ across populations. Additionally, such an approach could serve as a valuable tool for self-assessing the effectiveness of palliative care units.\u003c/p\u003e\u003cp\u003eAlthough Spain ranks among the leading countries in palliative care research(\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e), further studies, particularly on non-oncological advanced diseases, are needed to address the growing demands driven by increased life expectancy and the rising prevalence of chronic non-communicable diseases.\u003c/p\u003e\u003cp\u003eFinally, the high reliability values of the FACIT-Sp scale observed in this study are consistent with findings from previous research (\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e, \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e), supporting its potential application in clinical practice.\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eStrengths and limitations\u003c/h2\u003e\u003cp\u003e To the best of our knowledge, this is the first study in Spain to describe the most relevant aspects of HRQoL in palliative care patients with oncologic and no oncologic conditions, using validated tools to measure outcomes in terms of HRQoL and functional status.\u003c/p\u003e\u003cp\u003eThe present work provides original observational data supporting a care approach centered on the perceived well-being of patients with life-threatening illnesses. Despite its methodological rigor, certain limitations must be acknowledged.\u003c/p\u003e\u003cp\u003eThe main limitation of this study is the small final sample size. Despite a high number of annual admissions to the palliative care unit, few patients met the inclusion criteria due to end-of-life status, severe cognitive impairment, or rapid clinical deterioration between screening and intervention. This highlights the frailty of palliative care patients and constrained the scope of statistical analyses.\u003c/p\u003e\u003cp\u003eA potential performance bias is also recognized, as the principal investigator was part of the palliative care medical team. Still, to minimize this, patients were informed that their responses would not influence their treatment.\u003c/p\u003e\u003cp\u003eDue to the selection process, we acknowledge that our findings may not be fully generalizable to the entire population with palliative care needs. However, owing to its rigorous methodology, this study remains reproducible, its limitations are clearly identified for potential refinement, and it contributes to the advancement of high-quality evidence in related research.\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eAccording to our findings, engaging in some level of physical activity is an important determinant of better perceived HRQoL among patients with life-threatening illnesses. In palliative care, functional capacity is particularly significant, as patients prioritize maintaining independence beyond their illness. This study also sheds light on factors influencing HRQoL in both oncological and non-oncological populations. Although some observed differences did not reach statistical significance, their potential clinical relevance reinforces the importance of a comprehensive, patient-centered approach and the ongoing evaluation of existing care programs.\u003c/p\u003e\u003cp\u003eHigher scores in physical well-being reflect the effectiveness of current interventions targeting symptom control, a cornerstone of palliative care. By contrast, the spiritual dimension, widely recognized as essential in clinical practice, remains challenging to quantify, underscoring the need for complementary methodological approaches to assess its contribution.\u003c/p\u003e\u003cp\u003eDespite its limitations, we expect that the patient-reported outcomes of this study will contribute to enhancing the integrated approach to palliative care and encourage further research in this field, particularly among populations with advanced non-cancer diseases, while acknowledging their vulnerability and specific needs\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical considerations and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study adheres to the ethical standards of the Declaration of Helsinki and has been approved by the ethics committees of Hospital Universitario Ram\u0026oacute;n y Cajal (Reg. No. 311-22 acta 433 CEIM) and Universidad Rey Juan Carlos (Reg. No. 1601202303923). Data collection complied with the EU General Data Protection Regulation (2016/679).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe study involved the use of participants\u0026apos; clinical data; therefore, each questionnaire was assigned a numerical code without including any identifying information. Data were handled exclusively by the principal investigator and securely stored, ensuring its use was limited to the research objectives.\u003c/p\u003e\n\u003cp\u003eGiven the vulnerable nature of the study population, efforts were made to keep data collection brief. The questionnaire was designed to be clear and accessible, avoiding technical jargon, lengthy phrases, or information overload. People eligible for the study were already aware of their diagnosis and prognosis. Before participation, everyone received an information sheet outlining the study details and the contact information of the principal investigator. Voluntary informed consent was obtained from each participant. No participants were enrolled in the study while experiencing moderate or severe pain or other uncontrolled symptoms.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis study did not involve the use of natural or environmental resources, did not affect biodiversity, and did not require the handling of biological materials.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eData available\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request. A sample version of the questionnaire developed for this study is also available.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no conflicts of interest.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that no funding was received for this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor\u0026rsquo;s contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e1 Investigator: Participated in study design, accrual of study participants, data collection through review of medical records and surveys, data analysis, manuscript writing, edition and review, translation to English language.\u003c/p\u003e\n\u003cp\u003e2 Investigator: Participated in study design, data analysis, review of manuscript and critical revisions for important intellectual content.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAll authors read and approved the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors express their profound gratitude to the patients of the palliative care unit for their generous participation in this study and they kindness, as well as to the healthcare professionals of Hospital Hestia Madrid for their support. The lead author further acknowledges Maria Eugenia Zuluaga Ruiz for her insightful feedback and meticulous review of the manuscript, and extends heartfelt thanks to Dino Ventolini for his patience and dedicated support.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor details\u003c/strong\u003e\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003eEscuela Internacional de Doctorado. Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos. Madrid, Spain.\u003c/li\u003e\n \u003cli\u003eHospital Universitario de Fuenblabrada. Servicio de Rehabilitaci\u0026oacute;n y Medicina F\u0026iacute;sica. Madrid, Spain.\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e* Correspondence: [email protected]\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWorldwide Hospice Palliative Care Alliance. Global Atlas of Palliative Care. WHO. 2nd Edition ed. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://thewhpca.org/resources/global-atlas-of-palliative-care-2nd-ed-2020/\u003c/span\u003e\u003cspan address=\"https://thewhpca.org/resources/global-atlas-of-palliative-care-2nd-ed-2020/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e; 2020.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMechler K, Liantonio J. Palliative Care Approach to Chronic Diseases: End Stages of Heart Failure, Chronic Obstructive Pulmonary Disease, Liver Failure, and Renal Failure. Prim Care. 2019;\u0026ndash;09(3):415\u0026ndash;32.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBostwick D, Wolf S, Samsa G, Bull J, Taylor DH, Johnson KS et al. Comparing the Palliative Care Needs of Those With Cancer to Those With Common Non-Cancer Serious Illness. 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Mol Oncol. 2022;\u0026ndash;10(19):3399\u0026ndash;409.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKaplan RM, Hays RD. Health-Related Quality of Life Measurement in Public Health. Annu Rev Public Health 2022-04-05;43:355\u0026ndash;73.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eVanbutsele G, Van Belle S, Surmont V, De Laat M, Colman R, Eecloo K, et al. The effect of early and systematic integration of palliative care in oncology on quality of life and health care use near the end of life: A randomised controlled trial. Eur J Cancer. 2020;\u0026ndash;01124:186\u0026ndash;93.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHaun MW, Estel S, R\u0026uuml;cker G, Friederich H, Villalobos M, Thomas M et al. Early palliative care for adults with advanced cancer. Cochrane Database Syst Rev 2017-06-12;6:CD011129.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHui D, Bruera E. 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Accessed May, 2023.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBrintz CE, Birnbaum-Weitzman O, Merz EL, Penedo FJ, Daviglus ML, Fortmann AL et al. Validation of the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being-Expanded (FACIT-Sp-Ex) Across English and Spanish-Speaking Hispanics/Latinos: Results From the Hispanic Community Health Study/Study of Latinos Sociocultural Ancillary Study. Psycholog Relig Spiritual 2017 -11;9(4):337\u0026ndash;347.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAbu-Odah H, Molassiotis A, Liu JYW. Global palliative care research (2002\u0026ndash;2020): bibliometric review and mapping analysis. BMJ Support Palliat Care 2022 -12;12(4):376\u0026ndash;87.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTayjasanant S, Bruera E, Hui D. How far along the disease trajectory? An examination of the time-related patient characteristics in the palliative oncology literature. Support Care Cancer. 2016;\u0026ndash;09(9):3997\u0026ndash;4004.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZimmermann C, Burman D, Swami N, Krzyzanowska MK, Leighl N, Moore M, et al. Determinants of quality of life in patients with advanced cancer. Support Care Cancer. 2011;\u0026ndash;05(5):621\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRogers JG, Patel CB, Mentz RJ, Granger BB, Steinhauser KE, Fiuzat M et al. Palliative Care in Heart Failure: The PAL-HF Randomized, Controlled Clinical Trial. J Am Coll Cardiol 2017-07-18;70(3):331\u0026ndash;41.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChan LML, Yan OY, Lee JJJ, Lam WWT, Lin C, Auyeung M, et al. Effects of Palliative Care for Progressive Neurologic Diseases: A Systematic Review and Meta-Analysis. J Am Med Dir Assoc. 2023;\u0026ndash;02(2):171\u0026ndash;84.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDawson B, McConvey K, Gofton TE. When to initiate palliative care in neurology. Chapter 8. In: Miyasaki JM, Kluger BM, editors. Handbook of Clinical Neurology. Elsevier; 2022. pp. 105\u0026ndash;25.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKaasa S, Torvik K, Cherny N, Hanks G, de Conno F. Patient demographics and centre description in European palliative care units. Palliat Med 2007 -01;21(1):15\u0026ndash;22.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNavarro-Mel\u0026eacute;ndez A, Gimenez MJ, Robledo-Donascimento Y, R\u0026iacute;o-Gonz\u0026aacute;lez A, Lend\u0026iacute;nez-Mesa A. Physiotherapy applied to palliative care patients: a descriptive practice-based study. BMC Palliat Care 2023-07-20;22(1):99.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePutt K, Faville KA, Lewis D, McAllister K, Pietro M, Radwan A. Role of Physical Therapy Intervention in Patients With Life-Threatening Illnesses: A Systematic Review. Am J Hosp Palliat Care 2017-03-01;34(2):186\u0026ndash;96.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSantiago-Palma J, Payne R. Palliative care and rehabilitation. Cancer 2001-08-15;92(4 Suppl):1049\u0026ndash;52.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMontagnini M, Javier NM, Mitchinson A. The Role of Rehabilitation in Patients Receiving Hospice and Palliative Care. Rehabilitation Oncol. 2020 January;38(1):9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eStucki G, Bickenbach J. Functioning: the third health indicator in the health system and the key indicator for rehabilitation. Eur J Phys Rehabil Med 2017 -02;53(1):134\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAlam S, Hannon B, Zimmermann C. Palliative Care for Family Caregivers. J Clin Oncol 2020-03-20;38(9):926\u0026ndash;36.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKrug K, Miksch A, Peters-Klimm F, Engeser P, Szecsenyi J. Correlation between patient quality of life in palliative care and burden of their family caregivers: a prospective observational cohort study. BMC Palliat Care 2016-01-15;15:4.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRodr\u0026iacute;guez AM, Mayo NE, Gagnon B. Independent contributors to overall quality of life in people with advanced cancer. Br J Cancer. 2013;05\u0026ndash;14(9):1790\u0026ndash;800.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFranchini L, Ercolani G, Ostan R, Raccichini M, Samolsky-Dekel A, Malerba MB et al. Caregivers in home palliative care: gender, psychological aspects, and patient's functional status as main predictors for their quality of life. Support Care Cancer 2020 -07;28(7):3227\u0026ndash;35.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBajwah S, Oluyase AO, Yi D, Gao W, Evans CJ, Grande G et al. The effectiveness and cost-effectiveness of hospital-based specialist palliative care for adults with advanced illness and their caregivers. Cochrane Database Syst Rev 2020-09-30;9(9):CD012780.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePerpi\u0026ntilde;\u0026aacute;-Galva\u0026ntilde; J, Orts-Beneito N, Fern\u0026aacute;ndez-Alc\u0026aacute;ntara M, Garc\u0026iacute;a-Sanju\u0026aacute;n S, Garc\u0026iacute;a-Caro MP, Caba\u0026ntilde;ero-Mart\u0026iacute;nez MJ. Level of Burden and Health-Related Quality of Life in Caregivers of Palliative Care Patients. Int J Environ Res Public Health 2019-11-29;16(23).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKavalieratos D, Corbelli J, Zhang D, Dionne-Odom JN, Ernecoff NC, Hanmer J et al. Association Between Palliative Care and Patient and Caregiver Outcomes: A Systematic Review and Meta-analysis. JAMA 2016-11-22;316(20):2104\u0026ndash;14.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHenson LA, Maddocks M, Evans C, Davidson M, Hicks S, Higginson IJ. Palliative Care and the Management of Common Distressing Symptoms in Advanced Cancer: Pain, Breathlessness, Nausea and Vomiting, and Fatigue. J Clin Oncol 2020-03-20;38(9):905\u0026ndash;14.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eIannizzi P, Feltrin A, Martino R, De Toni C, Galiano A, Pambuku A, et al. Psychological assessment and the role of the psychologist in early palliative care. Front Psychol. 2024;15:1437191.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGreer JA, Applebaum AJ, Jacobsen JC, Temel JS, Jackson VA. Understanding and Addressing the Role of Coping in Palliative Care for Patients With Advanced Cancer. J Clin Oncol 2020-03-20;38(9):915\u0026ndash;25.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCenteno C, Hernansanz S, Flores LA, Rubiales AS, L\u0026oacute;pez-Lara F. Spain: palliative care programs in Spain, 2000: a national survey. J Pain Symptom Manage. 2002;\u0026ndash;08(2):245\u0026ndash;51.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePeterman AH, Fitchett G, Brady MJ, Hernandez L, Cella D. Measuring spiritual well-being in people with cancer: the functional assessment of chronic illness therapy\u0026ndash;Spiritual Well-being Scale (FACIT-Sp). Ann Behav Med. 2002;24(1):49\u0026ndash;58.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBalboni TA, Paulk ME, Balboni MJ, Phelps AC, Loggers ET, Wright AA et al. Provision of spiritual care to patients with advanced cancer: associations with medical care and quality of life near death. J Clin Oncol 2010-01-20;28(3):445\u0026ndash;52.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAustin PD, Lee W, Keall R, Lovell MR. Efficacy of spiritual interventions in palliative care: An umbrella review of systematic reviews. Palliat Med 2025 -01;39(1):70\u0026ndash;85.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eQuinn KL, Shurrab M, Gitau K, Kavalieratos D, Isenberg SR, Stall NM et al. Association of Receipt of Palliative Care Interventions With Health Care Use, Quality of Life, and Symptom Burden Among Adults With Chronic Noncancer Illness: A Systematic Review and Meta-analysis. JAMA 2020-10-13;324(14):1439\u0026ndash;50.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGaertner J, Siemens W, Meerpohl JJ, Antes G, Meffert C, Xander C et al. Effect of specialist palliative care services on quality of life in adults with advanced incurable illness in hospital, hospice, or community settings: systematic review and meta-analysis. BMJ 2017 /07/04;357:j2925.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDapueto JJ, Servente L, Francolino C, Hahn EA. Determinants of quality of life in patients with cancer. Cancer 2005-03-01;103(5):1072\u0026ndash;81.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMold\u0026oacute;n-Ballesteros E, Llamas-Ramos I, Calvo-Arenillas JI, Cusi-Idigoras O, Llamas-Ramos R. Validation of the Spanish Versions of FACIT-PAL and FACIT-PAL-14 in Palliative Patients. Int J Environ Res Public Health 2022-08-29;19(17):10731.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-palliative-care","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pcar","sideBox":"Learn more about [BMC Palliative Care](http://bmcpalliatcare.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pcar/default.aspx","title":"BMC Palliative Care","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Palliative care, quality of life, terminal care, exercise, Physical Functional Performance, Spain, caregivers","lastPublishedDoi":"10.21203/rs.3.rs-7595021/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7595021/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003ePalliative care enhances the health-related quality of life of patients with advanced diseases. Therefore, it is essential to identify which factors contribute most to the perception of well-being to develop timely intervention strategies. The aim of this study was to examine factors associated with health-related quality of life in adults with advanced disease of any etiology.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eAn observational cross-sectional study with a questionnaire based on the Functional Assessment of Chronic Illness Therapy \u0026ndash; Palliative Care Spiritual Well-Being scale (FACIT-Sp) and performance status was conducted.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eForty-two patients with life-threatening illnesses of 71.8\u0026thinsp;\u0026plusmn;\u0026thinsp;11.29 years, 64.3% diagnosed with oncological disease. The mean Barthel Index was 59.5\u0026thinsp;\u0026plusmn;\u0026thinsp;24.34, and an estimated survival prognosis of 50\u0026ndash;60 days based on the Palliative Performance Scale. The mean FACIT-Sp was 87.9\u0026thinsp;\u0026plusmn;\u0026thinsp;22.1, the highest scores observed in physical well-being dimension. Patients who engaged in some degree of physical activity the year prior to the study reported higher scores (103.51\u0026thinsp;\u0026plusmn;\u0026thinsp;15.35 vs. 83.73\u0026thinsp;\u0026plusmn;\u0026thinsp;21.88 [p\u0026thinsp;=\u0026thinsp;0.015]). Additionally, participants with a primary caregiver\u0026mdash;59.4% of whom were female\u0026mdash;had higher scores on FACIT-G subscale (64.09\u0026thinsp;\u0026plusmn;\u0026thinsp;13.48 vs. 53.38\u0026thinsp;\u0026plusmn;\u0026thinsp;18.38 [p\u0026thinsp;=\u0026thinsp;0.05]). The FACIT-Sp scale and its subscales demonstrated high reliability (Cronbach\u0026rsquo;s alpha\u0026thinsp;=\u0026thinsp;0.889).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eEngaging in some degree of physical activity and maintaining functional performance may be associated with a better perception of health-related quality of life in palliative care patients.\u003c/p\u003e","manuscriptTitle":"Health-Related Quality of Life in Palliative Care: Determinants Identified in a Hospital-Based Observational Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-22 19:34:40","doi":"10.21203/rs.3.rs-7595021/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-11-11T03:14:59+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-27T17:48:28+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-22T19:10:04+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-22T14:25:03+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-21T18:47:26+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"105937945807875999257124328778737569056","date":"2025-10-18T17:19:50+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"237222640621024291773592826058651499613","date":"2025-10-18T15:56:07+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"2287000539809809270287348448599334696","date":"2025-10-15T16:24:17+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"140610384576597690440426396330008316554","date":"2025-10-12T07:11:01+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-09T10:17:17+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-09-16T05:44:44+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-16T05:28:13+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-15T09:21:22+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Palliative Care","date":"2025-09-11T21:47:17+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-palliative-care","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pcar","sideBox":"Learn more about [BMC Palliative Care](http://bmcpalliatcare.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pcar/default.aspx","title":"BMC Palliative Care","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"533e2e59-6ac4-4ff7-9943-d85d0b87a665","owner":[],"postedDate":"October 22nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-12-29T16:04:32+00:00","versionOfRecord":{"articleIdentity":"rs-7595021","link":"https://doi.org/10.1186/s12904-025-01974-1","journal":{"identity":"bmc-palliative-care","isVorOnly":false,"title":"BMC Palliative Care"},"publishedOn":"2025-12-27 15:57:38","publishedOnDateReadable":"December 27th, 2025"},"versionCreatedAt":"2025-10-22 19:34:40","video":"","vorDoi":"10.1186/s12904-025-01974-1","vorDoiUrl":"https://doi.org/10.1186/s12904-025-01974-1","workflowStages":[]},"version":"v1","identity":"rs-7595021","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7595021","identity":"rs-7595021","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}