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The multidimensional view of disease is fundamental in the care of complex diseases such as chronic kidney disease (CKD). It is appropriate to define and unify concepts that allow the different professionals involved in care to provide a multidisciplinary approach tailored to the needs of each individual. Given the increasing incidence of CKD worldwide and the fact that the disease may progress at different rates, there is a need to establish personalized, comprehensive approaches for each patient and their families at an earlier stage. This approach goes beyond the simple control of uremic symptoms or congestion and consists of addressing not only symptomatic but also functional, social and coping problems at an early stage, facilitating decision making both in the CKD and in acute situations, potentially irreversible or interventions that do not improve life expectancy. To ensure excellence in care, it is important to assess indicators of palliative care and kidney support, such as the presence of advance and shared care planning, the inclusion of psychosocial, ethical, spiritual and bereavement care. This enables the provision of comprehensive, humanized, and high-quality care for patients and their families. Palliative and kidney care is not just about patients in the last days of life. Defining, unifying, and evaluating the concepts will allow them to be applied in a timely manner at each specific moment of the CKD trajectory.

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Optimal pain management in patients with advanced cancer often requires multiple pharmacological interventions and multimodal approach. Ketamine is an anaesthetic agent with increasing evidence supporting its use for pain. Due to its N-methyl-D-aspartate antagonism and its activity at opioid receptors, it is an adjuvant to traditional analgesics. Ketamine has a safety profile with limited experience of oral prolonged use in patients with cancer. We report a case of a 40-year-old man with refractory neuropathic cancer-related pain. Opioid rotation to methadone was previously performed, coanalgesics were added, the patient was reluctant to invasive anaesthetic techniques and his pain was poorly controlled. Ketamine was added to attenuate pain keeping functionality. This is a report of a patient with refractory cancer pain treated with methadone and ketamine orally during months, without reported side effects. Ketamine's use to treat pain is increasing along with its evidence of efficacy for long-term oral use.

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Introducción: Dentro de la autonomía se debe contemplar las preferencias de los pacientes sobre cómo recibir la información (mediante conversación con profesionales o informáticamente). En Cataluña los ciudadanos tienen acceso a un portal informático (“La Meva Salut”) donde pueden consultar información relevante sobre su historial clínico. En cuanto al grado de participación en la toma de decisiones, Control Preferences Scale valora las preferencias en la toma de decisiones. Objetivos: Conocer las preferencias de los pacientes sobre cómo desean ser informados y sobre cómo tomar decisiones. Metodología: Estudio observacional descriptivo transversal realizado en una planta de hospitalización de oncología, hematología y cuidados paliativos en un hospital terciario. Recogidas variables sociodemográficas, nivel de estudios, estadio de la enfermedad, preferencias sobre cómo recibir información y Control Preferences Scale. Se dispuso de la aprobación del CEIC. Resultados: Incluidos 33 pacientes, con mediana de edad de 51 años. El 76 % hombres; el 57 % tenían enfermedad metastásica; el 51 % con estudios elementales. 22 pacientes (66 %) no conocían el portal “La Meva Salut”. El 91 % quería que un profesional sanitario les informara sobre sus enfermedades y ninguno de manera informática. El 33 % quería tomar decisiones de forma compartida, con médico y familia. Los 11 pacientes que conocían el portal (33 %) eran más jóvenes, afectados principalmente de enfermedades hematológicas y con nivel de estudios superior. Conclusiones: Al 91 % de los pacientes les gustaría que un profesional sanitario les diera información sobre su salud. El 33 % de los pacientes querían tomar las decisiones después de escuchar tanto la opinión o el aporte de la familia como del médico. Ninguno prefería que el portal informático fuese su única fuente de información. (AU)

Introduction: Within the Autonomous Community, the preferences of patients on how to receive information should be considered (whether in a conversation with professionals or via electronic means). In Catalonia, citizens have access to an Internet web page (“La Meva Salut”) where they can consult relevant information about their medical history. Regarding the degree of participation in decision-making, the “Control Preferences Scale” values preferences in decision-making. Objectives: To know the preferences of patients on how they want to be informed and on how to make decisions. Methodology: A cross-sectional, descriptive, observational study carried out in an oncology, hematology, and palliative care hospitalization unit at a tertiary hospital. Collected sociodemographic variables included educational level, stage of disease, preferences on how to receive information, and “The Control Preferences Scale”. The Ethics Committee approval was obtained. Results: A total of 33 patients were included with a median age of 51 years; 76% were men, 57 % had metastatic disease; 51 % had basic education; 22 patients (66 %) were unaware of the web page; 91 % wanted a health professional to inform them about their illness, and none preferred it delivered through electronic means; 33 % wanted decisions to be made in a shared way, with heir doctor and family. The 11 patients who were aware of the web age (33 %) were younger, mainly affected by hematological diseases, and with a higher educational level. Conclusions: 91 % of patients would like a healthcare professional to give them information about their health; 33 % preferred to make their decisions after listening to their physicians’ and family’s opinions. None preferred that the web page was their only source of information. (AU)

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