This observational cross-sectional study evaluates and compares healthcare professionals' perceptions of key domains of home-based palliative care. Using an anonymous online survey and multicriteria decision analysis (MCDA) methods, the study explores perceived importance, strategic prioritization, and self-assessed performance across five core palliative care domains. The study is conducted across Hospital-at-Home units throughout the Valencian Community (Spain).

MULTIPAL is an observational, analytical, cross-sectional census survey designed to assess healthcare professionals' perceptions of home-based palliative care within Hospital-at-Home units. The study is grounded in international palliative care frameworks, including those promoted by the World Health Organization, which define palliative care as a multidimensional approach encompassing symptom control, psychosocial and spiritual care, communication, coordination, and professional well-being.

Differences in professional priorities may influence clinical decision-making, coordination, and care quality. Despite increasing attention to palliative care quality indicators, professionals' perspectives-particularly in home-based settings-remain underexplored.

The study applies complementary Multicriteria Decision Analysis methods (TOPSIS, PROMETHEE, Analytic Hierarchy Process) to evaluate and compare professional priorities across five predefined domains: symptom control; communication and shared decision-making; psychosocial and spiritual care; coordination and continuity of care; and support for healthcare professionals.

Initially conceived as a single-center study, MULTIPAL was expanded to all Hospital-at-Home units in the Valencian Community to enhance representativeness, external validity, and relevance for system-level quality improvement.

Inclusion Criteria:

• Healthcare professionals working in Hospital-at-Home units providing home-based palliative care within the Valencian Community.

Exclusion Criteria:

• Healthcare professionals without direct clinical or care-related responsibilities (e.g., administrative or non-clinical support staff) within Hospital-at-Home units.

The survey will be addressed to healthcare professionals working in Hospital-at-Home units across the Valencian Community (Spain). Eligible participants will be professionals with direct clinical responsibilities in the care of patients and families receiving home-based palliative care.

The following professional profiles will be included:

Physicians Nursing assistants Nurse case managers (including those involved in remote monitoring and disease management) Clinical psychologists Social workers Physiotherapists

Professionals who do not have direct clinical or care-related responsibilities, such as administrative staff or other non-clinical support personnel within Hospital-at-Home units, will be excluded from the study.

Aggregated and fully anonymized data will be shared with all participating Hospital-at-Home units as part of a structured feedback and quality improvement process.

Study results and aggregated datasets will also be disseminated through peer-reviewed publications in journals focused on palliative care and health services research.

Shared data will include anonymized MCDA-derived summary scores and rankings (TOPSIS, PROMETHEE, AHP). No individual-level identifiable data will be shared.

Time Frame: Data sharing will begin after completion of data analysis and primary dissemination of results.

Access Criteria: Data will be shared upon reasonable request for academic, educational, or quality improvement purposes, in accordance with institutional data protection policies.

De-identified and aggregated data will become available after completion of data analysis and publication of the main study results, expected within 6 months after study completion. Data will remain available for a minimum period of 5 years following initial dissemination, in accordance with institutional data retention policies

Access to the shared data will be granted to investigators from participating Hospital-at-Home units within the Valencian Community and to qualified researchers who submit a reasonable request. Shared data will consist of aggregated and fully de-identified datasets, including multicriteria decision analysis outputs (TOPSIS, PROMETHEE, AHP summary scores), descriptive subgroup analyses, and supporting documentation (e.g., data dictionary).

Requests for access will be reviewed by the study investigators. Data will be provided exclusively for academic research, quality improvement, or educational purposes, and users may be required to agree to conditions of use that prohibit re-identification attempts and unauthorized redistribution.