Aim: This study aims to assess the influence of training on nurses’ attitudes toward end-of-life care during the COVID-19 pandemic alarm state in Spain. Design: Cross-sectional descriptive study. Data collection was carried out by means of an ad hoc questionnaire using Google Forms in April and May 2020. The score of attitudes toward end-of-life care was used, to which sociodemographic variables and training in palliative care were added. Methods: Data were collected from 238 nursing professionals who had cared for COVID-19 and non-COVID-19 adult patients at the end-of-life stage in a hospital or nursing home. Results: Results showed that 51% of the nurses in the sample had training in palliative care. However, the percentage decreased to 38.5% among those who cared for COVID-19 patients and to 44.5% in those who cared for non-COVID-19 patients. In relation to attitudes about end-of-life care, more positive attitudes and a higher mean score were found in the trained group. Conclusions: Palliative care training is a key element in end-of-life care and is even more important in times of COVID-19. Impact: Although end-of-life accompaniment has been studied, few studies have included the influence of training on this during the pandemic. This study identifies key elements of accompaniment and training in a comparison of COVID-19 and non-COVID-19 patients during the pandemic. In relation to attitudes toward end-of-life care, the results showed a more positive attitude and a higher mean score in the trained group (3.43 ± 0.37 versus 3.21 ± 0.32), the difference being statistically significant (p < 0.001).

Background/Objectives: To identify and evaluate contemporary clinical practice guidelines for the care of adult patients in their last days of life, their families and caregivers. Methods: A systematic review was conducted following the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) statement (PROSPERO: CRD42021258311). PubMed, TRIP Database, Cochrane Library, ProQuest, and CINAHL were searched for CPGs published between January 2016 and December 2025 in English or Spanish, supplemented by searches of seven palliative care organisation websites. Two independent reviewers screened records; the AGREE II instrument was applied by four evaluators to assess methodological quality. Recommendations from included guidelines were categorised into 12 inductively derived decision areas encompassing recognition of the dying phase, communication and decision-making, multidisciplinary care, symptom management, and grief and bereavement. A narrative synthesis was adopted due to heterogeneity in guideline structure and recommendation grading systems. Results: Of 1118 records identified, 20 were retrieved for full-text assessment. Sixteen met CPG criteria and were appraised with AGREE II, of which eight were finally included. Included guidelines originated from five countries (UK, Spain, USA, Canada, and Europe) and were published between 2018 and 2021. Overall AGREE II scores ranged from 71% to 100%, with the lowest domain scores consistently found in Applicability. Strong recommendations were identified across most guidelines for recognition of the LDS, communication, and interdisciplinary coordination; recommendations on symptom management were mixed. Conclusions: Findings may inform professionals and health system managers in identifying key LDS care recommendations. Gaps in social, cultural, and spiritual dimensions should guide future guideline development. Key limitations include heterogeneity in guideline methods and restriction to English and Spanish publications. No external funding was received.