4.1. Study Limitations
tiredness, ill
DISEASE, RECRUITMENT
Our study had several limitations. Firstly, only one nurse provided the intervention, which might have influenced the results. Secondly, the rapid deterioration in the health status of the participants implied a decrease in the number of patients in each group, which might impact the results. Indeed, participants’ numbers are lower than proposed in the planned power analysis due to recruitment challenges common to end-of-life studies. This reality is unavoidable and is often responsible for the low number of longitudinal studies carried out in this population. The effect of disease symptoms was the main factor behind the study’s dropout rate, with identical rates in both groups. In this study, the HPP was not responsible for patient exhaustion to the point of inducing them to give up due to tiredness. In the per-protocol analysis, data were examined only for those patients who completely adhere to the protocol, as this reduces the statistical power of the study, and the benefits of randomization are lost because the composition of the original groups has been disturbed. Despite the constraints motivated by the loss of subjects, the cases analysed guaranteed group homogeneity, which attests to the reliability of the results. Future studies with mixed methods should address these limitations with larger sample sizes and more diverse settings, including extended and more detailed follow-ups. The HPP should also be extended to include non-terminally ill patients, patients receiving palliative care, and patients with lower levels of functional status [Lastly, and while our clinical trial has not been prospectively registered, this study contains valuable information to improve palliative care and inform future clinical practice. 