Do palliative care proffesionals know about advanced care planning document? a critic review
Joana Maria Julià-Móra1, Miguel Ángel Rodríguez-Calero2
1equipo de soporte hospitalario en atención paliati. Hospital de Manacor, Manacor. 2departamento de Enfermería y Fisioterapia. Universitat de les Illes Balears,
Rationale: 'Previous instructions' or 'Advance directives' document (PI/ADD) constitute a group of formal documents in which a patient can express the way he/she would like to die or be treated in the last days of life. These documents ensure patients’ final wishes will be considered and respected. The emerging trend of Advance Care Planning appeared in 1998, and the ADD was proposed in this context as a broad-based communication effort, which requires that healthcare professionals have proper training for end of life care. In this respect, previous studies show that inadequate training with regard to end of life care, especially in critical care units (ICU), hinder communication skills and attitudes, provision of care and finally, preservation of patient dignity during the process of death.
Objective: To analyse the competency (knowledge, skills and attitudes) about PI/ADD among physicians and nurses of ICUs in the region of Madrid.
Design: Cross-sectional study.
Place and timing: Nine hospitals in the region of Madrid, from October to December 2010.
Participants: All physicians and nurses from all adult ICUs of the nine participating hospitals constituted a convenience sample.
Instrument: An anonymous, structured, self-completed ad hoc questionnaire was sent to participants with dichotomous and Likert scale variables.
Data collection and analysis: Socio-demographic variables, as well as knowledge, skills and attitudes-related variables were collected. Previous to data collection, medical and nurse supervisors were contacted, information sessions carried out and informative posters displayed in participating units. The questionnaires were distributed through key informants and deposited in closed boxes after completion. Previous informed consents were obtained; the study was approved by the Committee of Clinical Research Ethics of San Carlos Hospital, Madrid.
Qualitative variables were described with absolute and relative rates and percentages according to categories. Association analysis included chi-squared and exact Fisher tests. A confidence interval with 5% error was applied, using the statistic package SPSS v. 18.0.
Results: A total of 649 questionnaires was delivered and 331 of them were sent back during the pre-established period of 3 months. The response rate was 51%. As for socio-demographic variables, 73,4% (253) of responders were women and 67,2 % (222) were older than 31 years old; 20,5% (68) of professionals were physicians and 79,5 % (263) were nurses. Regarding knowledge, 64,4% of participants reported not to know about the different documents available for patients to formalise their last wills. With respect to concrete measures included in the PI, such as the limitation of therapeutic effort, palliative care, organ donation, rejection of therapeutic obstinacy and the assignation of a legal representative, only 9,7% of professionals knew all of them. 82,8% of participants believed that ADD was a useful instrument for professional decision-making. 50,2% believed ADD were not respected. 85,3% of physicians would respect ADD in case of vital emergency, in contrast to 66,2% of nurses (p=0,007). Only 19,1% of physicians and 2,3% of nurses actually knew whether the patients they had in charge at the moment had a ADD or not (p<0,001).
Conclusions: Although healthcare professionals present a low level of knowledge about PI, they show a favourable attitude about their utility. However, most of the participants do not actually know if their patients have a ADD and some professionals, even when they know about the existence, would not respect it in case of an emergency. In this regard, further training is required with relation to PI.
Fear of death and its relationship with emotional intelligence in students of the last nursing year
Elena Fernández-Martínez1, Cristina Liébana-Presa1, María Martínez-Soriano2, Ana López-Alonso1
1Universidad de León, León. 2Hospital Comarcal de Alcañiz, Teruel
Nursing students have to acquire emotional competence of facing death as part of their learning stage. With this study, describing the fear variables and emotional intelligence are considered, as well as analysing the relationship between the two and comparing if differences exist with other social-demographic variables. Method: Transversal descriptive study, comparative and correlation design. 164 fourth-year students from the Nursing Degree. Data collection was carried out through an anonymous questionnaire that contained social-demographic variables, the Collett-Lester Fear of Death Scale (EMMCL) and the Emotional Intelligence Scale (TMMS-24). Descriptive statistics and the Pearson Correlation Coefficient were analysed and the T-Student Test was applied. Results: 101 students participated (61.6%). Inverse correlation was obtained between emotional regulation and fear of death. There are significant differences between fear of death and gender. Prior experiences related to death and the preparations in caring for a terminal ill patient are inversely correlated with fear of death. Conclusions: The women obtained higher scores of fear of death than the men. Also, when the regulation of emotions is bigger, the fear of death reduces. It is important to be aware of the persons view and attitude towards death and to implement training programs for emotional skills among nursing students.
The palliative sedation is a covered way of euthanasia?
Roberto Germán Zurriaráin1
1Departamento de Ciencias Humanas y Sociales. Universidad de La Rioja, La Rioja
Distress and coping strategies in advanced patients in front of end-of-life situation
Eva Rodríguez Bruzos1, Clara Fraguell Hernando1, Mercè Navarro Rodríguez1, Anna Escolà Fustero1, Helena Villar Abelló1, Sílvia de Quadras Roca1, Marta Argilés Huguet1, Meritxell Naudeillo Cosp1
1EAPS Mutuam Barcelona,
Introduction: The end-of-life is a situation of an important emotional impact for patients and family members. Under these circumstances, patients put in place different coping strategies in order to cope with this complex and difficult situation.
Objectives: To know the distress of end-of-life patients, to explore the coping strategies that are used by them and compare the distress and the coping strategies of the patients attended in a hospital and at home.
Method: We have made a cross-sectional study. The sample is formed by 75 patients in end-of-life situation. 53,3% were attended to at home and 46,7% in hospital facilities. We carried out a personal interview with each patient in order to recollect sociodemographic and clinical data and conducted questionnaires on their emotional distress (DME) and coping strategies (MINI-MAC and BRCS).
Results: 73,7% of patients have emotional distress and 81,3% express worry about their family (47,5%). The most used coping strategies are fighting spirit (45,5%) and resilience (44%). The patients attended at home present significantly higher scores in the strategies of anxious worry (p=0,016) and hopelessness (p=0,005) compared to patients admitted to a hospital center.
Conclusions: In spite of the fact of these patients having emotional distress, an important amount used adaptative coping strategies. However, the high proportion of patients’ emotional distress suggests the importance of developing preventive psychological interventions in order to decrease this distress and provide adaptative strategies which improve the quality of life of the end-of-life patients.
Relationships between Spirituality and Emotional Well-Being In Patients With Cancer: A Preliminary Study
Nieves Moyano1, Alfonso Cuvi2, Ester Ayllón1
1Universidad de Zaragoza, Zaragoza. 2Universidad de Especialidades Espíritu Santo,
Objective. To examine the role spirituality plays on mental health, through the assessment of anxiety-state, depression in cancer patients of palliative care from Ecuador. Method. Data were collected from 74 Palliative Care patients with cancer (19 men and 55 women) aged between 24 and 88 years (M = 58.07; SD = 13.84). We administered the following self-reported measures: FACIT Sp-12, STAI-E and PHQ-9 to evaluate spirituality and its dimensions (meaning, peace and faith), anxiety-state and depression respectively.
Results. Cluster analysis, both hierarchical and based on k-means, indicated four clusters. Two clusters provided high and low scores in spirituality respectively, with scores in anxiety and depression low and high respectively. On the other hand, medium levels of spirituality were associated with medium scores in emotional well-being. Finally, the last cluster represented high levels in faith and medium in peace and meaning, which did not yield significant differences in emotional well-being, instead there were differences in education and age.
Discussion and conclusion. Spirituality is relevant for anxiety and depression. The dimension faith from spirituality differs from meaning and peace, however it impacts on negative affect remains unclear. Clinical implications for patient´s well-being are discussed.
ICD and Pacemaker Deactivation : important issues to clarify
Gabriela Picco1, Rocío Ríos1, Isabel Erquiaga1, Helena Escalada1
1Unidad de Cuidados Paliativos . Hospital San Juan de Dios , Pamplona
Respuesta a: Insuficiencia cardiaca terminal ¿es posible morir bien?
Miguel Ángel Sancho Zamora1
1Equipo de Soporte de Cuidados Paliativos. Hospital Universitario Ramón y Cajal, Madrid
Quantitative assessment health care received by advanced chronic patients in a regional hospital
Estefania Serratusell1, Miguel Ángel Rodríguez-Calero2, Joana Maria Julià Móra3, Enric Benito4, Joan Vidal5, Catalina Vadell6, Noemí Sansó7
1Servei de Salut de les Illes Balears, Palma de Mallorca. 2Unidad de calidad, docencia e investigación . Hospital Manacor, Palma de Mallorca. 3Equipo de soporte hospitalario de atención paliati. Hopital de Manacor, Palma de Mallorca. 4PortalsNous., Calviá. 5Servicio de Urgencias. Hospital Manacor, Manacor. 6Gerencia Hospital Manacor, Palma de Mallorca. 7Departamento de Enfermería y Fisioterapia . Universidad de las Islas Baleares, Palma de Mallorca
The main goal is to assess the potential need for palliative care during the last month of life in patients who passed away in a regional hospital from Mallorca. Quantification of therapeutic and diagnostic procedures as well as the economic costs are also estimated.
A retrospective observational study has been conducted on a sample of 119 patients. An expert on palliative care has revised the clinical history of each patient, and quantified the use of hospital services and clinical procedures. Total costs have been estimated on the basis of Diagnosis-Related Groups (DGR).
Statistical analyses have been performed on 62 women and 57 men whose average age was 78.15 ± 12.62. Prevalence of deceased patients who meet the criteria for palliative care represents 88.81%. However, nothing only the prior identification of the patients as a palliative in 6.7%.
Cancer was diagnosed in 44 cases. The average of imaging tests performed was 3.61 ± 2.70. The average of blood tests performed was 7.46 ± 7.69. The average of antibiotic treatment was 1.51 ± 1.60. Total average cost of hospital care was 5.662,44 €.
The results evidence the high prevalence of patients in need of palliative care among total of deceased and a low prior identification. There is a high frequency of hospital services and a high level of invasive procedures in the last year of life, with the high economic and potential suffering that entails.