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Diagnostic obstinacy in hospitalized oncologic patients in their last days of life

MA González-Benítez1, ML Amaya González1, M Godoy Guerrero1, A Ruz Zafra1, C Segura Schultz2, A Ruiz-Cantero1
1UGC Medicina Interna. Hospital de la Serranía, Ronda. 2Equipo de Soporte de Cuidados Paliativos. Hospital de la Serranía, Ronda

ABSTRACT: Limitation of therapeutic effort should include limitation of diagnostic tests that do not contribute to patients’ comfort. The aim of the present study was to assess the use of diagnostic tests among hospitalized oncologic patients in their last days of life. Methods: A retrospective observational study was performed including all oncologic patients stage IV who died while hospitalized in the Internal Medicine Unit during a two-years period. Analized variables were: age, gender, number of laboratory tests, number of imaging tests (plain X-ray, ultrasound, computed tomography -CT-, magnetic resonance imaging -MR-), and if a blood test was performed in the last 48 hours of life. Results: 51 patients were included (women 15, 29.4%), with an average age of 71.94 years (standard deviation 11.06). 45 patients (88.4%) underwent laboratory tests with a median of 3 tests per patient (interquartile range 1,5). 41 patients (80.4%) underwent imaging tests, with a median of 1 test per patient (interquartile range 1,3). The frequency of imaging tests were: plain X-ray 37 patients (72.5%), ultrasound 17 patients, (33.3%), CT 12 patients (23.6%), MR 1 patient (2%). 23 patient (45.1%) underwent at least one blood test in the last 48 hours of life. Conclusions: A large number of laboratory and imaging tests are performed during the last days of terminally-ill hospitalized cancer patients. Although these test are not considered invasive, they cause an unneccesary discomfort to patients, and do not contribute to symptoms relief.

DOI: 10.20986/medpal.2019.1066/2019

Multiple primary neoplasms in Palliative Care, a cases study

Iago Villamil Cajoto1, Carmen Martínez Lamas1, Lucía Balea Vázquez1, Nieves Fernández Castro1
1Unidad de Hospitalización a Domicilio, Cuidados Pa. Hospital da Costa, Burela

Multiple primary neoplasms in Palliative Care, a cases study

DOI: 10.20986/medpal.2019.1074/2019

Perineal and gluteal dermatosis in a palliative patient with rapid response to oral treatment

María de las Mercedes Barrio Gordillo1, Olivia López- Barrantes González2
1Cuidados Paliativos. Centro de cuidados Laguna, . 2Dermatología. Hospital infanta Sofía,

Patients with terminal disease frecuently present various skin problems due to their underlying disease and complications of their clinical situation: bed-ridden, immobility, malnutrition, incontinence, etc. These lesions commonly produce significant suffering because of pain, itching, discomfort, body image distortion and lack of intimacy. Thus, an effective management of these by palliative care is prioritary. Occasionally, a specific treatment efficacious in the short time avalilable is possible as the present case shows.

DOI: 10.20986/medpal.2019.1111/2019

Knowledge and Assessment of the Living Wills of the Health Professionals at Home Hospitalization Units, Medical Oncology, Daytime Hospital and Emergency Services

María Teresa García Salvador1, Nuria Garrido Rodríguez1, Vicente Ribes Gadea2, Luis Gómez Royuela1, Silvia Forcano Sanjuan1, Vicente Ruiz García1
1Unidad de Hospitalización a Domicilio. Hospital Universitario y Politécnico La Fe, Valencia. 2Servicio de Urgencias. Hospital La Ribera, Alzira

Objective: To describe the doctors and nurses’ medical knowledge who work with advanced palliative patients about the patient´s living wills and the national registry of these. We want to describe its knowledge and the use of this file.
Material and Methods: Multicentric, descriptive transversal study, by an anonymous survey self-completed with 14 questions about the file of early decisions planning. We also collected characteristic items about works and demographics of nurses and MD that works in Emergency and Oncology Departments, Hospital at home and a Day Hospital of three hospitals of Valencia (Spain)
Results: We collected 160 surveys (MD n= 58), and nurses (n=102).
The average of age of the people in the survey was 42 ± 9, years and the average of time worked was 17 ± 9.3 years. The 83.1 % answered that they knew the file of early decisions of patients, but only 53.8 % described how they could filled it in. Only 8.1 % responded correctly where they could check the file. The 92.5 % never checked it. Two respondents who claimed to consult it regularly, didn’t know how to locate it.
Conclusions: There is a lack of knowledge about this file. Neither the professional position nor the year experience, neither the health service were related to the use or the knowledge of this file.

DOI: 10.20986/medpal.2019.1069/2019

Chemical compensation and opioid addiction: the point of opioid household surpluses in Palliative care

Iago Villamil Cajoto1, Iago Villamil Cajoto1, alicia alvarez perez2, lucia balea vazquez3, carmen martinez lamas4
1Hospitalización a domicilio-Coidados paliativos. Hospital da Costa, Burela (Lugo), . 2Hospitalizacion a domicilio-Coidados paliativos. Hospital da Costa, . 3Hsopitalizacion a domicilio-Coidados paliativos. H da Costa, Burela, . 4Hospitalización a domicilio-Coidados paliativos. H da Costa, Burela,

DOI: 10.20986/medpal.2019.1006/2018

A narrative experience in Palliative Care. Reflections of a medical student

1Unidad de Cuidados Paliativos. Complejo Hospitalario Universitario de Ourense, Ourense. 2Facultad de Medicina. Universidad Internacional de Barcelona,

DOI: 10.20986/medpal.2019.1010/2018

Evaluation of health care in the dying process of patients with respiratory disease

Juana Mª Sepúlveda-Sánchez1, Francisco Rivas-Ruiz2, Alejandra Chica-Rama1, Alicia Padilla-Galo1, Jose Joaquín Cebrián-Gallardo1, Jose Carlos Canca-Sánchez1
1Servicio de Neumología. Agencia Pública Empresarial Costa del Sol, Marbella. 2Unidad de Investigación. Red de Investigación en Servicios de Salud en Enfermedades Crónicas. REDISSEC, Marbella

Evaluation of health care in the dying process of patients with respiratory disease

DOI: 10.20986/medpal.2019.1064/2019

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.

DOI: 10.20986/medpal.2019.1053/2019

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.

DOI: 10.20986/medpal.2019.1063/2019

The palliative sedation is a covered way of euthanasia?

Roberto Germán Zurriaráin1
1Departamento de Ciencias Humanas y Sociales. Universidad de La Rioja, La Rioja

DOI: 10.20986/medpal.2019.1060/2019

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