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1.
Article in Japanese | WPRIM | ID: wpr-913212

ABSTRACT

Purpose: This study clarified the general public’s end-of-life decision-making expectations and related factors. Method: We analyzed secondary data of 1,000 adults surveyed through the Internet. The outcome was to determine the life expectancy at the end of life, end-of-life care, and decision-makers’ wishes. Results: Regarding the prognosis, 54% wanted to know the life expectancy in end-of-life. This preference was independently associated with being notified of cancer at a young age, trust in medical professionals, and the view of life and death that disappears. Regarding end-of-life care preferences, 11% requested active treatment, and 58% requested palliative care. This preference was independently associated with older age, women, and an emphasis on being pain-free and being yourself. Regarding decision-makers’ preferences, 77% wanted to decide for themselves, and 11% wanted to decide for their families. This preference was independently associated with the young, carefree of life and death, who did not want to be notified of cancer. Conclusion: We revealed the general public’s desire for end-of-life decision-making and associated factors. In clinical practice, it can be used for screening.

2.
Rev. Assoc. Med. Bras. (1992) ; 67(9): 1261-1267, Sept. 2021. tab, graf
Article in English | LILACS | ID: biblio-1351476

ABSTRACT

SUMMARY OBJECTIVE: The aim of this study was to estimate self-perception of anguish and low quality of life among health care professionals who cared for the dying patients during the COVID-19 pandemic and to determine the characteristics of health care professionals and patients and end-of-life care. METHODS: An online survey that included health care professionals who cared for the dying patient from July 1 to October 31, 2020 was conducted. Low quality of life, anguish, characteristics of patients and health care professionals, and end-of-life care were recorded. Poisson regression was performed to assess the predictors of anguish and low quality of life. RESULTS: A total of 102 health care professionals, including 14 males (13.7%), with a median age of 37 years, composed of 41 physicians (40.2%), 36 physiotherapists (35.3%), and 25 nurses (24.5%) were included in this study. Self-perception of anguish occurred in 69.6% and was associated with physicians and disagreement with end-of-life care offered. Low quality of life was reported in 64.7% and was associated with not having time to talk to patients' relatives. The agreement that medical care was enough reduced self-perception of low quality of life. CONCLUSION: Self-reported anguish was more frequent in physicians and when the disagreement about end-of-life care occurred. Low quality of life was more frequent when health care professionals did not have time to talk to patients' relatives and was less frequent when health care professionals agreed that medical care was enough. Strategies should be done by health services to reduce the impact of the pandemic on health care professionals.


Subject(s)
Humans , Male , Adult , Terminal Care , COVID-19 , Quality of Life , Health Personnel , Pandemics , SARS-CoV-2
3.
Palliative Care Research ; : 289-299, 2021.
Article in Japanese | WPRIM | ID: wpr-906945

ABSTRACT

Objective: To determine ICU nurses’ perceptions of end-of-life care and the factors associated with these perceptions. Methods: An anonymous self-administered questionnaire was mailed to 650 nurses with at least three years of ICU experience at an emergency and critical care center regarding their basic attributes and their perceptions of end-of-life care. Logistic regression analysis was performed with the constructs of perception of end-of-life care as the dependent variables. Results: A total of 277 valid responses were obtained. The following three constructs of perception of end-of-life care were extracted: difficulty in family care, negative perception of end-of-life care, and positive perception of end-of-life care. “Difficulty in family care” was significantly associated with “10 or more years of ICU experience” and “PNS”; “negative perception of end-of-life care” was significantly associated with “age 30–39,” “age 40 years or older,” and “manuals and guidelines for end-of-life care”; and “positive perception of end-of-life care” was significantly associated with “interest in end-of-life care.” Conclusion: In order to raise awareness of end-of-life care, it is necessary to address factors such as nurses’ personal experiences of and interest in end-of-life care, and use of manuals and guidelines for end-of-life care.

4.
Article in Japanese | WPRIM | ID: wpr-873949

ABSTRACT

Purpose: This study aimed to implement an end-of-life care simulation that was assessed at one facility (University A) on nursing university students in a different educational environment (University B), and assess the simulation through a review. Method: After the simulation, participants were asked to freely comment on the review sheet and the contents were analyzed. There were 12 participants. Results: Comments on the review sheet were summarized in 13 categories: self-understanding of nursing, realization of one’s positive view regarding nursing, acquisition of knowledge regarding communication, acquisition of knowledge regarding end-of-life, gaining learning opportunities, realization of effects from debriefing, positive change one experiences regarding nursing, acquisition of knowledge regarding nursing, realization of reality, assessment of teachers’ involvement, assessment of implementation method, assessment of the atmosphere of the venue, and assessment of experiences. Conclusion: Participants of the simulation can be expected to gain a similar learning experience regardless of the learning environment.

5.
Palliative Care Research ; : 197-207, 2021.
Article in Japanese | WPRIM | ID: wpr-886244

ABSTRACT

Palliative sedation (PS) is an effective way to alleviate the refractory symptom of terminally ill cancer patients, however it can be ethical. PS is now being implemented in general wards, and there is an urgent need to understand the actual conditions of sedation care for general ward nurses and improve the quality of care. In this study, a semi-structured interview was conducted with nurses working in a respiratory medicine ward of a core cancer treatment hospital. By Krippendorff’s content analysis, 16 categories of nurses’ actions/judgments, 8 categories of positive thoughts, and 5 categories of negative thoughts were extracted. Nurses have always sought the best way to alleviate the pain of patients and their families, and have endeavored to be close to their feelings. However, there was a difference in confidence and positivity regarding multidisciplinary collaboration and sedation discussions. It was suggested that the confident efforts of nurses may support the decision-making of patients and their families and consider methods for pain relief and QOL.

6.
Article in Japanese | WPRIM | ID: wpr-886189

ABSTRACT

Introduction: We investigated the end-of-life care preferences of patients with mild dementia and compared them with the hopes of caregivers regarding end-of-life care for patients.Methods: A questionnaire survey was conducted among outpatients with mild dementia or mild cognitive impairment and their family caregivers who visited the Medical Center for Dementia.Results: We analyzed 50 pairs of dementia patients and their family caregivers. Of people with dementia, 24 respondents (48.0%) preferred "antibiotics and infusions for pneumonia" at the end of life. Eleven respondents (22.0%) preferred "central parenteral nutrition". Eight respondents (16.0%) preferred "resuscitation". For each end-of-life care item, the concordance rate between patients and caregivers on "prefer" / "do not prefer" was 0%-76%. Patients and their families who discussed end-of-life care had a significantly higher concordance rate for "resuscitation" preference than those who did not.Conclusion: For patients and their families to be able to make decisions they do not regret, it is important to promote discussions about end-of-life medical care before the patient's condition becomes severe.

7.
Inmanencia (San Martín, Prov. B. Aires) ; 8(1): 144-149, 2021. tab.
Article in Spanish | LILACS, BINACIS | ID: biblio-1222723

ABSTRACT

Las secuencias integradas de cuidado para últimos días de vida proponen estándares de calidad para optimizar la atención de pacientes y familias. Se implementó el Programa Asistencial Multidisciplinario Pallium (PAMPA ©) basado en estándares del International Collaborative for Best Care for the Dying Person en cuatro fases: inducción, implementación, diseminación y sustentabilidad, en cinco centros de salud en Argentina, entre 2008 y 2018. Se incluyeron 1237 pacientes adultos en situación de últimos días de vida, en seguimiento por equipos de cuidados paliativos entrenados en el PAMPA ©. Se efectuó una auditoría antes y después de la ejecución del programa, aún en curso. El rango de medianas de permanencia en los cinco centros desde el inicio de la secuencia hasta el fallecimiento fue de 16 a 178 horas. Se compararon objetivos de cuidado: control de síntomas, comunicación, necesidades multidimensionales, hidratación y nutrición, documentación de intervenciones y cuidados post mortem. El análisis conjunto mostró una mejoría del número de registros (p = 0.001). La comunicación del plan de cuidados con el paciente no mostró diferencias (p = 0.173). Se realizó capacitación y supervisión permanente a los equipos profesionales de quienes se registraron percepciones de la implementación. Los principales emergentes de este análisis cualitativo fueron: actitudes ante el programa, aportes fundamentales, fortalezas, debilidades y definición subjetiva del programa, reconocimiento de las singularidades culturales institucionales y su influencia en el cuidado. El PAMPA © demostró la factibilidad de un modelo de atención para pacientes y familias en final de vida, basado en estándares de calidad internacionales


The integrated care pathways for the last days of life propose quality standards optimizing the care of patients and families. The Pallium Multidisciplinary Assistance Program (PAMPA ©) was implemented based on standards of the International Collaborative for Best Care for the Dying Person in 4 phases: induction, implementation, dissemination and sustainability, in five health centers in Argentina, between 2008 and 2018. A total of 1237 adult patients in the last days of life were included and cared for by palliative care teams trained in PAMPA ©. An audit was conducted before and after the implementation of the Program, which is still going on. The median range of follow up into five centers from the beginning of the pathway until death varied from 16 to 178 hours. Care goals were compared: symptom control, communication, multidimensional needs, hydration and nutrition, documentation of interventions and post-mortem care. The overall analysis showed an improvement in the number of records (p = 0.001). The goal of communication on care plan to the patient showed no difference (p = 0.173). Continuous training, support and permanent teams' supervision were carried out and perceptions and impact of the implementation were registered. The main emerging items of the qualitative analysis were attitudes towards the program, fundamental contributions, strengths, weaknesses and subjective definition of the program, recognition of institutional cultural singularities and its influence on care. PAMPA © demonstrated its feasibility as a model of end of life care for patients and families, based on international quality standards


Dez anos de experiência. Resumo: As sequências integradas de cuidado para últimos dias de vida propõem padrões de qualidade para otimizar a atenção de pacientes e famílias. Implementou-se o Programa Assistencial Multidisciplinar Pallium (PAMPA ©) baseado em parâmetros do International Collaborative for Best Care for the Dying Person em quatro fases: indução, implementação, disseminação e sustentabilidade, em cinco centros de saúde na Argentina, entre 2008 e 2018. Se incluíram 1237 pacientes adultos em situação terminal, assistidos por equipes de cuidados paliativos treinadas no PAMPA ©. Fez-se uma auditoria antes e despois da execução do programa, que ainda está sendo desenvolvido. A média de permanência nos cinco centros desde o início da sequência até a morte deu entre 16 a 178 horas. Conferiram-se objetivos de cuidado: controle de sintomas, comunicação, necessidades multidimensionais, hidratação e nutrição, documentação de intervenções e cuidados post mortem.A análise conjunta tem evidenciado uma melhora do número de registros (p = 0.001). A comunicação do regime de cuidados com o paciente não mostrou diferenças (p = 0.173). Realizou-se capacitação e supervisão permanente às equipes profissionais e se registraram as percepções da implementação.Desta análise qualitativa surgiram notadamente: atitudes em fase do programa, contribuições fundamentais, fortalezas, fraquezas e definição subjetiva do programa, reconhecimento das singularidades culturais institucionais e sua influência no cuidado. O PAMPA © demonstrou a factibilidade de um modelo de atendimento para pacientes e famílias em estado terminal, baseado em padrões de qualidade internacionais


Subject(s)
Humans , Male , Female , Palliative Care , Terminal Care , Hospice Care , Critical Illness
8.
J. pediatr. (Rio J.) ; 96(5): 652-659, Set.-Dec. 2020. tab
Article in English | LILACS, ColecionaSUS, SES-SP | ID: biblio-1135070

ABSTRACT

Abstract Objective: To present the characteristics of pediatric patients with chronic and irreversible diseases submitted to palliative extubation. Method: This is a descriptive analysis of a series of patients admitted to a public pediatric hospital, with chronic and irreversible diseases, permanently dependent on ventilatory support, who underwent palliative extubation between April 2014 and May 2019. The following information was collected from the medical records: demographic data, diagnosis, duration and type of mechanical ventilation; date, time, and place of palliative extubation; medications used; symptoms observed; and hospital outcome. Results: A total of 19 patients with a mean age of 2.2 years were submitted to palliative extubation. 68.4% of extubations were performed in the ICU; 11 patients (57.9%) died in the hospital. The time between mechanical ventilation withdrawal and in-hospital death ranged from 15 minutes to five days. Thirteen patients used an orotracheal tube and the others used tracheostomy. The main symptoms were dyspnea and pain, and the main drugs used to control symptoms were opioids and benzodiazepines. Conclusions: It was not possible to identify predictors of in-hospital death after ventilatory support withdrawal. Palliative extubation requires specialized care, with the presence and availability of a multidisciplinary team with adequate training in symptom control and palliative care.


Resumo Objetivo: Apresentar as características de pacientes pediátricos portadores de doenças crônicas e irreversíveis submetidos a extubação paliativa. Método: Trata-se de análise descritiva de uma série de casos de pacientes internados em hospital público pediátrico, portadores de doenças crônicas e irreversíveis, dependentes de forma permanente de suporte ventilatório e que foram submetidos a extubação paliativa entre abril de 2014 e maio de 2019. Foram coletadas as seguintes informações do prontuário: dados demográficos, diagnóstico, duração e tipo de ventilação mecânica; data, hora e local de realização da extubação paliativa, medicamentos utilizados, sintomas observados e desfecho hospitalar. Resultados: 19 pacientes com idade média de 2,2 anos foram submetidos a extubação paliativa. 68,4% das extubações foram realizadas dentro da UTI, 11 pacientes (57,9%) evoluíram para óbito no hospital. O tempo entre a retirada de ventilação mecânica e o óbito hospitalar variou entre 15 minutos e 5 dias. 13 pacientes usavam tubo orotraqueal e os demais, traqueostomia. Os principais sintomas foram dispneia e dor e as principais drogas utilizadas para o controle dos sintomas foram os analgésicos opioides e benzodiazepínicos. Conclusões: Não foi possível identificar fatores preditores de óbito no hospital após a retirada do suporte ventilatório. A extubação paliativa demanda cuidado especializado com presença e disponibilidade de equipe multiprofissional com formação adequada em controle de sintomas e cuidados paliativos.


Subject(s)
Humans , Child, Preschool , Palliative Care , Airway Extubation , Respiration, Artificial , Ventilator Weaning , Hospitals, Pediatric
9.
Rev. colomb. anestesiol ; 48(4): e201, Oct.-Dec. 2020. tab, graf
Article in English | LILACS, COLNAL | ID: biblio-1144312

ABSTRACT

Abstract Introduction: Aging of the population and the accompanying increase in prevalence of chronic illnesses mean that more people will need palliative care. This need has not been extensively quantified in middle-income countries to policy planning and expanding health care. Objective: Provide an estimate of the need of palliative care services in Colombia and compare these needs with the current available offer. Methods: Cross-sectional study based on mortality statistics for Colombia for the period 2012 to 2016. We calculated age-specific and sex-specific numbers of deaths and mortality rates from death certificate for defined chronic illnesses to estimate the prevalence of palliative care need in Colombia, and contrasted this information with the current offer according to the Colombian Observatory of Palliative Care. Results: The numbers of deaths requiring palliative care increased from 107,065 in 2012 to 128,670 in 2016 (61.2% of total deaths). The causes of these deaths vary by age group, with a clearly more important proportion of heart and cerebrovascular diseases and dementia in advances ages, and HIV/AIDS in young ages. In all age groups, malignant neoplasms are an important part of the causes of deaths of those requiring palliative care (31.3% of all deaths in 2016). Contrasting this needs, in most areas there is no or very limited offer of palliative care services. Conclusion: A real palliative care policy, including a vast increase in training opportunities in the field and regulation allowing a wide range of health practitioners to be involved in palliative care, is necessary in Colombia to improve the palliative care offer.


Resumen Introducción: El envejecimiento de la población y el consecuente aumento en la prevalencia de enfermedades crónicas implica que habrá más personas que necesitarán cuidados paliativos. Esta necesidad no se ha cuantificado mayormente en los países de medianos ingresos con miras a la planificación de políticas y a la ampliación de la atención en salud. Objetivo: Ofrecer un estimado de la necesidad de servicios de cuidados paliativos en Colombia y comparar dichas necesidades con la oferta disponible en la actualidad. Métodos: Estudio transversal basado en estadísticas de mortalidad en Colombia para el periodo comprendido entre 2012-2016. Calculamos las cifras de muertes y tasas de mortalidad específicas por edad y sexo a partir de los certificados de defunción correspondientes a enfermedades crónicas definidas, a _n de estimar la prevalencia de la necesidad de cuidados paliativos en Colombia, y se comparó dicha información con la oferta actual, de acuerdo con el Observatorio Colombiano de Cuidados Paliativos. Resultados: Las cifras correspondientes a muertes que requirieron cuidados paliativos aumentaron de 107 065 en el 2012 a 128 670 en el 2016 (61.2% del total de muertes). Las causas de estas muertes varían según el grupo etario, con un porcentaje evidentemente mayor de enfermedades cardiacas, cerebrovasculares y demencia en edades avanzadas, y VIH/SIDA en los grupos más jóvenes. En todos los grupos etarios, las neoplasias malignas son una parte importante de las causas de muerte de quienes requieren cuidados paliativos (31.3% de todas las muertes en el 2016). Estas necesidades contrastan con el hecho de que en la mayoría de las áreas no existen servicios de cuidados paliativos, o su oferta es muy limitada. Conclusiones: En Colombia se necesita una verdadera política de cuidados paliativos, incluyendo un aumento significativo de las oportunidades de capacitación en el área, así como un marco regulatorio que permita que una amplia gama de profesionales de la salud participen en cuidados paliativos, a in de mejorar la oferta de estos servicios.


Subject(s)
Humans , Adult , Middle Aged , Aged , Palliative Care , Terminal Care , Health Services Needs and Demand , Population Dynamics , Needs Assessment , Observational Studies as Topic , Health Policy
10.
Sex., salud soc. (Rio J.) ; (35): 218-236, maio-ago. 2020. tab
Article in Spanish | LILACS | ID: biblio-1139645

ABSTRACT

Resumen El artículo aborda la perspectiva de profesionales de oncología y cuidados paliativos de Argentina sobre la planificación anticipada de los cuidados en el final de la vida de pacientes con enfermedades oncológicas avanzadas. A partir de un diseño de investigación cualitativa, basado en entrevistas semi-estructuradas con profesionales de diferentes disciplinas, se analizaron las dificultades para la participación de los y las pacientes en el proceso de toma de decisiones y en los procesos de consentimiento informado en torno a los cuidados en el final de la vida. Pese a valorar la planificación anticipada del cuidado e instrumentos como las directivas anticipadas, se identifican barreras para la implementación de estas prácticas. La falta de herramientas comunicacionales para abordar este tipo de conversaciones con los pacientes, el ocultamiento de la información sobre el diagnóstico y/o el pronóstico de la enfermedad, la falta de articulación entre equipos que realizan el seguimiento de pacientes con enfermedad avanzada, y la resistencia de familiares y pacientes, limitan los márgenes de decisión y consentimiento por parte de los pacientes.


Abstract The article addresses the perspective of oncologist and palliative care professionals of Argentina on the advance end of life care planning for patients with advanced cancer. Based on semi-structured interviews with professionals from different disciplines, the paper explores barriers for the patient participation in the decision-making process in end of life care. Despite the acceptance of advance care planning and instruments such as advance directives, barriers to the implementation of these practices are identified. The lack of communication skills to deal with this type of conversation with patients, the concealment of information on the diagnosis and prognosis of the disease, the lack of coordination between teams that keep track of patients with advanced disease, and the resistance from relatives and patients, limit the margins of decision and consent by patients.


Resumo O artigo aborda a perspectiva dos profissionais de oncologia e cuidados paliativos na Argentina sobre o planejamento antecipado dos cuidados de fim de vida para pacientes com doenças oncológicas avançadas. Partindo de um desenho de pesquisa qualitativa, com base em entrevistas semiestruturadas com profissionais de diferentes disciplinas, o artigo analisa as dificuldades para a participação dos pacientes no processo de tomada de decisão e nos processos de consentimento informado em torno aos cuidados de fim de vida. Apesar de valorizar o planejamento do cuidado antecipado e instrumentos como as diretrizes antecipadas, identificam-se barreiras para a implantação dessas práticas. A falta de instrumentos de comunicação para atender esse tipo de conversa com os pacientes, o encobrimento do diagnóstico e / ou prognóstico da doença, a falta de articulação entre as equipes que acompanham os pacientes com doença avançada e a resistência dos familiares e pacientes, limitam as margens de decisão e consentimento por parte dos pacientes.


Subject(s)
Humans , Terminal Care , Advance Directives , Terminally Ill , Decision Making , Informed Consent , Neoplasms , Patient Care Team , Patients , Argentina , Hospice Care , Critical Illness , Qualitative Research
11.
Palliative Care Research ; : 321-329, 2020.
Article in Japanese | WPRIM | ID: wpr-837440

ABSTRACT

The aim was to explore existential suffering n physicians caring for terminally ill cancer patients. We performed qualitative analyses of 30 physician-reported descriptions of the clinical experience of caring for terminally ill cancer patients. Analyses were conducted using descriptive phenomenology to clarify the meaning of physicians’ experiences, guided by the three dimensions of Murata’s human being model. In their descriptions, all physicians mentioned existential suffering related to incompetence, and three themes were identified: 1) physicians who focus on the limitations of what they can achieve with curative or palliative treatment feel a sense of incompetence; 2) physicians who focus on difficulties in caring for patients with existential suffering feel a sense of incompetence; and 3) physicians who focus on environmental factors, such as work overload and insufficient communication skills training, experience a sense of incompetence. Physicians experience a sense of incompetence when they face treatment limitations and/or difficulties in caring for patients with existential suffering.

12.
Singapore medical journal ; : 254-259, 2020.
Article in English | WPRIM | ID: wpr-827306

ABSTRACT

INTRODUCTION@#The integration of advance care planning (ACP) as part of the comprehensive geriatric assessment (CGA) of hospitalised frail elderly patients, together with the clinical and demographic factors that determine successful ACP discussion, has not been previously explored.@*METHODS@#A cross-sectional study on patients and family caregivers admitted under the geriatric medicine department of a tertiary hospital was conducted from October 2015 to December 2016.@*RESULTS@#Among 311 eligible patients, 116 (37.3%) patients completed ACP discussion while 166 (53.4%) patients declined, with 62 (37.3%) of the decliners providing reasons for refusal. Univariate logistic regression analysis showed that older age, higher Charlson Comorbidity Index, poorer functional status and cognitive impairment had statistically significant associations with agreeing to ACP discussion (p < 0.05). On multivariate logistic regression analysis, only poorer functional status was significantly associated (odds ratio 2.22 [95% confidence interval 1.27-3.87]; p = 0.005). Among those who completed ACP discussion, a majority declined cardiopulmonary resuscitation (79.3%), preferred limited medical intervention or comfort care (82.8%), and opted for blood transfusion (62.9%), antibiotics (73.3%) and intravenous fluid (74.1%) but declined haemodialysis (50.9%). Decision-making was divided for enteral feeding. Among decliners, the main reasons for refusal were 'not keen' (33.9%), 'deferring to doctors' decision' (11.3%) and 'lack of ACP awareness' (11.3%).@*CONCLUSION@#The feasibility and utility of integrating ACP as part of CGA has been demonstrated. Poorer functional status is significantly associated with successful ACP discussion. Greater public education on end-of-life care choices (besides cardiopulmonary resuscitation) and follow-up with decliners are recommended.

13.
Palliative Care Research ; : 153-160, 2020.
Article in Japanese | WPRIM | ID: wpr-826280

ABSTRACT

Objective: This study evaluated the effectiveness of an end-of-life care simulation as a way to improve nursing students’ resilience. Methods: In total, 61 baccalaureate nursing students were randomly assigned to control or education groups. In this randomized controlled study on an end-of-life care simulation, resilience was measured at baseline, and after the simulation. Result: At the baseline, the two groups showed no statistical differences in their resilience scores. However, the total score, and scores for the factors “I am”, “I have”, and “I will/ do” were significantly higher for the education group than the control group in the post-test. The total scores and three factor scores within the education group were also significantly higher in the post-test than at baseline, but in the control group only the “I am” factor significantly increased over time. Conclusion: The end-of-life care simulation scenario showed the potential to increase the resilience of participants, especially their ability to build trusting relationships with others and expand their network, and to set goals and grow toward them.

14.
Rev. latinoam. enferm. (Online) ; 28: e3234, 2020. tab
Article in English | LILACS, BDENF | ID: biblio-1101731

ABSTRACT

Objective: to explore self-perception competence among Spanish nurses dealing with patient death and its relationship with work environment, evidence-based practice, and occupational stress. Method: a cross-sectional web-based survey collected information from a convenience sample of 534 nurses from professional Spanish Colleges who answered four validated questionnaires: Coping with Death Scale, Practice Environment Scale of the Nursing Work Index, Perception of Evidence-Based Practice (EBP) and Nursing Stress Scale. Results: a total of 79% of the participants were women, the average age was 40 years old, 38% had a postgraduate degree and 77% worked in public health settings. Many nurses evaluated their work environment as unfavorable (66%), reported high occupational stress (83.5±14.9), and had high scores on knowledge/skills in EBP (47.9±11.3). However, 61.2% of them perceived an optimal coping (>157 score). The multivariate logistic model indicated positive associations with work environment and EBP characteristics (OR: 1.30, p=0.054; OR: 1.04, p=0.007; OR: 1.13, p<0.001, respectively) but negative associations with occupational stress and short work experience (OR: 0.98, p=0.0043; OR: 0.74, p<0.002, respectively). These factors explained 23.1% of the coping variance (p<0.001). Conclusion: although most nurses perceived optimal coping, the situation could be enhanced by modifying several contextual factors. The identification of these factors would improve the quality of end-of-life care by facilitating nursing management.


Objetivo: explorar a capacidade de autopercepção entre enfermeiros espanhóis que lidam com a morte do paciente e sua relação com o ambiente de trabalho, a prática baseada em evidências e o estresse ocupacional. Método: pesquisa transversal pela internet coletou informações de uma amostra de conveniência de 534 enfermeiros das Faculdades Profissionais Espanholas que responderam a quatro questionários: Escala de Enfrentamento da Morte, Escala Ambiente de Trabalho da Prática de Enfermagem, Percepção da Prática Baseada em Evidências (EBP, acrônimo em inglês) e Escala de Estresse em Enfermagem. Resultados: 79% das participantes eram mulheres com média de 40 anos, 38% tinham pós-graduação e 77% trabalhavam em ambiente de saúde pública. Muitos enfermeiros avaliaram seu ambiente de trabalho como desfavorável (66%), relataram alto estresse ocupacional (83,5 ± 14,9) e altas pontuações em conhecimento/habilidades em EBP (47,9 ± 11,3). No entanto, 61,2% deles consideraram um enfrentamento ótimo (pontuação >157). O modelo logístico multivariado indicou associações positivas com o ambiente de trabalho e as características da EBP (OR: 1,30, p = 0,054; OR: 1,04, p = 0,007; OR: 1,13, p < 0,001, respectivamente), mas negativas com estresse ocupacional e curta experiência de trabalho (OR: 0,98, p = 0,0043; OR: 0,74, p < 0,002, respectivamente). Esses fatores explicaram 23,1% da variância de enfrentamento (p < 0,001). Conclusão: embora a maioria dos enfermeiros considerasse um enfrentamento ótimo, a situação poderia ser melhorada pela modificação de vários fatores contextuais. A identificação desses fatores melhoraria a qualidade da assistência no final da vida, facilitando a gestão da enfermagem.


Objetivo: explorar el afrontamiento autopercibido por los profesionales españoles de enfermería para trabajar con pacientes moribundos y su relación con el entorno laboral, la práctica clínica y el estrés ocupacional. Método: estudio observacional transversal vía internet de una muestra de conveniencia con 534 enfermeros reclutados a través de colegios profesionales españoles que respondieron a cuatro cuestionarios validados: Escala de Afrontamiento de la Muerte, Entorno de la Práctica Enfermera, Práctica Basada en la Evidencia en Enfermería (PBE) y Escala de Estrés para Enfermería. Resultados: la mayoría de los participantes fueron mujeres (79%), de 40 años de media, con estudios de posgrado (38%) y trabajando en el sistema público (77%). Gran parte evaluó su ambiente de trabajo como desfavorable (66%), mostrando estrés ocupacional (83,5 ± 14,9) y altas puntuaciones en conocimiento/habilidades-PBE (47,9 ± 11,3). Sin embargo, el 61,2% autopercibía un afrontamiento óptimo (> 157 puntos). El análisis de regresión logística multivariante mostró que el afrontamiento se asociaba positivamente con el entorno laboral y dos subescalas-PBE (OR: 1,30, p= 0,054; OR: 1,04, p= 0,007; OR: 1,13, p <0,001, respectivamente), pero negativamente con el estrés ocupacional y la poca experiencia laboral (OR: 0,98, p= 0,0043; OR: 0,74, p <0,002, respectivamente). Estos factores explicaban el 23,1% de la varianza (p <0.001). Conclusión: aunque la mayoría de los enfermeros percibían un afrontamiento óptimo, la situación podría mejorarse modificando algunos factores. La identificación de estos factores mejoraría la calidad de la atención de los pacientes al final de la vida, facilitando la gestión de enfermería.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Physician-Patient Relations , Stress, Psychological , Terminal Care , Adaptation, Psychological , Surveys and Questionnaires , Workplace/psychology , Death , Evidence-Based Practice , Nursing Staff, Hospital
15.
Article | IMSEAR | ID: sea-196081

ABSTRACT

Background & objectives: In developing countries like India, there is a lack of clarity regarding the factors that influence decisions pertaining to life supports at the end-of-life (EOL). The objectives of this study were to assess the factors associated with EOL-care decisions in the Indian context and to raise awareness in this area of healthcare. Methods: This retrospectively study included all patients admitted to the medical unit of a tertiary care hospital in southern India, over one year and died. The baseline demographics, economic, physiological, sociological, prognostic and medical treatment-related factors were retrieved from the patient's medical records and analysed. Results: Of the 122 decedents included in the study whose characteristics were analyzed, 41 (33.6%) received full life support and 81 (66.4%) had withdrawal or withholding of some life support measure. Amongst those who had withdrawal or withholding of life support, 62 (76.5%) had some support withheld and in 19 (23.5%), it was withdrawn. The documentation of the disease process, prognosis and the mention of imminent death in the medical records was the single most important factor that was associated with the EOL decision (odds ratio - 0.08; 95% confidence interval, 0.01-0.74; P=0.03). Interpretation & conclusions: The documentation of poor prognosis was the only factor found to be associated with EOL care decisions in our study. Prospective, multicentric studies need to be done to evaluate the influence of various other factors on the EOL care.

16.
Oncol. (Guayaquil) ; 29(3): 199-209, 31 de diciembre del 2019.
Article in Spanish | LILACS | ID: biblio-1140833

ABSTRACT

Propósito de la revisión: el objetivo de la revisión es delinear el rol dela Comunicación en la relación Médico-Paciente-Familia.Buscamos reportes endonde se incluyeala familia en la relación de cuidadores de pacientes enfocados en el área oncológica de cuidados paliativos. Recientes hallazgos:La verdad es uno de los agentes terapéuticos más potentes disponibles.El objetivo de la comunicación es: Disminuir la incertidumbre, por dolorosa que sea la información solicitada.La informacióny entrevista al paciente oncológico debe ser preparada con anterioridad tomando en cuenta un Formato el más usado es el protocolo "COMFORT"por sus siglas en inglés. Extracto: Dentro de cualquier ámbito de trabajo que concierne a los profesionales de la salud, pero muy especialmente en el de los Cuidados Paliativos, la comunicación se constituye como uno de los elementos terapéuticos fundamentales en la intervención médica y psicológica. La manera de transmitir malas noticias y el manejo del impacto emocional que esto puede ocasionar, el acompañamiento profesional necesario en las distintas fases de la enfermedad, o la fundamental coordinación y manejo de situaciones difíciles por parte de los profesionales sanitarios son sólo algunos de los aspectos importantes en la calidad, eficacia y eficiencia del abordajeintegral en Cuidados Paliativos Esta revisión tiene por objetivo estudiar la bibliografía existente y hacer un análisis en relación con la comunicación con la familia y con el paciente en cuidados paliativos


Purpose of the review: the objective of thisreview is to delineate the role of Communication in the Doctor-Patient-Family relationship. We seek reports where the family is included in the relationship of caregivers of patients focused on the oncology area of palliative care. Recent Findings: The Truth is one of the most powerful therapeutic agents available. The goal of communication is: Reduce uncertainty, no matter how painful the information requested. The information and interview to the oncology patient must be prepared in advance, taking into account the most used format is the "COMFORT" protocol for its acronym in English. Extract: Within any field of work that concerns health professionals, but especially in that of Palliative Care, communication is constituted as one of the fundamental therapeutic elements in medical and psychological intervention. The way of transmitting bad news and the management of the emotional impact that this can cause, the necessary professional support in the different phases of the disease, orthe fundamental coordination and management of difficult situations by health professionals are just some of the aspects important in the quality, efficacy and efficiency of the comprehensive approach in Palliative Care This review aims to study the existing bibliography and make an analysis in relation to communication with the family and with the patient in palliative care


Subject(s)
Humans , Palliative Care , Physician-Patient Relations , Communication , Hospice Care
17.
Medicina (B.Aires) ; 79(6): 468-476, dic. 2019. ilus, tab
Article in Spanish | LILACS | ID: biblio-1056755

ABSTRACT

Las secuencias integradas de cuidado para ó;ºltimos días de vida proponen estándares de calidad para optimizar la atenció;n de pacientes y familias. Se implementó; el Programa Asistencial Multidisciplinario Pallium (PAMPA©) basado en estándares del International Collaborative for Best Care for the Dying Person en cuatro fases: inducció;n, implementació;n, diseminació;n y sustentabilidad, en cinco centros de salud en Argentina, entre 2008 y 2018. Se incluyeron 1237 pacientes adultos en situació;n de ó;ºltimos días de vida, en seguimiento por equipos de cuidados paliativos entrenados en el PAMPA©. Se efectuó; una auditoría antes y despuó;©s de la ejecució;n del programa, aó;ºn en curso. El rango de medianas de permanencia en los cinco centros desde el inicio de la secuencia hasta el fallecimiento fue de 16 a 178 horas. Se compararon objetivos de cuidado: control de síntomas, comunicació;n, necesidades multidimensionales, hidratació;n y nutrició;n, documentació;n de intervenciones y cuidados post mortem. El análisis conjunto mostró; una mejoría del nó;ºmero de registros (p = 0.001). La comunicació;n del plan de cuidados con el paciente no mostró; diferencias (p = 0.173). Se realizó; capacitació;n y supervisió;n permanente a los equipos profesionales de quienes se registraron percepciones de la implementació;n. Los principales emergentes de este análisis cualitativo fueron: actitudes ante el programa, aportes fundamentales, fortalezas, debilidades y definició;n subjetiva del programa, reconocimiento de las singularidades culturales institucionales y su influencia en el cuidado. El PAMPA© demostró; la factibilidad de un modelo de atenció;n para pacientes y familias en final de vida, basado en estándares de calidad internacionales.


The integrated care pathways for the last days of life propose quality standards optimizing the care of patients and families. The Pallium Multidisciplinary Assistance Program (PAMPA©) was implemented based on standards of the International Collaborative for Best Care for the Dying Person in 4 phases: induction, implementation, dissemination and sustainability, in five health centres in Argentina, between 2008 and 2018. A total of 1237 adult patients in the last days of life were included and cared for by palliative care teams trained in PAMPA©. An audit was conducted before and after the implementation of the Program, which is still going on. The median range of follow up into five centres from the beginning of the pathway until death varied from 16 to 178 hours. Care goals were compared: symptom control, communication, multidimensional needs, hydration and nutrition, documentation of interventions and post-mortem care. The overall analysis showed an improvement in the number of records (p = 0.001). The goal of communication on care plan to the patient showed no difference (p = 0.173). Continuous training, support and permanent teams supervision were carried out and perceptions and impact of the implementation were registered. The main emerging items of the qualitative analysis were: attitudes towards the program, fundamental contributions, strengths, weaknesses and subjective definition of the program, recognition of institutional cultural singularities and its influence on care. PAMPA© demonstrated its feasibility as a model of end of life care for patients and families, based on international quality standards.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Palliative Care/standards , Quality Assurance, Health Care/standards , Terminal Care/standards , Program Evaluation , Palliative Care/methods , Argentina , Terminal Care/methods , Time Factors , Reproducibility of Results , Critical Pathways/standards , Health Plan Implementation/methods , Health Plan Implementation/standards
18.
Acta bioeth ; 25(2): 177-186, dic. 2019.
Article in English | LILACS | ID: biblio-1054626

ABSTRACT

Abstract: This paper examines the possible impacts of the Act on Decisions on Life-Sustaining Treatment for Patients in Hospice and Palliative Care or at the End of Life in Korea (Korea's end-of-life act), legislated in 2016, on the development of hospital ethics committees and clinical ethics consultation services in South Korea. Clinical ethics in Korea has not made much progress in comparison to other subdisciplines of biomedical ethics. While the enactment of this law may give rise to beneficial clinical ethics services, it is possible that customary practices and traditional authorities in Korean society will come into conflict with the norms of clinical ethics. This paper examines how the three main agents of Korean society—family, government, and medical professionals—may clash with end-of-life stage norms in clinical ethics, thus posing obstacles to the development of hospital committees and consultation services. A brief outline of what lies ahead for the progress of clinical ethics practice is explored.


Resumen: Este documento examina los posibles impactos de la Ley de decisiones sobre el tratamiento de soporte vital para pacientes en hospicios y cuidados paliativos, o al final de la vida en Corea (Ley de Corea del Final de la Vida), legislada en 2016, sobre el desarrollo de comités de ética hospitalaria y servicios de consulta de ética clínica en Corea del Sur. La ética clínica en Corea no ha avanzado mucho en comparación con otras subdisciplinas de la ética biomédica. Si bien la promulgación de esta ley puede dar lugar a servicios de ética clínica beneficiosos, es posible que las prácticas tradicionales y las autoridades tradicionales en la sociedad coreana entren en conflicto con las normas de ética clínica. Este documento examina cómo los tres agentes principales de la sociedad coreana —familia, gobierno y profesionales médicos— pueden chocar con las normas de ética clínica al final de la vida, lo que plantea obstáculos para el desarrollo de comités hospitalarios y servicios de consulta. Se explora un breve resumen de lo que queda por delante para el progreso de la práctica de la ética clínica.


Resumo: Este artigo examina os possíveis impactos que o Ato sobre Decisões Relacionadas a Tratamento de Manutenção da Vida para Pacientes em Casas de Idosos e de Cuidados Paliativos ou ao Fim da Vida na Coréia (ato de fim da vida da Coréia), aprovado pelo legislativo em 2016, sobre o desenvolvimento de comitês de ética de hospitais e serviços de consulta sobre ética clínica na Coréia do Sul. Ética clínica na Coréia não sofreu muito progresso em comparação com outras subdisciplinas da ética biomédica. Enquanto a promulgação desta lei pode dar origem a serviços de ética clínica proveitosos, é possível que práticas usuais e autoridades tradicionais na sociedade coreana entrarão em conflito com as normas da ética clínica. Este artigo examina como os três principais agentes da sociedade coreana - família, governo e profissionais médicos - podem se chocar com normas de estágios de fim da vida em ética clínica, colocando assim obstáculos para o desenvolvimento de comitês hospitalares e serviços de consulta. Um breve esboço do que vem pela frente para o progresso da prática de ética clínica é explorado.


Subject(s)
Humans , Palliative Care , Life , Ethics, Clinical , Jurisprudence , Republic of Korea
19.
Salud pública Méx ; 61(4): 504-513, Jul.-Aug. 2019. tab, graf
Article in Spanish | LILACS | ID: biblio-1099327

ABSTRACT

Resumen: Objetivo: Estimar el gasto de bolsillo (GB) durante el último año de vida en adultos mayores (AM) mexicanos. Material y métodos: Estimación del GB del último año de vida de AM, ajustando por tipo de manejo, afiliación y causa de muerte. Se emplearon datos del Estudio Nacional de Salud y Envejecimiento en México (2012). Los gastos en medicamentos, consultas médicas y hospitalización durante el año previo a la muerte conforman el GB. El GB se ajustó por inflación y se reporta en dólares americanos 2018. Resultados: La media de GB fue $6 255.3±18 500. En el grupo de atención ambulatoria el GB fue $4 134.9±13 631.3. El GB en hospitalización fue $7 050.6±19 971.0. Conclusiones: La probabilidad de incurrir en GB es menor cuando no se requiere hospitalización. Con hospitalización, la afiliación a la seguridad social y atenderse en hospitales públicos juega un papel protector.


Abstract: Objective: To estimate the out-of-pocket expenses (OOPE) during the last year of life in Mexican older adults (OA). Materials and methods: Estimation of the OOPE corresponding to the last year of life of OA, adjusting by type of management, affiliation and cause of death. Data from the National Health and Aging Study in Mexico (2012) were used. To calculate the total OOPE, the expenses in the last year were used in: medications, medical consultations and hospitalization. The OOPE was adjusted for inflation and is reported in US dollars 2018. Results: The mean OOPE was $6 255.3±18 500. In the ambulatory care group, the OOPE was $4 134.9±13 631.3. The OOPE in hospitalization was $7 050.6±19 971.0. Conclusions: The probability of incurre in OOPE is lower when hospitalization is not required. With hospitalization, affiliation to social security and attending to public hospitals plays a protective role.


Subject(s)
Humans , Male , Female , Aged , Pharmaceutical Preparations/economics , Health Expenditures , Cost of Illness , Financing, Personal/economics , Ambulatory Care/economics , Hospitalization/economics , Social Security/economics , Terminal Care/economics , Cause of Death , Mexico
20.
Rev. costarric. salud pública ; 28(1): 117-125, ene.-jun. 2019.
Article in Spanish | LILACS | ID: biblio-1013981

ABSTRACT

Resumen La demencia es condición que típicamente involucra un deterioro gradual y progresivo de la cognición, el comportamiento y el funcionamiento de un individuo, hasta alcanzar la muerte. La medicina paliativa asiste a pacientes que enfrentan procesos degenerativos progresivos como este y les provee insumos para mejorar su calidad de vida, aliviar su dolor y apoyar a quienes les asisten; en una forma interdisciplinaria e integral hasta el final de su vida. Este trabajo pretende exponer brevemente, mediante una revisión de literatura vigente, el conocimiento y teorías actuales sobre demencia como una condición terminal que requiere atención paliativa; desde una perspectiva integral, enfocándose en el manejo y los objetivos de cuidado del paciente con esta condición, que reúna tanto la visión médica como la del paciente, su red de apoyo y su entorno. Se describe la demencia como una condición terminal que requiere de atención paliativa desde el momento de su diagnóstico, las necesidades propias del paciente con esta condición y las implicaciones de su atención, requiriendo un abordaje integral y un planteamiento de objetivos claros, humanizados y centrados en el paciente; que satisfacen sus necesidades, consideran y respetan su individualidad y contemplan aspectos como la voluntad adelantada.


Abstract Dementia is a condition that typically involves a gradual and progressive deterioration of the cognition, behavior and functioning of an individual, to death. Palliative medicine assists patients who face progressive degenerative processes like this one and provides them with supplies to improve their quality of life, relieve their pain and support those who assist them; in an interdisciplinary and integral way until the end of his life. This work aims to briefly expose, through a review of current literature, knowledge and current theories about dementia as a terminal condition that requires palliative care; from a holistic perspective, focusing on the management and objectives of patient care with this condition, which brings together both the medical and the patient's vision, their support network and their environment. Dementia is described as a terminal condition that requires palliative care from the moment of diagnosis, the specific needs of the patient with this condition and the implications of their care, requiring a comprehensive approach and a clear, humanized and patient-centered approach to goals of care; that meet their needs, consider and respect their individuality and contemplate aspects such as their advanced wills.


Subject(s)
Palliative Care/ethics , Hospice Care/ethics , Dementia/complications , Ethics, Professional
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