Responding to the Spiritual Needs of Palliative Care Patients: A Randomized Controlled Trial to Test the Effectiveness of the Kibo Therapeutic Interview.

CONTEXT: The WHO recognizes the need to attend to patients' spiritual needs as being fundamental to comprehensive and high-quality end-of-life care. Spiritual needs must be attended to since the resolution of biological and psychosocial issues is insufficient to reduce patients' suffering. Associations have been found between spiritual needs and other variables of importance for patients in palliative care. Despite the consensus that exists regarding the importance of assessing and attending to spiritual needs, professionals encounter many difficulties in attempting to do so. OBJECTIVES: Our study aims to demonstrate the benefits that the Kibo therapeutic interview in palliative care patients can have for spirituality, demoralization, and resilience. METHODS: A parallel randomized controlled trial of two groups was undertaken. Information on 60 palliative care patients during pre- and post-intervention time points was gathered. RESULTS: ANOVAs showed a statistically significant effect of the intervention on the dimension of transpersonal spirituality. The ANCOVA for the effect of the intervention on resilience also pointed to its effectiveness. When the means of demoralization were examined, a higher decrease in the levels of demoralization for patients in the intervention group was observed, when compared to patients in the control group. CONCLUSION: Our findings point to this interview as an effective means to attend to the spiritual needs of palliative patients, reducing demoralization and increasing resilience. Future research could focus on a broader sample and on the effects of this interview on family caregivers, mourners, and health care professionals. CLINICAL TRIAL REGISTRATION NUMBER: https://clinicaltrials.gov/ct2/show/ Identifier NCT03995095.

Intervenciones psicológicas en espiritualidad en cuidados paliativos: una revisión sistemática / Psychological interventions in spirituality: A systematic review in palliative care

CONTEXTO: La espiritualidad puede entenderse como una condición fundamental del sentido de la persona. Se incluye dentro de los objetivos fundamentales de trabajo de los cuidados paliativos, considerándose que la calidad de vida del paciente no puede favorecerse en su conjunto si no se aborda la dimensión espiritual. Objetivo: El objetivo de esta revisión sistemática es sintetizar la evidencia científica más reciente en espiritualidad en pacientes paliativos con enfermedad avanzada, atendiendo sobre todo a qué tipo de intervención que contemple la dimensión espiritual se ha llevado a cabo con ellos. Se recogen datos sobre el tipo de estudio y resultados estadísticos encontrados en cuanto a espiritualidad. Método: Se llevó a cabo una búsqueda en la literatura científica siguiendo las guías PRISMA en 13 bases bibliográficas electrónicas, resultando 10 estudios experimentales o cuasiexperimentales (1.067 participantes) y 38 revisiones de intervenciones y conceptos teóricos en espiritualidad en cuidados paliativos. Los estudios fueron seleccionados en función del nivel de información que aportaban sobre la evidencia requerida en los objetivos del estudio y siguiendo los criterios de inclusión/exclusión. Resultados: A diferencia de lo que sucede con otros conceptos como el distrés emocional o la dignidad, nuestros resultados sugieren que, aunque la espiritualidad es un aspecto que en cuidados paliativos se contempla de manera continuada, no existe todavía una metodología/protocolo consensuado de trabajo, concreto y sistematizado. La mejoría observada en algunos estudios en aspectos de la espiritualidad es obtenida de manera tangencial o colateral. En cuanto a los instrumentos, el FACIT-Sp es el instrumento más empleado para medir los resultados en espiritualidad. Conclusión: Esta revisión se ha visto muy limitada por la amplia variabilidad de las características de los estudios. Existe una gran dificultad a la hora de seleccionar criterios de comparación, dado que el diseño de los estudios es muy diverso, así como las variables estudiadas y los instrumentos de evaluación. Aunque se han encontrado intervenciones que implican una mejora en la espiritualidad, estas no se centran en el trabajo concreto de esta dimensión. Todo esto dificulta la evaluación de la eficacia de los protocolos de actuación en espiritualidad, obstaculizando el acceso al conocimiento relativo a la atención, por parte de los profesionales de la salud, de las necesidades espirituales del paciente paliativo

CONTEXT: Spirituality can be seen as a fundamental condition of a person's sense of being. It is included among the fundamental objectives of palliative care work, considering that the quality of life of patients cannot be enhanced as a whole if the spiritual dimension is not addressed. OBJECTIVE: The objective of this systematic review is to summarize the latest scientific evidence on spirituality in palliative patients with advanced disease, paying particular attention to the kind of intervention that addresses the spiritual dimension that has been used. Data on the type of study and statistical results regarding spirituality were collected. METHOD: We conducted a search of the scientific literature following the PRISMA guidelines in 13 electronic bibliographic databases, resulting in 10 experimental or quasi-experimental studies (1,067 participants) and 38 reviews of interventions and theoretical concepts on spirituality in the hospice. The studies were selected based on the level of information they supplied for the evidence required in the study objectives and the criteria for inclusion/exclusion. RESULTS: Unlike with other concepts such as emotional distress or dignity, our results suggest that, while spirituality is an aspect that is continually contemplated in palliative care, there is still an agreed, specific and systematic methodology/protocol,. The improvement observed in some studies on aspects of spirituality is obtained tangentially or collaterally. The FACIT-Sp is the instrument most used to measure results in spirituality. CONCLUSION: This review has been severely limited by the wide variability of the characteristics of the studies. There is great difficulty in selecting benchmarks, since the design of the studies is very diverse, as well as the variables and testing instruments. Although interventions were found that implied an improvement in spirituality, they do not focus on the actual work on this element. All this makes an evaluation of the effectiveness of protocols on spirituality difficult and hinders access to knowledge concerning the care by health professionals of the spiritual needs of palliative patients

Frail elderly with and without cognitive impairment at the end of life: Their emotional state and the wellbeing of their family caregivers.

PURPOSE OF THE STUDY: (1) To identify the main predictors of the emotional state of the frail elderly at the end-of-life and that of their primary family caregivers, taking into consideration the presence/absence of significant cognitive impairment in the patient and (2) to analyse the relationship between the emotional state of the patient and that of their primary family caregiver. METHODS: Our study is cross-sectional. 85 frail elderly patients at the end-of-life and their primary family caregivers participated. Information on the following aspects was collected: (1) From the patients: Socio-demographics, Functional independence, and Cognitive and Emotional state; (2) From the caregivers: Socio-demographics, Emotional state and Overburden (according to Zarit Scale). Descriptive, correlational and linear regression analyses were computed using SPSS. RESULTS: The models that best predict the observed variance in the emotional state of patients (with or without significant cognitive impairment) include the same variables: functional independence of the patient and caregiver's overburden. Similarly, the models that best predict the observed variance in the emotional state of family caregivers include: cognitive state of the patient and caregiver's overburden. IMPLICATIONS: The overburden of the family caregiver stands out as a key factor in the reduction of the emotional distress of frail elder patients -whether or not they present significant cognitive impairment- and that of their family caregivers. Our results suggest that reducing overburden of the family caregiver may also reduce the emotional distress of the patient and that of their family caregiver.

Estudio comparativo de la eficacia del counselling y de la terapia de la dignidad en pacientes paliativos / Comparative study on the efficacy of Counselling and Dignity Therapy in palliative care patients

OBJETIVO: Existen múltiples trabajos que contemplan el conjunto de las necesidades de los pacientes al final de la vida, contando con propuestas de modelos integrales para una intervención terapéutica paliativa. La metodología más común que aborda estas necesidades es la intervención de counselling, aunque recientemente también ha crecido el uso internacional de la «terapia de la dignidad». Este estudio tiene como objetivo identificar y cuantificar diferencias en términos de distrés emocional, calidad de vida y preservación de la dignidad tras el tratamiento con estos 2 tipos de INTERVENCIONES: MÉTODO: Diseño cuasi-experimental en la Unidad de Hospitalización a Domicilio (UHD) del Hospital General Universitario de Valencia. Tras aplicar criterios de inclusión y exclusión, 30 pacientes con diagnóstico oncológico avanzado fueron asignados aleatoriamente a los 2 grupos de intervención. Se registraron datos sociodemográficos, clínicos, sobre malestar emocional (EVA sufrimiento), ansiedad (HADS), depresión (HADS), dignidad (IPD) y calidad de vida (EORT-QLQ-30). Siguiéndose las guías de intervención, los pacientes recibieron tratamiento psicológico de 2-3 sesiones semanales en sus domicilios. Se llevaron a cabo pruebas t y χ2para comparar las características de los grupos en la línea base, pruebas t de medidas repetidas para evaluar la eficacia de los tratamientos y pruebas t para muestras independientes para comparar las diferencias entre INTERVENCIONES: RESULTADOS: Los grupos no fueron diferentes en la línea base en ninguna de las variables, a excepción del género. El grupo counselling mejoró las variables sufrimiento, calidad de vida y 2 de las dimensiones de dignidad (angustia existencial y angustia dependencia). El grupo Dignidad obtuvo los mismos resultados, a excepción de la variable ansiedad, en la que no se encontró mejoría tras la intervención. La comparación de la eficacia de las intervenciones no mostró diferencias entre estas. CONCLUSIONES: Ambas intervenciones fueron beneficiosas para los pacientes, en la misma medida, mejorando su calidad de vida, bienestar emocional y distrés. Futuras investigaciones deberían abordar esta problemática haciendo frente a una de las limitaciones del estudio, el reducido tamaño muestral, y estudiar la posible replicabilidad de los resultados encontrados en este trabajo, pionero en terapia de la dignidad en el contexto español

AIM: Many works contemplate patient needs at the end of life, with many integral models for palliative care INTERVENTIONS: The most commonly used methodology for meeting these needs is Counselling therapy, although recently there has been an increase in the international use of the Dignity therapy. This study aims to identify and quantify differences in emotional distress, quality of life, and preservation of dignity after both of these types of INTERVENTIONS: Method: A study of quasi-experimental design was developed in the Home Hospitalization Service (HHS) of University General Hospital of Valencia. After applying inclusion and exclusion criteria, 30 patients with an advanced oncology diagnosis were randomly assigned to the two intervention groups. Data were collected on sociodemographic, clinical, emotional distress (EVA), anxiety (HADS), depression (HADS), dignity (PDI) and quality of life (EORT-QLQ-30). Following intervention guides, patients received psychological treatment of 2-3 sessions per week at home. The statistics tests t and χ2 were used to compare the baseline characteristics of both groups, t tests for repeated measures to assess treatments efficacy, and t tests for independent groups to compare differences between INTERVENTIONS: RESULTS: There were no differences between the groups at baseline, except for gender. The Counselling group improved in suffering, quality of life, and in two of the dignity dimensions (existential and dependence anguish). The Dignity group results were similar, except for anxiety, which did not improve after the intervention. The comparison of efficacy showed no differences between the INTERVENTIONS: CONCLUSIONS: Both interventions were beneficial for patients, to the same extent, improving their quality of life, emotional well-being, and distress. Future research should study this situation taking into account one of the limitations of this study, the small sample size, and studying the repeatability of the results found in this ground-breaking work on Dignity Therapy in the Spanish context

The Short Demoralization Scale (SDS): A new tool to appraise demoralization in palliative care patients.

OBJECTIVE: The Demoralization Scale (DS) is the most widely used measure for assessing demoralization. Following the recent clamor for brief assessment tools, and taking into account that demoralization has proved to be a symptom that needs to be controlled and treated in the palliative care setting, a shorter scale is needed. The aim of the present research is to introduce and evaluate the Short Demoralization Scale (SDS). METHOD: We employed a cross-sectional design that included a survey of 226 Spanish palliative care patients from the Hospital General Universitario de Valencia. We employed the SDS, the DS, and the Hospital Anxiety and Depression Scale (HADS). RESULTS: The confirmatory factor analysis supported the one-factor structure of the SDS (χ2(5) = 12.915; p = 0.024; CFI = 0.999; RMSEA = 0.084; CI 95% = [0.028, 0.141]). The reliability was found to be appropriate, with a value of Cronbach's alpha (α) equal to 0.920. A cutoff criterion of 10 was established, which favored the interpretability of the instrument. SIGNIFICANCE OF RESULTS: The SDS corrects previous limitations, has a simple scoring system, is cost-effective, and is widely and fully available. In addition, our findings demonstrate that the SDS can be employed effectively in the clinical context.

Demoralization Scale in Spanish-Speaking Palliative Care Patients.

CONTEXT: Among the approaches to the demoralization syndrome, the one proposed by Kissane et al. is prevalent in the literature. These authors developed the Demoralization Scale (DS) to assess emotional distress, conceived as demoralization. OBJECTIVES: To present the Spanish adaptation of the Demoralization Scale in palliative care patients, with a new and more comprehensive approach to its factorial structure. METHODS: A cross-sectional study was carried out in 226 Spanish palliative care patients in three different settings: hospital, home care unit, and continued care unit. Outcome measures included the DS and the Hospital Anxiety and Depression Scale. Analyses comprised confirmatory factor analyses to test the original, German, and Irish structure of the DS, exploratory structural equation modeling (ESEM), estimations of internal consistency, and multivariate analyses of variance for criterion-related validity. RESULTS: The confirmatory factor analyses showed inappropriate fit for the previous structures when studied in the Spanish version of the DS. With ESEM, the best fitting structure was the five-factor solution, without item 18. Reliability results offered good estimations of internal consistency for all the dimensions except for sense of failure. Cronbach alpha coefficients were appropriate for the dimensions of loss of meaning (0.86), helplessness (0.79), disheartenment (0.88), and dysphoria (0.80), but low reliability was found for sense of failure (0.62). Convergent and discriminant validity showed positive correlations between demoralization, anxiety, and depression. Patients with higher levels of anxiety had higher scores on every dimension of demoralization, and those with higher levels of depression had higher scores on loss of meaning, disheartenment, and sense of failure, but not on dysphoria or helplessness. CONCLUSION: The Spanish adaptation of the DS has shown appropriate psychometric properties. It has been useful to differentiate between depression and the demoralization syndrome, pointing to helplessness and dysphoria as unique characteristics of demoralized palliative care patients.

Comparing counseling and dignity therapies in home care patients: A pilot study.

OBJECTIVE: Several studies have successfully tested psychosocial interventions in palliative care patients. Counseling is the technique most often employed. Dignity therapy (DT) has recently emerged as a tool that can be utilized to address patients' needs at the end of life. The aims of our study were to examine the effects of DT and counseling and to offer useful information that could be put into practice to better meet patients' needs. METHOD: We developed a pilot randomized controlled trial at the Home Care Unit of the General University Hospital of Valencia (Spain). Some 70 patients were assigned to two therapy groups. The measurement instruments employed included the Patient Dignity Inventory (PDI), the Hospital Anxiety and Depression Scale (HADS), the Brief Resilient Coping Scale (BRCS), the GES Questionnaire, the Duke-UNC-11 Functional Social Support Questionnaire, and two items from the EORTC Quality of Life C30 Questionnaire (EORTC-QLQ-C30). RESULTS: The results of repeated-measures t tests showed statistically significant differences with respect to the dimensions of dignity, anxiety, spirituality, and quality of life for both groups. However, depression increased in the DT group after the intervention, and there were no differences with respect to resilience. Therapy in the counseling group did not negatively affect depression, and resilience did improve. When post-intervention differences between groups were calculated, statistically significant differences in anxiety were found, with lower scores in the counseling group (t(68) = -2.341, p = 0.022, d = 0.560). SIGNIFICANCE OF RESULTS: Our study provided evidence for the efficacy of dignity therapy and counseling in improving the well-being of palliative home care patients, and it found better results in the counseling therapy group with respect to depression, resilience, and anxiety.

Effect of a short-term psychological intervention on the anxiety and depression of amyotrophic lateral sclerosis patients.

This study evaluated the effectiveness of a psychological intervention in amyotrophic lateral sclerosis patients, consisting of four semi-structured sessions of cognitive behavioural therapy combined with counselling techniques. An intervention group and a control group were established. The Hospital Anxiety and Depression Scale was used to assess levels of anxiety and depression. In total, fifty-four patients took part. Prior to the intervention, the intervention group displayed rates of 63.3 and 36.7 per cent for anxiety and depression, respectively, falling to 16.7 and 10.0 per cent afterwards. The psychological intervention demonstrated potential for the reduction of levels of anxiety and depression in amyotrophic lateral sclerosis patients.

Spirituality in patients with advanced illness: The role of symptom control, resilience and social network.

In this study, we analyzed the relationships among clinical, emotional, social, and spiritual dimensions of patients with advanced illness. It was a cross-sectional study, with a sample of 108 patients in an advanced illness situation attended by palliative care teams. Statistically significant correlations were found between some dimensions of spirituality and poor symptomatic control, resiliency, and social support. In the structural model, three variables predicted spirituality: having physical symptoms as the main source of discomfort, resiliency, and social support. This work highlights the relevance of the relationships among spirituality and other aspects of the patient at the end of life.

A new measure of home care patients' dignity at the end of life: The Palliative Patients' Dignity Scale (PPDS).

OBJECTIVE: This study aimed to develop a new and brief instrument to be employed in dignity measurement, one based on the perceptions of patients, relatives, and professionals about dignity. METHOD: Surveys of patients receiving palliative care, family caregivers, and palliative care professionals were first carried out (sample 1). In the second step, palliative care patients were surveyed with a pilot questionnaire (sample 2). Finally, a survey design was used to assess patients admitted into a home care unit (sample 3). Sample 1 included 78 subjects, including patients, family caregivers, and professionals. Some 20 additional palliative patients participated in sample 2. Finally, 70 more patients admitted to a home care unit participated were surveyed (sample 3). Together with the Palliative Patients' Dignity Scale (PPDS), our survey included other measures of dignity, anxiety, depression, resilient coping, quality of life, spirituality, and social support. RESULTS: After analyzing data from steps 1 and 2, an eight-item questionnaire was presented for validation. The new scale showed appropriate factorial validity (χ2(19) = 21.43, p = 0.31, CFI = 0.99, GFI = 0.92, SRMR = 0.07, and RMSEA = 0.04), reliability (internal consistency estimations of 0.75 and higher), criterial validity (significant correlations with the hypothesized related variables), and a cutoff criteria of 50 on the overall scale. SIGNIFICANCE OF RESULTS: The new PPDS has appropriate psychometric properties that, together with its briefness, encourages its applicability for dignity assessment at the end of life.

Síndrome de desmoralización como alternativa diagnóstica al estado de ánimo deprimido en pacientes paliativos / Demoralization syndrome as an alternative diagnostic to depressed mood in palliative patients

El estado de ánimo de los pacientes paliativos es uno de los objetivos fundamentales en la atención profesional a los mismos. Distintos autores han estudiado dicho estado de ánimo tomando como base definiciones de la depresión tal como se entiende en la población general. Son muchas las voces y los datos de investigación que apuntan a la necesidad de adecuar la investigación a la situación del paciente en final de vida. Quizá una de las ideas más interesantes es la planteada por Frank y desarrollada por Kissanne y colaboradores, proponiendo la diferenciación entre depresión y desmoralización. Siguiendo esta línea de pensamiento, la desmoralización reflejaría mejor la situación observada en estos pacientes, permitiendo un mejor diagnóstico diferencial y promoviendo un afinamiento mayor en las intervenciones. El síndrome de desmoralización vendría definido como la presencia de desánimo, desaliento, desamparo, pérdida de sentido de la vida y fracaso, sin que los síntomas somáticos propios de la conceptualización de la depresión tengan un peso importante. Teniendo en cuenta esta definición, las intervenciones psicológicas tendrían unos objetivos operativos distintos al tratamiento de depresión, obteniéndose resultados en el bienestar del paciente paliativo. En este trabajo se realiza un planteamiento crítico y se invita a reflexionar sobre las intervenciones psicológicas que actualmente se llevan a cabo en pacientes paliativos

The emotional state of palliative patients is one of the main aims in their professional attention. Several authors have approach this matter using depression definitions as defined for the general population. There are also many expert professional opinions and research data pointing to the need for adequate research at the patient’s end of life situation. Perhaps one of the most interesting ideas is that one initially expressed by Frank and developed by Kissanne et al., suggesting differentiation between depression and demoralization. Following this line of thought, demoralization would more accurately reflect the situation observed in these patients, allows a better differential diagnosis and promotes more tailored interventions. Demoralization syndrome would be defined as the presence of discouragement, despair, helplessness, loss of meaning in life and feelings of failure. That approach leaves aside somatic symptoms of depression scores. This work exposes a critical view and being thought-provoking about current interventions in palliative care

Bienestar emocional y espiritualidad al final de la vida / Emotional and spiritual well-being at the end of life

OBJETIVO: La atención al conjunto de las necesidades físicas, sociales, psicológicas y espirituales de los pacientes es un elemento clave para la disminución del sufrimiento en el marco de los cuidados paliativos. MATERIAL Y MÉTODOS: Desde el modelo antropológico planteado por el Grupo de Espiritualidad de la SECPAL y mediante un nuevo cuestionario desarrollado para evaluar la espiritualidad en 3 niveles: intrapersonal (sentido), interpersonal (armonía) y transpersonal (pertenencia), se han estudiado los recursos y las necesidades espirituales, así como las relaciones entre espiritualidad y funcionamiento emocional, atendiendo a aspectos como ansiedad, depresión y resiliencia. Esta investigación se basa en una muestra de 121 pacientes en situación de cuidados paliativos distribuidos a lo largo de la geografía estatal. Para ello se han llevado a cabo estadísticos descriptivos, correlaciones de Pearson y un modelo de ecuaciones estructurales con un factor y 6 variables observables que ofrece un marco multivariante para la reflexión sobre dichas relaciones. RESULTADOS: Los resultados indican valores similares a los de otras muestras en las variables relativas al bienestar emocional y correlaciones estadísticamente significativas entre espiritualidad, depresión, ansiedad y resiliencia. El modelo se ajustó correctamente, indicando alta capacidad de predicción del grado de espiritualidad sobre la depresión y la ansiedad, en sentido negativo, y una relación positiva entre espiritualidad y resiliencia. CONCLUSIONES: Las conclusiones ponen en relación estos resultados con la literatura previa, aportando evidencia de la importancia que la espiritualidad tiene para el bienestar emocional de los pacientes

OBJECTIVE: The study of the physical, social, psychological and spiritual needs of the patient is a key element in the decreasing of suffering within the palliative care framework. MATERIAL AND METHODS: From the anthropological model proposed by the SECPAL Spirituality Group, and using a new measurement tool developed to assess the spirituality within three levels: intrapersonal (meaning), interpersonal (membership), and transpersonal (harmony), the resources and spiritual needs, together with the relationships between this spirituality and the emotional functioning, including anxiety, depression and resilience. The research is based on a sample of 121 palliative care patients, distributed throughout the country. Several descriptive analyses have been developed for this purpose. Pearson's correlations and a structural equations model with a factor and six observable variables, a technique which offers a multivariate framework to evaluate the results. RESULTS: The results showed values in emotional well-being similar to findings in other studies, with statistically significant correlations between spirituality, depression, anxiety and resilience. The data fit the model properly, indicating high predictive power of the spirituality level on depression and anxiety, in a negative way, and a positive relationship between spirituality and resilience. CONCLUSIONS: Conclusions show that these results are similar to those in previously published studies, providing evidence on the importance of spirituality for the emotional well-being of the patient

Teoría y práctica de la dignidad en cuidados paliativos: una revisión / Theory and praxis of dignity in palliative care: a review

Se realiza un estudio de revisión sobre la dignidad humana, con el objetivo de entender este concepto a nivel teórico en los cuidados paliativos, y además, saber en qué medida estas ideas están desarrolladas a nivel práctico. Se realiza un estudio de textos centrados en revisiones de la dignidad humana desde diferentes disciplinas: filosofía, derecho, religión, bioética, atención sanitaria y cuidados paliativos. También se realiza un trabajo consistente en hallar coincidencias entre los diferentes puntos de vista, encontrando algunas semejanzas entre todas las disciplinas pero también diferencias que en Cuidados Paliativos generan el debate actual. Los autores consideran que es necesaria una revisión del tema de la dignidad humana más cercana a la práctica clínica en Cuidados Paliativos

A review study on human dignity is performed in order to theoretically understand this concept in the framework of palliative care, and in which extent these ideas have been developed on a practical level. Specifically, a review of those texts focused on human dignity from philosophy, law, religion, bioethics, health care and palliative care was carried out. This review also tried to find and report some similarities and differences among different approaches. Those differences are the basis of current debate on palliative care. Authors conclude that any approach to human dignity should be closer to the clinical practice in palliative care

Development and validation of a new tool for the assessment and spiritual care of palliative care patients.

CONTEXT: Spiritual assessment tools and interventions based on holistic approaches are needed to promote healing. Such tools must be adapted to the wide cultural backgrounds of contemporary Western society. OBJECTIVES: To develop and validate a new brief measure, simultaneously featuring clinical applicability and adequate psychometric properties. The tool uses six initial questions to establish a climate of trust with patients before they complete an eight-item, five-point Likert scale. The questionnaire is based on a model of spirituality generated by the Spanish Society of Palliative Care (SECPAL) Task Force on Spiritual Care (Grupo de Espiritualidad de la SECPAL), which aims to recognize, share, and assess the spiritual resources and needs of palliative care patients. METHODS: Multidisciplinary professionals from 15 palliative care teams across Spain interviewed 108 patients using the Grupo de Espiritualidad de la SECPAL questionnaire. Confirmatory factor analysis techniques were used to study the new tool factor structure and reliability. Additionally, concurrent criterion validity coefficients were estimated considering spiritual well-being, anxiety, depression, resilience, and symptoms. Descriptive statistics on questionnaire applicability were reported. RESULTS: Analyses supported a three-factor structure (intrapersonal, interpersonal, transpersonal) with an underlying second-order factor representing a spirituality construct. Adequate reliability results and evidence for construct validity were obtained. CONCLUSION: The new questionnaire, based on empirical research and bedside experience, showed good psychometric properties and clinical applicability.

Detección de duelo complicado / No disponible

Objetivo: Conocer en profundidad el fenómeno del duelo complicado o patológico, y recabar aquellos indicadores de detección y evaluación que nos permitan su pronta identificación en la práctica clínica. Método: Tras una amplia revisión de la literatura científica aparecida en los últimos años, y a la luz de nuestra experiencia profesional, se realizó una recopilación de los indicadores más significativos. Resultados: Presentamos los principales criterios diagnósticos e instrumentos de medida utilizados en la actualidad, que permiten a los profesionales del ámbito de la salud valorar con precisión posibles complicaciones en el proceso de duelo. Conclusiones: Contamos con importantes indicadores e instrumentos de valoración del duelo complicado, siendo cada vez mayor el reconocimiento de este diagnóstico clínico como una entidad propia, por parte de la comunidad científica. Resulta fundamental el desarrollo de la investigación en duelo complicado con miras a optimizar las posibilidades de apoyo emocional (AU)

Aim: A thorough study of the complicated or pathological grief phenomenon and a recapitulation of those detection and assessment indicators enabling a speedy identification in the clinical practice. Method: A compilation of the most significant indicators was carried out after a large research on the scientific literature appeared latterly and the results derived from our professional experience. Results: A presentation of the major diagnosis criteria and tools used at present, which allow professionals of the field of health to a more precise valuation of possible complications happening during the grief process. Conclusions: We rely on important indicators and grief assessment tools since the recognition of such clinical diagnosis is gaining in importance, thus becoming a matter of significance within the scientific community. Consequently, a development in the investigation of the complicated grief aimed at optimizing the possibilities of the emotional support should be considered a must (AU)

Proper information during the surgical decision-making process lowers the anxiety of patients with high-grade gliomas.

PURPOSE: We aim to analyse the relationship between the quality of information during the decision-making process regarding surgery to treat high-grade gliomas and the level of anxiety of the patients. METHODS: This is a transversal, descriptive and correlational study on 26 patients with a clinical and radiological diagnosis of high-grade glioma. They scored the quality (in terms of comprehension and satisfaction) of information received about the treatment options and prognosis during the surgical decision-making process, and the Hospital Anxiety and Depression Scale questionnaire (HADS) was applied immediately afterward. RESULTS: Lower levels of anxiety were observed in patients who showed a desire to receive information regarding their illness, those with a higher degree of comprehension, and those with a higher level of satisfaction with the information provided. CONCLUSIONS: An improvement in the communication process contributes to a decrease in the levels of anxiety, and consequently to enhancement of the well-being of these patients.

Predictores del duelo complicado / Predictors of complicated grief

Objetivo: Estudiar el proceso de evolución en sus primeras etapas tras la pérdida y determinar cuáles son los factores de riesgo y protección previos a la muerte que permiten predecir el surgimiento de posibles complicaciones en los familiares/cuidadores de pacientes oncológicos. Método: Se evaluaron 236 dolientes cuyos familiares eran pacientes oncológicos atendidos en servicios de cuidados paliativos de Valencia y Madrid y se realizó un seguimiento en 2 momentos temporales: 2 y 6 meses tras la muerte, evaluándose la presencia/ausencia de complicaciones en el proceso de duelo mediante dos criterios diagnósticos (DSM e ICG). Resultados: Se encontró una gran estabilidad de las puntuaciones en los indicadores de duelo entre 2 y 6 meses post mortem. Respecto a los indicadores de riesgo pre-mortem se han encontrado como discriminativos: dependencia afectiva, expresiones de rabia y culpa, vulnerabilidad psíquica previa (antecedentes psicopatológicos y duelos anteriores no resueltos), la falta de control de síntomas durante toda la enfermedad del paciente y los problemas económicos. Con respecto a los factores protectores que diferencian a los dolientes con /sin complicaciones son: capacidad para encontrar sentido a la experiencia, competencia en manejo de situaciones (sentimientos de utilidad, planificación de actividades agradables, capacidad de genera alternativas) y gestión de emociones. También la capacidad de auto cuidado, de experimentar emociones positivas y la confianza en la propia recuperación. La regresión logística binaria muestra cómo las variables: dependencia, culpa, duelos, anteriores no resueltos, síntomas sin control durante todo proceso de enfermedad y problemas económicos predicen complicaciones. CONCLUSIÓN: Similares complicaciones presentes a los 2 y 6 meses post mortem sugieren la posibilidad de intervención temprana. Es importante también intervenir antes de la muerte en los factores de riesgo modificables que predicen futuras complicaciones. Atención especial a la dependencia, la rabia y la culpa así como a la promoción de recursos que muestran ser grandes facilitadores de la adaptación (AU)

Aim: To examine the evolution of first moment´s grief and determine which risk and protective factors pre loss may predict future complications in oncology patient´s caregiver´s grief. Methods. There have been assessed 236 oncology´s patient´s grievers form Valencia and Madrid palliative care settings. Structured interview following DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders IV- TR, 2002) complicated fried criteria and Inventory of Complicated Grief (ICG Prigerson & Jacobs 2001) administered 2 and 6 mo. Post-loss. Results. Similar answer patterns were found at 2 and 6 mo. Post-loss in grievers (with and without complicated grief). Best complicated grief predictors were caregiver´s dependency, anger and guilt, previous grief problems (previous psychiatric problems and previous unresolved grief problems),l symptoms without control during end of life last days and financial problems. Best protective factors that predicts between complicated/uncomplicated grievers were: capacity to find sense to the death, ability to manage difficult situations and emotions. It was also considered self care, express positive emotions and confidence in their own recovery. Binary logistic regression show how the variables: dependency, guilt , previous unresolved grief problems, symptoms without control during all illness trajectory and financial problems predict complicated grief. Conclusions. Similar patterns of answers at 2 and 6 months post-loss in grievers with and without complicated grief suggest the possibility of earlier grief support. It is important to prevent grief complications by working in grief changeable risk factors before the death of the patient. Special attention has to be made toward dependency, anger, guilt and also resources enhancement as they facilitate grievers to adapt their new situation (AU)

Grief support provided to caregivers of palliative care patients in Spain.

Grief support for relatives of patients in palliative care is recognized as a fundamental practice within palliative medicine. The aim of this research was to determine the nature and extent of grief support programs offered to relatives of patients in palliative care in Spain. A postal survey was carried out among members of the Spanish Society of Palliative Care. The members' names were obtained through the Society's 2000 Directory, which lists 160 different teams, of which 50% answered a questionnaire made up of 34 questions, some open-ended and others multiple choice. Results show that 88.6% of the services include grief support, that mainly emotional and one-to-one care is provided (92.4 and 89.9%, respectively), and that the number of psychologists and social workers in each team is limited. The risk factors most commonly taken into account by professionals are: absence of family support (36.92%) and the bereaved's case history (21.54%); while the most widely used diagnostic criteria for complicated bereavement are blame and depression (12.5 and 11.36%). In conclusion, it can be seen that bereavement services are not completely consolidated in Spain and there is a need for a greater variety of intervention strategies.

Cuestionario de respuesta emocional a la violencia doméstica y sexual / Emotional response questionnaire to domestic and sexual violence

La violencia doméstica y sexual contra la mujer repercute de forma negativa en su salud. La depresión, la ansiedad y el trastorno por estrés postraumático son las consecuencias psicológicas más frecuentes. El objetivo de este trabajo se centra en el desarrollo de un instrumento que permita identificar el nivel de distrés emocional en situaciones de crisis. La muestra (N= 861) está formada por mujeres, entre 18 y 70 años, víctimas de violencia doméstica (n= 769) y violencia sexual (n= 92). El Cuestionario de Respuesta Emocional a la Violencia (REV) está formado por cuatro escalas que a través de 22 ítems informa sobre depresión, ansiedad, ajuste psicosocial y humor irritable. Los buenos índices de ajuste del modelo propuesto a priori para el Análisis Factorial Confirmatorio (AFC) determinan que es un instrumento adecuado de evaluación psicológica en situaciones críticas para ser utilizado en mujeres víctimas de violencia doméstica y/o sexual

Domestic and sexual violence against women has a negative impact on their health. The most frequent psychological consequences are depression, anxiety and post-traumatic stress disorder. The aim of this research was to develop an instrument to identify the level of emotional distress in a crisis situation. The sample (N= 861) includes women, between 18 and 70 years old, who had been victims of domestic (n= 769) and sexual violence (n= 92). The questionnaire Emotional Response to Violence Questionnaire (REV) was composed by 22 items that provide information on Depression, Anxiety, Psychological Adjustment and Irritability scales. The close fit of the model proposed a priori for Confirmatory Factor Analysis (CFA), showed that it constitute a suitable instrument for psychological evaluation in critical situations to be used with women who have been victims of domestic and/or sexual violence