Preferences of caregivers and patients regarding opioid analgesic use in terminal care.

CONTEXT: Patients and caregivers participate in decision-taking, and their views should be considered in the preparation of Clinical Practice Guidelines (CPGs). We involved them in the development of a CPG on the safe use of major opioids. OBJECTIVE: To identify the values and preferences of patients and caregivers on the use of opioids and the desired outcomes, to investigate motives for the acceptance/rejection of opioid therapy, and to evaluate their beliefs and information about these drugs. METHODS: A qualitative study was conducted using semi-structured interviews in an Andalusian population of terminal patients and caregivers (N = 42). Study variables included the role, diagnosis, and adherence to treatment. Content and validity analyses were performed. RESULTS: Less than one-third of participants recognized the term opioid. Among these, false beliefs were held related to the addictive nature of these drugs, their exclusive use in terminal cases and at the end of life, and their association with premature death. The information received was very general: it was known that they are "useful for pain," and some were informed about the administration route, composition, and habituation. Participation in decision making was usually limited to reporting symptoms to the physician. CONCLUSION: These patients and caregivers demonstrated a preference for pain alleviation by opioid treatment and gave negative assessments on adverse digestive effects that can cause this treatment to be abandoned. They expressed interest in receiving more information and in participating in therapeutic decision making, and they reported erroneous beliefs and a lack of information about the effects of these drugs.

Definición de competencia médica según pacientes crónicos del sistema sanitario público de Andalucía / Definition of medical competence. The point of view of chronically-ill patients in the Andalusian public healthcare system (Spain)

Objetivo Identificar los atributos con los cuales los/las pacientes crónicos/as atendidos/as en el Sistema Sanitario Público de Andalucía (SSPA) describen la competencia profesional del personal facultativo que les atiende a lo largo de su proceso asistencial. Métodos 147 pacientes crónicos de diferentes procesos asistenciales y sus familiares. Investigación cualitativa con grupos focales y entrevistas en profundidad, realizadas en centros de salud y consultas externas de Granada, Málaga, Sevilla, Cádiz y Córdoba, entre 2007 y 2008. Análisis de contenido con Nudist Vivo. Resultados Las personas participantes definen la competencia médica enlazando elementos de habilidad y conocimientos técnicos (tener conocimientos e interés por la enfermedad, mantener una continuidad en la atención mediante seguimientos correctos o solicitar las pruebas precisas) con otros relacionales, tanto sobre comunicación e información (informar, escuchar, confiar, estimular las preguntas) como sobre trato (humanidad, amabilidad, respeto, interés, cercanía). En la valoración de la asistencia en atención primaria, las expectativas incluyen relación cercana, trato personalizado, información, gestión de recetas y baja laboral, y derivación al/a la especialista. Sobre las consultas de especialidad destaca acertar diagnóstico y tratamiento, informar y hacer un seguimiento del/de la paciente. En el servicio de urgencias se valoran especialmente el alivio de los síntomas, acertar el diagnóstico, ser derivado al/a la especialista y recibir un trato humano. Conclusiones Las necesidades y las expectativas de los/as pacientes crónicos/as hacia la competencia médica se organizan en torno a habilidades técnicas y relacionales (AU)

Objective To identify the attributes used by chronically-ill patients to describe physicians’ competence in the public healthcare system in Andalucia. Methods A total of 147 chronically-ill patients and their relatives were included in this qualitative study. Focal groups and in-depth interviews were performed in health centers and outpatient centers in Granada, Malaga, Seville, Cadiz and Cordoba between 2007 and 2008. Content analysis was carried out using Nudist Vivo. Results The participants defined medical competence as combining elements of technical ability and knowledge (awareness of and interest in the disease, continuity of follow-up and requesting specific tests) with interpersonal skills related to communication, information (informing, listening, trust, prompting questions) and attention (courtesy, cordiality, respect, interest and approachability). Primary care was expected to provide a close relationship, personalized treatment, information, drug prescription, and referral to specialized care. Specialized care was expected to provide an accurate diagnosis and appropriate treatment, information and follow-up. Highly valued aspects of emergency care were symptom relief, accurate diagnosis, referral to specialists and courtesy. Conclusions Chronically-ill patients based their evaluation of medical competence on technical and interpersonal skills (AU)

El consumo de alcohol en la población joven (12-17 años). El punto de vista de los profesionales de la salud / Alcohol consumption in adolescents (12 to 17 years). The point of view of health professionals

Objetivo: Conocer las opiniones del personal sanitario sobre el consumo de alcohol en menores. Conocer la valoración que hacen los profesionales de la salud acerca de las medidas reguladoras del consumo de alcohol. Metodología: Diseño: Estudio cualitativo. Diseño exploratorio basado en entrevistas semiestructuradas. Emplazamiento: Cuatro ciudades de 4 CC. AA. diferentes: Palma de Mallorca, Granada, Barcelona y Pamplona. Participantes: Treinta y seis médicos/as y enfermeros/as de atención primaria y de urgencias, de 4 CC. AA., seleccionados por muestreo intencional. Mediciones: Treinta y seis entrevistas semiestructuradas analizadas a través del programa Nudist Vivo 4.0.Resultados: Los profesionales de la salud aceptan su papel fundamental en la prevención e intervención sobre el consumo de alcohol en adolescentes. En general, consideran el problema en términos de salud pública. La prevención se asocia a la atención primaria, mientras que el servicio de urgencias actúa en situaciones concretas de consumo abusivo. El acceso de los adolescentes a las consultas es escaso, por lo que la prevención se centra en los centros educativos y necesita la colaboración constante de padres y docente. Los sanitarios tienen un conocimiento insuficiente de la normativa vigente antialcohol y consideran que las medidas educativas son más eficientes que las sancionadoras. Conclusiones: La importancia de asumir responsabilidades y de coordinar la actuación desde los ámbitos sanitario, educativo y familiar requiere la formación específica de los profesionales sanitarios y la adecuación de la normativa vigente(AU)

Objective: To find out the opinions of health professionals on adolescent alcohol drinking and their evaluation of the existing legal regulation measures. Methodology: Design: Qualitative and exploratory study, based on semi-structured interviews. Setting: Four cities representing four different regions in Spain: Palma de Mallorca, Granada, Barcelona and Pamplona. Participants: A total of 36 physicians and nurses from four Spanish regions, working in Primary Care and Emergency Care, selected by intentiones samples. Measurements: A total of 36 deep interviews, analysed using the software Nudist Vivo 4.0.Results: Health professionals accept their important role in preventing and intervening in adolescent alcohol drinking. Generally, they consider it as a public health problem. Prevention is associated with Primary Care, while the Emergency Departments act in specific situations of alcohol abuse. Adolescents infrequently visit Primary Care, thus prevention must centre on education system and constant coordination between health professional and parents. Health personnel do not have sufficient knowledge on legal regulations. They consider educational measures as more efficient than sanctions. Conclusions: Specific professional training is required in order to guarantee the coordination between the health and education systems and the family(AU)

[Alcohol consumption in adolescents (12 to 17 years): the point of view of health professionals]. / El consumo de alcohol en la población joven (12-17 años). El punto de vista de los profesionales de la salud.

OBJECTIVE: To find out the opinions of health professionals on adolescent alcohol drinking and their evaluation of the existing legal regulation measures. DESIGN: Qualitative and exploratory study, based on semi-structured interviews. SETTING: Four cities representing four different regions in Spain: Palma de Mallorca, Granada, Barcelona and Pamplona. PARTICIPANTS: A total of 36 physicians and nurses from four Spanish regions, working in Primary Care and Emergency Care, selected by intentiones samples. MEASUREMENTS: A total of 36 deep interviews, analysed using the software Nudist Vivo 4.0. RESULTS: Health professionals accept their important role in preventing and intervening in adolescent alcohol drinking. Generally, they consider it as a public health problem. Prevention is associated with Primary Care, while the Emergency Departments act in specific situations of alohol abuse. Adolescents infrequently visit Primary Care, thus prevention must centre on education system and constant coordination between health professional and parents. Health personnel do not have sufficient knowledge on legal regulations. They consider educational measures as more efficient than sanctions. CONCLUSIONS: Specific professional training is required in order to guarantee the coordination between the health and education systems and the family.

[Definition of medical competence. The point of view of chronically-ill patients in the Andalusian public healthcare system (Spain)]. / Definición de competencia médica según pacientes crónicos del sistema sanitario público de Andalucía.

OBJECTIVE: To identify the attributes used by chronically-ill patients to describe physicians' competence in the public healthcare system in Andalucia. METHODS: A total of 147 chronically-ill patients and their relatives were included in this qualitative study. Focal groups and in-depth interviews were performed in health centers and outpatient centers in Granada, Malaga, Seville, Cadiz and Cordoba between 2007 and 2008. Content analysis was carried out using Nudist Vivo. RESULTS: The participants defined medical competence as combining elements of technical ability and knowledge (awareness of and interest in the disease, continuity of follow-up and requesting specific tests) with interpersonal skills related to communication, information (informing, listening, trust, prompting questions) and attention (courtesy, cordiality, respect, interest and approachability). Primary care was expected to provide a close relationship, personalized treatment, information, drug prescription, and referral to specialized care. Specialized care was expected to provide an accurate diagnosis and appropriate treatment, information and follow-up. Highly valued aspects of emergency care were symptom relief, accurate diagnosis, referral to specialists and courtesy. CONCLUSIONS: Chronically-ill patients based their evaluation of medical competence on technical and interpersonal skills.

Posicionamiento de padres y madres ante el consumo de alcohol en población de 12 a 17 años en el ámbito urbano de seis Comunidades Autónomas / Parent’s positioning towards alcohol consumption in 12 to 17 years old adolescents from six urban areas in Spain

ObjetivosConocer las opiniones de padres y madres de zonas urbanas sobre el consumo de alcohol en menores y analizar su posicionamiento respecto a las medidas reguladoras existentes.Material y métodosEstudio cualitativo de seis grupos focales con 42 padres y madres de adolescentes de 6 Comunidades Autónomas, respetando la diversidad sociocultural. La parte cuantitativa consiste en un cuestionario en escala 1–10 sobre la aceptación de las medidas reguladoras del consumo de alcohol en menores, calculando medias y desviación típica.ResultadosPadres y madres no consideran un problema el consumo de alcohol de sus hijos/as, siempre que sea moderado y relacionado con el ocio. El hábito se normaliza en un contexto social y cultural permisivo. El consumo depende de factores externos (la presión social o del grupo de pares) e internos (los familiares). La intervención paterna se inclina hacia imponer la autoridad, las madres prefiriendo la vía de la comunicación y educativa. La labor de los profesores se considera adecuada, sobre todo cuando se les atribuye funciones en la educación integral del alumno, no sólo como transmisor de conocimientos. Sin embargo, los padres y las madres consideran que las instituciones públicas y las autoridades son en parte culpables de la desinformación y de las escasas alternativas de ocio juvenil, así como de no asegurar el cumplimiento de las normas vigentes. En cuanto a las medidas legales, tiene buena aceptación la prohibición de la venta de alcohol y de la publicidad.ConclusionesPadres y madres tienen conciencia del consumo de alcohol en sus hijos/as, pero tienden a normalizar el problema. Desarrollan estrategias diferentes de actuación y, en general, aprueban las medidas reguladoras existentes(AU)

ObjectivesTo determine the opinions of urban parents on alcohol drinking in teenagers and their positioning regarding the legal restrictive measures.Material and methodsWe performed a qualitative study of six focal groups including 42 mothers and fathers of adolescents from six different Spanish regions and from diverse social strata. The quantitative part of the study consisted of a 1–10 scale questionnaire, measuring parents’ acceptance and opinion about legal measures restricting underage drinking. Means and standard deviation were calculated.ResultsParents did not consider adolescent alcohol drinking to be a problem so long as it was moderate and leisure time-related. The social and cultural context was permissive with the alcohol consumption. Alcohol intake depended on both external (social pressure) and internal (family) factors. Fathers’ preferred to exercise authority, while mothers preferred communication and education skills. Parents approved of teachers’ interventions, especially when based on the student’s overall education and not restricted to knowledge transmission. Public institutions and authorities were held responsible for adolescents’ lack of information, the scarcity of leisure-time alternatives and for not ensuring compliance with current regulations. Parents approved restrictions regarding the sale and advertising of alcohol.ConclusionsParents recognize adolescent alcohol drinking as a problem and tend to deal with it. Parents use distinct intervention strategies and generally approve legal measures(AU)

Fibromialgia: percepción de pacientes sobre su enfermedad y el sistema de salud. Estudio de investigación cualitativa / Fibromyalgia: Patient perception on their disease and health system. Qualitative research study

Objetivo Conocer la experiencia y vivencia de personas con fibromialgia y sus expectativas sobre el sistema sanitario y sus profesionales. Métodos Diseño cualitativo a través de grupos focales. Se realizaron tres grupos, uno con pacientes que pertenecían a asociaciones de fibromialgia. Participaron 20 mujeres y 1 varón. Se incluyeron personas que recibían atención en el sistema sanitario público, con distintas trayectorias asistenciales y evolución. Se pidió consentimiento informado. Análisis de contenido. Resultados Describen una vivencia difícil con una sintomatología que puede ser incapacitante para las actividades cotidianas. Hasta que reciben el diagnóstico, perciben incomprensión y soledad. Desarrollan distintas estrategias de afrontamiento, como buscar información o asociarse. Esperan del sistema sanitario: atención y diagnósticos ágiles, acceso a consultas, pruebas que necesiten y terapias beneficiosas o impulso a la investigación. Quieren profesionales con formación para abordar la fibromialgia, una actitud proactiva, interés, empatía e información. Discusión La metodología cualitativa fue idónea para profundizar en la experiencia de pacientes. La atención sanitaria debe dirigirse a mejorar su calidad de vida facilitando su proceso asistencial y ofreciendo acompañamiento, interés, comprensión y apoyo(AU)

Objective To know the experiences and expectations of persons with fibromyalgia towards the health system and its professionals. Methods Qualitative study with three focal groups. The first focal group included patients with fibromyalgia, 20 women and 1 man, receiving care in the public health system, with different assistance paths and progression. Informed Consent was required. Content analysis was done. Results Patients describe a difficult experience, with symptoms that may involve incapacity for daily activities. Until knowing their diagnosis, they feel a lack of understanding and also loneliness. They develop different coping strategies, as looking for information or association. From the health system they expect: attention and a fast diagnosis, accessibility to consultations, medical exams and therapies or an impulse for research. They want trained professionals, proactive attitudes, interest, empathy and information. Discussion Qualitative methods seem suitable for delving into patient experience. Health assistance must improve patients’ quality of life, facilitating their assistance process and offering companionship, interest, comprehension and support(AU)

[Fibromyalgia: Patient perception on their disease and health system. Qualitative research study]. / Fibromialgia: percepción de pacientes sobre su enfermedad y el sistema de salud. Estudio de investigación cualitativa.

OBJECTIVE: To know the experiences and expectations of persons with fibromyalgia towards the health system and its professionals. METHODS: Qualitative study with three focal groups. The first focal group included patients with fibromyalgia, 20 women and 1 man, receiving care in the public health system, with different assistance paths and progression. Informed Consent was required. Content analysis was done. RESULTS: Patients describe a difficult experience, with symptoms that may involve incapacity for daily activities. Until knowing their diagnosis, they feel a lack of understanding and also loneliness. They develop different coping strategies, as looking for information or association. From the health system they expect: attention and a fast diagnosis, accessibility to consultations, medical exams and therapies or an impulse for research. They want trained professionals, proactive attitudes, interest, empathy and information. DISCUSSION: Qualitative methods seem suitable for delving into patient experience. Health assistance must improve patients' quality of life, facilitating their assistance process and offering companionship, interest, comprehension and support.

[Parental stance towards alcohol consumption in 12- to 17-year-old adolescents from six urban areas in Spain]. / Posicionamiento de padres y madres ante el consumo de alcohol en población de 12 a 17 años en el ámbito urbano de seis Comunidades Autónomas.

OBJECTIVES: To determine the opinions of urban parents on alcohol drinking in teenagers and their positioning regarding the legal restrictive measures. MATERIAL AND METHODS: We performed a qualitative study of six focal groups including 42 mothers and fathers of adolescents from six different Spanish regions and from diverse social strata. The quantitative part of the study consisted of a 1-10 scale questionnaire, measuring parents' acceptance and opinion about legal measures restricting underage drinking. Means and standard deviation were calculated. RESULTS: Parents did not consider adolescent alcohol drinking to be a problem so long as it was moderate and leisure time-related. The social and cultural context was permissive with the alcohol consumption. Alcohol intake depended on both external (social pressure) and internal (family) factors. Fathers' preferred to exercise authority, while mothers preferred communication and education skills. Parents approved of teachers' interventions, especially when based on the student's overall education and not restricted to knowledge transmission. Public institutions and authorities were held responsible for adolescents' lack of information, the scarcity of leisure-time alternatives and for not ensuring compliance with current regulations. Parents approved restrictions regarding the sale and advertising of alcohol. CONCLUSIONS: Parents recognize adolescent alcohol drinking as a problem and tend to deal with it. Parents use distinct intervention strategies and generally approve legal measures.