Proyecto de investigación para evaluar la eficacia de los «Cuidados Primarios de Duelo» (CPD) en viudas: un ensayo clínico aleatorizado por médicos / No disponible

Objetivo: evaluar la eficacia de los «Cuidados Primarios de Duelo» (CPD), una intervención biopsicosocial en duelo diseñada específicamente para la atención primaria (AP). Diseño: ensayo clínico aleatorizado por médicos, distribuidos en dos grupos paralelos: control (GC) e intervención (GI). Emplazamiento: 19 Centros de Salud de Vizcaya del Servicio Vasco de Salud/Osakidetza. Participantes: 104 mujeres captadas antes de transcurridos 3 meses del fallecimiento de su pareja y 31 médicos de AP colaboradores. Intervenciones: GI: 7 sesiones de CPD, de 45 minutos cada una, realizadas a los 4, 4½, 5, 6, 8, 10 y 13 meses de la muerte del cónyuge y en lasque se aplicarán las técnicas generales (REFINO: relación, escucha, facilitación, información, normalización y orientación) y específicas (anticipación de fechas, toma de decisiones,...) de los CPD. GC: 7 sesiones realizadas con la misma periodicidad que el GI, pero libres en duración y contenido. Mediciones principales: se analizarán las «mejorías» en el InventarioTexas Revisado de Duelo, Inventario de Experiencias en Duelo, calidad de vida (SF-36) y salud mental (GHQ-28), a los 3, 9, 15 y 21 meses del fallecimiento del cónyuge; mediante análisis de la covarianza ajustado por las variables predictoras y confusoras que se consideren, y con un modelo lineal mixto. Todos los análisis se harán por intención de tratar. Discusión: el proyecto es muy complejo y está lleno de dificultades, pero las conclusiones que se deriven del mismo aportarán evidencias científicas útiles para definir la atención más apropiada a las personas en duelo en AP (AU)

Objective: to evaluate the effectiveness of «Primary BereavementCare» (PBC), a bereavement intervention specifically designed for primary health care (PHC). Design: a cluster (family physicians)-randomized controlled trial. Location: 19 Basque Health Service (Osakidetza) Centers in Biscay. Participants: 104 women selected within 3 months of their partners' demise, and 31 collaborating family physicians. Interventions: experimental group: 7 sessions of 45 minutes each, performed at 4, 4½, 5, 6, 8, 10 and 13 months after partner death, applying PBC general techniques (REFINO: relationship, «ear», facilitation, information, normalization, and orientation) and PBC specific techniques(date anticipation, decision taking, etc.). Control group: 7 sessions with the same frequency, but without specific content and duration. Principal measurements: «improvements» are analyzed according tothe Texas Revised Inventory of Grief, Grief Experiences Inventory, qualityof life (SF-36) and mental health (GHQ-28), at 3, 9, 15 and 21 monthsfollowing the partner's death; via a covariance analysis adjusted by predictedand confounding variables, using a mixed linear model. All analyses will be performed on an intention-to-treat basis. Discussion: the project is very complex and full of difficulties, but theconclusions obtained will provide useful scientific evidence for the definitionof the most appropriate care for the bereaved in PHC (AU)

La forma de captar participantes influye en su grado de colaboración / The way participants are recruited affects their degree of collaboration

No disponible

[Texas revised inventory of grief: adaptation to Spanish, reliability and validity]. / Inventario Texas Revisado de Duelo (ITRD): adaptación al castellano, fiabilidad y validez.

OBJECTIVES: To adapt into Spanish the Texas Revised Inventory of Grief (TRIG) of Faschinbaguer et al (1977, 1981) and to examine its reliability and validity. DESIGN: Two stages: a) cross-culture adaptation of a questionnaire, and b) cross-sectional study of reliability and validity. SETTING: Primary care teams in Vizcaya, north of Spain. PARTICIPANTS: 118 people who had been widowed between 3 months and 3 years before the study. MAIN MEASUREMENTS AND RESULTS: Cross-culture adaptation: the TRIG was translated from American English, then back-translated and finally compared with the version in American Spanish by Grabowski & Frantz (1993). Reliability: the Cronbach's alpha coefficients (internal consistency) of the 2 TRIG scales were 0.75 and 0.86. Factorial validity: all items except one threw saturation >0.40 on the 2 factors extracted from the varimax rotation. Validity by hypothesis: the TRIG scales showed differences (P<.05) between the grieving in terms of the expected or unexpected character of death, the place where death occurred and time elapsed since the death. The scores on the adapted TRIG were similar to scores on the American Spanish TRIG for Latins and higher than those on the original TRIG and the American Spanish TRIG for Anglo-saxons. Convergent validity: the 2 TRIG scales correlated positively (P<.05) with all the clinical scales on the Inventory of Grief Experiences of Sanders et al (1985) and García García et al (2001). CONCLUSIONS: In the evaluation of grief due to the death of the spouse, the TRIG adapted to Spanish is as reliable and valid as the original version.

Inventario Texas Revisado de Duelo (ITRD): adaptación al castellano, fiabilidad y validez / Texas revised inventory of grief: adaptation to spanish, reliability and validity

Objetivo. Adaptar al castellano el Inventario Texas Revisado de Duelo (ITRD) de Faschinbaguer et al (1977, 1981) y estudiar su fiabilidad y validez. Diseño. Se realizó en 2 fases: a) adaptación transcultural de un cuestionario, y b) estudio transversal de fiabilidad y validez. Emplazamiento. Equipos de atención primaria de Vizcaya. Participantes. Un total de 118 personas que habían enviudado entre los 3 meses y 3 años anteriores al estudio. Mediciones y resultados principales. Adaptación transcultural: el ITRD en inglés americano fue traducido, retrotraducido y finalmente comparado con la versión en hispano de Grabowski & Frantz (1993). En cuanto a la fiabilidad, los coeficientes alfa de Cronbach (consistencia interna) de las 2 escalas del ITRD fueron de 0,75 y 0,86. Validez factorial: todos los ítems menos uno ofrecieron saturaciones > 0,40 a los 2 factores extraídos de la rotación varimax. Validez por hipótesis: las escalas del ITRD mostraron diferencias (p < 0,05) entre los dolientes según lo esperado o inesperado del fallecimiento, el lugar donde ocurrió la muerte y el tiempo transcurrido desde ésta; las puntuaciones del ITRD adaptado son similares a las del ITRD hispano en latinos y más elevadas que las del ITRD original y las del ITRD hispano en anglosajones. Validez convergente: las 2 escalas del ITRD correlacionaron positivamente (p < 0,05) con todas las escalas clínicas del Inventario de Experiencias en Duelo de Sanders et al (1985) y García García et al (2001). Conclusiones. En la evaluación del duelo por la muerte del cónyuge, el ITRD adaptado al castellano es tan fiable y válido como el original

Objectives. To adapt into Spanish the Texas Revised Inventory of Grief (TRIG) of Faschinbaguer et al (1977, 1981) and to examine its reliability and validity. Design. Two stages: a) cross-culture adaptation of a questionnaire, and b) cross-sectional study of reliability and validity. Setting. Primary care teams in Vizcaya, north of Spain. Participants. 118 people who had been widowed between 3 months and 3 years before the study. Main measurements and results. Cross-culture adaptation: the TRIG was translated from American English, then back-translated and finally compared with the version in American Spanish by Grabowski & Frantz (1993). Reliability: the Cronbach's alpha coefficients (internal consistency) of the 2 TRIG scales were 0.75 and 0.86. Factorial validity: all items except one threw saturation >0.40 on the 2 factors extracted from the varimax rotation. Validity by hypothesis: the TRIG scales showed differences (P<.05) between the grieving in terms of the expected or unexpected character of death, the place where death occurred and time elapsed since the death. The scores on the adapted TRIG were similar to scores on the American Spanish TRIG for Latins and higher than those on the original TRIG and the American Spanish TRIG for Anglo-saxons. Convergent validity: the 2 TRIG scales correlated positively (P<.05) with all the clinical scales on the Inventory of Grief Experiences of Sanders et al (1985) and García García et al (2001). Conclusions. In the evaluation of grief due to the death of the spouse, the TRIG adapted to Spanish is as reliable and valid as the original version

[Inventory of experiences in grief (IEG): adaptation to Spanish, reliability and validity]. / Inventario de experiencias en duelo (IED): adaptación al castellano, fiabilidad y validez.

OBJECTIVE: To adapt to Castilian the Inventory of Experiences of Grief (IEG) of Catherine Sanders et al. (1977) and study its reliability and validity. DESIGN: In two stages: cross-cultural adaptation of a questionnaire and cross-sectional study with control group. SETTING: Primary care teams in Vizcaya. PARTICIPANTS: 147 people bereaved in the period between 3 months and 3 years before the study, and 36 who had lost no direct family member in the previous 5 years. MEASUREMENTS AND MAIN RESULTS: The IEG in American English was translated, back-translated and finally reviewed by Sanders and her colleagues, whose valuation was that the Castilian version was the same as the original. Reliability: the internal consistency of each of the scales of grief on the IEG (Cronbach's alpha) ran from 0.43 to 0.85. Factor validity: the first IEG factor adapted was similar to the original one (despair, somatization, anger, blame, depersonalisation and social isolation). Discriminating validity: all the grief scales on the IEG, except anxiety in face of death, discriminated (p < 0.05) between grieving and not grieving. Validity by hypothesis: the IEG scales showed differences (p < 0.05) between the bereaved according to sex, age, place of death of the spouse and time elapsed since death. Convergent validity: all the IEG grief scales correlated positively (p < 0.05) with the scales in the Texas Revised Inventory of Grief. CONCLUSIONS: The IEG adapted to Castilian is equivalent to the original and has similar reliability and validity.

Inventario de experiencias en duelo (EID): adaptación al castellano, fiabilidad y validez / Inventory of experiences in grief: adaptation to spanish, reliability and validity

Objetivo. Adaptar al castellano el Inventario de Experiencias de Duelo (IED) de Catherine Sanders et al (1977) y estudiar su fiabilidad y validez. Diseño. En dos fases: a) adaptación transcultural de un cuestionario, y b) estudio transversal con grupo control. Emplazamiento. Equipos de atención primaria de Vizcaya. Participantes. Un total de 147 personas que habían enviudado entre los 3 meses y 3 años anteriores al estudio y 36 que no habían perdido a ningún familiar directo en los 5 años previos. Mediciones y resultados principales. El IED en inglés americano fue traducido, retrotraducido y finalmente revisado por Sanders y sus colaboradores, quienes valoraron la versión adaptada al castellano como equivalente al original. Fiabilidad: la consistencia interna de cada una de las escalas de duelo del IED (alfa de Cronbach) fue de 0,43-0,85. Validez factorial: el primer factor del IED adaptado resultó semejante al del original (desesperanza, somatización, enfado, culpa, despersonalización y aislamiento social). Validez discriminante: todas las escalas de duelo del IED, excepto la de ansiedad ante la muerte, discriminaron (p < 0,05) entre dolientes y no dolientes. Validez por hipótesis: las escalas del IED mostraron diferencias (p < 0,05) entre dolientes según sexo, edad, lugar del fallecimiento del cónyuge y tiempo transcurrido desde la muerte. Validez convergente: todas las escalas de duelo del IED correlacionaron positivamente (p < 0,05) con las del Inventario Texas Revisado de Duelo. Conclusiones. El IED adaptado al castellano es equivalente al original y tiene una fiabilidad y validez similar. (AU)

[Grief for loss of a spouse: a study with discussion groups in primary care]. / El duelo por la pérdida del cónyuge: un estudio mediante grupos de discusión en atención primaria.

OBJECTIVE: To understand the grieving process after the loss of a spouse and to find the opinion of the person grieving about the best intervention under the circumstances. DESIGN: Qualitative, with discussion groups. SETTING: Primary care. PATIENTS AND OTHER PARTICIPANTS: Widowers/widows between 30 and 70, who suffered their loss between 3 months and 2 years before the study. MEASUREMENTS AND MAIN RESULTS. The data were obtained from recordings and transcriptions, and the main ideas analysed. Two groups were defined: 11 widows between 49 and 68 years old and 6 widowers between 36 and 70. The majority of deaths had followed a previous terminal illness. Four phases of grief were found: 1) anticipated grief, 2) early grief, 3) intermediate grief and 4) delayed grief. There were differences between widows and widowers. An intervention could involve: pre-arranged appointments, home visits, and groups and, in general, spaces to be able to "talk". CONCLUSIONS: The results, in so far as they refer to the grieving process and similarities and differences of type, coincide with other authors. The participants highlighted the importance of psychological support from health workers during the last moments of the illness and the importance of this in how grieving developed. Similarly, they evaluated their own support to the dying spouse as an additional factor which helped them.

[The care of the terminal patient as viewed by the family physician]. / Cuidado del enfermo terminal visto por el médico de familia.

We made a survey among physicians of primary care teams (PCT) from Vizcaya to assess their opinion about the care of the patient with cancer in the terminal period. A total of 85% of the surveyed physicians responded; 70% considered that the care given was inadequate; 90% thought that the patients wishes to die at home. 50% felt that the patient should know the diagnosis, although 85% believed that it was virtually always unknown to him in practice. The most commonly found symptoms were anorexia, asthenia, pain, depression and anxiety, which resulted in serious management difficulties for 25-45% of physicians. 65% were assisted by nurses. The participation of the rest of the team and of specialists was irrelevant. Most felt frustration (59%) and dissatisfaction (78%) with those patients. The physicians find great difficulty to communicate with the patient, and need more information, training and cooperation. Is should be clear that the aim is the well being of the patient, thus diminishing the frustration of the professionals.