Valoración de los servicios de cuidados paliativos desde la perspectiva de los profesionales sanitarios de Andalucía / Evaluation of Palliative Care services from the perspective of the health professionals of Andalusia

OBJETIVO: Conocer la opinión de profesionales sanitarios sobre los servicios en cuidados paliativos (CP), así como identificar barreras y facilitadores en la implementación del Plan Andaluz de CP. MÉTODO: Diseño observacional transversal. Muestreo aleatorizado estratificado por perfiles de profesionales sanitarios de Andalucía (500 personas, error global ± 0,044, tasa de respuesta del 78%). Entrevista telefónica. Análisis univariante y bivariante. RESULTADO: El 72,8% valoraron como buena o muy buena la situación de CP y el 91,9% consideraron que es mejor o mucho mejor que 5 años atrás. Las 3 razones de calificación positiva de CP más frecuentemente identificadas coincidieron con las 3 primeras fortalezas identificadas en su ejercicio de CP: «mejor atención, trato, accesibilidad del paciente», «organización y coordinación» y «creación de unidades de CP». Por el contrario, identificaron como lo más negativo: la falta de «medios»; la de «personal», y la de «formación/información». Estas 2 últimas razones coincidieron también con las 2 principales carencias o dificultades en el ejercicio de CP, situando como tercera carencia la «falta de organización/coordinación de profesionales». Los profesionales de atención primaria presentaron valoraciones más altas, mientras que los de recursos avanzados de CP presentaron las mayores diferencias entre todos los perfiles, sin que se observaran diferencias destacables según sexo o la experiencia en CP. CONCLUSIONES: Evaluar las opiniones de los diferentes profesionales que intervienen en CP proporciona información valiosa para orientar las decisiones sobre la mejora de la atención al paciente y la organización del sistema de salud en general

OBJECTIVE: To evaluate the opinions of healthcare professionals on Palliative Care (PC) services and the implementation of a PC Strategy. METHOD: A cross-sectional study was conducted by interview on a random sample of 500 Andalusian healthcare professionals with stratification by work profiles (Overall error of ± 0.044). Univariate and bivariate analysis were used to analyse the RESULTS: RESULT: A total of 72.8% of the health professionals assessed PC in the region as good or very good, and 91.9% considered it to be better or much better than 5 years before. The most frequent reasons identified for a positive assessment of PC were: increased patient access to better quality personalised services; better organization and coordination of the system; and the creation of PC units in the region. On the other hand, professionals identified the following as three important negative aspects of regional PC: lack of resources; insufficient staff; and lack of adequate training and information support. Primary care practitioners had the highest levels of satisfaction with PC, while specialists had the greatest differences in opinion when compared with other professionals. There were no differences by gender or level of expertise in PC. CONCLUSIONS: Assessing the opinions of different professionals involved in PC provides valuable insights to guide decisions on the improvement of patient care and the organization of the healthcare system in general

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.