ABSTRACT
Las percepciones de los profesionales de la salud ante el final de la vida pueden influir en la comunicación con pacientes y familias. Si bien en cuidados paliativos (CP) la muerte es algo esperable y natural, genera emociones de distinta intensidad y pone en evidencia la propia finitud y/o la de seres amados y pérdidas previas no elaboradas. El Liverpool Care Pathway (LCP) propone un programa de calidad de atención para personas en situación de últimos días (SUD). En Argentina y España se está implementando el LCP (en español) desde las ONG Pallium (programa PAMPA) y Cudeca respectivamente. Nuestro objetivo es explorar las condiciones subjetivas (percepciones) que enfrentan los profesionales de la salud en relación con la atención en el final de la vida, en el contexto previo y posterior a la implementación de una secuencia de cuidado integral LCP/PAMPA en un contexto binacional latino (Argentina-España). Proponemos identificar y describir los significados que los profesionales le asignan a: los cuidados del muriente, la comunicación, el trabajo en equipo, la documentación y las actitudes en SUD. METODOLOGÍA: Es un estudio de casos múltiples, conformado por 2 módulos independientes articulados en un análisis integrador. El primer módulo realizó un tipo de etnografía utilizada en instituciones sanitarias (EF) en el equipo hospitalario de CP que iniciaban la capacitación con el LCP/PAMPA en Argentina. El segundo módulo consistió en la aplicación de un cuestionario estructurado y pregunta abierta sobre las percepciones de los profesionales sobre las necesidades y condiciones de implementación del LCP (en ambos países). RESULTADOS: Módulo 1. Ejes de indagación: a) acercamiento a la intervención en SUD; b) expectativas sobre la capacitación con LCP; c) dudas y temores en la aplicabilidad del LCP y d) lugar de la intuición en las INTERVENCIONES: Los datos muestran la variabilidad en los motivos de elección a los CP como formación profesional (personales versus necesidades del sistema sanitario) y las expectativas favorables con respecto a la utilidad del LCP. Módulo 2. Se exploraron las categorías específicas para ambos países (España n: 23, Argentina n: 112), siendo lo más relevante el acuerdo pleno del 73,7% de los encuestados argentinos respecto a los indicadores que reflejan los objetivos de calidad del instrumento. En España el acuerdo pleno alcanza el 91,4% teniendo en cuenta la capacitación específica en CP de los profesionales del Plan Nacional de CP. En Argentina aparece como evidente la falta de formación específica en CP antes de la implementación del LCP/PAMPA (91%) CONCLUSIÓN: Este estudio pretendió explorar por primera vez en un contexto de habla hispana, tanto en España como en América latina, las condiciones subjetivas de profesionales de la salud que pueden implementar una secuencia de cuidado integral sistemática muy utilizada en el contexto cultural anglosajón
Health professionals' perceptions on the end of life (EoL) can influence communication with patients and families. Although death is expected in palliative care (PC), emotions of varying intensity are generated. The fears and difficulties encountered in facing this subject will be different according to previous personal experiences. The Liverpool Care Pathway (LCP) proposes a quality programme of care for people at the EoL. Both in Argentina, Pallium and in Spain, Cudeca, are implementing a Spanish version of LCP. Our goal is to explore the subjective conditions (perceptions) faced by health professionals concerning EoL, and the influence before and after the implementation of the LCPin a Latin-American cultural context (Argentina-Spain). We propose to: identify and describe the meanings that professionals assigned to the care of the dying, communication, teamwork, documentation, and attitudes to EoL. METHODOLOGY: A multiple case study, consisting of 2 independent modules articulated in integrative analysis. The first module performed a type of ethnography used in health institutions (focused ethnography) in a PC hospital team who started training with the LCP/PAMPA in Argentina. The second module was the implementation of a structured questionnaire and open questions about the professional's perceptions and conditions of the implementation of the LCP (in both countries). RESULTS: Module 1. Axes of inquiry: a) approach to intervention in EoL, b) expectations about training with LCP, c) doubts and fears in the applicability of LCP, and d) place of intuition in INTERVENTIONS: The data show the variability for choosing the PC as training and the favorable expectations regarding the use of the LCP. Module 2. Specific categories were explored for both countries (Spain n: 23, Argentina n: 112) the most relevant of the full agreement of 73.7% of Argentines respondents on indicators that reflect the quality goals of the instrument. In Spain the full agreement reached 91.4%, keeping in mind the specific training of professionals of the PC National Plan. Argentina showed evidence of the lack of specific training in PC before the implementation of the LCP/PAMPA (91%). CONCLUSIONS: This study aimed to explore, for the first time in a Spanish-speaking context, both in Spain and in Latin America, the subjective conditions of health professionals who can implement a systematic pathway widely used in the Anglo-Saxon cultural context
Subject(s)
Female , Humans , Male , Palliative Care/methods , Palliative Care/standards , Palliative Care , Hospice Care/methods , Research/trends , Palliative Care/organization & administration , Hospice Care/organization & administration , Hospice Care/standards , Hospice Care , Perception , Anthropology, Cultural/statistics & numerical data , Surveys and QuestionnairesABSTRACT
Objetivo: Adaptacion transcultural al castellano del protocolo de actuacion multidisciplinar de cuidados ofrecidos a pacientes en situacion de ultimos dias Liverpool Care Pathway for the Dying Patient (LCP) Version 11, para su implementacion en un centro de cuidados paliativos. Metodo: El presente proyecto fue desarrollado durante los años 2007-2008, en la Fundacion CUDECA de Malaga, siguiendo los pasos del proceso de acreditacion establecido por The MarieCurie Palliative Care Institute de Liverpool (MCPCIL). Para ello se elabora un informe previo de necesidades del centro solicitante; se tradujo al español siguiendo el protocolo del EORTC Translation Guidance (EORTC Quallity of Live Study Group Translation Procedure. July 1998.EORTC. Brussels). Se testo la adecuacion en el centro de la version del LCP V.11 hospice, con larevision de 40 historias clinicas (HC) de pacientes (..) (AU)
Objective: To translate into Spanish the multidisciplinary protocol for the care of the dying patient, Liverpool Care Pathway for the Dying Patient (LCP) Version 11 and to incorporateits use into a Palliative Care Centre Method: This project took place during 2007-2008 in the Cudeca Foundation of Malaga following the stages set by The Marie Curie Palliative Care Institute de Liverpool (MCPCIL). This involved producing a base review analysis; the document was translated into Spanish following the EORTCTranslation Guidance (EORTC Quality of Live Study Group Translation Procedure. July 1998.EORTC. Brussels). A study of adjustments needed by the centre to implement version 11, of the LCP hospice document was made by reviewing 40 medical histories of patients who had died in the Cudeca hospice (20 retrospective and 20 prospective, once the protocol was in use).Results: Version 11 Hospice of the LCP was translated into Spanish and permission was given for its use in the Cudeca Foundation Hospice by the MCPCIL Institute from January 2009. (LCP V.11for Foundation Cudeca Hospice). The pathway was implemented in the Inpatient unit. There was an improvement in 11 of the 18 of its objectives. Rate of achievement was ≥ 95% in 16 of the objectives Conclusions: The translation into our language gives access to a quality, integrated method for the care of the dying patient (AU)
Subject(s)
Humans , /standards , Practice Patterns, Physicians' , Palliative Care/standards , Clinical Protocols , Cross-Cultural ComparisonABSTRACT
BACKGROUND: Low therapeutic adherence to medication is very common. Clinical effectiveness is related to dose rate and route of administration and so poor therapeutic adherence can reduce the clinical benefit of treatment. The therapeutic adherence of patients with chronic obstructive pulmonary disease (COPD) is extremely poor according to most studies. The research about COPD adherence has mainly focussed on quantifying its effect, and few studies have researched factors that affect non-adherence. Our study will evaluate the effectiveness of a multifactor intervention to improve the therapeutic adherence of COPD patients. METHODS/DESIGN: A randomized controlled clinical trial with 140 COPD diagnosed patients selected by a non-probabilistic method of sampling. Subjects will be randomly allocated into two groups, using the block randomization technique. Every patient in each group will be visited four times during the year of the study. INTERVENTION: Motivational aspects related to adherence (beliefs and behaviour): group and individual interviews; cognitive aspects: information about illness; skills: inhaled technique training. Reinforcement of the cognitive-emotional aspects and inhaled technique training will be carried out in all visits of the intervention group. DISCUSSION: Adherence to a prescribed treatment involves a behavioural change. Cognitive, emotional and motivational aspects influence this change and so we consider the best intervention procedure to improve adherence would be a cognitive and emotional strategy which could be applied in daily clinical practice. Our hypothesis is that the application of a multifactor intervention (COPD information, dose reminders and reinforcing audiovisual material, motivational aspects and inhalation technique training) to COPD patients taking inhaled treatment will give a 25% increase in the number of patients showing therapeutic adherence in this group compared to the control group.We will evaluate the effectiveness of this multifactor intervention on patient adherence to inhaled drugs considering that it will be right and feasible to the clinical practice context. TRIAL REGISTRATION: Current Controlled Trials ISRCTN18841601.
Subject(s)
Bronchodilator Agents/administration & dosage , Health Knowledge, Attitudes, Practice , Medication Adherence , Patient Education as Topic , Pulmonary Disease, Chronic Obstructive/drug therapy , Research Design , Administration, Inhalation , Cognition , Emotions , Health Behavior , Humans , Motivation , Nebulizers and Vaporizers , Reinforcement, Psychology , Spain , Treatment OutcomeABSTRACT
BACKGROUND: Therapeutic adherence of patients with chronic obstructive pulmonary disease (COPD) is poor. It is therefore necessary to determine the magnitude of non-adherence to develop strategies to correct this behaviour. The purpose of this study was to analyse the diagnostic validity of indirect adherence methods. SAMPLE: 195 COPD patients undergoing scheduled inhaled treatment attending 5 Primary Care Centres of Malaga, Spain. VARIABLES: Sociodemographic profile, illness data, spirometry, quality of life (St. George Respiratory Questionnaire: SGRQ), and inhaled medication counting (count of dose/pill or electronic monitoring) were collected. The patient's knowledge of COPD (Batalla test:BT),their attitude towards treatment (Morisky-Green test: MGT) and their self-reported therapeutic adherence (Haynes-Sackett test: HST) were used as methods of evaluating adherence. The follow-up consisted four visits over one year (the recruitment visit: V0; and after 1 month:V1; 6 months:V2; and 1 year:V3). RESULTS: The mean age was 69.59 (95% CI, 68.29-70.89) years old and 93.8% were male. Other findings included: 85.4% had a low educational level, 23.6% were smokers, 71.5% mild-moderate COPD stage with a FEV1 = 56.86 (SD = 18.85); exacerbations per year = 1.41(95% CI, 1-1.8). The total SGRQ score was 44.96 (95% CI, 42.46-47.46), showing a mild self-perceived impairment in health. The prevalence of adherence (dose/pill count) was 68.1% (95% CI, 60.9-75.3) at V1, 80% (95% CI, 73-87) at V2 and 84% (95% CI, 77.9) at V3. The MGT showed a specificity of 67.34% at V1, 76.19% at V2 and 69.62% at V3. The sensitivity was 53.33% at V1, 66.66% at V2 and 33.33% at V3.The BT showed a specificity of 55.1% at V1, 70.23% at V2 and 67.09% at V3. The sensitivity was 68.88% at V1, 71.43% at V2 and 46.66% at V3. Considering both tests together, the specificity was 86.73% at V1, 94.04% at V2 and 92.49% at V3 and the sensitivity was 37.77% at V1, 47.62% at V2 and 13.3% at V3. CONCLUSIONS: The prevalence of treatment adherence changes over time. Indirect methods (dose/pill count and self-reported) can be useful to detect non-adherence in COPD patients. The combination of MGT and BT is the best approach to test self-reported adherence.
Subject(s)
Health Knowledge, Attitudes, Practice , Medication Adherence , Pulmonary Disease, Chronic Obstructive/drug therapy , Self Report , Surveys and Questionnaires , Adrenal Cortex Hormones/therapeutic use , Adrenergic beta-2 Receptor Agonists/therapeutic use , Aged , Cholinergic Antagonists/therapeutic use , Cohort Studies , Female , Humans , Male , Predictive Value of TestsABSTRACT
OBJECTIVE: Analyze the correspondence between health technologies (HT) to develop --doctor's opinion-- and the ones assessed by Spanish Agencies for Health Technologies Assessment. DESIGN: Response analysis of HT obtained from participant doctors. Comparison with assessment reports of agencies. SETTING: Andalusian Public Health System; 2003. Spanish Agencies for Health Tecnologies Assessment. PARTICIPANTS: One hundred and forty-seven specialised doctors of 46 MIR specialties. METHOD: Non-random sample. Andalusian experts and leaders professional selected. Exhaustive searching in Internet or assessment reports of HT. A "score of effort" (SE) was calculated for each Agency. RESULTS: Seven HT groups agree with agency assessment reports: systems and communication network (SE, 0.78%-6.25%); mollecular biology for diagnosis and treatment (SE, 3.12%-42.73%); functional image technologies, monitorization, quick diagnosis, and non-invasive methods (SE, 3.93%-31.25%); lasertherapy, microsurgery, endoscopic surgery, minimally invasive, virtual and remote-controlled surgery (SE, 3.22%-31.25%); stem cells, artificial organs, and xenotransplantation (SE, 0.78%-12.34%); psychosocial interventions (SE, 0.78%-7.69%); management, planification and record systems (SE, 9.67%-76.92%). Two additional cathegories not cited by doctors but evaluated by agencies were identified: Effectiveness of therapeutic and disgnostic implanted strategies and sterilization methods of surgical material (SE, 3.86%-43.18%); Matural drugs, alternative therapies (SE, 1.78%-6.25%). CONCLUSIONS: Greater concordance between doctors and agencies in: mollecular biology, functional image technology, new surgical techniques and management, planification and record systems.
Subject(s)
Medical Laboratory Science , Medicine , Specialization , Technology Assessment, Biomedical , SpainABSTRACT
Objetivo. Analizar la correspondencia entre tecnologías sanitarias (TS) a desarrollar en opinión de médicos especialistas y las evaluadas por las agencias de evaluación de tecnologías españolas. Diseño. Análisis de respuestas sobre TS obtenidas de los médicos participantes. Comparación con informes de evaluación de las agencias. Emplazamiento. Sistema Sanitario Público Andaluz, Agencias Españolas de Evaluación de Tecnologías Sanitarias. Participantes. Se incluyó en el estudio a 147 especialistas de las 46 especialidades MIR. Método. Muestreo no probabilístico. Selección de expertos y líderes profesionales andaluces. Búsqueda exhaustiva en internet de informes de evaluación de tecnologías. Elaboración de indicador de esfuerzo dedicado por las agencias (IE). Resultados. Identificadas 7 categorías de TS coincidentes con las evaluaciones de agencias: sistemas y redes de comunicación (IE, 0,78-6,25%); biología molecular para diagnóstico y tratamiento (IE, 3,12-42,73%); tecnologías de imagen funcional, monitorización, diagnósticos rápidos y métodos no invasivos (IE, 3,93-31,25%); laserterapia, microcirugía, cirugía endoscópica, cirugía mínimamente invasiva y virtual teledirigida (IE, 3,22-31,25%); células madre, órganos artificiales y xenotrasplantes (IE, 0,78-12,34%); intervenciones psicosociales (IE, 0,78-7,69%); sistemas de información, planificación y gestión (IE, 9,67-76,92%). Se identificaron dos categorías no citadas evaluadas por las agencias (y efectividad de estrategias diagnósticas y terapéuticas implantadas y técnicas de esterilización de material quirúrgico (IE, 3,86-43,18%); drogas naturales, terapias alternativas (IE, 1,78-6,25%). Conclusiones. Mayor coincidencia entre profesionales y agencias en: biología molecular, tecnología de imagen funcional, nuevas técnicas quirúrgicas y planificación, gestión y sistemas de información
Objective. Analyze the correspondence between health technologies (HT) to develop --doctor's opinion-- and the ones assessed by Spanish Agencies for Health Technologies Assessment. Design. Response analysis of HT obtained from participant doctors. Comparison with assessment reports of agencies. Setting. Andalusian Public Health System; 2003. Spanish Agencies for Health Tecnologies Assessment. Participants. One hundred and forty-seven specialised doctors of 46 MIR specialties. Method. Non-random sample. Andalusian experts and leaders professional selected. Exhaustive searching in Internet or assessment reports of HT. A "score of effort" (SE) was calculated for each Agency. Results. Seven HT groups agree with agency assessment reports: systems and communication network (SE, 0.78%-6.25%); mollecular biology for diagnosis and treatment (SE, 3.12%-42.73%); functional image technologies, monitorization, quick diagnosis, and non-invasive methods (SE, 3.93%-31.25%); lasertherapy, microsurgery, endoscopic surgery, minimally invasive, virtual and remote-controlled surgery (SE, 3.22%-31.25%); stem cells, artificial organs, and xenotransplantation (SE, 0.78%-12.34%); psychosocial interventions (SE, 0.78%-7.69%); management, planification and record systems (SE, 9.67%-76.92%). Two additional cathegories not cited by doctors but evaluated by agencies were identified: Effectiveness of therapeutic and disgnostic implanted strategies and sterilization methods of surgical material (SE, 3.86%-43.18%); Matural drugs, alternative therapies (SE, 1.78%-6.25%). Conclusions. Greater concordance between doctors and agencies in: mollecular biology, functional image technology, new surgical techniques and management, planification and record systems
