Investigating moral distress over a shortage of organs for transplantation / Investigando la angustia moral por la escasez de órganos para trasplantes / Investigando sofrimento moral por falta de órgãos para transplante

Abstract We verified moral distress related to organ shortage for transplantation in nursing students. This quantitative pilot study analyzed data from 104 nursing undergraduate students. Data were collected through a survey composed of four questions and two sociodemographic items. The chi-squared test was used to examine categorical variables, whereas continuous variable data were analyzed using ANOVA and the Pearson Product Moment correlational test for determining the existence of moral distress regarding the availability of one heart for four individuals susceptible to heart transplantation. A high level of moral distress was identified with regard to the hypothetical decision-making process, which justifies the need for further studies on the subject. Given the hypothetical scenario, moral distress was observed among the students, reaching severe distress in some cases. Approval CEP-University of Alberta Pro00068610

Resumen Nuestro objetivo con esta investigación fue identificar la angustia moral en estudiantes de enfermería relacionada con la escasez de órganos para trasplante. Este es un estudio piloto cuantitativo que analizó datos de 104 estudiantes de grado de enfermería. Los datos fueron recolectados a través de una investigación compuesta por 4 preguntas y 2 ítems sociodemográficos. Posteriormente, se utilizó la prueba de Chi-cuadrado para examinar las variables categóricas, mientras que las variables continuas se analizaron utilizando las pruebas correlacionales Anova y Pearson Product Moment para determinar la existencia de angustia moral en relación con la disponibilidad de un corazón para cuatro personas que requieren el trasplante. Se identificó un alto nivel de angustia moral en relación con el hipotético proceso de toma de decisiones, lo que justifica la necesidad de realizar más estudios sobre el tema. Dada la situación hipotética, la angustia moral entre los estudiantes, incluida la angustia severa, es notable. Aprobado CEP-University of Alberta Pro00068610

Resumo Objetivou-se identificar sofrimento moral em estudantes de enfermagem relacionado à escassez de órgãos para transplante. Este estudo-piloto quantitativo analisou dados de 104 graduandos de enfermagem. Os dados foram coletados por meio de questionário composto de quatro questões e dois itens sociodemográficos. O teste qui--quadrado foi usado para examinar as variáveis categóricas, enquanto as variáveis contínuas foram analisadas utilizando os testes correlacionais Anova e Pearson Product Moment a fim de determinar a existência de sofrimento moral quanto à disponibilidade de um coração para quatro indivíduos que necessitam de transplante. Identificou-se alto nível de sofrimento moral relacionado ao processo de tomada de decisão hipotético, o que justifica a necessidade de novos estudos acerca do tema. Diante da situação hipotética, observou-se sofrimento moral entre estudantes, incluindo sofrimento severo. Aprovação CEP-University of Alberta Pro00068610

Place of death for people with HIV: a population-level comparison of eleven countries across three continents using death certificate data.

BACKGROUND: With over 1 million HIV-related deaths annually, quality end-of-life care remains a priority. Given strong public preference for home death, place of death is an important consideration for quality care. This 11 country study aimed to i) describe the number, proportion of all deaths, and demographics of HIV-related deaths; ii) identify place of death; iii) compare place of death to cancer patients iv), determine patient/health system factors associated with place of HIV-related death. METHODS: In this retrospective analysis of death certification, data were extracted for the full population (ICD-10 codes B20-B24) for 1-year period: deceased's demographic characteristics, place of death, healthcare supply. RESULTS: i) 19,739 deaths were attributed to HIV. The highest proportion (per 1000 deaths) was for Mexico (9.8‰), and the lowest Sweden (0.2‰). The majority of deaths were among men (75%), and those aged <50 (69.1%). ii) Hospital was most common place of death in all countries: from 56.6% in the Netherlands to 90.9% in South Korea. The least common places were hospice facility (3.3%-5.7%), nursing home (0%-17.6%) and home (5.9%-26.3%).iii) Age-standardised relative risks found those with HIV less likely to die at home and more likely to die in hospital compared with cancer patients, and in most countries more likely to die in a nursing home. iv) Multivariate analysis found that men were more likely to die at home in UK, Canada, USA and Mexico; a greater number of hospital beds reduced the likelihood of dying at home in Italy and Mexico; a higher number of GPs was associated with home death in Italy and Mexico. CONCLUSIONS: With increasing comorbidity among people ageing with HIV, it is essential that end-of-life preferences are established and met. Differences in place of death according to country and diagnosis demonstrate the importance of ensuring a "good death" for people with HIV, alongside efforts to optimise treatment.

Place of death of children with complex chronic conditions: cross-national study of 11 countries.

Cross-national understanding of place of death is crucial for health service systems for their provision of efficient and equal access to paediatric palliative care. The objectives of this population-level study were to examine where children with complex chronic conditions (CCC) die and to investigate associations between places of death and sex, cause of death and country. The study used death certificate data of all deceased 1- to 17-year-old children (n = 40,624) who died in 2008, in 11 European and non-European countries. Multivariable logistic regression was performed to determine associations between place of death and other factors. Between 24.4 and 75.3% of all children 1-17 years in the countries died of CCC. Of these, between 6.7 and 42.4% died at home. In Belgium and the USA, all deaths caused by CCC other than malignancies were less likely to occur at home, whereas in Mexico and South Korea, deaths caused by neuromuscular diseases were more likely to occur at home than malignancies. In Mexico (OR = 0.91, 95% CI: 0.83-1.00) and Sweden (OR = 0.35, 95% CI: 0.15-0.83), girls had a significantly lower chance of dying at home than boys. CONCLUSION: This study shows large cross-national variations in place of death. These variations may relate to health system-related infrastructures and policies, and differences in cultural values related to place of death, although this needs further investigation. The patterns found in this study can inform the development of paediatric palliative care programs internationally. What is known: • There is a scarcity of population-level studies investigating where children with CCC die in different countries. • Cross-national understanding of place of death provides information to health care systems for providing efficient and equal access to paediatric palliative care. What is new : • There are large cross-national variations in the place of death of children with CCC, with few deathsoccuring at home in some countries whereas hospital deaths are generally most common. • In general, deaths caused by neuromuscular diseases and malignancies occur at home more often thanother CCC.