Interprofessional interventions and factors that improve end-of-life care in intensive care units: An integratory review.

INTRODUCTION: The changes in health dynamics, caused by the SARS-COVD-2 pandemic and its consequences, generated a greater need to integrate palliative care in the ICU to promote a dignified death. OBJECTIVE: Identify interprofessional interventions and factors that improve the care of patients at the end of life. METHODOLOGY: Integrative review, including experimental, quasi-experimental, observational, analytical, and descriptive studies with correlation of variables, published from 2010 to 2021, identified in COCHRANE, CINAHL, CUIDEN, LILACS, SCIELO, Dialnet, PsychInfo, PubMed, PROQUES, PSYCHOLOGY, JOURNALS, SCIENCEDIRECT, with MeSH/DECS terms: "Critical Care", "IntensiveCare" "Life support care", "Palliative care", "Life Quality", "Right to die". 36,271 were identified, after excluding duplicate title, abstract, year of publication, design, theme, methodological quality, objectives, and content, 31 studies were found. RESULTS: It included 31 articles, 16.7% experimental, 3.3% quasi-experimental, 80% observational, analytical, and descriptive with correlation of variables, 38% published in the United States, 38%, and 19% in Brazil. The pooled sample was 24,779 participants. 32.2% of the studies had level of evidence 1 recommendation (c), and 25.8% level of evidence 2 recommendation (c). This paper synthesises evidence to promote Interprofessional Collaborative Practice in the ICU, improve end-of-life care, and interventions to achieve established therapeutic goals, implement effective care policies, plans, and programmes for critically ill patients and their families; factors that affect palliative care and improve with training and continuing education for health personnel. CONCLUSION: There are interventions to manage physical and emotional symptoms, training strategies and emotional support aimed at health personnel and family members to improve the quality of death and reduce stays in the ICU. The interdisciplinary team requires training on palliative and end-of-life care to improve care.

Diseño y validación de un instrumento sobre calidad de la planificación anticipada de decisiones para profesionales / Design and validation of an instrument about quality of the advance care planning for professionals

Objetivo: Diseñar y validar un cuestionario dirigido a profesionales para la medición de la calidad del proceso de planificación anticipada de decisiones y determinar sus propiedades psicométricas. Método: Estudio instrumental de validación de cuestionario. Emplazamiento: centros de atención primaria y consultas externas de hospitales de Ferrol, Ourense, Monforte-Lugo y el Área Sanitaria V del Servicio de Salud de Asturias. Participantes: médico/as y enfermera/os. Fases: 1) diseño de la primera versión del cuestionario mediante técnica Delphi; 2) construcción de la segunda versión de 21 ítems, tras acuerdo de jueces y prueba W de Kendal; 3) pilotaje, análisis de consistencia interna mediante alfa de Cronbach y coeficiente omega, test-retest mediante coeficiente de correlación de Pearson; y 4) validación, test de esfericidad de Barlett y medida de Kaiser-Meyer-Olkin, análisis factorial exploratorio con rotación varimax y estudio de las dimensiones del cuestionario (número, coeficiente de correlación intraclase y correlación), consistencia interna mediante alfa de Cronbach. Resultados: Estudio piloto con 28 profesionales. Fiabilidad ɷ = 0.917, α = 0, 841 y coeficiente de correlación test-retest 0,785 (intervalo de confianza del 95%: 0,587-0,894; p < 0,001). Validación del cuestionario (21 ítems) en 204 profesionales. El análisis de los ítems y el factorial exploratorio (test de Barlett [χ2 = 1298,789] y KMO = 0,808; p < 0,001) arrojaron un modelo de cinco factores que explican el 64,377% de la varianza total, con 18 ítems agrupados en 5 dimensiones (información, preferencias, intención de conducta, capacitación y comunicación). El alfa de Cronbach del cuestionario global fue de 0,841. Conclusiones: El cuestionario ProPAD-pro ha demostrado ser un instrumento válido y fiable para evaluar la calidad del proceso de planificación anticipada de decisiones. (AU)

Objective: To develop a questionnaire aimed to measure the quality of the advance care planning process in healthcare professionals and to assess its psychometric quality. Method: Instrumental questionnaire validation study. Scope: primary care centers and outpatients clinics from general hospitals in Ferrol, Ourense, Monforte-Lugo and Health Area V of the Health Service of Asturias. Participants: physicians and nurses. Phases: (1) design of the first version of the questionnaire using the Delphi technique; (2) construction of the second version of 21 items, after judges’ agreement and Kendall's W test; (3) pilot study: internal consistency using Cronbach's alpha and omega coefficient, retest–test by Pearson's correlation coefficient; (4) validation: Barlett's spherity test and Kaiser–Meyer–Olkin measurement, exploratory factor analysis with varimax rotation and study of the dimensions of the questionnaire (number, CCI and correlation), internal consistency using Cronbach's alpha. Results: Pilot study with 28 professionals. Reliability ɷ = 0.917, α = 0.841, and test–retest correlation coefficient of 0.785 (95% confidence interval: 0.587–0.894; p < 0.001). Validation of the questionnaire (21 items) in 204 professionals. Ítem analysis and exploratory factor analysis (Barlett's test [χ2 = 1298,789] and KMO = 0.808; p < 0.001) yielded a five-factor model explaining 64.377% of the total variance, with 18 items grouped into 5 dimensions (information, preferences, behavioral intention, training and communication). Cronbach's alpha of the global questionnaire was 0.841. Conclusions: The ProPAD-pro questionnaire has showed to be a valid and reliable instrument to assess the quality of the advance care planning process. (AU)

[Design and validation of an instrument about quality of the advance care planning for professionals]. / Diseño y validación de un instrumento sobre calidad de la planificación anticipada de decisiones para profesionales.

OBJECTIVE: To develop a questionnaire aimed to measure the quality of the advance care planning process in healthcare professionals and to assess its psychometric quality. METHOD: Instrumental questionnaire validation study. SCOPE: primary care centers and outpatients clinics from general hospitals in Ferrol, Ourense, Monforte-Lugo and Health Area V of the Health Service of Asturias. PARTICIPANTS: physicians and nurses. Phases: (1) design of the first version of the questionnaire using the Delphi technique; (2) construction of the second version of 21 items, after judges' agreement and Kendall's W test; (3) pilot study: internal consistency using Cronbach's alpha and omega coefficient, retest-test by Pearson's correlation coefficient; (4) validation: Barlett's spherity test and Kaiser-Meyer-Olkin measurement, exploratory factor analysis with varimax rotation and study of the dimensions of the questionnaire (number, CCI and correlation), internal consistency using Cronbach's alpha. RESULTS: Pilot study with 28 professionals. Reliability É·=0.917, α=0.841, and test-retest correlation coefficient of 0.785 (95% confidence interval: 0.587-0.894; p<0.001). Validation of the questionnaire (21 items) in 204 professionals. Ítem analysis and exploratory factor analysis (Barlett's test [χ2=1298,789] and KMO=0.808; p<0.001) yielded a five-factor model explaining 64.377% of the total variance, with 18 items grouped into 5 dimensions (information, preferences, behavioral intention, training and communication). Cronbach's alpha of the global questionnaire was 0.841. CONCLUSIONS: The ProPAD-pro questionnaire has showed to be a valid and reliable instrument to assess the quality of the advance care planning process.

La planificación compartida de la atención en personas con enfermedad oncológica en un instituto monográfico de cáncer: estudio descriptivo retrospectivo / Advance care planning in people with cancer disease in a monographic cancer institute: retrospective cross-sectional study

Introducción: La planificación compartida de la atención (PCA) promueve que las personas expresen deseos, preferencias o preocupaciones con el objetivo de facilitar un proceso de atención consensuado y compartido entre paciente, familia y equipo. Esto es especialmente relevante en el contexto oncológico. Materiales y métodos: Se desarrolló un estudio descriptivo para analizar las prácticas de PCA de los profesionales a partir de los registros en las historias clínicas de los últimos 3 meses de vida de una muestra de pacientes fallecidos en un hospital monográfico de cáncer. Se definieron variables sociodemográficas, diagnóstico, nivel de intensidad terapéutica, estado cognitivo y variables de PCA: preferencias, preocupaciones, lugar de atención y defunción preferentes, elección del representante y documento de voluntades anticipadas (DVA). Resultados: Se incluyeron 54 pacientes, el 61,1 % hombres; mediana de edad: 64,5 años. Patología oncológica principal: respiratoria (22,2 %). Las variables relacionadas con la PCA fueron: preferencias 74,1 % (n = 40); preocupaciones 75,9 % (n = 41); representante 7,4 % (n = 4); lugar de atención 27,8 % (n = 15); lugar de defunción: 16,7 % (n = 9). Ninguno disponía de DVA. Son los equipos de cuidados paliativos quienes registran principalmente las preferencias y preocupaciones, asociados a un nivel de intensidad terapéutica 3A. El registro de preocupaciones se asoció con la capacidad de expresión del paciente (p < 0,001). Discusión: El registro de dimensiones de PCA es escaso y se recoge principalmente en cuidados paliativos. Escasean variables como la figura representante o los DVA. La integración precoz de la PCA en la práctica clínica facilitaría la toma de decisiones con pacientes oncológicos y contribuiría a adecuar el proceso asistencial a los deseos y preferencias de los mismos. (AU)

Introduction: Advance care planning (ACP) encourages people to express wishes, preferences and concerns in order to facilitate a shared care process involving patients, their families and professionals. This is especially relevant in the cancer context. Materials and methods: A cross-sectional study was carried out to analyze the ACP process practices of professionals through the clinical records of a sample of patients in their last 3 months of life who died during one month in a monographic cancer hospital. Sociodemographic variables, diagnosis, level of therapeutic intensity, cognitive status, and ACP variables were defined: preferences, concerns, preference for place of care and place of death, choice of representative, and advance directive document (ADC) existence. Results: N = 54; 61.1 % men; median age: 64.5 years. Main cancer disease: respiratory (22.2 %). ACP-related variables included preferences (74.1 %, n = 40); concerns (75.9 %, n = 41); proxy (7.4 %, n = 4); place of care (27.8 %, n = 15); place of death (16.7 %, n = 9). None had an ADC. Preferences and concerns are mainly recorded by palliative care teams, and the level of therapeutic intensity in the preferences/concerns record was 3A. Concerns were associated with level of patient self-expression (p < 0.001). Conclusions: ACP dimensions are scarcely recorded. Recording occurs mainly in the end-of-life context. Variables such as presence of a representative and ADCs are rarely registered. Early integration of ACP in clinical practice would facilitate shared decision-making with cancer patients, and would help define the care process according to their wishes and preferences. (AU)

Impacto de estilos de vida sobre la salud sexual de estudiantes universitarios / Impact of lifestyles on sexual health of university students / Impacto do estilo de vida na saúde sexual de estudantes universitários

Disertar respecto al impacto de los estilos de vida sobre la salud sexual en estudiantes universitarios debe organizarse en torno a la descripción del conjunto de características que conforman los esti-los de vida como lo son: el área educativa, familiar/social, espiritual y autocuidado; así mismo, hay que reconocer los diversos factores protectores y de riesgo representados en el conocimiento o desco-nocimiento en temáticas sobre la sexualidad. Lo planteado anterior-mente facilita al lector la vinculación con el modelo de toma de decisiones compartidas, como uno de los medios en la educación sobre salud sexual. Se finaliza con la reflexición sobre la capacidad de elección que los jóvenes universitarios vivencian durante su paso por las IES y las decisiones que pueden tomar con relación a su vida sexual.

Discourse regarding the impact of lifestyles on sexual health in university students should be organized by describing the set of characteristics that make up lifestyles as it would be: the educational, family / social, spiritual and self-care area, as well as , recognizing the various protective and risk factors represented in the knowledge or ignorance of sexuality issues, would facilitate the reader to link the shared decision-making model as one of the means in sexual health education, ending with reflectively integrating the capacity for choice that young university students experience during their time at higher education and the decisions they can make in relation to their sexual life.

Dissertar respeito ao impacto do estilo de vida sob a saúde sexual de estudantes universi-tários, deve dispor a discussão ao redor do conjunto de características que compõem o estilo de vida como: a área de ensino, familiar/social, espiritual e autocuidado; além disso, precisa reconhecer os diversos fatores protetores e de risco representados no conhecimento ou des-conhecimento em temáticas sobre a sexualidade. O planteado anteriormente facilita ao leitor a vinculação com o modelo de toma de decisões compartilhadas, como um dos meios na educação sobre saúde sexual. Se finaliza com a reflexão sob a capacidade de eleição que os jovens universitários experimentam durante a sua vida na faculdade e as decisões que podem tomar com relação à sua vida sexual

[Health care based on cooperation between professionals and affected people]. / La atención sanitaria basada en la cooperación entre profesionales y personas afectadas.

The purpose of this article is to support the need for a change of care, based on cooperation between those who provide care and those who receive it. This article develops the decisive factors for change: the investee cooperation, the reference in case management, the concept of recovery and terminal care, the reduction of suffering and the value of change reflected in the 'win-win'. In each of them a questioning of the current situation, a methodological analysis and an input of tools and consequences of the change is made. To conclude, the article incorporates the 'itinerary of shared care' as a resource and one of the ways to bring these changes to the reality of day-to-day care.