Interventions to promote the use of advance directives: an overview of systematic reviews.

OBJECTIVE: To identify, appraise and synthesise the results of systematic reviews of the literature (SRLs) that examines the effectiveness of interventions to increase advance directive (AD) completion rate. METHODS: Narrative review of the literature-an overview of SRLs focused on interventions to improve patients' AD completion rate. RESULTS: Seven SRLs were located. A wide range of interventions was identified in order to determine their influence on the AD completion rate. CONCLUSION: The most effective method of increasing the use of ADs is the combination of informative material and repeated conversations over clinical visits. The use of passive informative material in isolation does not significantly increase AD completion rates. However, when interactive informative interventions are employed, the AD completion rate increases and the majority of the studies identify multiple sessions as the most effective method for direct interaction between patients and health care professionals. PRACTICE IMPLICATIONS: The progressive ageing of the population and the provision of quality care during the process of ageing and dying, have given rise to the Governments' interest in developing moral autonomy and regulating tools as ADs. In order to put legislation into practice it is necessary to set up successful interventions to expand ADs use.

Advance directives and proxies' predictions about patients' treatment preferences.

The accuracy of proxies when they interpret advance directives or apply substituted decision-making criteria has been called into question. It therefore became important to know if the Andalusian Advance Directive Form (AADF) can help to increase the accuracy of proxies' predictions. The aim of this research was to compare the effect of the AADF on the accuracy of proxies' predictions about patients' preferences with that gained from informative and deliberative sessions about end-of-life decision making. A total of 171 pairs of patients and their proxies were randomized to three groups. The control group's answers to the Life Sustaining Preferences Questionnaire (LSPQ) were compared with their proxies' answers to the same questionnaire. In one intervention group, the patients had already completed the AADF and given it to their proxies, who used it to guide their own answers to the LSPQ. In the second intervention (discussion) group, both patients and proxies attended two educative sessions guided by trained nurses and later filled in the LSPQ. Comparisons of accuracy and other variables showed a strong association with the discussion group. The findings show that promoting communication between patients and their proxies improves the accuracy of proxies' predictions much more than isolated use of the AADF form.

Ética y muerte digna: propuesta de consenso sobre un uso correcto de las palabras / Ethics and dignified death: consensus proposal on the correct use of words

Un debate serio sobre el “derecho a una muerte digna” sólo es posible si se hace un uso correcto de las palabras con que se lo construye. La palabra “eutanasia” es la que exige una mayor clarificación terminológica y conceptual, dado el abuso al que ha sido sometida. Hay cinco escenarios relevantes en relación con la tomade decisiones clínicas al final de la vida. Estos cinco escenarios son: eutanasia y suicidio asistido, limitación del esfuerzo terapéutico, rechazo de tratamiento, sedación paliativa y suspensión deatención médica por fallecimiento. Este artículo plantea que sólo el primero carece de acuerdo ético suficiente en la sociedad española y en el centro de la controversia sobre la “muerte digna”. En los otros cuatro escenarios, que no son en ningún caso eutanasia, sí existe ya un amplio grado de acuerdo ético y jurídico que ampara las actuaciones de los profesionales

The debate about the “right to die with dignity” will only be productive if the words used are constructed properly. “Euthanasia” is probably the word that most needs further clarification. This word isfrequently abused and still remains unclear. Five scenarios around end-of-life care can be highlighted: euthanasia and assisted suicide, withholding or withdrawal of life sustaining therapies, refusal oftreatment or withdrawal of consent, palliative sedation and withdrawal of treatment because of patient death. This work supports the hypothesis that Spanish society has reached a sufficient ethical and legal consensus on the lastfour scenarios, which should never beenconsidered “euthanasia” but forms of dignified death and good clinical practice. So, the mainstream of the Spanish debate on the “right to die” should not be based on these four scenarios but on the first, the question of “euthanasia and assisted suicide”, whichremain open to further discussion

[Validation of the Life-Support Preferences Questionnaire (LSPQ) for its use in Spain]. / Validación del Cuestionario de Preferencias de Soporte Vital (LSPQ) para su uso en la población española.

OBJECTIVE: To validate the Life-Support Preferences Questionnaire (LSPQ) for its use in Spain. DESIGN: Three-stage study: a) translation and linguistic adaptation; b) evaluation of its validity; and c) validation of its psychometric properties. SETTING: Nine primary care nursing clinics and 2 university classes in Granada, Spain. PARTICIPANTS: Patients who were of age and were first- or second-year university students, without any cognitive deterioration. MAIN MEASUREMENTS: The equivalence of the translation and the original was checked by bilingual people; its linguistic and grammatical standard was appraised by experts in Spanish. The validity of the questionnaire was evaluated by 15 judges-experts and 20 patients; linguistic complexity (Szigriszt index); stability in time (McNemar test); internal consistency (Cronbach's alpha). RESULTS: a) 2 bilingual people did a translation that was reviewed by 6 experts in Spanish. After alterations suggested by the experts, the bilingual people ratified its equivalence with the original; b) 15 experts affirmed that each item was a good indicator of care preferences at the end of life; c) 20 users confirmed the acceptability and comprehensibility of the questionnaire; d) reliability: 299 participants out of the 369 initially selected filled in the questionnaire; and e) its stability was 0.92; and its internal consistency, 0.85. CONCLUSION: The LSPQ questionnaire in Spanish (LSPQ-e) is a reliable tool, designed to help patients to clarify their care and treatment preferences at the end of their lives.

Validación del Cuestionario de Preferencias de Soporte Vital (LSPQ) para su uso en la población española / Validation of the life-support preferences questionnaire (LSPQ) for its use in Spain

Objetivo. Validar el Cuestionario de Preferencias de Soporte Vital (LSPQ ) para su uso en población española. Diseño. Estudio realizado en tres fases: a) traducción y adaptación idiomática; b) evaluación de su validez, y c) validación de sus propiedades psicométricas. Emplazamiento. El estudio se ha llevado a cabo en 9 consultas de enfermería de atención primaria y en 2 aulas universitarias de Granada. Participantes. Se incluyeron pacientes mayores de edad y estudiantes universitarios de primer y segundo cursos, sin deterioro cognitivo. Mediciones principales. Equivalencia de la traducción con el original verificada por bilingües. Corrección lingüística y gramatical evaluada por expertos en lengua española. Validez del cuestionario evaluada por 15 jueces-expertos y 20 pacientes. Complejidad lingüística (índice de Szigriszt). Estabilidad temporal (test de McNemar). Consistencia interna (alfa de Cronbach). Resultados. a) 2 personas bilingües realizaron una traducción que fue revisada por 6 expertos en lengua española. Tras las modificaciones que sugirieron, las personas bilingües aseguraron su equivalencia con el original; b) 15 expertos afirmaron que cada ítem era buen indicador de las preferencias de cuidado al final de la vida; c) 20 usuarios confirmaron la aceptabilidad y comprensibilidad del cuestionario; d) en relación con la fiabilidad, completaron el cuestionario 299 participantes (de los 369 inicialmente seleccionados), y e) la estabilidad del cuestionario es de 0,92 y su consistencia interna de 0,85. Conclusión. El cuestionario LSPQ en español (LSPQ-e) es una herramienta fiable diseñada para ayudar a los pacientes a clarificar sus preferencias de cuidado y tratamiento al final de la vida

Objective. To validate the Life-Support Preferences Questionnaire (LSPQ) for its use in Spain. Design. Three-stage study: a) translation and linguistic adaptation; b) evaluation of its validity; and c) validation of its psychometric properties. Setting. Nine primary care nursing clinics and 2 university classes in Granada, Spain. Participants. Patients who were of age and were first- or second-year university students, without any cognitive deterioration. Main measurements. The equivalence of the translation and the original was checked by bilingual people; its linguistic and grammatical standard was appraised by experts in Spanish. The validity of the questionnaire was evaluated by 15 judges-experts and 20 patients; linguistic complexity (Szigriszt index); stability in time (McNemar test); internal consistency (Cronbach's alpha). Results. a) 2 bilingual people did a translation that was reviewed by 6 experts in Spanish. After alterations suggested by the experts, the bilingual people ratified its equivalence with the original; b) 15 experts affirmed that each item was a good indicator of care preferences at the end of life; c) 20 users confirmed the acceptability and comprehensibility of the questionnaire; d) reliability: 299 participants out of the 369 initially selected filled in the questionnaire; and e) its stability was 0.92; and its internal consistency, 0.85. Conclusion. The LSPQ questionnaire in Spanish (LSPQ-e) is a reliable tool, designed to help patients to clarify their care and treatment preferences at the end of their lives

Advance directives in Spain. Perspectives from a medical bioethicist approach.

Spain is one of the most advanced European countries in terms of the legislative and administrative development of ADs. Article 11 of Law 41/2002, concerning Patient Autonomy, regulates 'advance directives' and has prompted various Autonomous Regions to develop legislation in this area. Nevertheless, whilst the variety of legislations in different territories presents advantages, the disparity of criteria also presents problems. Despite significant legislative development, only 23,000 Spanish citizens have filled in an AD. Clearly, AD use is confined to a minority. Several surveys, however, show that the Spanish population views these documents in a positive light. Thus, we must analyse this discrepancy between attitude and practice. A similar situation exists amongst health professionals. Whilst they generally feel that the use of ADs is positive and necessary, they are frequently unwilling to employ them. Bioethical literature and research on ADs has significantly increased in Spain over the last six years. It is likely that this trend will continue in the foreseeable future; but more resources and effort are required if ADs are to become consolidated.

[Not Available]. / Ética y muerte digna: propuesta de consenso sobre un uso correcto de las palabras.

The debate about the "right to die with dignity" will only be productive if the words used are constructed properly. "Euthanasia" is probably the word that most needs further clarification. This word is frequently abused and still remains unclear. Five scenarios around end-of-life care can be highlighted: euthanasia and assisted suicide, withholding or withdrawal of life sustaining therapies, refusal of treatment or withdrawal of consent, palliative sedation and withdrawal of treatment because of patient death. This work supports the hypothesis that Spanish society has reached a sufficient ethical and legal consensus on the lastfour scenarios, which should never been considered "euthanasia" but forms of dignified death and good clinical practice. So, the mainstream of the Spanish debate on the "right to die" should not be based on these four scenarios but on the first, the question of "euthanasia and assisted suicide", which remain open to further discussion.

Malos tratos a personas mayores: guía de actuación

Presenta un guía sobre los malos tratos contra las personas mayores, como prevenir los malos tratos, como detectar y que hacer cuando se sospechan. Documento en formato PDF, requiere Acrobat Reader.