Palliative care management in patients with Parkinson's disease and other movement disorders in Spain. National survey of neurologists.

INTRODUCTION: Palliative care in neurodegenerative diseases is useful but underused. The objective of this study is to know how palliative care (PC) is applied in Spain in order to identify limitations and unmet needs. MATERIALS AND METHODS: It is a descriptive, observational, cross-sectional study, anonymous survey type of 20 questions, directed and answered by neurologists dedicated to movement disorders (MD) in Spain. RESULTS: 58 responses were obtained from neurologists from 15 autonomous communities. 69% answered that they did not have a specialised MD nursing facility but did have a PC team in their centre (81%). No specific protocol for PC in MD was identified. All except one neurologist stated that they lacked sufficient training in PC, the main training need being the "advance directives explanation". Only 1 in 4 neurologists answered routinely explaining advance healthcare planning to their patients, recognising up to 84.5% of neurologists not knowing how to assess the patient's competence. 60.3% of those surveyed answered that between 10% and 30% of their patients would be candidates for PC, although 1 in 3 said they were not clear when to refer the patient to PC. 100% of neurologists affirmed the priority need to implement PC protocols in MD. CONCLUSIONS: Our study shows a formative deficit in PC in this area and in the care of the patient with movement disorders and their environment, and should serve as a starting point to develop consensual care protocols.

Percepción de utilidad entre profesionales sanitarios de un servicio de consultoría ética clínica / Healthcare workers’ perception of the usefulness of a healthcare ethics consultation service

Antecedentes y objetivo Los servicios de consultoría en ética clínica (CEC) surgen de los comités de ética para la asistencia sanitaria (CEAS) para atender conflictos éticos en tiempo real. Nuestro objetivo es conocer la percepción de utilidad de la CEC entre los profesionales sanitarios tras un año de su creación, así como evaluar los cambios de tendencia en el uso de la CEC y de los CEAS entre 2015 y 2021. Material y método Estudio observacional transversal mediante una encuesta estandarizada a los profesionales sanitarios de un hospital terciario urbano. Se compararon estos resultados con los de una encuesta idéntica realizada sobre la misma población en 2015. Resultados Participaron 213 profesionales (edad media 44 ± 11 años, 69% mujeres). Los profesionales conocían más la existencia de los CEAS que la CEC (94 vs. 61%; p<0,001). Un total de 45 encuestados (21%) habían consultado a la CEC desde su puesta en marcha; el 95% de ellos reconocían la utilidad de la consulta. Los facultativos conocían y utilizaban más la CEC que otros grupos profesionales. El grado de conocimiento sobre los CEAS en 2021 aumentó significativamente respecto a 2015 (94 vs. 76%; p<0,001). Se identificaron como áreas de mejora la necesidad de una mayor difusión del servicio, garantizar recursos institucionales para su mantenimiento y fomentar mayor participación de distintos profesionales. Conclusiones En los últimos años ha aumentado el conocimiento de los CEAS y de la CEC entre los profesionales sanitarios quienes consideran a la CEC útil para la atención de problemas éticos cotidianos (AU)

Background and objective Clinical ethics consultation services (CEC) have arisen from healthcare ethics committees (HEC) to address ethical conflicts in real-time. Our aim was to determine the perception of usefulness of a CEC service among healthcare workers one year after its creation as well as to assess changes in trends in the use of the CEC and HEC between 2015 and 2021. Material and method This observational, cross-sectional study was based on a standardized survey of healthcare workers at an urban tertiary care hospital. The results were also compared to those from an identical survey conducted in the same population in 2015. Results A total of 213 professionals participated (mean age 44±11 years, 69% women). The professionals were more familiar with the HEC than the CEC service (94 vs. 61%; p<0.001). Forty-five individuals (21%) had consulted the CEC since its implementation; 95% of them found the consultation useful. Physicians knew about and used the CEC more than other groups of professionals. The degree of knowledge of the HEC increased significantly by 2021 compared to 2015 (94 vs. 76%; p<0.001). Some areas for improvement identified were the need for greater dissemination of the service, guaranteeing institutional resources to maintain the service, and encouraging greater participation from different professional groups. Conclusions Knowledge of the institutional HEC and CEC services has increased in recent years among healthcare workers, who considered the CEC service to be useful for addressing ethical conflicts in daily practice (AU)

Healthcare workers' perception of the usefulness of a healthcare ethics consultation service.

BACKGROUND AND OBJECTIVE: Clinical ethics consultation services (CEC) have arisen from Healthcare Ethics Committees (HEC) to address ethical conflicts in real-time. Our aim was to determine the perception of usefulness of a CEC service among healthcare workers one year after its creation as well as to assess changes in trends in the use of the CEC and HEC between 2015 and 2021. MATERIALS AND METHODS: This observational, cross-sectional study was based on a standardized survey of healthcare workers at an urban tertiary care hospital. The results were also compared to those from an identical survey conducted in the same population in 2015. RESULTS: A total of 213 professionals participated (mean age 44 ± 11 years, 69% women). The professionals were more familiar with the HEC than the CEC service (94% vs 61%; p < 0.001). Forty-five individuals (21%) had consulted the CEC since its implementation; 95% of them found the consultation useful. Physicians knew about and used the CEC more than other groups of professionals. The degree of knowledge of the HEC increased significantly by 2021 compared to 2015 (94% v. 76%; p < 0.001). Some areas for improvement identified were the need for greater dissemination of the service, guaranteeing institutional resources to maintain the service, and encouraging greater participation from different professional groups. CONCLUSIONS: Knowledge of the institutional HEC and CEC services has increased in recent years among healthcare workers, who considered the CEC service to be useful for addressing ethical conflicts in daily practice.

Descripción de la experiencia de un servicio de consultoría en ética clínica en el período 2019-2021 / Description of the experience of a clinical ethics consultation service from 2019-2021

Introducción La consultoría en ética clínica (CEC) es un modelo útil de asesoría ética, pero con escasa implantación en Europa. En el presente artículo se comparte la experiencia de uno de los primeros servicios de consultoría ética en España. Material y métodos Estudio observacional retrospectivo de todas las consultas recibidas por el servicio de CEC del Hospital Universitario de La Princesa (Madrid, España) entre el 1 de septiembre de 2019 y el 31 de agosto de 2021. Se analizaron variables demográficas, logísticas y éticas de los casos. Resultados Se analizaron 63 casos, en los que se identificaron un total de 124 conflictos éticos. El 41% (n=26) de las consultas eran de carácter urgente y el 38% (n=24), preferentes. La evaluación inicial se realizó en menos de 24horas en 50 casos (79%). El servicio que consultó con mayor frecuencia fue Medicina Intensiva (9; 14%). Los medios de contacto preferidos fueron el busca (36; 57%), el sistema electrónico de historia clínica (13; 21%) o la conversación directa con el equipo consultor (7; 11%). Los problemas éticos más comunes estaban relacionados con la adecuación de medidas terapéuticas (24; 19%), el rechazo del tratamiento (19; 15%), la comunicación con el paciente o su familia (29; 23%) o la competencia del paciente (13; 11%). Conclusiones Los servicios de CEC proporcionan una asistencia rápida y eficiente para la resolución de problemas éticos en la práctica habitual. Su implementación en España es factible (AU)

Introduction Clinical ethics consultation services (CEC) are useful model for ethical counselling, albeit with scarce implementation in European countries. This article shares the experience of one of the first ethics consultation services in Spain. Materials and methods This work is a retrospective, observational study of all consultations received by the CEC service at La Princesa University Hospital (Madrid, Spain) from September 1, 2019 to August 31, 2021. The demographic, logistic, and ethical variables of the cases were analyzed. Results A total of 63 cases were analyzed in which a total of 124 ethical conflicts were identified. Forty-one percent of the cases (n=26) were emergency consultations and 38% (n=24) were preferential inquiries. An initial evaluation was performed with 24hours in 50 cases (79%). The department that consulted most often was the Intensive Care Unit (9; 14%). The preferred contact methods were via pager (36; 57%), the electronic medical record system (13; 21%), or direct conversations with consulting team (7; 11%). The most common ethical conflicts were those related to the adequacy of treatment measures (24; 19%), refusal of treatment (19; 15%), communication with the patient or his/her family (29; 23%), or the patient's capacity (13; 11%). Conclusion CEC services provide quick, efficient assistance for resolving ethical problems in daily practice. Their implementation in Spain is feasible (AU)

Description of the experience of a clinical ethics consultation service from 2019 to 2021.

INTRODUCTION: Clinical ethics consultation services (CEC) are useful model for ethical counselling, albeit with scarce implementation in European countries. This article shares the experience of one of the first ethics consultation services in Spain. MATERIALS AND METHODS: This work is a retrospective, observational study of all consultations received by the CEC service at La Princesa University Hospital (Madrid, Spain) from September 1, 2019 to August 31, 2021. The demographic, logistic, and ethical variables of the cases were analyzed. RESULTS: A total of 63 cases were analyzed in which a total of 124 ethical conflicts were identified. Forty-one percent of the cases (n = 26) were emergency consultations and 38% (n = 24) were preferential inquiries. An initial evaluation was performed with 24 h in 50 cases (79%). The department that consulted most often was the Intensive Care Unit (9; 14%). The preferred contact methods were via pager (36; 57%), the electronic medical record system (13; 21%), or direct conversations with consulting team (7; 11%). The most common ethical conflicts were those related to the adequacy of treatment measures (24; 19%), refusal of treatment (19; 15%), communication with the patient or his/her family (29; 23%), or the patient's capacity (13; 11%). CONCLUSION: CEC services provide quick, efficient assistance for resolving ethical problems in daily practice. Their implementation in Spain is feasible.