Spiritual issues, beliefs, needs, and resources in palliative healthcare providers: An Italian qualitative study.

The significance of spirituality in navigating the meaning of illness and death has been well-established. However, healthcare professionals working with palliation also grapple with their own spiritual dimensions when confronted with these circumstances. This study aimed to explore spirituality from a subjective standpoint among a sample of palliative care professionals, investigating its role and associated needs. For the first time, the FICA Spiritual History Tool was applied in a focus group setting. The meetings were transcribed, and thematic analysis was performed. The findings underscore how spirituality is perceived as more relational than transcendent, potentially fostering connections between the self, patients, and colleagues, thereby enhancing resilience. Simultaneously, spirituality needs to be considered as a potential source of suffering that could impact both the quality of life and work of healthcare workers involved. This issue should be addressed through dedicated moments of shared reprocessing, with beneficial implications for public health.

Loss of Personal Autonomy and Dignity-Related Distress in End-Of-Life Cancer Patients.

The objective of this cross-sectional study is to investigate Dignity-Related Loss of Personal Autonomy (DR-LPA) intended as loss of relational independence causing dignity-related distress. Moreover, it analyzes its possible relationships with demoralization, spirituality, quality of life, hope, and coping styles in a sample composed of 207 end-of-life cancer patients. These variables have been assessed through the following rating scales: Patient Dignity Inventory - Italian version, Demoralization Scale - Italian version, Functional Assessment of Cancer Therapy Scale - General Measure, Functional Assessment of Chronic Illness Therapy - Spiritual Well-Being, Brief Coping Orientation to Problem Experienced, and Herth Hope Index. The results have shown that most of the DR-LPA items were considered a problem by most patients. Functional, social, emotional, and spiritual wellbeing, disheartenment, age, and sex emerged as significant predictors of DR-LPA. In conclusion, this study showed that DR-LPA can be a relevant concern for patients at the end-of-life and for this reason it becomes necessary for psychosocial provides to consider it to deliver better dignity conserving care.

Balance improvements in healthy subjects are independent to postural strategies involved in the training.

BACKGROUND: Adequate postural strategies have a pivotal role in ensuring balance during the performance of daily or sport activities. These strategies are responsible for the management of center of mass kinematics and depend on the magnitude of perturbations and posture assumed by a subject. RESEARCH QUESTION: Are there differences in postural performance after a standardized balance training performed in sitting versus standing posture in healthy subjects? Does a standardized unilateral balance training with the dominant or non-dominant limb improve balance on trained and untrained limbs in healthy subjects? METHODS: Seventy-five healthy subjects reporting a right-leg dominance were randomized into a Sitting, Standing, Dominant, Non-dominant or Control groups. In the Experiment 1, Sitting group performed a 3-week balance training in seated posture, whereas Standing group performed the same training in bipedal stance. In the Experiment 2, Dominant and Non-dominant groups underwent a 3-week standardized unilateral balance training on the dominant and non-dominant limbs, respectively. Control group underwent no intervention and was included in both experiments. Dynamic (Lower Quarter Y-Balance Test with the dominant and non-dominant limbs and trunk and lower limb 3D kinematics) and static (center of pressure kinematics in bipedal and bilateral single-limb stance) balance were assessed before and after the training, and at 4 weeks follow-up. RESULTS: A standardized balance training in sitting or standing posture improved balance without between-group differences, while a unilateral balance training with the dominant or non-dominant limb improved postural stability on the trained and untrained limbs. Trunk and lower limb joints range of motion increased independently to their involvement in the training. SIGNIFICANCE: These results may allow clinicians to plan effective balance interventions even when a training in standing posture is not possible or in subjects with restricted limb weight-bearing.

A Qualitative Study to Explore Healthcare Providers' Perspectives on End-of-Life Patients' Dignity. How Can Dignity Be Defined, and Which Strategies Exist to Maintain Dignity?

Dignity is a core topic within palliative care, and thus, it is important to get a detailed assessment of healthcare providers' (HCPs) perspectives on this subject. This study aimed to explore various HCPs' perspectives on end-of-life patients' dignity by collecting different testimonies about what dignity entails and which strategies HCPs use to maintain patients' dignity. A sample of 104 participants was interviewed using two open questions to collect qualitative data. Content analysis was performed to identify the central themes among answers. Regarding the first question ("What comes to your mind when I say "Dignity" in relation to your patients?"), nine themes emerged. The majority sampled stated that dignity means respecting the patient by considering him/her as a person in his/her entirety. Two other themes frequently emerged: "Respect the patient's will/wishes/needs" and "Self-determination/Self-expression." Concerning the second question ("Which strategies do you use to maintain patients' dignity?"), seven themes emerged. The "Caring skills" theme was most frequently identified, followed by "Empathic skills" and "Professional strategies." This study has enabled a better understanding of HCPs' perspectives on end-of-life patients' dignity. Through the interviews, HCPs were given an opportunity to reflect on dignity, possibly helping them improve their understanding of their patients' conditions and promote higher quality of care.

Demoralization in End-of-Life Cancer Patients' Family Caregivers: A Cross-Sectional Study.

OBJECTIVES: The aims of this study were to evaluate the prevalence of demoralization in a sample of end-of-life cancer patients' family caregivers and investigate the association between demoralization and different factors, such as distress, hope, quality of life, and caregiver burden. METHODS: The study used a cross-sectional design and 142 participants were sampled. Family caregivers were included if they were caring for a cancer patient in palliative care with a limited life expectancy.Socio-demographic data were gathered, and Italian versions of the following scales were administered: Demoralization Scale (DS), Herth Hope Index (HHI), Caregiver Reaction Assessment (CRA), Short Form-36 Health Survey (SF-36), and Distress Thermometer (DT). RESULTS: The average total demoralization score was 29.04 (SD = 13.62). 19.50% of caregivers was the low scorers at DS (0-25th percentile), 27.50% was the middle scorers (25th-75th percentile), and 39.00% was the high scorers (75th-100 percentile). 19.50% of the caregivers showed mild demoralization, 27.50% moderate demoralization, and 39.00% showed severe demoralization. Strong Moderate correlations were found between the total DS score and the Temporality and Future HHI subscale (ρ = .520); the HHI total score (ρ = .528); the Social functioning (ρ = .536) and Mental health (ρ = .675) SF-36 subscales. The HHI total score and the Mental health SF-36 subscale emerged as the main predictors of demoralization. CONCLUSIONS: The results show that not only end-of-life patients but also family caregivers may experience demoralization. This demoralization seems to be more associated to spiritual and psychological suffering rather than difficulties relating to caregivers' personal time, social roles, physical states, and financial resources.

Hope in end-of-life cancer patients: A cross-sectional analysis.

OBJECTIVE: Hope promotes oncology patients' adaptability to their illness, regardless of the stage of cancer. This study aimed to determine the prevalence of hope in a sample of end-of-life patients and to investigate the possible relationships between hope and a set of clinical and psychosocial measures. METHOD: Three hundred and fifty end-of-life oncology patients, with a presumed life expectancy of 4 months or less and a Karnofsky Performance Status (KPS) of 50 or lower, were administered the Italian validated versions of a set of rating scales during their first consultation with a psychologist. This included the Herth Hope Index (HHI), Patient Dignity Inventory (PDI), Demoralization Scale (DS), Hospital Anxiety and Depression Scale (HADS), Functional Assessment of Chronic Illness Therapy (FACIT-Sp), and the Visual Analogue Scale for pain (VAS). RESULTS: On average, the sample scored between moderate and high on the HHI and the average level of spirituality was high. However, most patients had clinically relevant anxious and depressive symptomatology and high levels of demoralization. Other than the pain scale, the total HHI score significantly correlated with the total scores of all rating scales and their subscales, as well as with the measure of personal religious practice. The "Meaning" FACIT-Sp subscale was found to be the main predictor of hope. SIGNIFICANCE OF RESULTS: Since hope represents a core need and a tool for patients dealing with their illness, it is essential to implement stage-specific and realistic hope-facilitating interventions and support patients in their search for meaning, which promotes spiritual well-being and appears relevant in fostering hope.

Personality Traits and Sense of Dignity in End-of-Life Cancer Patients: A Cross-Sectional Study.

CONTEXT: Patients' personality traits can play an important role in the end-of-life care process. OBJECTIVES: The present study aimed to investigate the relationship between personality traits and dignity in cancer patients nearing death. In addition, the associations between personality traits and physical, psychological symptoms, and coping strategies during the end-of-life stage were explored. METHODS: The study is cross-sectional. The sample consisted of 210 participants with a Karnofsky Performance Status (KPS) lower than 50 and a life expectancy of a few weeks. For each patient, personal and clinical data were collected and a set of validated rating scales, assessing personality, dignity, physical, psychological symptoms and coping strategies was administered during the first psychological consultation. RESULTS: The results highlighted significant associations between personality traits and dignity. In particular, Conscientiousness was negatively correlated with Social Support and Extroversion was negatively associated with Loss of Purpose and Meaning. Neuroticism was related to all the dimensions of dignity and Extroversion was significantly associated with the physical and psychological symptoms. Regarding coping styles, active coping strategies were predictors of Extroversion and Agreeableness. Conversely, anxiety symptoms predicted the Neuroticism trait. CONCLUSIONS: Personality traits seem to be actively involved into the loss of dignity. These findings highlighted the importance of including personality traits and dignity into the patient's care process. Exploring individual differences and coping mechanisms at the end-of-life could improve palliative care and lead to better patient-tailored psychological interventions.

Definition of a Good Death, Attitudes Toward Death, and Feelings of Interconnectedness Among People Taking Care of Terminally ill Patients With Cancer: An Exploratory Study.

The concept of a good death is crucial in palliative care, but its relationship with attitudes toward death and feelings of interconnectedness needs to be further deepened. The first aim of this study was to explore the concept of good death, attitudes toward death, and feelings of interconnectedness among family caregivers (FCs) and health-care providers (HCPs) of terminally ill patients with cancer. The second aim was to analyze associations of good death concept with attitudes toward death and feelings of interconnectedness. Participants were asked to assess the importance of features that characterize a good death. To explore each person's attitude toward death and feelings of interconnectedness, 3 open questions were used. The sample consisted of 49 participants: 24 (48.98%) FCs and 25 (51.02%) HCPs. Nine good death features were considered essential by more than 70% of participants. These referred to the physical (eg, symptoms control), social (eg, loved ones' presence), emotional (eg, sharing emotions), and spiritual (eg, inner peace) dimensions. Importance attributed to components of a good death such as patient's awareness and acceptance of death, meaning, respect for the patient's wishes, and inner peace were found to be associated with lack of avoidance and acceptance toward death and feelings of interconnectedness. Given the importance of FCs and HCPs in providing care and their impact on the patients' dying process, it is necessary to reflect upon how their personal attitudes and previous experiences influence the care of dying patients.