Revistas
Revista:
BMC PALLIATIVE CARE
ISSN:
1472-684X
Año:
2024
Vol.:
23
N°:
1
Págs.:
57
The experience of Wish to Die is common in patients living with Advanced Disease. It has been studied worldwide and qualitative studies have
contributed to the understanding of the complexity of the phenomenon of the WTD but a deeper understanding on the individual¿s views is still needed. The objective of this study was to identify common characteristics of the experience of wish to die in advanced disease.
Methods. A phenomenological study was carried out with multicenter participation of patients with advanced disease who had expressed their wish to die to health professionals. Semi-structured interviews were employed to obtain an in-depth perspective of each patient¿s lived experience. A phenomenological analysis of the data collected was performed to describe and explore the characteristic aspects of the phenomenon under study.
Results. Fourteen patients with advanced disease were interviewed. Most of them had cancer. In the analysis of the patients; accounts of their experiences, three common characteristics were identified: a) experiencing a state of transience; b) the attempt to reconnect with oneself; and c) additional disease-related aspects that influence the wish to die. Patients expressed the need for a safe space to address the wish to die and the
importance of receiving care that considers both being and doing.
Conclusions. Patients with advanced disease and wish to die experience a state of transience where the patient lives and ephemeral state of existence. Interventions focused on reinforcing the intrinsic value of the individual emerge as essential components of a compassionate accompaniment of those facing the wish to die.
Revista:
PALLIATIVE CARE AND SOCIAL PRACTICE
ISSN:
2632-3524
Año:
2023
Vol.:
17
Págs.:
26323524221147538
Background: Gratitude has sparked interest in the world of health. It is considered as a personality characteristic or as an emotion. However, little has been explored in the context of the interpersonal relationship of caring. An exploration in the context of end of life is ground-breaking.
Objectives: This study analyses and reflects on the object of gratitude from the perspective of both the persons being cared for and the professionals providing health care. What are patients and their family members grateful for in palliative care? What is the reason for gratitude? What do these health professionals perceive when there is gratitude? These questions were answered considering the gratitude generated in health care encounters, not gratitude as personality trait.
Methods: The phenomenological approach was used starting from lived clinical experiences. In the light of the dialogue between clinical experiences and philosophy, this study proposes an explanation of the 'real' or essential object of gratitude in palliative care. It was conducted within the context of palliative care. The study materials were manifestations of gratitude expressed or felt in clinical encounters and published in newspapers or shared in daily encounters. These were the basis for analysis and reflection and interdisciplinary dialogue.
Findings: The analyses performed indicated healing or deep relief in serious diseases as objects of gratitude according to patients' perspective, and professional self-affirmation until the end according to the professionals' perspective.
Conclusion: The two perspectives shared an important common fact, namely, the need to consider the persons in their entirety, and the importance of not losing sight of the value they have. This concept would characterize the nature of gratitude, its object being the 'objective good' for patients, family members, and palliative care professionals.
Autores:
Predoiu, O.; Tsekezogiou, A. J.; Payne, S.; et al.
Revista:
PALIATIA- JOURNAL OF PALIATIVE CARE
ISSN:
1844-7058
Año:
2023
Vol.:
16
N°:
2
Págs.:
5 - 10
Abstract
RESPACC was an Erasmus + funded project to develop a framework of core research competencies for palliative care (PC)
clinicians and supporting education materials (http://www.studiipaliative.ro/projects/research-respacc/). The supporting materials
included a self-assessment quiz to guide PC multidisciplinary team members on areas of research understanding that needed
further development. The objective was to pilot the self-assessment quiz developed based on the research competency
framework for PC clinical teams and test it for face validity and clarity.
Methods: A pilot observational study was conducted to test the self-assessment quiz for face validity and clarity.
The self-assessment quiz was developed between May-November 2021. It was structured to include questions about each of
the competencies in the seven domains of the framework, using the examples. Items within the quiz were responded on a 5-
points ordinal scale, with participants identifying their perceived competency as: Novice, Advanced Beginner, Competent,
Proficient, Expert (each clearly defined). The quiz was developed in English and then translated into the national languages of
partners (Greek, Romanian, Spanish). The quiz was piloted with Romanian PC professionals attending the National Palliative
Care Conference. Questions about clarity of the quiz, suggestions for improvements were asked together with some
demographic data about participants.
Results: Multidisciplinary PC clinicians participated in the pilot testing (18 physicians, 4 nurses, 2 psychologists and 1
physiotherapist). Most (n=15) had less than one year of experience in PC. Participants identified themselves as: Novice (n=5),
Advanced beginner (n=9), Competent (n=5), Proficient (n=3), Expert (n=3). All respondents answered all question without
difficulties and considered the quiz to be clearly written, well structured and adequate.
Conclusions: The self-assessment quiz is easy to use, and may be useful in helping members of PC teams assess their
competencies and identify their research education needs.
Keywords: pilot test, competency, research, palliative care
https://www.paliatia.eu/new/wp-content/uploads/2023/05/Jurnalul-Paliatia_apr-2023_1-6.pdf
Autores:
Cibula, D. (Autor de correspondencia); Raspollini, M. R.; Planchamp, F.; et al.
Revista:
VIRCHOWS ARCHIV
ISSN:
0945-6317
Año:
2023
Vol.:
482
N°:
6
Págs.:
935 - 966
In 2018, the European Society of Gynecological Oncology (ESGO) jointly with the European Society for Radiotherapy and Oncology (ESTRO) and the European Society of Pathology (ESP) published evidence-based guidelines for the management of patients with cervical cancer. Given the large body of new evidence addressing the management of cervical cancer, the three sister societies jointly decided to update these evidence-based guidelines. The update includes new topics to provide comprehensive guidelines on all relevant issues of diagnosis and treatment in cervical cancer.To serve on the expert panel (27 experts across Europe) ESGO/ESTRO/ESP nominated practicing clinicians who are involved in managing patients with cervical cancer and have demonstrated leadership through their expertise in clinical care and research, national and international engagement, profile, and dedication to the topics addressed. To ensure the statements were evidence based, new data identified from a systematic search was reviewed and critically appraised. In the absence of any clear scientific evidence, judgment was based on the professional experience and consensus of the international development group. Before publication, the guidelines were reviewed by 155 independent international practitioners in cancer care delivery and patient representatives.These updated guidelines are comprehensive and cover staging, management, follow-up, long-term survivorship, quality of life and palliative care. Management includes fertility sparing treatment, early and locally advanced cervical cancer, invasive cervical cancer diagnosed on a simple hysterectomy specimen, cervical cancer in pregnancy, rare tumors, recurrent and metastatic diseases. The management algorithms and the principles of radiotherapy and pathological evaluation are also defined.
Autores:
Cibula, D. (Autor de correspondencia); Raspollini, M. R.; Centeno, Carlos; et al.
Revista:
RADIOTHERAPY AND ONCOLOGY
ISSN:
0167-8140
Año:
2023
Vol.:
184
Págs.:
109682
In 2018, the European Society of Gynecological Oncology (ESGO) jointly with the European Society for Radiotherapy and Oncology (ESTRO) and the European Society of Pathology (ESP) published evidencebased guidelines for the management of patients with cervical cancer. Given the large body of new evidence addressing the management of cervical cancer, the three sister societies jointly decided to update these evidence-based guidelines. The update includes new topics to provide comprehensive guidelines on all relevant issues of diagnosis and treatment in cervical cancer. To serve on the expert panel (27 experts across Europe) ESGO/ESTRO/ESP nominated practicing clinicians who are involved in managing patients with cervical cancer and have demonstrated leadership through their expertise in clinical care and research, national and international engagement, profile, and dedication to the topics addressed. To ensure the statements were evidence based, new data identified from a systematic search was reviewed and critically appraised. In the absence of any clear scientific evidence, judgment was based on the professional experience and consensus of the international development group. Before publication, the guidelines were reviewed by 155 independent international practitioners in cancer care delivery and patient representatives. These updated guidelines are comprehensive and cover staging, management, follow-up, long-term survivorship, quality of life and palliative care. Management includes fertility sparing treatment, early and locally advanced cervical cancer, invasive cervical cancer diagnosed on a simple hysterectomy specimen, cervical cancer in pregnancy, rare tumors, recurrent and metastatic diseases. The management algorithms and the principles of radiotherapy and pathological evaluation are also defined. & COPY; 2023 ESGO, ESTRO, ESP. Published by Elsevier B.V. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/) Radiotherapy and Oncology 184 (2023) 109682 This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
Autores:
Cibula, D. (Autor de correspondencia); Raspollini, M. R.; Planchamp, F.; et al.
Revista:
INTERNATIONAL JOURNAL OF GYNECOLOGICAL CANCER
ISSN:
1048-891X
Año:
2023
Vol.:
33
N°:
5
Págs.:
649 - 666
In 2018, the European Society of Gynecological Oncology (ESGO) jointly with the European Society for Radiotherapy and Oncology (ESTRO) and the European Society of Pathology (ESP) published evidence-based guidelines for the management of patients with cervical cancer. Given the large body of new evidence addressing the management of cervical cancer, the three sister societies jointly decided to update these evidence-based guidelines. The update includes new topics to provide comprehensive guidelines on all relevant issues of diagnosis and treatment in cervical cancer.To serve on the expert panel (27 experts across Europe) ESGO/ESTRO/ESP nominated practicing clinicians who are involved in managing patients with cervical cancer and have demonstrated leadership through their expertise in clinical care and research, national and international engagement, profile, and dedication to the topics addressed. To ensure the statements were evidence based, new data identified from a systematic search was reviewed and critically appraised. In the absence of any clear scientific evidence, judgment was based on the professional experience and consensus of the international development group. Before publication, the guidelines were reviewed by 155 independent international practitioners in cancer care delivery and patient representatives.These updated guidelines are comprehensive and cover staging, management, follow-up, long-term survivorship, quality of life and palliative care. Management includes fertility sparing treatment, early and locally advanced cervical cancer, invasive cervical cancer diagnosed on a simple hysterectomy specimen, cervical cancer in pregnancy, rare tumors, recurrent and metastatic diseases. The management algorithms and the principles of radiotherapy and pathological evaluation are also defined.
Revista:
PLOS ONE
ISSN:
1932-6203
Año:
2023
Vol.:
18
N°:
6
Págs.:
e0286343
Introduction: Society associates palliative care with "death" or "end of life", which cause them fear and anxiety. In Spain, the media worsens the misunderstanding by depicting a wrong picture of palliative care. Educational innovation for university students may serve as an alternative communication strategy. Care and Society is a university course designed by and for students from non-health degrees to help disseminate the palliative care message. The first year of the Teach-Inn Pal project aims to evaluate the effects of the course and to identify areas of improvement.
Objective: To present an evaluation to determine if the course can work as a campaign to refocus the public opinion on palliative care and share the preliminary results of the pilot study.
Methodology: A prospective Participatory Action Research study. University students enrolled in the course (n = 29) are invited to test and redesign the palliative care message. Knowledge and empathy will be measured throughout the learning process. Afterwards, qualitative, thematic, inductive analysis of the course material will be carried out. This study is registered on the ISRCTN Registry under the name "Can a university course help communicate palliative care?" (Registration number: ISRCTN10236642).
Discussion: This study is part of a doctoral thesis. Education is used as a creative outlet, allowing rapid testing of multiple tools to create ambassadors of palliative care that may reframe the public opinion.
Conclusion: The understanding of students about palliative care changed, the overall impression of the experience was positive, and students were also able to explain palliative care to people with little or no experience in the topic. However, to determine if they became ambassadors the results of the mid-term assessment are required.
Revista:
JOURNAL OF PALLIATIVE MEDICINE
ISSN:
1096-6218
Año:
2023
Vol.:
26
N°:
12
Págs.:
1709 - 1714
Background: Despite a steady increase in palliative care (PC)-oriented research, authentic engagement of stakeholders with findings needs to be more used.Objective: This study aimed to explore how ATLANTES Observatory can effectively promote the global development of PC by engaging with stakeholders and addressing their specific needs and priorities.Design: An international e-survey among Observatory collaborators explored key audiences, best ways to reach them, and priority activities. Answers were evaluated according to respondents' roles (Academics, Policymakers, and clinicians) and toward impact on diverse key stakeholders. Correlation between respondents' roles with select products was studied.Results: One hundred fifty-five collaborators participated. The collaborators suggested addressing ATLANTES Global Observatory's activities to policymakers (5,6/7), professional associations (5,2/7), and health care practitioners (4,4/7). Preferred activity to reach all stakeholders is the use of websites and social networks, while particularly for policymakers, academics, and general practitioners, the conduction of atlases and articles stand out.Conclusions: Our study emphasizes prioritizing policymakers and all health care practitioners as key stakeholders in promoting PC and driving global development and integration into health care systems. By leveraging innovative web tools and social networks for dissemination, our aim is to extend the reach of our efforts beyond the PC community.
Autores:
Rijpstra, M. (Autor de correspondencia); Vissers, K.; Centeno, Carlos; et al.
Revista:
BMC PALLIATIVE CARE
ISSN:
1472-684X
Año:
2023
Vol.:
22
N°:
1
Págs.:
8
Background Palliative sedation involves the intentional lowering of consciousness at the end of life. It can be initiated to relieve a patient's burden caused by refractory symptoms at the end of life. The impact of palliative sedation needs to be clinically monitored to adjust the proper dose and regimen of sedative medication to ensure that patients are at ease and comfortable at the end of their lives. Although there is consensus among health care professionals and within guidelines that efficacy of palliative sedation needs to be closely monitored, there is no agreement about how, when, and by whom, this monitoring should be performed. The aim of this study is to evaluate the effects of palliative sedation by measuring the discomfort levels and sedation/agitation levels of the patients at regular timepoints. In addition, the clinical trajectories of those patients receiving palliative sedation will be monitored and recorded.Methods The study is an international prospective non-experimental observational multicentre study. Patients are recruited from in-patient palliative care settings in Belgium, Germany, Italy, Spain and the Netherlands. Adult patients with advanced cancer are monitored by using proxy observations of discomfort (DS-DAT) and depth of sedation/agitation levels (RASS-PAL) during palliative sedation. After the palliative sedation period, the care for the specific participant case is evaluated by one of the attending health care professionals and one relative via a questionnaire.Discussion This study will be the first international prospective multicenter study evaluating the clinical practice of palliative sedation including observations of discomfort levels and levels of sedation. It will provide valuable information about the practice of palliative sedation in European countries in terminally ill cancer patients. Results from this study will facilitate the formulation of recommendations for clinical practice on how to improve monitoring and comfort in patients receiving palliative sedation.
Autores:
Martucci, G. (Autor de correspondencia); Pereira, J.; Busa, C.; et al.
Revista:
PALLIATIVE CARE AND SOCIAL PRACTICE
ISSN:
2632-3524
Background:Although training in palliative care (PC) is increasingly frequent in medical schools, some barriers still hamper the design and implementation of effective educational programs. Information Technology-based distance learning (IT-DL) might contribute to the development of appropriate knowledge on PC in students, but it is still not clear how to best develop such curricula and how to deliver methodologically sound learning activities, allowing students to work on the complex skills required in PC.Objectives:To describe how internet-based education can be used in undergraduate medical PC education, in terms of realist theorization.Design:A realist review was carried out, producing a framework - or, in the terms of a realist review, a theory - focusing on finding out what might work, for whom, and in which circumstances, describing these variables in terms of Contexts, Mechanism, and Outcomes.Methods:An international group of experts of PC education assessed the relevance and pertinence of 256 articles resulting from systematic retrieval of literature and expert suggestions.Results:The final synthesis, mainly informed by the 43 articles rated as most relevant, is presented in propositions regarding three groups: (1) Educational theory, where (a) Cognitivism (learning as an increase in knowledge); (b) Constructivism (learning as a social, cultural, and negotiated process); and (c) Behaviorism (learning as an observable modification of behaviors) appear to be consistent with the learning outcome of PC. (2) Desired effect of the technology, suggesting the simple use of IT-DL is not an additional value per se, as it should overcome objective limits set for face-to-face activities. (3) Contextualization and duration of the curricular activity, suggesting PC training activities should be included in an organic and legitimate way in the overall curriculum.Conclusion:This field is expected to experience huge growth soon, and present and future research could use a realist approach like the one here presented to make sense of all the different variables involved.
Autores:
Reigada, C.; Sandgren, A.; Rivas, S.; et al.
Revista:
BMC PALLIATIVE CARE
ISSN:
1472-684X
Año:
2023
Vol.:
22
N°:
1
Págs.:
46
IntroductionThe message of palliative care can be promoted using creative thinking and gamification. It can be an innovative strategy to promote changes in behaviour, promote thinking, and work on skills such as empathy.AimDesign, test and evaluate a gamified social intervention to enhance palliative care awareness among young university students from non-health background.MethodsParticipatory action research study with mixed methods, Design Thinking and using the Public Engagement strategy. Forty-three undergraduate students participated in a Palliative Care Stay Room and completed the Test of Cognitive and Affective Empathy (TECA) before and after the game. At the end of the game, a ten-minute debriefing was held with the participants, which was concluded with an open conversation. The content analysis was done independently and the sum of the scores of each dimension was compared before and after the activity.FindingsThe Stay Room improved the participants' knowledge and new perspectives about palliative care. Before the game, their views focused on the end of life and after the game on their values, highlighting the dedication of the healthcare professionals who do not treat death but the life until death. After de game, participants (N = 43: female = 23; male = 20; x 19.6 years old) presented higher values in perspective adoption (intellectual ability to put oneself in the other's place) p = 0.046 and in emotional understanding (ability to recognize emotional states) p = 0.018, and had high scores on empathic joy (p = 0.08).ConclusionGamification can be used in teaching and transmitting positive attitudes. Palliative Care and can help young university students to think positively about care issues.
Revista:
EUROPEAN JOURNAL OF PUBLIC HEALTH
ISSN:
1101-1262
Año:
2023
Vol.:
33
N°:
1
Págs.:
35 - 41
Background Palliative sedation is a commonly accepted medical practice. This study aims to clarify how palliative sedation is regulated in various countries and whether this may impact its practice. Methods An online survey requesting regulations on palliative sedation was conducted in Belgium, Germany, Hungary, Italy, The Netherlands, Spain, Romania and the UK. Purposive sampling strategy was used to identify clinicians from different medical fields and legal experts for each country. Regulations were analyzed using the principles of the European Association for Palliative Care Framework on palliative sedation. Country reports describing how palliative sedation is regulated were elaborated. Results One hundred and thirty-nine out of 223 (62%) participants identified 31 laws and other regulations affecting palliative sedation. In Spain, 12 regional laws recognize palliative sedation as a right of the patient at the end of life when there are refractory symptoms. In Italy, the law of informed consent and advance directives specifically recognizes the doctor can use deep sedation when there are refractory symptoms. There are also general medical laws that, while not explicitly referring to palliative sedation, regulate sedation-related principles: the obligation of doctors to honour advance directives, informed consent, the decision-making process and the obligation to document the whole process. In Germany, the Netherlands and the UK, palliative sedation is also regulated through professional guidelines that are binding as good practice with legal significance. Conclusions Palliative sedation is considered in the general law of medical practice, in laws regarding the patient's autonomy, and through professional guidelines.
Revista:
BMC PALLIATIVE CARE
ISSN:
1472-684X
Año:
2022
Vol.:
21
N°:
1
Págs.:
227
Background: Patients at the end-of-life may experience refractory symptoms of which pain, delirium, vomiting and dyspnea are the most frequent. Palliative sedation can be considered a last resort option to alleviate one or more refractory symptoms. There are only a limited number of (qualitative) studies exploring the experiences of relatives of sedated patients and their health care professionals (HCPs). The aims of this study protocol are: 1) to elicit the experiences of bereaved relatives and health care professionals of patients treated with palliative sedation and 2) to explore the understanding of the decision-making process to start palliative sedation across care settings in 5 European countries.
Methods: This study protocol is part of the larger HORIZON 2020 Palliative Sedation project. Organisational case study methodology will be used to guide the study design. In total, 50 cases will be conducted in five European countries (10 per country). A case involves a semi-structured interview with a relative and an HCP closely involved in the care of a deceased patient who received some type of palliative sedation at the end-of-life. Relatives and health care professionals of deceased patients participating in a linked observational cohort study of sedated patients cared for in hospital wards, palliative care units and hospices will be recruited. The data will be analyzed using a framework analysis approach. The first full case will be analyzed by all researchers after being translated into English using a pre-prepared code book. Afterwards, bimonthly meetings will be organized to coordinate the data analysis.
Discussion: The study aims to have a better understanding of the experiences of relatives and professional caregivers regarding palliative sedation and this within different settings and countries. Some limitations are: 1) the sensitivity of the topic may deter some relatives from participation, 2) since the data collection and analysis will be performed by at least 5 different researchers in 5 countries, some differences may occur which possibly makes it difficult to compare cases, but using a rigorous methodology will minimize this risk.
Revista:
THINKING SKILLS AND CREATIVITY
ISSN:
1871-1871
Año:
2022
Vol.:
46
Págs.:
101179
Society's understanding of palliative care has room for improvement. Although the World Health Organisation highlighted palliative care as a human right, many people still lack access to this crucial form of treatment. The paucity of understanding and social discussion surrounding palliative care has, moreover, negatively impacted its development and implementation. This study therefore aims to construct a strategy that will empower a specific community to solve their own palliative care-related misunderstandings. Using Participatory Action Research and Design Thinking methodologies and adopting the strategy of Public Engagement in Responsible Research and Innovation, a design group worked for three months through five virtual focus groups. Moving through the phases of empathizing, defining, ideation, prototyping, and testing, the design group generated 33 ideas to address palliative care-related problems. Ideas related to self-learning, the use of technology, and the exchange of personal experiences are highlighted as innovative ways to promote palliative care. The design group adopted a variety of strategies, used disruptive tools, and created and tested rapid prototypes to discover novel solutions. This method of working, centred on interdisciplinarity and creativity, presents an efficient way to involve the members of a community in solving their own problems.
Revista:
MEDICINA PALIATIVA
ISSN:
1134-248X
Año:
2022
Vol.:
29
N°:
1
Págs.:
1 - 2
En este contexto, Erasmus + ha promovido un proyecto (RESPACC 2020-1-R001-KA202-080128) en el que participan cuatro países:
Rumanía (Hospice Casa Sperantei y la Universidad de Transilvania), España (Universidad de Navarra), Grecia (Hospice Galillee) y
Bélgica (European Association for Palliative Care EAPC). El proyecto ¿Competencias de Investigación para Clínicos de Cuidados
Paliativos¿ (RESPACC) hace referencia a Research (Investigación) Expertise (Experiencia), Selfdevelopment (Autodesarrollo) Palliative Care (Cuidados Paliativos), Attitude (Actitud), Communication (Comunicación) y Competence (Competencia).
Revista:
EASTERN MEDITERRANEAN HEALTH JOURNAL
ISSN:
1687-1634
Año:
2022
Vol.:
28
N°:
8
Págs.:
614 - 621
The increasing number of people experiencing serious health-related suffering due to severe illness is an urgent issue in the WHO Eastern Mediterranean Region (EMR). Although palliative care can mitigate much of this suffer-ing, its current development and indicators to measure progress remain unknown. Aims: To describe the development of the Atlas of palliative care in the Eastern Mediterranean Region 2021. Methods: Recently, the WHO Regional Office for the Eastern Mediterranean, together with a network of palliative care experts, identified the best indicators and collected data across the Region. These indicators include national palliative care strategies, number of specialized palliative care services per population, inclusion of palliative care in the health ben-efits package and national health budget, and the use of pain medication. These and other useful information form the Atlas of palliative care in the Eastern Mediterranean Region 2021. Results: The Atlas shows that provision of specialized palliative care services and pain medication in the Region is low. Several of the indicators suitable to the region are new and include the level of public awareness of palliative care, inclu-sion of palliative care in health insurance plans, availability of centres of excellence for palliative clinical care, and availa-bility of grants to finance palliative care research. Conclusion: Adoption of favourable policies, educational initiatives, and the involvement of stakeholders, represent an opportunity for future development of palliative care in the EMR.
Autores:
Aparicio, M. (Autor de correspondencia); Centeno, Carlos; Juliá, G.; et al.
Revista:
BMJ SUPPORTIVE & PALLIATIVE CARE
ISSN:
2045-435X
Año:
2022
Vol.:
12
N°:
E4
Págs.:
e562 - e569
Objectives: To explore the expressions of gratitude (EoG) received from patients and relatives and their influence on palliative care professionals (PCPs).
Methods: A national online survey was sent to a representative of PCPs of each service listed in the national directory of palliative care (PC) services (n=272) (ie, hospital PC support team, hospice, paediatrics, etc). The questionnaire was pilot tested with experts. It comprised three sections: the overall perspective of receiving gratitude in the service, the personal experience of its influence and sociodemographic questions. A mailing schedule was designed to enhance the response rate.
Results: 186 representatives from all over Spain completed the questionnaire (68% response rate). 79% of service representatives reported that they almost always received EoG. These came mainly from families (93%). These EoG were very often put on display (84%) and shared with other health professionals (HPs) involved in care (45%). EoG evoked positive feelings in the team members. Based on their experience, respondents attributed different functions to these EoG: increased professional satisfaction (89%), a source of support in difficult times (89%), mood improvement, encouragement to continue and rewards for effort (88%). Services, where gratitude was more frequently received, were associated with PCPs who more frequently reported being proud of their work (p=0.039, Pearson's correlation test).
Conclusions: Gratitude from patients and relatives was frequent and significant to those who work in PC. HPs considered that EoG offer multiple beneficial effects and also a protective role in their practice against distress and an increase in resilience skills.
Revista:
BMJ SUPPORTIVE & PALLIATIVE CARE
ISSN:
2045-435X
Año:
2022
Vol.:
12
N°:
2
Págs.:
226 - 234
Introduction: Methylphenidate is a psychostimulant drug used to treat fatigue in patients with advanced cancer, for which there is no gold standard of treatment.
Objective: To explore the efficacy of methylphenidate in the relief of fatigue in patients with advanced cancer.
Materials and methods: A randomised double-blind placebo-controlled multicentre clinical trial, stratified according to the intensity of fatigue. The treatment was considered effective if the improvement in mean fatigue intensity between baseline values and day 6 was significantly higher in the methylphenidate group than in the placebo group. The responses were measured using the Edmonton Symptoms Assessment System (ESAS) and the Functional Assessment of Cancer Therapy-Fatigue (FACT-F) scales.
Results: 35 patients received placebo and 42 patients received methylphenidate. The populations of both groups were homogeneous. Patients receiving methylphenidate did not exhibit statistically significant improvement of fatigue in comparison to patients receiving placebo (p=0.52). The mean improvement of fatigue (ESAS) on day 6 was -1.9 (±2.5) in the placebo group, and -2.3 (±2.6) in the methylphenidate group (p=0.52). The results obtained with the FACT-F were congruent with those obtained by the ESAS. The responses in patients with severe fatigue were -2.4 (±2.9) in the placebo group and -3.4 (±2.5) in the methylphenidate group; the difference was not statistically significant (p=0.3).
Conclusion: Methylphenidate was not more efficient than placebo to treat cancer-related fatigue. Fatigue improved significantly after 3 days of treatment and was stabilised on day 6, both with placebo and methylphenidate. The side effects of methylphenidate were mild and infrequent.
Trial registration number: EudraCT Registry (2008-002171-27).
Revista:
BMC PALLIATIVE CARE
ISSN:
1472-684X
Año:
2022
Vol.:
21
N°:
1
Págs.:
168
Background Monitoring the development of palliative care (PC) illustrates the capacity of health systems to respond to the needs of people experiencing serious health-related suffering. Aim To analyse comparatively the situation of PC in the countries of the Easter Mediterranean region using context-specific indicators. Method An online questionnaire with 15 context-specific PC indicators investigating service provision, use of medicines, policy, education, and vitality was designed. Authors Institution 1 nominated in-country experts to complete the survey. Data were analysed using a comparative description of indicators per domain and a multivariate analysis. Results In-country experts were identified in 17/22 countries. 12/17 contributed to the survey. In total, 117 specialized PC services were identified. Specialized services per population ranges from 0.09 per 100,000 inhabitants in Lebanon and Saudi Arabia, Qatar and Kuwait; to zero services in the Occupied Palestinian Territories. On average, opioid consumption was 2.40 mg/capita/year. National PC strategies were reported in nine countries. In six countries, PC is officially accredited either as a specialty or sub-specialty, and PC mandatory courses are implemented in 36% of medical schools and 46% of nursing schools. National PC associations were documented in six countries. A higher pattern of development was identified in Jordan, Kuwait, Saudi Arabia, Oman, Lebanon, Qatar. Conclusions Despite a higher development in the Arabian Peninsula, the region is characterised by a very low provision of specialized PC services and opioid consumption. Policy improvements represent an opportunity to improve access to PC.
Revista:
QUALITATIVE HEALTH RESEARCH
ISSN:
1049-7323
Año:
2022
Vol.:
32
N°:
7
Págs.:
1126 - 1138
Providing palliative care can be both challenging and rewarding. It involves emotionally demanding work and yet research shows that burnout is lower than in other fields of healthcare. Spontaneous expressions of gratitude from patients and family members are not uncommon and are highly valued. This study explored the experience of Spanish palliative professionals who received expressions of gratitude from their patients and families. A phenomenological approach was used to better understand the role of receiving gratitude in participants¿ lives. Interviews were transcribed verbatim and a phenomenological approach to analysis was undertaken using macro-thematic and micro-thematic reflection. Two team members independently engaged in this reflection with an inductive approach. The analysis was shared and discussed at periodic meetings to identify the key themes and sub-themes of the gratitude experience. Ten palliative professionals were interviewed. Participants engaged
in a process of recognizing, internalizing and treasuring the expressions of gratitude which they then used for reflection and growth. These expressions were a powerful and deeply meaningful resource that the palliative professionals revisited over time. Receiving expressions of gratitude invited a stronger sense of the value of one¿s self and one¿s work that was motivational and protective, particularly during challenging times.
Revista:
EASTERN MEDITERRANEAN HEALTH JOURNAL
ISSN:
1020-3397
Año:
2022
Vol.:
28
N°:
8
Págs.:
560 - 568
Background: The World Health Organization Office for the Eastern Mediterranean Region (WHO/EMRO), and the re-cently created palliative care experts network for the Eastern Mediterranean Region (EMR), decided to develop region -spe-cific indicators for monitoring national palliative care development in the Region. Aims: To identify relevant and feasible macro-indicators for palliative care development for the EMR. Methods: Palliative care experts from the EMR were nominated and invited to complete a 2-round Delphi study to rate macro-indicators from previous studies and propose new ones based on the EMR regional characteristics. All indicators were assessed according to regional relevance (R) and feasibility (F). A content validity index (CVI) was calculated. Indica-tors with CVI >= 0.7/1, and scoring >= 7/9 for the R and F averages were selected. Results: Twelve of the 22 countries in the Region were represented in the study. In the first round, 11 indicators were se-lected and 13 new ones proposed. In the second round, 15 indicators matched R, F and CVI criteria. Top-scored indicators were: existence of a current national palliative care strategy (R = 8, F = 8, CVI = 1); ratio of specialized services (for adults and children) in the country per population (R = 8, F = 7, CVI = 1); allocation of funds for palliative care in the national health budget by the Ministry of Health or equivalent government agency (R = 8, F = 6, CVI = 1); education for prequalifi-cation of doctors/nurses (R = 8, F = 8, CVI = 0.9); and availability of morphine and other strong opioids (R =8, F = 8, CVI= 0.9). Conclusion: A baseline set of 15 region-specific indicators for measuring the development of palliative care were validated by experts in the EMR.
Autores:
Rodríguez, M. (Autor de correspondencia); Feng, A.; Menjívar, C.; et al.
Revista:
INTERNATIONAL JOURNAL OF MEDICAL INFORMATICS
ISSN:
1386-5056
Año:
2022
Vol.:
166
Págs.:
104857
Introduction: Family members significantly value the professional and humane support that medical teams pro-vide in the process of caring for patients with advanced diseases. Communication is currently changing, making it of interest to explore technology & rsquo;s possible influence on communication and on the care relationship. It re-mains unknown whether this can vary based on increased use of technology in patient care. Using communi-cation technologies can facilitate recognition of professional support through the expression of gratitude aimed at healthcare professionals. The objective here is to describe expressions of gratitude sent via WhatsApp messages by patients who receive treatment from a palliative care team and their relatives. Method: A generic qualitative methodology was used. The palliative care service studied used WhatsApp in the patient/family-professional relationship. A content analysis of 130 WhatsApp messages sent to the professionals and containing expressions of gratitude was carried out. Two researchers inductively performed the analysis. Analysis included aspects for which senders were most grateful and others, such as who the messages came from, whether they were reactive or spontaneous and to whom they were directed. Results: Almost all of the patients treated transmitted their gratitude via WhatsApp. It was also observed that family members were most grateful for features of the care received (i.e., affection, availability), the pro-fessional & rsquo;s support (i.e., accompaniment, comfort) and the professional & rsquo;s qualities (i.e., professionalism, kind-ness). They also appreciated symptom control and attempts to resignify loss; these aspects received the most expressions of gratitude in the messages. In turn, all the messages contain expressions of support for palliative care professionals, evidencing a patient/family-professional relationship. Conclusion: The use of communication technologies like WhatsApp can contribute to the perception of pro-fessionals & rsquo; availability and closeness and become a facilitator of expressions of gratitude that specify the aspects that family members most appreciate from the palliative care team, such as skills related to humane care and availability.
Revista:
BMJ SUPPORTIVE & PALLIATIVE CARE
ISSN:
2045-435X
Año:
2021
Vol.:
11
N°:
2
Págs.:
156 - 162
OBJECTIVE:Cultural backgrounds and values have a decisive impact on the phenomenon of the wish to die (WTD), and examination of this in Mediterranean countries is in its early stages. The objectives of this study were to establish the prevalence of WTD and to characterise this phenomenon in our cultural context. METHODS:A cross-sectional study with consecutive advanced inpatients was conducted. Data about WTD (Assessing Frequency & Extent of Desire to Die (AFFED) interview) and anxiety and depression (Edmonton Symptom Assessment System-revised (ESAS-r)) were collected through two face-to-face clinical encounters. Data were analysed with descriptive statistics, ¿2 and analysis of variance. RESULTS:201 patients participated and 165 (82%) completed both interviews. Prevalence of WTD was 18% (36/201) in the first interview and 16% (26/165) in the second interview (p=0.25). After the first interview, no changes in depression (p=0.60) or anxiety (p=0.90) were detected. The AFFED shows different experiences within WTD: 11% of patients reported a sporadic experience, while 7% described a persistent experience. Thinking about hastening death (HD) appeared in 8 (22%) out of 36 patients with WTD: 5 (14%) out of 36 patients considered this hypothetically but would never take action, while 3 (8%) out of 36 patients had a more structured idea about HD. In this study, no relation was detected between HD and frequency of the appearance of WTD (p=0.12). CONCLUSIONS:One in five patients had WTD. Our findings suggest the existence of different experiences within the same phenomenon, defined according to frequency of appearance and intention to hasten death. A linguistically grounded model is proposed, differentiating the experiences of the 'wish' or 'desire' to die, with or without HD ideation.
Revista:
JOURNAL OF PALLIATIVE MEDICINE
ISSN:
1096-6218
Año:
2021
Vol.:
24
N°:
7
Págs.:
1061 - 1066
Objective: Recognizing delirium phenomenology (DP) aids the early diagnosis of this syndrome and improves quality of life in patients with advanced cancer. The aim of this study was to identify the neurobehavioral and cognitive patterns of delirium-related symptoms in persons with advanced cancer. Methods: We conducted an observational comparative prospective study on delirium in patients with advanced cancer in different palliative care settings, assessing the presentation/evolution of DP with the Memorial delirium assessment scale (MDAS). Results: Two hundred twenty-seven patients were enrolled on hospital/hospice admission. Of these, 57 were admitted with delirium, 170 without delirium, and 31 developed delirium during hospitalization. Of the 88 patients admitted with delirium or who developed it during hospitalization, only 32 underwent two consecutive MDAS evaluations (at diagnosis and after one week). Delirium resolved in 22 patients (first average MDAS score 10.08 vs. second 3.6 [p < 0.001]). Disorientation, short-term memory, and memory span were altered in all patients with unresolved delirium. The same features were altered in 18 (80%), 17 (80%), and 16 (70%) of the patients with resolved delirium, respectively, and in 58 (35%), 114 (67%), and 38 (23%) of no-delirium patients, respectively. Conclusion: Cognitive-related symptoms appear to be the most prevalent and earliest signs of DP in patients with advanced cancer.
Revista:
JOURNAL OF PAIN AND SYMPTOM MANAGEMENT
ISSN:
0885-3924
Año:
2021
Vol.:
61
N°:
4
Págs.:
812 - 816
Context: Palliative care is an emerging health care service essential for every health care system. Information on the current status of palliative care service delivery is needed in order to understand the gap between need for palliative care and current capacity to deliver.
Objectives: To estimate the number of providers delivering palliative care worldwide and the patients they served in 2017.
Methods: Estimates were obtained from a sample of countries from each World Bank income group using typical case purposive sampling methods. Reliable data from the United States, and eight additional countries were used for the high-income group. For low and middle-income countries (LMICs), in order to determine an estimate of the number of patients served 30 countries representative of palliative care service delivery in each region and income group were surveyed.
Results: Results from the mapping levels of palliative care development survey identified a total of approximately 25,000 palliative care service delivery teams globally. The total estimate of patients served in 2017 was approximately seven million.
Conclusion: Significant disparities in palliative care access exist both by region and income group. The European and Pan-American regions had most while the Eastern Mediterranean, Southeast Asian, and African regions had least. Much more needs to be done to develop and deliver palliative care in LMICs where 80% of the need for palliative care exists. With about 70% of operating palliative care services in high income countries and only 30% in LMICs, a major effort to develop palliative care in these settings is urgently needed.
Revista:
BMC PALLIATIVE CARE
ISSN:
1472-684X
Año:
2021
Vol.:
20
N°:
1
Págs.:
36
Background: Palliative care (PC) development cannot only be assessed from a specialized provision perspective. Recently, PC integration into other health systems has been identified as a component of specialized development. Yet, there is a lack of indicators to assess PC integration for pediatrics, long-term care facilities, primary care, volunteering and cardiology.
Aim: To identify and design indicators capable of exploring national-level integration of PC into the areas mentioned above.
Methods: A process composed of a desk literature review, consultation and semi-structured interviews with EAPC task force members and a rating process was performed to create a list of indicators for the assessment of PC integration into pediatrics, long-term care facilities, primary care, cardiology, and volunteering. The new indicators were mapped onto the four domains of the WHO Public Health Strategy.
Results: The literature review identified experts with whom 11 semi-structured interviews were conducted. A total of 34 new indicators were identified for national-level monitoring of palliative care integration. Ten were for pediatrics, five for primary care, six for long-term care facilities, seven for volunteering, and six for cardiology. All indicators mapped onto the WHO domains of policy and education while only pediatrics had an indicator that mapped onto the domain of services. No indicators mapped onto the domain of use of medicines.
Revista:
PALLIATIVE MEDICINE REPORTS
ISSN:
2689-2820
Año:
2021
Vol.:
2
N°:
1
Págs.:
34 - 39
Emotional exhaustion is a problem many palliative care professionals face during their activity. Art therapy is emotionally beneficial for palliative patients that experience suffering, but its impact on professionals¿ experience of suffering has not been researched.
Aim:To examine the immediate reactions of professionals after an art therapy workshop focused on personal self-care, also considering previously used coping strategies. Design: A four-hour art therapy workshop was designed including a generic qualitative study of participants. Participants were palliative care professionals and their reactions were examined using an ad hoc questionnaire with open-ended questions. Descriptive analysis of quantitative variables and thematic analysis of open-ended questions were conducted. Results: Seventeen professionals participated voluntarily. They rated the workshop positively, using words like ¿calm¿ and ¿relaxation¿ to express the effects of the workshop, which they considered therapeutic and a source of self-awareness. For some, it allowed them to release emotions; for others, it enabled introspection and opened up a more elaborated emotional response. They thought artistic expression would be useful for their colleagues, or even for their own personal development. In the workshop, professionals opened up and explained how they face intense moments on a day-to-day basis: how they approach the situation, or how they try to control their surroundings; how they disconnect/dista
Revista:
INTERNATIONAL JOURNAL OF QUALITATIVE STUDIES ON HEALTH AND WELL-BEING
ISSN:
1748-2623
Año:
2021
Vol.:
16
N°:
1
Págs.:
1955441
Background University students are the future professionals who will influence society. It is thus essential to improve students' understanding of palliative care (PC), especially those in the non-health field, to generate and encourage propitious opinions about PC. This study describes the perceptions of PC among university students from different disciplines. Method Qualitative exploratory study using virtual focus groups (FGs) and design thinking (DT) approach. An intentional sample of students from various disciplines, universities and cities from Spain were selected. Numerous researchers from different fields were involved in the discussion of the final thematic analysis. Results Four themes and seven subthemes were found: i) Students have an ambiguous understanding about PC; ii) PC is not a common issue for non-health students; ii) Students see PC as an important and necessary field; iii) Students build counter-narratives against PC myths, demonstrating PC brings key benefits into people's lives; iv) PC is a synonym of death. Conclusion Despite the fact that students do not know much about PC, the topic easily arouses reflection and positive discussion. Through the conversations they find positive values and arguments against misunderstand- ing. Students from different disciplines could be the target of innovative educational initia- tives and the social debate on PC.
Revista:
ANALES DEL SISTEMA SANITARIO DE NAVARRA
ISSN:
1137-6627
Año:
2021
Vol.:
44
N°:
1
Págs.:
125 - 126
Revista:
INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH
ISSN:
1660-4601
Año:
2021
Vol.:
18
N°:
10
Págs.:
5348
PC continues to be misunderstood within the world of healthcare. PC professionals are key agents for promoting a greater understanding of their field. It aims to examine the messages, both implicit and explicit, that PC professionals transmit about themselves and their work within their teams and to other health professionals. Methods: Focused ethnographic secondary analysis, exploring the interactions of PC professionals as it happens at everyday work. An inductive thematic analysis was developed from 242 h of observation of the daily work practices of palliative care professionals, focusing on their interactions with others. The data was coded without predefined categories, and the analysis was performed independently by two researchers. Results: Palliative professionals communicate that they are part of an active team working in an organized manner. They value and feel proud of their work. Despite the intensity of their work, these professionals are always available to others, to whom they demonstrate a clear professional identity. They convey their expertise in alleviating suffering, respectful behavior and collaborative ability. Conclusion: Professionals, in their daily work, communicate through their messages the essence of palliative care. It is essential that PC professionals perceive themselves as potential influencers and explicitly transmit the reasons for their intervention. Otherwise, others will perpetuate myths, misunderstandings, lack of positive PC reputation
Revista:
INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH
ISSN:
1660-4601
Año:
2021
Vol.:
18
N°:
20
Págs.:
10753
Background: The coverage of palliative care (PC) may be understood as a country's capacity to offer prevention and relief from serious health-related suffering in relation to an existing need. The aim of this study is to estimate European countries & PRIME; coverage capacities. Method: Secondary analysis of three indicators, including the number of specialized services (SSPC), integration capacity scores (ICS) and the PC needs. By means of a K-medians clustering supervised algorithm, three coverage profiles were obtained: (1) Advanced: countries with high ICS and SSPC, and low PC needs; (2) Limited: countries with low ICS and SSPC, and low PC needs; and (3) Low: countries with low ICS and SSPC and high PC needs. Results: On average, the ratio of specialized services per population was 0.79 per 100,000 inhabitants, the average ICS was 19.62 and the average number of deceased patients with SHS per 100,000 inhabitants was 5.69. Twenty countries (41%) reached an advanced coverage profile. Nine countries (18%) demonstrated a limited coverage profile; and 20 countries (41%) fell under a low-coverage capacity. Conclusion: The level of palliative care coverage across Europe shows that 59% of European countries have either limited or very low availability of PC resources as regards their palliative care needs.</p>
Revista:
INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH
ISSN:
1660-4601
Año:
2021
Vol.:
18
N°:
19
Págs.:
10345
Background: Palliative care is a priority for health systems worldwide, yet equity in access remains unknown. To shed light on this issue, this study compares populations' driving time to specialized palliative care services in three countries: Ireland, Spain, and Switzerland. Methods: Network analysis of the population's driving time to services according to geolocated palliative care services using Geographical Information System (GIS). Percentage of the population living within a 30-min driving time, between 30 and 60 minutes, and over 60 min were calculated. Results: The percentage of the population living less than thirty minutes away from the nearest palliative care provider varies among Ireland (84%), Spain (79%), and Switzerland (95%). Percentages of the population over an hour away from services were 1.87% in Spain, 0.58% in Ireland, and 0.51% in Switzerland. Conclusion: Inequities in access to specialized palliative care are noticeable amongst countries, with implications also at the sub-national level.
Revista:
JOURNAL OF PAIN AND SYMPTOM MANAGEMENT
ISSN:
0885-3924
Año:
2021
Vol.:
62
N°:
2
Págs.:
293 - 302
Context. The national evaluation of an individual country is a tool used to improve the universal provision of palliative care. The evaluation of a country's internal situation, by means of an analysis of the development of palliative care by region, may also be an instrument for improvement.
Objectives. The aim of this study was to understand the regional development of palliative care in Colombia, through the application of international indicators.
Methods. Regional development was analyzed for Colombia, with a country-specific adaptation of the evaluation method used in the latest edition of the Palliative Care World Map (Clark D, 2020), the need for palliative care per death with serious health-related suffering (Knaul FN, 2019), and the coverage of specialized services, following European standards (Centeno, 2016). A total of 33 of the country's regions were classified.
Results. Some 41% of the people who die in Colombia need palliative care. The average figure for specialized services is 0.5/100,000 inhabitants, with a maximum coverage of 51%. In Colombia, there are 12 regions with a generalized level of provision; six regions with isolated provision, nine regions developing their capacity, four with no known activity, and two at an advanced level of palliative care integration. The regions with the highest level of palliative care development coincide with higher demand and coverage of specialized services.
Conclusion. Regional palliative care development is unequal and unbalanced. Applying international indicators to levels of regional development allows for the identification of geographical inequalities and highlights low palliative care development, especially in the rural areas of the country. (C) 2020 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.
Revista:
JOURNAL OF PALLIATIVE MEDICINE
ISSN:
1096-6218
Año:
2020
Vol.:
23
N°:
9
Págs.:
1227 - 1232
Background: Delirium in advanced cancer inpatient ranges between 13% and 85%. Reasons for this variability on the reported data could be related to the setting where they are admitted. Methods: This is an observational, comparative, prospective study on delirium diagnosis and delirium course of advanced cancer inpatients in two different palliative care settings. Hospice (C1) versus palliative care supportive team (C2). Differences between delirium precipitants, delirium treatment, and delirium survival were observed. Results: From 582 consecutive admissions, 494 from C1 and 88 from C2, finally 227 patients met inclusion criteria, were entered in the study. Total population delirium rate at admission, if we add both centers, was 57 patients (25%), 46 (26%) from C1 and 11 (22%) from C2; no statistically significant differences between delirium rate at admission between the two centers were found (chi(2)). When delirium course between delirious patients admitted in C1 and C2 was analyzed, a significantly higher rate of delirium reversibility was found in C2 [11/14 (78%)] versus [9/65 (14%)] in C1 (chi(2) p <= 0.001). Conclusion: The frequency of delirium at admission and during the hospitalization in advanced cancer patients does not seem to be related to the setting, what seems to be related is the delirium course.
Revista:
EDUCACION MEDICA
ISSN:
1575-1813
Año:
2020
Vol.:
21
N°:
3
Págs.:
207-211
Revista:
ANALES DEL SISTEMA SANITARIO DE NAVARRA
ISSN:
1137-6627
Año:
2020
Vol.:
43
N°:
1
Págs.:
107 - 108
Autores:
Clark, D.; Baur, N.; Clelland, D.; et al.
Revista:
JOURNAL OF PAIN AND SYMPTOM MANAGEMENT
ISSN:
0885-3924
Año:
2020
Vol.:
59
N°:
4
Págs.:
794-807.e4
Context: Palliative care is gaining ground globally and is endorsed in high level policy commitments, but service provision, supporting policies, education and funding are incommensurate with rapidly growing need.
Objectives: To describe current levels of global palliative care development and report on changes since 2006.
Methods: An online survey of experts in 198 countries generated 2017 data on 10 indicators of palliative care provision, fitted to six categories of development. Factor analysis and discriminant analysis showed the validity of the categorization. Spearman correlation analyses assessed the relationship with World Bank Income Level (WBIL), Human Development Index (HDI) and Universal Health Coverage (UHC).
Results: Numbers (percentages) of countries in each development category were: 1) no known palliative care activity 47 (24%); 2) capacity-building 13 (7%); 3a) isolated provision 65 (33%); 3b) generalized provision 22 (11%); 4a) preliminary integration into mainstream provision 21 (11%); 4b) advanced integration 30 (15%). Development levels were significantly associated with WBIL (rS= 0·4785), UHC (rS=0·5558) and HDI (rS=0·5426) with p < 0.001. Net improvement between 2006-2017 saw 32 fewer countries in categories 1/2, 16 more countries in 3a/3b, and 17 more countries in 4a/4b.
Conclusion: Palliative care at the highest level of provision is available for only 14% of the global population and is concentrated in European countries. An 87% global increase in serious health related suffering amenable to palliative care interventions is predicted by 2060. With need rising, palliative care is not reaching the levels required by at least half the global population.
Revista:
JOURNAL OF PAIN AND SYMPTOM MANAGEMENT
ISSN:
0885-3924
Año:
2020
Vol.:
60
N°:
4
Págs.:
746 - 753
Context. Approximately 170,000 children in need of palliative care die every year in Europe without access to it. This field remains an evolving specialty with unexplored development. Objectives. To conduct the first regional assessment of pediatric palliative care (PPC) development and provision using data from the European Association for Palliative Care atlas of palliative care 2019. Methods. Two surveys were conducted. The first one included a single question regarding PPC service provision and was addressed by European Association for Palliative Care atlas informants. The second one included 10 specific indicators derived from an open-ended interview and rating process; a specific network of informants was enabled and used as respondents. Data were analyzed and presented in the map of the figure. Results. Data on PPC service provision were gathered from 51 of 54 (94%) European countries. Additional data were collected in 34 of 54 (62%) countries. A total of 680 PPC services were identified including 133 hospices, 385 home care services, and 162 hospital services. Nineteen countries had specific standards and norms for the provision of PPC. Twenty-two countries had a national association, and 14 countries offered education for either pediatric doctors or nurses. In seven countries, specific neonatal palliative care referral services were identified. Conclusion. PPC provision is flourishing across the region; however, development is less accentuated in low-to-middle-income countries. Efforts need to be devoted to the conceptualization and definition of the models of care used to respond to the unmet need of PPC in Europe. The question whether specialized services are required or not should be further explored. Strategies to regulate and cover patients in need should be adapted to each national health system. (C) 2020 The Authors. Published by Elsevier Inc. on behalf of American Academy of Hospice and Palliative Medicine.
Revista:
BMC PALLIATIVE CARE
ISSN:
1472-684X
Año:
2020
Vol.:
19
N°:
1
Págs.:
88
Despite 50 years of modern palliative care (PC), a misunderstanding of its purpose persists. The concept ¿Palliative Care¿ can be linked to feelings of fear, anxiety and death, instead of compassion, support or appropriate care. Society is still afraid to speak its name, and specialized units are identified as ¿places of death¿ as opposed to ¿places of life¿ meant to treat suffering. This issue is prohibitive to the implementation and development of PC policies worldwide. It is imperative to identify what message PC professionals are relaying to patients and other health care specialists and how that message may condition understandings of the right to access PC.
Methods
A qualitative study, employing focused ethnography and participant observation (PO) of the daily interaction of PC professionals with patients and family members in three different PC services. Two researchers independently conducted a thematic analysis, followed by member checking with participants.
Results
A total of 242 hours of participant observation revealed the following messages sent by PC professionals in their daily interaction with patients and families: i) We are focused on your wellbeing; ii) You matter: we want to get to know you; iii) Your family is important to us.
Conclusion
The complexity of PC discourses contributes to the difficulty of identifying a clear universal message between PC professionals, patients and families. The PC professionals observed transmit a simple message focused on their actions rather than their identity, which may perpetuate some social/cultural misunderstandings of PC. It seems there is a common culture, based on the same values and attitudes, within the messages that PC professionals transmit to patients and their families. PC teams are characterised by their availability.
Autores:
Pergolizzi, D.; Crespo, I.; Balaguer, A.; et al.
Revista:
BMJ OPEN
ISSN:
2044-6055
Año:
2020
Vol.:
10
N°:
2
Págs.:
e034413
We aim to design and evaluate a proactive and systematic method for the needs assessment using quality guidelines for developing complex interventions. This will involve patients, their relatives and healthcare professionals in all phases of the study and its communication to offer clinical practice a reliable approach to address the palliative needs of patients. Methods and analysis To design and assess the feasibility of an evidence-based, proactive and systematic Multidimensional needs Assessment in Palliative care (MAP) as a semistructured clinical interview guide for initial palliative care encounter/s in patients with advanced cancer. This is a two-phase multisite project conducted over 36 months between May 2019 and May 2022. Phase I includes a systematic review, discussions with stakeholders and Delphi consensus. The evidence gathered from phase I will be the basis for the initial versions of the MAP, then submitted to Delphi consensus to develop a preliminary guide of the MAP for the training of clinicians in the feasibility phase. Phase II is a mixed-methods multicenter feasibility study that will assess the MAP¿s acceptability, participation, practicality, adaptation and implementation. A nested qualitA nested qualitative study preliminary clues about the benefits and barriers of the MAP. The evidence gathered from phase II will build a MAP user guide and educational programme for use in clinical
practice.
Autores:
Radbruch, L. (Autor de correspondencia); De Lima, L. ; Knaul, F.; et al.
Revista:
JOURNAL OF PAIN AND SYMPTOM MANAGEMENT
ISSN:
0885-3924
Año:
2020
Vol.:
60
N°:
4
Págs.:
754 - 764
Context. The International Association for Hospice and Palliative Care developed a consensus-based definition of palliative care (PC) that focuses on the relief of serious health-related suffering, a concept put forward by the Lancet Commission Global Access to Palliative Care and Pain Relief. Objective. The main objective of this article is to present the research behind the new definition. Methods. The three-phased consensus process involved health care workers from countries in all income levels. In Phase 1, 38 PC experts evaluated the components of the World Health Organization definition and suggested new/revised ones. In Phase 2, 412 International Association for Hospice and Palliative Care members in 88 countries expressed their level of agreement with the suggested components. In Phase 3, using results from Phase 2, the expert panel developed the definition. Results. The consensus-based definition is as follows: Palliative care is the active holistic care of individuals across all ages with serious health-related suffering due to severe illness and especially of those near the end of life. It aims to improve the quality of life of patients, their families and their caregivers. The definition includes a number of bullet points with additional details as well as recommendations for governments to reduce barriers to PC. Conclusion. Participants had significantly different perceptions and interpretations of PC. The greatest challenge faced by the core group was trying to find a middle ground between those who think that PC is the relief of all suffering and those who believe that PC describes the care of those with a very limited remaining life span. (C) 2020 The Authors. Published by Elsevier Inc. on behalf of American Academy of Hospice and Palliative Medicine.
Revista:
PALLIATIVE MEDICINE
ISSN:
0269-2163
Año:
2020
Vol.:
34
N°:
8
Págs.:
1044 - 1056
Background: Service provision is a key domain to assess national-level palliative care development. Three editions of the European
Association for Palliative Care (EAPC) Atlas of Palliative Care monitored the changes in service provision across Europe since 2005.
Aim: To study European trends of specialized service provision at home care teams, hospital support teams, and inpatient palliative
care services between 2005 and 2019.
Design: Secondary analysis was conducted drawing from databases on the number of specialized services in 2005, 2012, and 2019.
Ratios of services per 100,000 inhabitants and increase rates on number of services for three periods were calculated. Analysis of
variance (ANOVA) analyses were conducted to determine significant changes and chi-square to identify countries accounting for the
variance. Income-level and sub-regional ANOVA analysis were undertaken.
Setting: 51 countries.
Results: Forty-two countries (82%) increased the number of specialized services between 2005 and 2019 with changes for home care
teams (104% increase-rate), inpatient services (82%), and hospital support teams (48%). High-income countries showed significant
increase in all types of services (p <¿0.001), while low-to-middle-income countries showed significant increase only for inpatient
services. Central¿Eastern European countries showed significant improvement in home care teams and inpatient services, while
Western countries showed significant improvement in hospital support a
Autores:
Zambrano, S. C. (Autor de correspondencia); Centeno, Carlos; Larkin, P. J.; et al.
Revista:
JOURNAL OF PALLIATIVE MEDICINE
ISSN:
1096-6218
Año:
2020
Vol.:
23
N°:
2
Págs.:
184 - 191
Background: The term "palliative care" (PC) has often been found to have a negative connotation leading some to suggest rebranding and some services to change their name. Perceptions of the PC community about the term remain largely unexplored. Objective: To explore how PC researchers/academics perceive the term is the objective of this study. Design: This is a cross-sectional survey of attendees to the 10th World Research Congress of the EAPC. The questionnaire covered areas of academic activity, including the use of the term. We analyzed data through descriptive and nonparametric statistics and open responses through content analysis. Participants: Academics and researchers in PC were the participants in this study. Results: Of 318 respondents, the majority were women (65%), physicians (48%), and had a postgraduate degree (90%). For 40%, the term hindered the positioning of PC, 28% worried about using the term, and 55% did not discuss these difficulties. We found significant differences between responses and several demographics (e.g., younger age and higher likelihood of worrying about the term). Through open responses, we identified that the term is widely in use, and that its limitations are seen as a cultural by-product, and not as something that a name change would solve. Conclusions: Senior PC academics, researchers, and clinicians have an onus to ensure that colleagues with limited PC experience have the opportunity to discuss and explore the impact of the term on the practice of research. Regarding the term itself, the community's views are conclusive: although using the term will remain a difficult task, the field's identity is in the name.
Revista:
JOURNAL OF PAIN AND SYMPTOM MANAGEMENT
ISSN:
0885-3924
Año:
2019
Vol.:
58
N°:
3
Págs.:
445 - 453.e1
Context. International consensus on indicators is necessary to standardize the global assessment of palliative care (PC) development. Objectives. To identify the best indicators to assess current national-level PC development. Methods. Experts in PC development were invited to rate 45 indicators organized by domains of the World Health Organization Public Health Strategy in a two-round RAND/UCLA-modified Delphi process. In the first round, experts rated indicators by relevance, measurability, and feasibility (1-9). Ratings were used to calculate a global score (1-9). Indicators scoring >7 proceeded to the second round for fine-tuning of global scores. Median, confidence interval, Content Validity Index, and Disagreement Index were calculated. Indicators scoring a lower limit 95% confidence interval of >7 and a Content Validity Index of >= 0.30 were selected. Results. 24 experts representing five continents and several organizations completed the study. 25 indicators showed a high content validity and level of agreement. Policy indicators (n = 8) included the existence of designated staff in the National Ministry of Health and the inclusion of PC services in the basic health package and in the primary care level list of services. Education indicators (n = 4) focused on processes of official specialization for physicians, inclusion of teaching at the undergraduate level, and PC professorship. Use of medicines indicators (n = 4) consisted of opioid consumption, availability, and prescription requirements. Services indicators (n = 6) included number and type of services for adults and children. Additional indicators for professional activity (n = 3) were identified. Conclusion. The first list including 25 of the best indicators to evaluate PC development at a national level has been identified. (C) 2019 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.
Revista:
THE LANCET. GLOBAL HEALTH
ISSN:
2214-109X
Año:
2019
Vol.:
7
N°:
7
Págs.:
E815 - E816
Revista:
JOURNAL OF PAIN AND SYMPTOM MANAGEMENT
ISSN:
0885-3924
Año:
2019
Vol.:
57
N°:
3
Págs.:
627 - 634
CONTEXT:
Demoralization is a state of existential distress in patients with advanced illness, typically with coping difficulties, feelings of loss of sense, and purpose in life and despair, among other things. The New Demoralization Scale (DS-II) is an evaluation tool for this syndrome, which has recently been reformulated on a shorter scale.
OBJECTIVES:
The objective of this study was to obtain a Spanish version of the DS-II and to assess its psychometric properties in advanced cancer patients in Spain and a number of Latin American countries.
METHODS:
Following a translation-back translation process, a validation study and a confirmatory analysis using structural equation models with their corresponding latent constructs were undertaken. Patients completed the DS-II in Spanish (DS-II (es)), the Hospital Anxiety and Depression Scale, and the Edmonton Symptom Assessment System-revised. Reliability was studied according to internal consistency; construct validity and concurrent validity with the Hospital Anxiety and Depression Scale and the Edmonton Symptom Assessment System-revised; discriminant validity using the Karnofsky Performance Status scale; and feasibility, with response ratio and required time. Cutoff points were established, and sensitivity and specificity were studied.
RESULTS:
The DS-II (es) was obtained. One hundred fifty patients completed the validation study. The confirmatory analysis showed coherence, and all items correlated positively with their subscales and with the overall scale. Cronbach's alpha for the DS-II (es) was 0.88, for the sense and purpose subscale 0.83, and for the coping ability 0.79. Demoralization correlated significantly with emotional distress (rho = 0.73, P < 0.001). The tool distinguished between patients with diverse functional levels (rho = -0.319, P = 0.001). Cutoff points at 10 and 20 out of 32 were established. The scale showed high sensitivity (81.97%) and specificity (80.90%). The prevalence of demoralization was 33% in our sample.
CONCLUSION:
The Spanish version of the new Kissane DS-II demoralization scale has shown to be valid, reliable, and feasible with adequate psychometric properties.
Revista:
WELLCOME OPEN RESEARCH
ISSN:
2398-502X
Revista:
PLOS ONE
ISSN:
1932-6203
Año:
2019
Vol.:
14
N°:
1
Págs.:
e0211106
Background Lack of social awareness is a major barrier to the development of palliative care. Mass media influences public opinion, and frequently deal with palliative care contributing to its image and public understanding. Aim To analyse how palliative care is portrayed in Spanish newspapers, as well as the contribution made by the press to its social representation. Design Based on criteria of scope and editorial plurality, four print newspapers were selected. Using the newspaper archive MyNews (www.mynews.es), articles published between 2009 and 2014 containing the words "palliative care" or "palliative medicine" were identified. Sociological discourse analysis was performed on the identified texts on two levels: a) contextual analysis, focusing on the message as a statement; b) interpretative analysis, considering the discourse as a social product. Results We examined 262 articles. Politician and healthcare professionals were the main representatives transmitting messages on palliative care. The discourses identified were characterised by: strong ideological and moral content focusing on social debate, strong ties linking palliative care and death and, to a lesser degree, as a healthcare service. The messages transmitted by representatives with direct experience in palliative care (professionals, patients and families) contributed the most to building a positive image of this healthcare practice. Overall, media reflect different interests in framing public understanding about palliative care. Conclusion The knowledge generated about how palliative care is reflected in the printed media may help to understand better one of the main barriers to its development not only in Spain, but also in other contexts.
Revista:
INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH
ISSN:
1660-4601
Año:
2019
Vol.:
16
N°:
24
Quality medical education, centred on patient¿s needs, is crucial to develop the health professionals that our society requires. Research suggests a strong contribution of palliative care education to professionalism. The aim of this study was to design and validate a self-report inventory to measure student¿s professional development. Method: Sequential exploratory strategy mix method. Inventory was built based on the themes that emerged from the analysis of four qualitative studies about nurse and medical students¿ perceptions related to palliative care teaching interventions (Ballesteros et al 2014, Centeno et al 2014&2017, Rojí et al 2017). The structure and psychometrics of the inventory obtained has been tested in two different surveys with two different groups of medical students. Inventory reliability and construct validity were tested in the first survey group. To verify the inventory structure a confirmatory factor analysis was performed in a second survey group. Results: the has 33-items and seven dimensions: holistic approach, caring for and understanding the patient, personal growth, teamwork, decision-making, patient evaluation, and being a health care professional. Cronbach¿s-alpha was 0.73-0,84 in all seven domains, ICC: 0.95. The confirmatory factor analysis CFI was 1 with a Standardized Root Mean Square index 0,088(SRMR) and obtained a 0,99 goodness-of-fit R-square coefficient. Conclusions: This inventory is valid to assess student¿s professional development
Revista:
ANALES DEL SISTEMA SANITARIO DE NAVARRA
ISSN:
1137-6627
Año:
2019
Vol.:
42
N°:
3
Págs.:
257 - 260
Revista:
BMC PALLIATIVE CARE
ISSN:
1472-684X
Año:
2019
Vol.:
18
N°:
1
Págs.:
28
Background: In palliative care (PC) patients and relatives (P/R) often show their gratitude to the healthcare professionals (HP) who care for them. HP appreciate these displays of gratitude, although the impact of the same has not been examined in detail. Publications analysed tell personal experiences in which HP say that displays of gratitude create sensations of well-being, pride and increased motivation to carry on caring. No systematic examination in PC was found. These aspects related to gratitude may be important in the field of PC, where there is constant exposure to suffering and the preoccupation which arises from wanting to help HP to go on with their work, but it needs closer study and systemisation. The purpose of this study is to understand the significance and the role of the gratitude received from P/R for palliative care health professionals (PCHP). Methods: A suitable mixed method will be used. The first phase will be quantitative and will consist of a survey, piloted by experts, whose goal is to explore the current situation in Spain as regards displays of gratitude received by HP at PC services. It will be sent by e-mail. The results from this part will be incorporated into the second part which will be qualitative and whose goal is to understand the significance of the experience of receiving displays of gratitude from the perspective of PCHP, using a phenomenological approach. Interviews will be undertaken amongst PCHP. The interview guide will be designed after taking the survey results into account. The project has been granted ethical approval. Discussion: These results are set to provide a key contribution within the context of the growing preoccupation on how to care for HP, how to ensure retention and keep them from resigning, as well as preventing burnout, emotional fatigue and boosting their resilience. In order to do this, it is both interesting and ground breaking, to analyse the repercussion of spontaneous gratitude shown by P/R towards PCHP, to see if this is a useful resource to reduce these problems and to encourage the greater presence of dignity and humanisation, for both those receiving care and for those providing it. This gratitude may be one of these strategies.
Autores:
Reigada, C. (Autor de correspondencia); Martin-Utrilla, S. ; Perez-Ros, P.; et al.
Revista:
HELIYON
ISSN:
2405-8440
Año:
2019
Vol.:
5
N°:
8
Págs.:
e02196
Audio-visual materials play a fundamental role in the context of education, care and clinical treatment, as they seem to have a high impact on public awareness. This study aims to describe what messages are perceived by the society at an International Festival of Short Films and Art on Diseases that may help to understand difficult topics, such as illness, dying and suffering. Through an observational, descriptive, cross-sectional study, using full participant observation and an open, self-administered questionnaire, 32 short films were analysed during a healthcare art festival. Categories were developed using inductive content analysis. The message perceived by the participants, after the viewing of the shorts and reflection of the debates among the attendees, were considered in four categories: i) creative and positive education is possible; ii) awareness of preconception and practical duties; iii) meaning of life changes the experience of illness; iv) family and caregivers also experienced suffering. The short films are considered as an excellent tool to generate social dialogue and debate. Public events can be understood as an opportunity to acquire, in an emotional and critical manner, other competencies for public awareness. Together, they are capable of communicating difficult messages through a fast, positive, and creative way.
Autores:
Rhee, J. Y.; Garralda, E; Namisango, E.; et al.
Revista:
JOURNAL OF PAIN AND SYMPTOM MANAGEMENT
ISSN:
0885-3924
Año:
2018
Vol.:
56
N°:
2
Págs.:
230 - 238
CONTEXT:
To date, there is no study comparing palliative care (PC) development among African countries.
OBJECTIVE:
To analyze comparatively PC development in African countries based on region-specific indicators.
METHODS:
Data were obtained from the APCA Atlas of PC in Africa and a comparative analysis conducted. Nineteen indicators were developed and defined through qualitative interviews with African PC experts and a two-round modified Delphi consensus process with international experts on global PC indicators. Indicators were grouped by the WHO public health strategy for PC dimensions. These indicators were then sent as a survey to key informants in 52/54 African countries. Through an expert weighting process and ratings from the modified Delphi, weights were assigned to each indicator.
RESULTS:
Surveys were received from 89% (48/54) of African countries. The top three countries in overall PC development were, in order, Uganda, South Africa, and Kenya. Variability existed by dimension. The top three countries in specialized services were Uganda, South Africa, and Nigeria; in policies, it was Botswana followed by parity among Ethiopia, Rwanda, and Swaziland; in medicines, it was Swaziland, South Africa, then Malawi; in education, it was equivalent between Uganda and Kenya, then Ghana and Zambia.
CONCLUSION:
Uganda, South Africa, and Kenya are the highest performing countries and were the only ones with composite scores greater than 0.5 (50%). However, not one country universally supersedes all others across all four PC dimensions. The breakdown of rankings by dimension highlights where even high-performing African countries can focus their efforts to further PC development.
Revista:
MEDICINA PALIATIVA
ISSN:
1134-248X
Año:
2018
Vol.:
25
N°:
3
Págs.:
119 - 120
Autores:
Bush, S. H. (Autor de correspondencia); Lawlor, P. G.; Ryan, K. ; et al.
Revista:
ANNALS OF ONCOLOGY
ISSN:
0923-7534
Año:
2018
Vol.:
29
Págs.:
143 - 165
Autores:
Rhee, J. Y. (Autor de correspondencia); Garralda, E; Namisango, E.; et al.
Revista:
JOURNAL OF PALLIATIVE MEDICINE
ISSN:
1096-6218
Año:
2018
Vol.:
21
N°:
3
Págs.:
342-353
Revista:
JOURNAL OF PALLIATIVE MEDICINE
ISSN:
1096-6218
Año:
2018
Vol.:
21
N°:
10
Págs.:
1398-1407
Resumen Contexto: La Academia Pontificia de la Vida (PAV) es una institucion academica de la Santa Sede (Vaticano) cuyo objetivo es promover una vision catolica de la etica biomedica. La PAV invito a una serie de expertos en Cuidados Paliativos (CP) de todo el mundo, de todas las creencias, a desarrollar recomendaciones estrategicas para el desarrollo global de CP (Grupo PAL-LIFE). Diseno: Trece expertos internacionales reconocidos por su actividad promotora global de CP participaron en un estudio Delphi on-line. En un proceso de cuatro rondas, se pidio a los participantes que identificasen los grupos de interes o instituciones claves para la promocion de CP y que propusieran, para cada uno de ellos, recomendaciones estrategicas para el desarrollo de CP. Cada ronda incorporaba los comentarios de las rondas previas hasta lograr el consenso en las recomendaciones mas importantes. En una ultima fase, al grupo de expertos se le solicito la jerarquizacion por importancia de los grupos clave en una escala de 1 a 13. Tambien se solicitaron sugerencias concretas para la implementacion de las recomendaciones. Mediante analisis cluster se ordenaron los grupos de interes en dos niveles de importancia para el desarrollo de CP. Resultados: Trece recomendaciones fueron seleccionadas como las mas importantes (una por cada grupo clave). Las recomendaciones para los grupos mejor puntuados fueron: (1) Responsables Politicos: garantizar el acceso universal a los CP; (2) Academia: ofrecer cursos obligatorios de CP en el pregrado; (3) Profesionales sanitarios: promover una certificacion adecuada; (4) Hospitales e Instituciones sanitarias: asegurar el acceso a medicamentos de CP; y (5) Asociaciones de CP: ser promotoras eficaces y trabajar con los gobiernos en la implementacion de las recomendaciones internacionales sobre CP. Tambien se presentan recomendaciones para los ocho grupos clave restantes. Discusion: Este documento representa la posicion oficial de la PAV en lo que respecta a estrategias de promocion para el desarrollo de los CP en el mundo.
Revista:
JOURNAL OF PAIN AND SYMPTOM MANAGEMENT
ISSN:
0885-3924
Año:
2018
Vol.:
55
N°:
5
Págs.:
1313 - 1320
CONTEXT:
Factors contributing to and impeding palliative care (PC) development in Africa can provide insights into current strategies for advancing PC.
OBJECTIVES:
To identify key factors affecting PC development in African countries from in-country PC experts' perspectives.
METHODS:
Sixteen PC experts from seven African countries undertook semi-structured interviews on PC development in their respective countries. An interpretive description approach was adopted, with data analyzed using constant comparison.
RESULTS:
Emerged themes included: drivers, strengths, challenges, and aspirations for PC development in Africa. Drivers included advocates and pioneering organizations, HIV/AIDS, culture of caregiving, and the World Health Assembly PC Resolution. Strengths included community health workers, the special role of nurses, diversity of services, and short training courses. Challenges included lack of PC education, lack of standardization in implementation, limited availability of and/or accessibility to morphine, poverty and disease burden, and lack of funding for PC. Aspirations included integration of PC, specialization in PC, nurse prescribing, and strong partnerships with Ministries of Health. Factors already highlighted in the literature were only briefly discussed.
CONCLUSION:
The key factors underpinning PC development in the seven countries contributed to the beginnings of PC in Africa, fueled by advocates that built on existing strengths to maximize opportunities
Revista:
JOURNAL OF PALLIATIVE MEDICINE
ISSN:
1096-6218
Año:
2018
Vol.:
21
N°:
11
Págs.:
1621 - 1626
Background: In Europe in recent decades, university teaching of palliative medicine (PM) has evolved. In some countries it has been introduced as a compulsory subject in all medical schools, but in a majority of countries it remains an isolated subject at few universities. Objective: To explore how PM has been introduced into the curricula and how it is currently being taught at different European universities. Method: Case study method using face-to-face semistructured interviews with experienced PM professors, comparing how they have developed PM undergraduate programs at their universities. Results: An intentional sample of eight university professors from Spain, France, UK, Italy, Hungary, Sweden, Germany, and Poland was chosen. The introduction of PM in the universities depends on the existence of a favorable social and political context in relation to palliative care and the initiative of pioneers, trusted by students, to push this education forward. A PM curriculum frequently starts as an optional subject and becomes mandatory in a short period. In the reported universities, PM uses a wide variety of teaching methods, such as lectures, workshops, role-plays, and discussions. PM assessment included tests, discussions, reflections, portfolios, and research works. According to respondents' opinions, lack of recognition, funding, and accredited teachers, along with competition from other curricula, are the main barriers for palliative medicine teaching development at universities. Conclusion: Diverse paths and tools have been identified for PM teaching in Europe. The described cases may shed light on other medical schools to develop PM curricula.
Revista:
BMJ SUPPORTIVE & PALLIATIVE CARE
ISSN:
2045-435X
Año:
2018
Vol.:
8
N°:
3
Págs.:
356- +
Revista:
ANALES DEL SISTEMA SANITARIO DE NAVARRA
ISSN:
1137-6627
Año:
2018
Vol.:
41
N°:
2
Págs.:
283 - 284
Revista:
PALLIATIVE & SUPPORTIVE CARE
ISSN:
1478-9523
Año:
2018
Vol.:
16
N°:
1
Págs.:
73-79
ICS ATLANTES
The PDI has intrinsic therapeutic value and is useful in clinical practice, and it is also a way of examining issues related to dignity and the meaning of life within the context of advanced-stage illness. There is a need for studies that examine patient experiences through a PDI-based intervie
Autores:
Rhee, J. Y. (Autor de correspondencia); Foley, K.; Morrison, R. S.; et al.
Revista:
JOURNAL OF PAIN AND SYMPTOM MANAGEMENT
ISSN:
0885-3924
Año:
2018
Vol.:
55
N°:
5
Págs.:
E2 - E4
Revista:
JOURNAL OF PALLIATIVE MEDICINE
ISSN:
1096-6218
Año:
2018
Vol.:
21
N°:
10
Págs.:
1389 - 1397
ackground: The Pontifical Academy for Life (PAV) is an academic institution of the Holy See (Vatican), which aims to develop and promote Catholic teachings on questions of biomedical ethics. Palliative care (PC) experts from around the world professing different faiths were invited by the PAV to develop strategic recommendations for the global development of PC (PAL-LIFE group). Design: Thirteen experts in PC advocacy participated in an online Delphi process. In four iterative rounds, participants were asked to identify the most significant stakeholder groups and then propose for each, strategic recommendations to advance PC. Each round incorporated the feedback from previous rounds until consensus was achieved on the most important recommendations. In a last step, the ad hoc group was asked to rank the stakeholders' groups by order of importance on a 13-point scale and to propose suggestions for implementation. A cluster analysis provided a classification of the stakeholders in different levels of importance for PC development. Results: Thirteen stakeholder groups and 43 recommendations resulted from the first round, and, of those, 13 recommendations were chosen as the most important (1 for each stakeholder group). Five groups had higher scores. The recommendation chosen for these top 5 groups were as follows: (1) Policy makers: Ensure universal access to PC; (2) Academia: Offer mandatory PC courses to undergraduates; (3) Healthcare workers: PC professionals should receive adequate certification; (4) Hospitals and healthcare centers: Every healthcare center should ensure access to PC medicines; and (5) PC associations: National Associations should be effective advocates and work with their governments in the process of implementing international policy framework. A recommendation for each of the remaining eight groups is also presented. Discussion: This white paper represents a position statement of the PAV developed through a consensus process in regard to advocacy strategies for the advancement of PC in the world.
Revista:
ANALES DEL SISTEMA SANITARIO DE NAVARRA
ISSN:
1137-6627
Año:
2017
Vol.:
40
N°:
3
Págs.:
339 - 349
The quality of end-of-life care in the participating ICU needs to be improved. The study identifies shortcomings and indicates existing resources in clinical practice from which a gradual improvement plan, adapted to the situation in each hospital, can be designed. The analysis, inexpensive in its implementation, offers an opportunity for improvement, a goal recommended by most professional societies of intensive care medicine. Key words. End-of-life care. Intensive care. Critical care. Palliative care. Quality improvement.
Revista:
EUROPEAN JOURNAL OF PALLIATIVE CARE
ISSN:
1352-2779
Año:
2017
Vol.:
24
N°:
2
Págs.:
72 - 74
The term intangible describes something that has no physical presence and that cannot be touched ¿love and truth, for example, are both intangible. To a certain extent, many of the values of palliative care are also intangible. In this article, we discuss these facets of palliative care along with the nature of advanced illness and the essence of caring. We also reflect on how these intangible values are perceived, both by those who receive palliative care and those who provide it. Finally, we analyse the difficulty in conveying the message of palliative care, to society and to other professionals, precisely because of the intangible nature of what we wish to transmit.
Autores:
Siouta N; Van Beek K; Payne S; et al.
Revista:
BMC PALLIATIVE CARE
Año:
2017
Vol.:
16
N°:
1
Págs.:
62
In Europe, the empirically observed imbalance in integration of PC for patients with cancer and CHF/COPD may only partially be attributed to the content of the guidelines/pathways that are utilized for the PC implementation. Given the similarities detected between cancer and CHF/COPD, other barriers appear to play a more prominent role.
Revista:
ANALES DEL SISTEMA SANITARIO DE NAVARRA
ISSN:
1137-6627
Año:
2017
Vol.:
40
N°:
2
Págs.:
315 - 317
Revista:
JOURNAL OF PALLIATIVE MEDICINE
ISSN:
1096-6218
Año:
2017
Vol.:
20
N°:
11
Págs.:
1180 - 1181
Revista:
BMC MEDICAL EDUCATION
ISSN:
1472-6920
Año:
2017
Vol.:
17
N°:
1
Págs.:
257
Medical Schools are challenged to improve PC education and to find ways to introduce and nurture attitudes and behaviours such as empathy, patient-centred care and wholistic care. This paper describes the curriculum and evaluation results of a unique course centred on PC decision-making but aimed at introducing these other important competencies as well. Methods: The 20 hour-long optional course, presented in an art museum, combined different learning methods, including reflections on art, case studies, didactic sessions, personal experiences of faculty, reflective trigger videos and group discussions. A mixed methods approach was used to evaluate the course, including a) a post-course reflective exercise; b) a standardized evaluation form used by the University for all courses; and c) a focus group. Results: 21 students (2nd to 6th years) participated. The course was rated highly by the students. Their understanding of palliative care changed and misconceptions were dispelled. They came to appreciate the multifaceted nature of decision-making in the palliative care setting and the need to individualize care plans. Moreover, the course resulted in a re-conceptualization of relationships with patients and families, as well as their role as future physicians. Conclusions: PC decision-making therefore, augmented by the visual arts, can serve as a vehicle to address several competencies, including the introduction of competencies related to being patient-centred and empathic.
Revista:
JOURNAL OF PALLIATIVE MEDICINE
ISSN:
1096-6218
Año:
2017
Vol.:
20
N°:
2
Págs.:
147 - 154
Context: A mandatory course in palliative care (PC) is organized for all final-year medical students at the University of Navarre. It consists of 24 lectures, 4 workshops, and 1 scheduled five hour clinical PC service experience at two different sites. In the 48 hours after the visit and related to the clinical experience, each student has to complete a 500-word reflective writing (RW) piece.
Objective: To investigate how a brief PC clinical experience helps equip the medical student.
Methods: Qualitative study of RW. Two researchers produced a content analysis of students¿ RW. They collaboratively developed themes and categories with a constant review of the classification tree and an exhaustive collection of quotes. Differences between services were analyzed (¿2).
Results: One hundred sixty-seven RW were analyzed from the 197 students on the course (response rate 85%). Six major themes emerged: All the students identified central aspects of PC work dynamics; students acquired specific PC knowledge (86%); the personal influence of the experience was reported (68%); students described how patients and their caregivers deal with the patients¿ illness (68%); students talked about the essence of PC and essential aspects of medicine (42%); students reported spontaneously having changed their assumptions about PC (15%); and they realized that the experience was relevant to all clinical practice. Categories such as teamwork, the expression of patients¿ and caregivers¿ feelings,
Revista:
PROGRESS IN PALLIATIVE CARE
ISSN:
0969-9260
Año:
2017
Vol.:
25
N°:
5
Págs.:
230 - 234
Patients with advanced cancer often continue to choose aggressive interventions and/or treatments up until
the final stages of life. This clinical approach may compromise the preservation of a patient¿s quality of life,
and secondarily, contributes to higher healthcare costs. Therefore, the ethics of enrolling terminal cancer
patients in clinical trials which are testing new, aggressive chemotherapy agents requires careful
discussion between the Oncology and the Palliative Care team. We present the case of a patient with
stomach cancer admitted to a clinical trial at a very advanced stage of her disease. A number of clinical
and ethical difficulties encountered by the PC team are discussed as well as possible solutions
Revista:
JOURNAL OF PALLIATIVE MEDICINE
ISSN:
1096-6218
Año:
2017
Vol.:
20
N°:
2
Págs.:
205 - 206
Revista:
JOURNAL OF PALLIATIVE MEDICINE
ISSN:
1096-6218
Año:
2017
Vol.:
20
N°:
12
Págs.:
1372-77
Background: Palliative care (PC) research in Africa has been proposed as a fifth dimension of the World Health Organization PC Public Health Strategy. We conducted a scoping review of published articles (2005-2016) on palliative care development (PCD) in African countries. Forty-seven articles were found across 26 countries.
Objective: To study whether the number of published articles on PCD in countries in Africa can be used as an indicator of PCD.
Design: This is a secondary analysis of a completed scoping review.
Measurements: Spearman correlations were applied to the number of published articles ("published articles") and the number of published articles with a coauthor from a high-income country (HIC) ("HIC published articles") with level of PCD using Lynch et al's updated world map (PC World Map) as a proxy. A subanalysis was undertaken for Anglophone versus non-Anglophone countries.
Results: There were positive Spearman correlations (r) between the PC World Map's levels and published articles (r¿=¿0.73; p¿<¿0.001), and with HIC published articles (r¿=¿0.68; p¿<¿0.001). For Anglophone countries, the r was statistically significant (p¿<¿0.001) at 0.69 and 0.70, versus 0.58 and 0.45 for non-Anglophone countries for published articles and HIC published articles, respectively. Kruskal-Wallis test showed a statistically significant difference between Anglophone and non-Anglophone countries for both published articles and HIC published articles (p¿<¿0.01).
Conclusion: Publish
Revista:
JOURNAL OF PALLIATIVE MEDICINE
ISSN:
1096-6218
Año:
2017
Vol.:
22
N°:
11
Págs.:
1195-1204
Results: In total, 48/53 (91%) European countries responded to the survey. A total of 43 barriers and 65
opportunities were identified as being related to PC integration. Main barriers were (1) lack of basic PC training,
with a particular emphasis on the absence of teaching at the undergraduate level; (2) lack of official certification
for professionals; (3) lack of coordination and continuity of care for users and providers; (4) lack of PC
integration for noncancer patients; (5) absence of PC from countries¿ regulatory frameworks; and (6) unequal
laws or regulations pertaining to PC within countries. Innovations in education and new regulatory frameworks
were identified as main opportunities in some European countries, in addition to opportunities around the
implementation of PC in home care, nursing home settings, and the earlier integration of PC into patients¿ continuum
of care. With increasing provision of services, more challenges for the integration are detected ( p < 0.005).
Revista:
BMC PALLIATIVE CARE
ISSN:
1472-684X
Año:
2017
Vol.:
16
N°:
1
Págs.:
47
Family members are involved in the care of palliative patients at home and therefore, should be viewed as important sources of information to help
clinicians better understand the quality palliative care service patients receive. The objective of the study was to analyse what is valued most by family carers undergoing bereavement of a palliative care home service in order to identify factors of quality of care. Qualitative exploratory study based on documentary analysis. Content analysis of 77 gratitude documents received over 8 years by a palliative home service in Odivelas, near Lisbon (Portugal) was undertaken, through an inductive approach and using investigator triangulation. Frequency of distinct categories was quantitatively defined. Results: Three different content categories emerged from the analysis: a) Recognition of the care received and the value of particular aspects of care within recognised difficult situations included aspects such as kindness, listening, relationships established (63/77 documents)¿ b) Family recognition of the achievements of the palliative care team (29/77) indicated as relief from suffering for the patient and family, opportunity of dying at home, help in facing difficult situations, improvement in quality of life and wellbeing, and feeling of serenity during bereavement¿ c) Messages of support (45/77) related to the need of resources provided.
Revista:
PLOS ONE
ISSN:
1932-6203
Año:
2017
Vol.:
12
N°:
10
Págs.:
e0184806
Introduction The goal of palliative care (PC) is to improve the quality of life of terminal stage patients and their families. The subject frequently appears in the mass-media and this helps create a socially accepted identity. The aim of this study is to describe and analyse PC related news items appeared in the Spanish written media. Methodology A descriptive cross-sectional study was designed. Considering diffusion, scope and the range in editorial policy criteria, four printed newspapers (PN) were selected, together with four exclusively digital media sources (DM). Through Mynews, a newspaper content depository, and the search tool for each DM website, articles published between 2009 and 2014 which included the terms "palliative care" and "palliative medicine" were sought. A questionnaire was created to characterise each article identified and a descriptive analysis was undertaken. Results A total of 627 articles were identified, of which 359 (57%) were published in PN (42% in the printed editions -PE- 16% in their online editions -OE-) and 268 (43%) in DM. In general, they appeared mainly in sections concerning Health (23%), Culture and Society (18%) and General/Home News (15%). In PE, just 2% were found in the Health section and nearly 70% in Culture and Society and General/Home News. Most of the articles were informative in nature and contained socio-political messages (90%). Statements by PC professionals were found in 35% of the articles and by politicians in 32%. The most frequent content was related to facing end of life (74%) and patient quality of life (70%). Conclusions The Spanish written media reflects the socio-political interest aroused by PC. Nevertheless, messages circulating about PC do not describe professional practice, or the contribution of the same for patients. Content more in line with the clinical practice might help contribute to the development of this new area of medicine.
Autores:
Balaguer, A.; Monforte-Royo, .; Porta-Sales, J.; et al.
Revista:
PLOS ONE
ISSN:
1932-6203
Año:
2016
Vol.:
11
N°:
1
Págs.:
e0146184
Revista:
PALLIATIVE MEDICINE
ISSN:
0269-2163
Año:
2016
Vol.:
30
N°:
9
Págs.:
805 - 806
Autores:
Went, R.; Lima, L.d; Mutto, E.; et al.
Revista:
MEDICINA PALIATIVA
ISSN:
1134-248X
Año:
2016
Vol.:
23
N°:
1
Págs.:
42-48
In many Latin American countries Palliative Care development is still in the initial stages. A key reason is that the training of health professionals in this discipline, although intense and gradually increasing, is still insufficient, and with variable quality. The different institutions and organizations involved in the promotion and implementation of Palliative Care sponsored the first regional meeting on technical aspects of Palliative Care teaching to undergraduates and primary care health professionals. The meeting was held in Buenos Aires, Argentina in November 2012, and was attended by 60 professionals from diverse disciplines with teaching activity in Palliative Care from 11 different Latin American countries. Key issues in basic education in Palliative Care were identified and analyzed, challenges were identified, and recommendations were made overcome them. All the participants were in agreement that palliative care should be available and accessible for the majority of the patient population with life threatening conditions. Also, with the evidence that indicates that more patients may be able to receive appropriate care provided by primary care health care professionals, as long as they have the basic palliative care knowledge, skills and attitudes. This report describes the design and organization of the meeting and presents the results and recommendations related to teaching at the undergraduate and the primary care level
Revista:
PERSONA Y BIOETICA
ISSN:
0123-3122
Año:
2016
Vol.:
20
N°:
1
Págs.:
38 - 47
"Meetings on Clinical Ethics in Palliative Medicine," as outlined in this article, is a project on ethical and clinical training in the area of palliative care. The project is part of a clinical program and broader research pertaining to recovery of the anthropological and ethical roots in the clinical practice of palliative care. It is aimed at professionals and researchers in palliative care and consists of informal meetings where the human and professional values involved in actual clinical cases are analyzed. Anthropology, general ethics, medical epistemology and philosophy of medicine are considered essential in this program of ethical and clinical training, as are the valuable insights provided by the humanities. The specific objective is not only to provide a list of ethical principles, but also to promote an ethical disposition on the part of the person who acts.
Revista:
CUADERNOS DE BIOETICA
ISSN:
1132-1989
Año:
2016
Vol.:
27
N°:
90
Págs.:
175 - 184
En la literatura científica se constata un reciente interés por integrar los principios de la medicina palia
-
tiva en el trabajo cotidiano de la unidad de cuidados intensivos (UCI). El artículo revisa este planteamiento
con la idea de fondo de que su aplicación pueda aportar luz en la resolución de ciertos problemas éticos
presentes. Los pacientes con procesos avanzados y en situación de final de vida ingresados en cuidados
intensivos se encuentran con un nivel de sufrimiento y vulnerabilidad que sólo una atención comprensiva
y holística puede dar un alivio adecuado. Sin embargo, la realidad clínica del cuidado de estos pacientes
en UCI, por el momento, está lejana a ese ideal. La mejora de la atención clínica en este sentido, especial
-
mente en el fallecimiento, es el punto de interés que nos ocupa. Avanzar en este aspecto es complejo pero
se hace necesario un esfuerzo. La propuesta es recurrir a la medicina paliativa como modelo de referencia
en los cuidados del final de vida y en la atención holística, e introducir sus principios de tratamiento en la
UCI. El objetivo del artículo es exponer una estrategia práctica para llevarlo a cabo y que pueda ser útil en
la mejora de la atención clínica y ética de los pacientes.
Autores:
Siouta N; van Beek K; van der Eerden ME; et al.
Revista:
BMC PALLIATIVE CARE
ISSN:
1472-684X
Año:
2016
Vol.:
15
N°:
1
Págs.:
56
Based on our findings, a generic framework for integrated PC in cancer and chronic disease is proposed. This framework fosters integration of PC in the disease trajectory concurrently with treatment and identifies the importance of employing a PC-trained multidisciplinary team with a threefold focus: treatment, consulting and training.
Revista:
BMC PALLIATIVE CARE
ISSN:
1472-684X
Año:
2016
Vol.:
15
N°:
1
Págs.:
49
The results show that explications of IPC in the Spanish literature exist, but that there is insufficient evidence of its impact in clinical practice. This review may be of interest for Spanish-speaking countries and for others seeking to know the status of IPC in the literature in their home nations.
Revista:
JOURNAL OF PAIN AND SYMPTOM MANAGEMENT
ISSN:
0885-3924
Año:
2016
Vol.:
52
N°:
3
Págs.:
370 - 377
The ranking method permitted a comparison of palliative care development between countries and shows changes over time. Recommendations for improving the ranking include improvements to the methodology and greater explanation of the levels and changes it reveals.
Autores:
Van Beck K; Siouta N; Preston N; et al.
Revista:
BMC PALLIATIVE CARE
ISSN:
1472-684X
Año:
2016
Vol.:
15
N°:
1
Págs.:
26
Overall, most of the identified guidelines/pathways highlighted the importance of the holistic approach of IPC. The studies that were found to fulfil at least 10/11 Emanuel's IPC criteria could serve as benchmarks of IPC.
Autores:
Siouta N; Van Beck K; Preston N; et al.
Revista:
BMC PALLIATIVE CARE
ISSN:
1472-684X
Año:
2016
Vol.:
15
N°:
1
Págs.:
18
The results illustrate that there is a growing awareness for the importance of integrated PC in patients with advanced CHF or COPD. At the same time, however, they signal the need for the development of standardized strategies so that existing barriers are alleviated.
Revista:
EUROPEAN JOURNAL OF PALLIATIVE CARE
ISSN:
1352-2779
Año:
2016
Vol.:
23
N°:
1
Págs.:
32-34
The image of palliative care portrayed by the media informs public opinion and can therefore affect palliative care development and practice. José Miguel Carrasco and Carlos Centeno have looked at some of the main Spanish media to find out how they talk about palliative care.
Revista:
JOURNAL OF PALLIATIVE MEDICINE
ISSN:
1096-6218
Año:
2016
Vol.:
19
N°:
6
Págs.:
589 - 590
Revista:
MEDICINE (ELSEVIER)
ISSN:
0304-5412
Año:
2015
Vol.:
43
N°:
12
Págs.:
696-698
The last quarter of the 20th century produced considerable advances in hospice and palliative care. In many countries, specialist services developed, education programmes got underway and in some cases palliative care ideas began to infiltrate national health policies. Globally, however, palliative care still faces many challenges: lack of recognition and understanding on the part of the health professions and the public; limited expression in health policy; insufficient funding; few accredited training programmes; and a paucity of evidence to demonstrate efficacy and cost benefits. We describe what is known about the development of palliative care around the world, how its clinical focus is changing and what prospects there are for further development.
Revista:
JOURNAL OF PAIN AND SYMPTOM MANAGEMENT
ISSN:
0885-3924
Año:
2015
Vol.:
49
N°:
5
Págs.:
861-70
PM is growing as a specialization field in Europe. Processes leading to certification are generally long and require substantial clinical training. The POSPM education plans are heterogeneous. The European Association for Palliative Care should commit to establishing common learning standards, leading to additional European-based recognition of expertise in PM.
Revista:
PALLIATIVE MEDICINE
ISSN:
0269-2163
Año:
2015
Vol.:
30
N°:
4
Págs.:
251 - 262
Although there has been a positive development in overall palliative care coverage in Europe between 2005 and 2012, the services available in most countries are still insufficient to meet the palliative care needs of the population.
Revista:
JOURNAL OF PAIN AND SYMPTOM MANAGEMENT
ISSN:
0885-3924
Año:
2015
Vol.:
50
N°:
4
Págs.:
516 - 523.e2
CONTEXT:
The lack of palliative medicine (PM) education has been identified as a barrier to the development of the discipline. A number of international institutions have called for its implementation within undergraduate medical curricula.
OBJECTIVES:
The objectives are to describe the situation of undergraduate PM education in Europe and to propose a scoring system to evaluate its status.
METHODS:
This descriptive study was conducted with data provided by key experts from countries of the World Health Organization European Region (n = 53). A numerical scoring system was developed through consensus techniques.
RESULTS:
Forty-three countries (81%) provided the requested information. In 13 countries (30%), a PM course is taught in all medical schools, being compulsory in six of them (14%). In 15 countries (35%), PM is taught in at least one university. In 14 countries (33%), PM is not taught within medical curricula. A full professor of PM was identified in 40% of countries. Three indicators were developed to construct a scale (rank 0-100) of educational development: 1) proportion of medical schools that teach PM (weight = 32%); 2) proportion of medical schools that offer PM as a compulsory subject (weight = 40%); 3) total number of PM professors (weight = 28%). The highest level of PM educational development was found in Israel, Norway, the U.K., Belgium, France, Austria, Germany, and Ireland.
CONCLUSION:
PM is taught in a substantial number of undergraduate medical programs at European universities, and a qualified teaching structure is emerging; however, there is a wide variation in the level of PM educational development between individual countries.
Revista:
JOURNAL OF PALLIATIVE MEDICINE
ISSN:
1096-6218
Año:
2015
Vol.:
18
N°:
5
Págs.:
429-37
A total of 577 statements were provided. Among the Strengths were integration into health systems and increasing number of professionals with PC training. Among weaknesses were lack of national PC programs, limited connection between policymakers and professionals, and barriers in the availability of opioids. Opportunities were increased awareness of policymakers and higher interest of students and professionals. Threats were competing funding for other services and medications, limited interest of the pharmaceutical industry in producing affordable opioid medications, and emphasis by the media on opioid diversion and abuse. Comments were categorized under (1) health policy, (2) education and research, (3) service provision, (4) opioid availability, and (5) advocacy. A moderately positive correlation was found (R=0.4 in both) between the ALCP development index and the number of positive/negative factors mentioned by country.
A SWOT framework is applicable in a situational analysis and helps to identify common aspects among the countries and key elements in the development of PC in Latin America.
Revista:
EUROPEAN JOURNAL OF PUBLIC HEALTH
ISSN:
1101-1262
Año:
2015
Vol.:
26
N°:
2
Págs.:
230 - 235
Background: With the goal of achieving greater unity and coherence, the Council of Europe developed a national palliative care (PC) policy framework-Recommendation (2003) 24. Although directed at member states, the policy spread to the wider World Health Organisation (WHO) European Region. This article aims to present the current situation relating to national PC health policies in European countries.
Methods: A cross-sectional survey was conducted in 53 European countries of the WHO European Region. Relevant data reported (i) the existence of official documents concerning the provision of PC; (ii) the role of health departments and policymakers in the evaluation of PC provision and (iii) the availability of financial resources for PC provision.
Results: In total, 46/53 (87%) EU and non-EU countries responded. PC legislation is established in 20 (71%) EU and nine (50%) non-EU countries. A total of 12 (43%) EU countries possess a PC plan or strategy in comparison with six (33%) non-EU countries. Individuals from Departments of Health and designated policymakers have established collaborative PC efforts. Quality systems have been initiated in 15 (54%) EU and four (22%) non-EU countries. Significant differences were not found in the reporting of payments for PC services between European regions.
Conclusion: An improvement in national PC policy in both EU and non-EU countries was observed. Future priorities include potential initiatives to improve relationships with policymakers, establish quality control programmes and ensure financial support for PC.
Revista:
JOURNAL OF PALLIATIVE CARE
ISSN:
0825-8597
Año:
2015
Vol.:
31
N°:
1
Págs.:
63-4
Revista:
EUROPEAN JOURNAL OF PALLIATIVE CARE
Año:
2015
Vol.:
15
N°:
22
Págs.:
288-291
Revista:
JOURNAL OF PAIN AND SYMPTOM MANAGEMENT
ISSN:
0885-3924
Año:
2015
Vol.:
50
N°:
6
Págs.:
874-81
The Spanish version of the PDI showed adequate psychometric properties when tested with advanced cancer patients. This research provides a three-factor alternative in Spanish to the PDI.
Revista:
CURRENT OPINION IN SUPPORTIVE AND PALLIATIVE CARE
ISSN:
1751-4258
Año:
2015
Vol.:
9
N°:
4
Págs.:
375-91
From research studies, there is only indirect evidence that palliative care training at university leads to better clinical care of patients. In the future, long-term cohort or controlled studies might answer that question.
Revista:
NURSE EDUCATION TODAY
ISSN:
0260-6917
Año:
2014
Vol.:
34
N°:
6
Págs.:
e1 - 6
Objective: We explored the contribution of optional palliative care (PC) learning to the training of undergraduate nursing students.
Design: This is a qualitative, exploratory study.
Participants: PC students from two universities (n=236) responded to the open question: What was the contribution of the PC course to your training?
Methods: A thematic analysis of the respondents' answers was performed with investigator triangulation.
Findings: Four themes were identified. Firstly, the PC course provided a comprehensive view of the nursing discipline. Secondly, the course helped the students to know how to interact with, communicate with and better understand patients. Thirdly, the contribution of the course to the students' personal growth prompted them to reflect personally on death, thus promoting self-awareness. Finally, the students considered the PC course to be of great importance in the nursing curriculum.
Conclusion: Nursing students believed that a PC course was an essential component in their training, which contributed favourably to their personal and professional development.
Autores:
Sanz, Álvaro; Zudaire, Maku; Morejón, Begoña; et al.
Revista:
MEDICINA PALIATIVA
ISSN:
1134-248X
Año:
2014
Vol.:
21
N°:
2
Págs.:
79-88
Revista:
BMJ SUPPORTIVE & PALLIATIVE CARE
ISSN:
2045-435X
Año:
2014
Vol.:
6
N°:
1
Págs.:
128-34
The subject of PC turns out to be very important to students, who almost unanimously evaluated their experience positively and highlighted the benefits of attending a PC course. Students especially reported being surprised by the humane and holistic features of the course, and they found that what they learned in the course is applicable to all patients and prepares them to work better as doctors. Participants recommend the course for all undergraduate students as a core component of the curricula.
Revista:
JOURNAL OF PAIN AND SYMPTOM MANAGEMENT
ISSN:
0885-3924
Año:
2014
Vol.:
47
N°:
1
Págs.:
189 - 197
The high responsiveness confirms the value of the MDAS for ongoing delirium assessment. Two differentiated factor loadings point to a potential future need for MDAS subscales
Revista:
PALLIATIVE MEDICINE
ISSN:
0269-2163
Año:
2014
Vol.:
28
N°:
2
Págs.:
99-100
Autores:
Elsner, Frank; Mason, Stephen; Blumhuber, Heidi; et al.
Revista:
EUROPEAN JOURNAL OF PALLIATIVE CARE
ISSN:
1352-2779
Año:
2014
Vol.:
21
N°:
4
Págs.:
193-195
Revista:
EUROPEAN JOURNAL OF PALLIATIVE CARE
ISSN:
1352-2779
Año:
2014
Vol.:
21
N°:
4
Págs.:
166-169
Revista:
CURRENT OPINION IN SUPPORTIVE AND PALLIATIVE CARE
ISSN:
1751-4258
Año:
2014
Vol.:
8
N°:
4
Págs.:
383-390
A bibliographic review found three randomized double-blinded placebo-controlled studies and five prospective studies, six of which showed that opioids significantly relieve dyspnea (P<0.001). The use of morphine for symptomatic relief does not significantly change the level of saturation of oxygen in the blood. In addition, the functional studies do not indicate that the use of opioids for dyspnea relief causes high CO2 levels in blood (P=0.05). The opioids used for treating dyspnea do not significantly compromise respiratory function; they are safe and effective.
Revista:
MEDICINA PALIATIVA
ISSN:
1134-248X
Año:
2014
Vol.:
21
N°:
1
Págs.:
3-8
Revista:
EUROPEAN JOURNAL OF PALLIATIVE CARE
ISSN:
1352-2779
Año:
2014
Vol.:
21
N°:
6
Págs.:
306-308
Revista:
JOURNAL OF PAIN AND SYMPTOM MANAGEMENT
ISSN:
0885-3924
Año:
2013
Vol.:
46
N°:
5
Págs.:
e1-3
Revista:
CURRENT OPINION IN SUPPORTIVE AND PALLIATIVE CARE
ISSN:
1751-4258
Año:
2013
Vol.:
7
N°:
4
Págs.:
396 - 405
Purpose Of Review: Patients with advanced diseases are exposed to many causes of hypomagnesaemia, the most frequent being pharmacological causes through the administration of chemotherapy, antibiotics, proton pump inhibitors, and so on. The objective of this review is to demonstrate the importance of measuring magnesium levels in the blood of these patients.
Recent Findings: In the last decade, studies have been published showing a direct relationship between low levels of magnesium and nonspecific symptoms including pain that is difficult to control. Nevertheless, hypomagnesaemia is still being omitted as a differential diagnosis in many such patients.
Summary: A review of recently published studies regarding the clinical presentation of hypomagnesaemia in patients with advanced cancer and other chronic diseases is presented. Many of the clinical conditions are reportedly alleviated with intravenous or even oral magnesium administration. The presence of nonspecific neurological signs and risk factors for hypomagnesaemia could serve as an indication that serum magnesium should be determined in these patients.
Revista:
ANALES DEL SISTEMA SANITARIO DE NAVARRA
ISSN:
1137-6627
Año:
2013
Vol.:
36
N°:
3
Págs.:
543 - 544
Revista:
JOURNAL OF PAIN AND SYMPTOM MANAGEMENT
ISSN:
0885-3924
Año:
2013
Vol.:
45
N°:
5
Págs.:
e7-8
Revista:
CURRENT OPINION IN SUPPORTIVE AND PALLIATIVE CARE
ISSN:
1751-4258
Año:
2013
Vol.:
7
N°:
4
Págs.:
411-16
Information in this review gives a broad notion of the current status of palliative care in Latin America. The Atlas is expected to help the progress of palliative care and serve as a driver of the field in Latin America and other regions.
Revista:
JOURNAL OF PAIN AND SYMPTOM MANAGEMENT
ISSN:
0885-3924
Año:
2013
Vol.:
45
N°:
1
Págs.:
129-36
The ESAS-r is a valid instrument with adequate psychometric characteristics. This version is preferred by patients with advanced cancer. The Spanish version of the ESAS-r can, therefore, replace the use of the ESAS.
Autores:
Alonso Babarro, A.; Astray Mochales,J.; Domínguez-Berjón, F; et al.
Revista:
PALLIATIVE MEDICINE
ISSN:
0269-2163
Año:
2013
Vol.:
27
N°:
1
Págs.:
68 - 75
Our findings suggest that a PHCT is associated with reduced in-patient deaths and overall hospitalization over the last two months of life.
Revista:
SUPPORT CARE CANCER
ISSN:
0941-4355
Año:
2012
Vol.:
20
N°:
9
Págs.:
2199 - 2203
ICS A significant number of patients were evaluated, many of them with severe symptoms and/or at the end of life. Inpatients receiving care from the PCCT experienced an improvement in symptom control within just a few days..
Revista:
European Journal of Palliative Care
ISSN:
1352-2779
Año:
2012
Vol.:
19
N°:
5
Págs.:
232 - 236
ICS It is only relatively recently that studies and initiatives that generate comparative analyses of palliative care development within European countries and contexts have begun to occur. One such initiative is the European Association for Palliative Care Task Force on the Development of Palliative Care in Europe, which was founded in 2003 under the leadership of Professor Carlos Centeno. The work of the Task Force encompasses the World Health Organization European Region (a vast geographic area of 53 countries, with a population of 879 million people).
Revista:
Medicina Paliativa
ISSN:
1134-248X
Año:
2012
Vol.:
19
N°:
3
Págs.:
125 - 126
Revista:
SUPPORTIVE CARE IN CANCER
ISSN:
0941-4355
Año:
2012
Vol.:
21
N°:
2
Págs.:
649-652
Revista:
BMJ Supportive & Palliative Care
ISSN:
2045-435X
Año:
2012
Vol.:
2
N°:
4
Págs.:
328-333
Compared with the placebo, methylphenidate demonstrated a positive trend in the incidence of response for depressive symptoms in advanced cancer patients
Revista:
European Journal of Cancer
ISSN:
0959-8049
Año:
2011
Vol.:
47
N°:
12
Págs.:
1863 -1872
Conclusion ESAS is a valid, reliable, responsive and feasible instrument with adequate psychometric properties when tested on Spanish advanced cancer patients..
Revista:
Patient Care, Ed. Portuguesa
ISSN:
0873-2167
Año:
2011
N°:
1
Págs.:
46 - 51
Revista:
Journal of Palliative Medicine
ISSN:
1096-6218
Año:
2011
Vol.:
14
N°:
1
Págs.:
4 - 5
Revista:
PALIATIA- JOURNAL OF PALIATIVE CARE
ISSN:
1844-7058
Año:
2011
Vol.:
4
N°:
2
Págs.:
4-8
Several considerations of this procedure and practical consequences for the clinical practices are discussed. Specialists in frequent contact wi
th advanced stage cancer patients should develop more experience in opioid switching.
Revista:
Medicina Paliativa
ISSN:
1134-248X
Año:
2011
Vol.:
18
N°:
4
Págs.:
127 - 128
Revista:
ANALES DEL SISTEMA SANITARIO DE NAVARRA
ISSN:
1137-6627
Año:
2010
Vol.:
33
N°:
3
Págs.:
319 - 322
Revista:
Palliative Medicine
ISSN:
0269-2163
Año:
2010
Vol.:
24
N°:
8
Págs.:
812 - 819
Revista:
SUPPORTIVE CARE IN CANCER
ISSN:
0941-4355
Año:
2010
Vol.:
18
N°:
11
Págs.:
1491-1494
The clinical practice of the use of oral laxatives in palliative care in our environment differs widely from that recommended in the literature. Further studies are required to confirm if a revision of clinical guidelines are required.
Revista:
Anales del Sistema Sanitario de Navarra
ISSN:
1137-6627
Año:
2010
Vol.:
33
N°:
3
Págs.:
315 - 318
Palliative care is generally understood on caring for terminal patients in chronic settings but more recently these units are developing also in acute care settings or university hospitals as consultants teams. We report the case of a complex patient with rectal adenocarcinoma and four problems of difficult approach: uncontrolled neuropathic pain despite opioids treatment, systemic infection, depression with intense demoralisation and open surgery wound. We show the measures adopted and how an excellent inter-departmental collaboration under the co-ordination of palliative medicine consultant team helped to resolve the untenable situation.
Revista:
JOURNAL OF PALLIATIVE CARE
ISSN:
0825-8597
Año:
2010
Vol.:
3
N°:
26
Págs.:
167 - 175
Studies on the effectiveness and efficiency of palliative care (PC) services that use a methodology similar to that used by studies in other medical specialties face serious limitations, since the goals of PC are substantially different. Qualitative research methods can make an important contribution to our understanding of the features of palliative care (PC) that are most relevant to patients and their relatives. The goal of this study was to understand the reasons behind the gratitude shown in letters from bereaved relatives sent to two PC units, one in Spain and one in Portugal. A thematic analysis of the content of the letters was independently carried out by three researchers, who later collaborated to write up the results. Relatives appeared grateful primarily for the humane attitude, professional treatment, and emotional support that their loved ones received from the PC team; they thanked the team for creating a special atmosphere and offering holistic care, and they talked about the contrast between PC and other forms of care. The unsolicited gratitude expressed in their letters constitutes a valid and particularly rich source of information about the contribution that a PC team can make.
Revista:
Medicina Paliativa
ISSN:
1134-248X
Año:
2010
Vol.:
17
N°:
2
Págs.:
103 - 118
