Nuestros investigadores

Carlos Centeno Cortés

Unidad de Medicina Paliativa
Clínica Universidad de Navarra. Clínica Universidad de Navarra
Atlantes, Cuidados paliativos
Instituto Cultura y Sociedad (ICS). Universidad de Navarra
Unidad de Formación Clínica
Facultad de Medicina. Universidad de Navarra
Líneas de investigación
Astenia en el cáncer avanzado y uso de psicoestimulantes; Evaluación de síntomas en enfermedad avanzada; Ciencias Sociales y Humanidades en Paliativos; Educación Médica en Cuidados Paliativos
Índice H
23, (Google Scholar, 01/01/2018)
17, (Scopus, 01/01/2018)
14, (WoS, 01/01/2018)

Publicaciones científicas más recientes (desde 2010)

Autores: Aparicio, M., (Autor de correspondencia); Centeno, Carlos; Robinson, C.; et al.
ISSN 0966-0429  Vol. 27  Nº 2  2019  págs. 286 - 300
AimTo synthesize existing evidence regarding gratitude in health care relationships, with a specific focus on expressions of gratitude from patients and their families to health professionals, including their meaning and impact. BackgroundStudying expressions of gratitude by patients and their families within the scope of health care is an innovative way of identifying the most valuable elements of care. EvaluationA scoping review of three data bases was conducted using the terms gratitude and health professionals (1984-2016). Data were extracted, analysed thematically and synthesized. Key IssuesA total of 32 publications were identified, around half being opinions or reflections. Thematic analysis resulted in the identification of three themes: the characteristics of expressions of gratitude, the focus of expressions of gratitude and the effect of gratitude on health professionals. ConclusionsExpressions of gratitude by patients and their families may have an important personal and professional effect on health professionals that is long lasting. A systematic study of its effect is needed. Implications for Nursing ManagementGratitude from patients and their families may contribute to motivation and retention among health professionals. Gratitude can be nurtured and is associated with a healthy work environment.
Autores: Arias, Natalia Sofía, (Autor de correspondencia); Garralda, Eduardo; De Lima, L. ; et al.
ISSN 1096-6218  Vol. 22  Nº 5  2019  págs. 580 - 590
Background: Indicators assessing national-level palliative care (PC) development used for cross-national comparison depict progress on this field. There is current interest on its inclusion in global monitoring frameworks. Objective: Identify and conceptualize those most frequently used for international PC development reporting. Design: Systematic review. Data Sources: PubMed, CINAHL, Google Scholar, and Google targeting national-level development indicators used for cross-national comparison. Additional search requesting experts' suggestions on key studies and "snow-balling" on reference section of all included studies. Identified indicators were listed and categorized in dimensions: services, use of medicines, policy, and education. Results: Fifty-four studies were included. Development has been evaluated using 480 different formulations of 165 indicators, 38 were highly reported. Thirty-two fell into proposed dimensions, 11 for use of medicines, 9 for policy, 7 for services, and 5 for education. Six into complementary dimensions: research, professional activity, and international cooperation. Six were the most frequently used indicators: number of PC services per population (40 reports), existence of PC national plan, strategy, or program (25), existence of palliative medicine specialization (22), availability and allocation of funds for PC (13), medical schools, including PC, in undergraduate curricula (13), and total use of opioids-morphine equivalents (11). Conclusion: There is a clear pattern for national-level PC development evaluation repeatedly using a small number of indicators. Indicators addressing generalistic provision, integration into health systems, and specific fields such as pediatric lack. This study invites international discussion on a global consensus on PC-development assessment.
Autores: Reigada, C., (Autor de correspondencia); Martin-Utrilla, S. ; Perez-Ros, P.; et al.
Revista: HELIYON
ISSN 2405-8440  Vol. 5  Nº 8  2019  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: Arias, Natalia Sofía, (Autor de correspondencia); Garralda, Eduardo; López-Fidalgo, J.; et al.
ISSN 0885-3924  Vol. 58  Nº 3  2019  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.
Autores: Noguera, Antonio Luís; Arantzamendi, María; López-Fidalgo, J.; et al.
ISSN 1660-4601  Vol. 16  Nº 24  2019  págs. E4925
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
Autores: Belar, Alazne; Arantzamendi, María, (Autor de correspondencia); Rodríguez-Núñez, A.; et al.
ISSN 0885-3924  Vol. 57  Nº 3  2019  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.
Autores: Centeno, Carlos; Arantzamendi, María;
ISSN 1472-684X  Vol. 18  Nº 1  2019  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: Carrasco, JM, (Autor de correspondencia); Gómez Baceiredo, Beatriz; Navas, Alejandro; et al.
Revista: PLOS ONE
ISSN 1932-6203  Vol. 14  Nº 1  2019 
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 (, 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.
Autores: Zambrano, S. C., (Autor de correspondencia); Centeno, Carlos; Larkin, P. J.; et al.
ISSN 1096-6218  2019 
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.
Autores: Centeno, Carlos; Sitte, T.; de-Lima, L.; et al.
ISSN 1096-6218  Vol. 21  Nº 10  2018  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.
Autores: Rhee, J.; Garralda, Eduardo; Namisango, E.; et al.
ISSN 0885-3924  Vol. 55  Nº 5  2018  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
Autores: Rhee, J. Y., (Autor de correspondencia); Garralda, Eduardo; Namisango, E.; et al.
ISSN 1096-6218  Vol. 21  Nº 3  2018  págs. 342-353
Autores: Rhee, J. ; Garralda, Eduardo; Centeno, Carlos;
ISSN 1134-248X  Vol. 25  Nº 3  2018  págs. 119 - 120
Autores: Rhee, J. Y.; Garralda, Eduardo; Namisango, E.; et al.
ISSN 0885-3924  Vol. 56  Nº 2  2018  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.
Autores: Noguera, Antonio Luís; Bolognesi, D.; Garralda, Eduardo; et al.
ISSN 1096-6218  Vol. 21  Nº 11  2018  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.
Autores: Bush, S. H. , (Autor de correspondencia); Lawlor, P. G.; Ryan, K. ; et al.
ISSN 0923-7534  Vol. 29  2018  págs. 143 - 165
Autores: Centeno, Carlos; Sitte, T.; de Lima, L.; et al.
ISSN 1096-6218  Vol. 21  Nº 10  2018  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.
Autores: Pallotti, M. C. , (Autor de correspondencia); Noguera, Antonio Luís; Rhee, J. Y.; et al.
ISSN 2045-435X  Vol. 8  Nº 3  2018  págs. 356- +
Autores: Rhee, J. Y., (Autor de correspondencia); Foley, K.; Morrison, R. S.; et al.
ISSN 0885-3924  Vol. 55  Nº 5  2018  págs. E2 - E4
Autores: Girbau, M. B., (Autor de correspondencia); Monedero, Pablo; Centeno, Carlos;
ISSN 1137-6627  Vol. 41  Nº 2  2018  págs. 283 - 284
Autores: Rojí, Rocío, (Autor de correspondencia); Centeno, Carlos;
ISSN 1751-4258  Vol. 11  Nº 4  2017  págs. 299 - 305
Purpose of review To review recent evidence on the efficacy and safety of methylphenidate as a symptomatic treatment of patients with cancer-related fatigue (CRF). Recent findings Five clinical trials published since 2011 were identified. Two of these concluded that methylphenidate is more efficacious than placebo in providing relief from CRF, but the remaining three showed no difference in favour of methylphenidate. The studies were heterogeneous as per the dosage, scales used for evaluating fatigue and the target group studied. None of the studies detected serious reactions, and only mild and infrequent side-effects of methylphenidate were reported. Three new metanalyses show the slightly superior effect of methylphenidate compared to placebo in CRF. Summary Overall, literature supports the existence of moderate benefit of methylphenidate in CRF, backed up by weak evidence. Future studies should aim at better identifying the profile of patients who would benefit most from this pharmacological intervention.
Autores: Comoretto, N.; Centeno, Carlos;
ISSN 1096-6218  Vol. 20  Nº 2  2017  págs. 205 - 206
Autores: Centeno, Carlos;
ISSN 1096-6218  Vol. 20  Nº 11  2017  págs. 1180 - 1181
Autores: Rojí, Rocío; Noguera, Antonio Luís, (Autor de correspondencia); Pikabea-Díaz, F.; et al.
ISSN 1096-6218  Vol. 20  Nº 2  2017  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,
Autores: Rhee JY; Garralda, Eduardo; Torrado C; et al.
Vol. 18  Nº 9  2017  págs. e522-e531
Since the last comprehensive review on the development of national palliative care in Africa was undertaken 12 years ago, in 2005, we did a scoping review of peer-reviewed, published articles on palliative care development between 2005-16 for each African country. The scoping review was conducted by assessing the medical literature and including local expert recommendations of suggested articles. We did a basic quality assessment of the articles using the journals' impact factor, journal quartile, and the number of citations as suitable metrics for quality consideration. Articles published in English, Spanish, Portuguese, and French that mentioned at least one dimension of WHO's palliative care public health strategy (implementation of services, education, policies, or medicine availability) and vitality (activity by professionals or advocates) were included. Of the 518 articles found, 49 met the inclusion criteria. Information on 26 (48%) of 54 African countries was found. Most services were concentrated in Kenya, South Africa, and Uganda, and 14 (26%) countries showed an increase in services during this timeframe. Stand-alone palliative care policies exist in Malawi, Mozambique, Rwanda, Swaziland, Tanzania, and Zimbabwe. Postgraduate diplomas in palliative care are available in Kenya, South Africa, Uganda, and Tanzania. Restricted access to opioids, prescriber restriction laws, and a low prevalence of morphine use remain common barriers to adequate palliative care provision
Autores: Nunziata Comoretto ; Larumbe, Ana María; Arantzamendi, María; et al.
ISSN 0969-9260  Vol. 25  Nº 5  2017  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
Autores: Centeno, Carlos; Carole Robinson; Noguera, Antonio Luís, (Autor de correspondencia); et al.
ISSN 1472-6920  Vol. 17  Nº 1  2017  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.
Autores: Girbau MB; Monedero, Pablo; Centeno, Carlos;
ISSN 1137-6627  Vol. 40  Nº 3  2017  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.
Autores: Aparicio, M.; Centeno, Carlos; Carrasco, JM; et al.
ISSN 1472-684X  Vol. 16  Nº 1  2017  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.
Autores: Carrasco, JM; García, M.; Navas, Alejandro; et al.
Revista: PLOS ONE
ISSN 1932-6203  Vol. 12  Nº 10  2017  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: Rullán, M., (Autor de correspondencia); Arantzamendi, María; Carvajal Valcarcel, A; et al.
ISSN 1478-9523  Vol. 16  Nº 1  2017  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.; Garralda, Eduardo; Torrado, C.; et al.
ISSN 1096-6218  Vol. 20  Nº 12  2017  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
Autores: Arantzamendi, María; Centeno, Carlos;
ISSN 1352-2779  Vol. 24  Nº 2  2017  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.
Vol. 16  Nº 1  2017  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.
Autores: Centeno, Carlos; Garralda, Eduardo; Carrasco, JM; et al.
ISSN 1096-6218  Vol. 22  Nº 11  2017  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).
Autores: Salas, Diego; Centeno, Carlos; Rojí, Rocío; et al.
ISSN 1137-6627  Vol. 40  Nº 2  2017  págs. 315 - 317
Autores: Martínez, Marina; Arantzamendi, María; Belar, A.; et al.
ISSN 0269-2163  Vol. 31  Nº 6  2016  págs. 492 - 509
Background: Dignity therapy is psychotherapy to relieve psychological and existential distress in patients at the end of life. Little is known about its effect. Aim: To analyse the outcomes of dignity therapy in patients with advanced life-threatening diseases. Design: Systematic review was conducted. Three authors extracted data of the articles and evaluated quality using Critical Appraisal Skills Programme. Data were synthesized, considering study objectives. Data sources: PubMed, CINAHL, Cochrane Library and PsycINFO. The years searched were 2002 (year of dignity therapy development) to January 2016. `Dignity therapy¿ was used as search term. Studies with patients with advanced life-threatening diseases were included. Results: Of 121 studies, 28 were included. Quality of studies is high. Results were grouped into effectiveness, satisfaction, suitability and feasibility, and adaptability to different diseases and cultures. Two of five randomized control trials applied dignity therapy to patients with high levels of baseline psychological distress. One showed statistically significant decrease on patients¿ anxiety and depression scores over time. The other showed statistical decrease on anxiety scores pre¿post dignity therapy, not on depression. Nonrandomized studies suggested statistically significant improvements in existential and psychosocial measurements. Patients, relatives and professionals perceived it improved end-of-life experience. Conclusion: Evidence suggests that dignity therapy is beneficial. One randomized controlled trial with patients with high levels of psychological distress shows DT efficacy in anxiety and depression scores. Other design studies report beneficial outcomes in terms of end-of-life experience. Further research should understand how dignity therapy functions to establish a means for measuring its impact and assessing whether high level of distress patients can benefit most from this therapy.
Autores: Elsner, F.; Centeno, Carlos; Ellershaw, J. E.;
ISSN 0269-2163  Vol. 30  Nº 9  2016  págs. 805 - 806
Autores: Balaguer, A.; Monforte-Royo, .; Porta-Sales, J.; et al.
Revista: PLOS ONE
ISSN 1932-6203  Vol. 11  Nº 1  2016  págs. e0146184
Autores: Van Beck K; Siouta N; Preston N; et al.
ISSN 1472-684X  Vol. 15  Nº 1  2016  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.
ISSN 1472-684X  Vol. 15  Nº 1  2016  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.
Autores: Siouta N; van Beek K; van der Eerden ME; et al.
ISSN 1472-684X  Vol. 15  Nº 1  2016  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.
Autores: Carrasco, JM; Centeno, Carlos;
ISSN 1352-2779  Vol. 23  Nº 1  2016  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.
Autores: Went, R.; Lima, L.d; Mutto, E.; et al.
ISSN 1134-248X  Vol. 23  Nº 1  2016  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
Autores: Comoretto N; Centeno, Carlos;
ISSN 0123-3122  Vol. 20  Nº 1  2016  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.
Autores: Girbau, B.; Monedero, Pablo; Centeno, Carlos;
ISSN 1132-1989  Vol. 27  Nº 90  2016  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: Garralda, Eduardo; Hasselaar, J.; Carrasco, JM; et al.
ISSN 1472-684X  Vol. 15  Nº 1  2016  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.
Autores: Woitha, Kathrin; Garralda, Eduardo; Martín-Moreno, J. M.; et al.
ISSN 0885-3924  Vol. 52  Nº 3  2016  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: Rhee J; Centeno, Carlos;
ISSN 1096-6218  Vol. 19  Nº 6  2016  págs. 589 - 590
Autores: Aldridge, Melissa; Hasselaar, Jeroen; Garralda, Eduardo; et al.
ISSN 0269-2163  Vol. 30  Nº 2  2015  págs. 224-39
We describe the key policy and educational opportunities in the United States to address and potentially overcome the barriers to greater integration of palliative care into the healthcare of Americans with serious illness.
Autores: Rullan; Carvajal Valcarcel, A; Núñez, Jorge María; et al.
ISSN 0885-3924  Vol. 50  Nº 6  2015  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.
Autores: Centeno, Carlos; Rodríguez-Núñez, A.;
ISSN 1751-4258  Vol. 9  Nº 4  2015  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.
Autores: Centeno, Carlos; Bolognesi, D.; Biasco, G.;
ISSN 0885-3924  Vol. 49  Nº 5  2015  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.
Autores: Centeno, Carlos; Lynch T.; Garralda, Eduardo; et al.
ISSN 0269-2163  Vol. 30  Nº 4  2015  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.
Autores: Clark. D.; Graham, F; Centeno, Carlos;
ISSN 0304-5412  Vol. 43  Nº 12  2015  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.
Autores: López Saca, M.; Centeno, Carlos;
Vol. 15  Nº 22  2015  págs. 288-291
Autores: Carrasco, JM; Lynch, T. J.; Garralda, Eduardo; et al.
ISSN 0885-3924  Vol. 50  Nº 4  2015  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.
Autores: Woitha, Kathrin; Carrasco, JM; Clark, D.; et al.
ISSN 1101-1262  Vol. 26  Nº 2  2015  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.
Autores: Pastrana, T.; Centeno, Carlos; De Lima, L.;
ISSN 1096-6218  Vol. 18  Nº 5  2015  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.
Autores: Bolognesi, D.; Centeno, Carlos; Biasco, G.;
ISSN 0825-8597  Vol. 31  Nº 1  2015  págs. 63-4
Autores: Centeno, Carlos;
ISSN 0269-2163  Vol. 28  Nº 2  2014  págs. 99-100
Autores: Centeno, Carlos; Bolognesi, Deborah; Garralda, Eduardo; et al.
ISSN 1352-2779  Vol. 21  Nº 6  2014  págs. 306-308
Autores: Centeno, Carlos;
ISSN 1751-4258  Vol. 8  Nº 4  2014  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.
Autores: Elsner, Frank; Mason, Stephen; Blumhuber, Heidi; et al.
ISSN 1352-2779  Vol. 21  Nº 4  2014  págs. 193-195
Autores: Sanz, Álvaro; Zudaire, Maku; Morejón, Begoña; et al.
ISSN 1134-248X  Vol. 21  Nº 2  2014  págs. 79-88
Autores: Ballesteros M.; Centeno, Carlos; Arantzamendi, María;
ISSN 0260-6917  Vol. 34  Nº 6  2014  págs. e1-6
Autores: Vaquero-Cruzado, Jesús Antonio; Centeno, Carlos;
ISSN 1134-248X  Vol. 21  Nº 1  2014  págs. 3-8
Autores: Najum, M.; Centeno, Carlos;
ISSN 1352-2779  Vol. 21  Nº 4  2014  págs. 166-169
Autores: Noguera, Antonio Luís, (Autor de correspondencia); Carvajal Valcarcel, A; Alonso-Babarro, A.; et al.
ISSN 0885-3924  Vol. 47  Nº 1  2014  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
Autores: Centeno, Carlos; Ballesteros, M.; Carrasco, JM; et al.
ISSN 2045-435X  Vol. 6  Nº 1  2014  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.
Autores: López Guzmán, José; Centeno, Carlos;
ISSN 1751-4258  Vol. 7  Nº 4  2013  págs. 424 - 430
PURPOSE OF REVIEW: Many health professionals still believe that opioids shorten the lifespan of patients. This situation implies that the ethical doctrine of double effect is often invoked to justify their use in extreme circumstances. The objective of this study is to revise the evidence existing in the recently published literature regarding the effect on patient survival of opioid used to control disease symptoms. RECENT FINDINGS: A review of the scientific literature regarding the effects of opioids on symptom control and survival does not provide any evidence that there is an association between these two variables. SUMMARY: The studies revised have not shown that the use of opioids for symptom control in advanced disease stages or in the last days of life has any effect on patient survival. Similarly, survival was not influenced by either the use of higher or lower doses of opioids, or by the practice of administering a double dose at night.
Autores: Carvajal Valcarcel, A; Martínez, Marina; Centeno, Carlos;
ISSN 1134-248X  Vol. 20  Nº 4  2013  págs. 143-149
El ESAS puede considerarse como un instrumento de referencia para la evaluación sintomática de los pacientes con cáncer avanzado en espa¿nol.
Autores: Alonso Babarro, A.; Astray Mochales,J.; Domínguez-Berjón, F; et al.
ISSN 0269-2163  Vol. 27  Nº 1  2013  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.
Autores: Pastrana T; Eisenchlas J.; Centeno, Carlos; et al.
ISSN 1751-4258  Vol. 7  Nº 4  2013  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.
Autores: Centeno, Carlos;
ISSN 1751-4258  Vol. 7  Nº 4  2013  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.
Autores: Carvajal Valcarcel, A; Hribernik, N.; Duarte, E.; et al.
ISSN 0885-3924  Vol. 45  Nº 1  2013  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: Centeno, Carlos; Zuriarrain Y.; et al.
ISSN 0885-3924  Vol. 46  Nº 5  2013  págs. e1-3
Autores: Vaquero-Cruzado, Jesús Antonio; Larumbe, Ana María; et al.
ISSN 0885-3924  Vol. 45  Nº 5  2013  págs. e7-8
Autores: Sanz-Rubiales A.; Centeno, Carlos;
ISSN 1137-6627  Vol. 36  Nº 3  2013  págs. 543-544
Autores: Carvajal Valcarcel, A; Martínez, Marina; Centeno, Carlos;
Revista: European Journal of Palliative Care
ISSN 1352-2779  Vol. 19  Nº 2  2012  págs. 77 - 81
The Edmonton Symptom Assessment System (ESAS) is one of the most widely used instruments in the assessment of palliative care and advanced cancer patients. It has been used internationally in clinical practice and research.
Autores: Centeno, Carlos; Sanz Rubiales, A; Cuervo, M.A.; et al.
Revista: BMJ Supportive & Palliative Care
ISSN 2045-435X  Vol. 2  Nº 4  2012  págs. 328-333
Compared with the placebo, methylphenidate demonstrated a positive trend in the incidence of response for depressive symptoms in advanced cancer patients
Autores: Larumbe, Ana María; et al.
Revista: Medicina Paliativa
ISSN 1134-248X  Vol. 19  Nº 3  2012  págs. 125 - 126
Autores: Lynch, T.; Centeno, Carlos; Rocafort Gil, J.; et al.
Revista: European Journal of Palliative Care
ISSN 1352-2779  Vol. 19  Nº 5  2012  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).
Autores: De Santiago, Ana; et al.
ISSN 0941-4355  Vol. 20  Nº 9  2012  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..
Autores: López-Picazo, José María; Larumbe, Ana María; et al.
ISSN 0941-4355  Vol. 21  Nº 2  2012  págs.  649-652
Autores: Sanz Rubiales, A; Martínez, Marina; et al.
Revista: Anales del Sistema Sanitario de Navarra
ISSN 1137-6627  Vol. 34  Nº 3  2011  págs. 471 - 479
Autores: Sanz, Alvaro; Centeno, Carlos;
ISSN 1751-4258  Vol. 5  Nº 2  2011  págs. 164 -168
Autores: Centeno, Carlos; Sanz Rubiales, A;
Revista: Medicina Paliativa
ISSN 1134-248X  Vol. 18  Nº 4  2011  págs. 149 - 156
Autores: Carvajal Valcarcel, A; Centeno, Carlos; Watson, Roger; et al.
Revista: Anales del Sistema Sanitario de Navarra
ISSN 1137-6627  Vol. 34  Nº 1  2011  págs. 63-72
Autores: Centeno, Carlos; Hribernik, N.;
ISSN 1844-7058  Vol. 4  Nº 2  2011  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.
Autores: Carvajal Valcarcel, A; Centeno, Carlos; Watson, R.; et al.
Revista: European Journal of Cancer
ISSN 0959-8049  Vol. 47  Nº 12  2011  págs. 1863 -1872
Conclusion ESAS is a valid, reliable, responsive and feasible instrument with adequate psychometric properties when tested on Spanish advanced cancer patients..
Autores: Galrica, I; Centeno, Carlos; Aparicio, M.C.; et al.
Revista: Patient Care, Ed. Portuguesa
ISSN 0873-2167  Nº 1  2011  págs. 46 - 51
Autores: Centeno, Carlos; Carvajal Valcarcel, A; et al.
Revista: Journal of Palliative Medicine
ISSN 1096-6218  Vol. 14  Nº 1  2011  págs. 4 - 5
Autores: Urdíroz, María Juliana; et al.
Revista: Medicina Paliativa
ISSN 1134-248X  Vol. 18  Nº 4  2011  págs. 127 - 128
Autores: Elsner, Frank; Centeno, Carlos; De Conno, Franco; et al.
Revista: Medicina Paliativa
ISSN 1134-248X  Vol. 17  Nº 2  2010  págs. 103 - 118
Autores: Urdíroz, María Juliana; Centeno, Carlos;
Revista: Anales del Sistema Sanitario de Navarra
ISSN 1137-6627  Vol. 33  Nº 3  2010  págs. 319 - 322
Autores: Lynch, T.; Clark, D; Centeno, Carlos; et al.
Revista: Palliative Medicine
ISSN 0269-2163  Vol. 24  Nº 8  2010  págs. 812 - 819
Autores: Centeno, Carlos; Arantzamendi, María; Rodríguez, Belén; et al.
ISSN 0825-8597  Vol. 3  Nº 26  2010  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.
Autores: Noguera, Antonio Luís, (Autor de correspondencia); Centeno, Carlos; Librada, S.; et al.
ISSN 0941-4355  Vol. 18  Nº 11  2010  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.
Autores: Larumbe, Ana María; Chopitea, Ana; et al.
Revista: Anales del Sistema Sanitario de Navarra
ISSN 1137-6627  Vol. 33  Nº 3  2010  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.
Autores: Centeno, Carlos; Garralda, Eduardo;
Libro:  Integrated palliative care
2016  págs. 9 - 12
Autores: Centeno, Carlos; Carrasco, JM; Woitha, Kathrin; et al.
Libro:  Palliative care for older people. A public health perspective
2015  págs. 76 - 85
Autores: Centeno, Carlos;
Libro:  Dehumanization and depersonalization in medicine and society
2014  págs. 251-265
Autores: Centeno, Carlos;
Libro:  Care professions and globalizations: theoretical and practical perspectives
2014  págs. 243-262
Autores: Clark D.; Centeno, Carlos;
Libro:  Safe Passage : a global spiritual sourcebook for care at the end of life
2014  págs. 36-70
Autores: Centeno, Carlos;
Título: Introducción
Libro:  El sentido de vivir en el morir
2013  págs. 8-10
Autores: Centeno, Carlos; Martínez, Marina;
Libro:  Comunicación de la salud: una aproximación multidisciplinar
2011  págs. 165-184
Autores: Arias-Casais, N.; Garralda, Eduardo; Rhee, J. Y.; et al.
Autores: Arias-Casais, N.; Garralda, Eduardo; López-Fidalgo, J.; et al.
List of national-level palliative care indicators providing a specific, evidence-based starting point on the development of palliative care, adding evidence to existence studies and allowing for replication. Furthermore, this allows for assessing national level progress and conducting comparative analysis and prospective studies. Tracking the indicators across time offers the opportunity to pool data data in a same repository that could be prospectively evaluated, allowing for trends in palliative care development at the international level.
Autores: Arias Casais, N.; Garralda, Eduardo; Rhee, J. Y.; et al.
Autores: Osman, H.; Rihan, A.; Garralda, Eduardo; et al.
This book aims to fill the gap in knowledge on the status of palliative care development in the Eastern Mediterranean region. It presents the most relevant information on palliative care development in a way that is clear, accessible, and easy to interpret for professionals, policymakers, and the general public. We explore the existence and availability of specialized palliative care services; the existence of a licensing process for physicians in the form of a specialty or sub-specialty; and the existence of educational initiatives within the field of palliative care in medical schools, nursing schools, or other settings. We also document the number of professors engaged in teaching palliative care in various disciplines; the existence of a policy umbrella insuring the proper implementation of palliative care services, such as a national law on palliative care, a national palliative care plan or strategy, or a concrete reference to palliative care in a national cancer control program; the existence of funding and coverage for palliative care; and the presence of evidence-based documents such as guidelines, recommendations, or clinical pathways. Data on the availability of strong opioids, as well as general data on consumption of opioids expressed in morphine equivalence are presented. Finally, existence of national palliative care organizations, and of individuals or larger groups devoted to research in palliative care are listed, as these are indications of vitality in the
Autores: Rhee, J. Y.; Luyirika, E.; Namisango, E.; et al.
The current APCA Atlas provides the most up-to-date information of palliative care development in nearly all countries in Africa, using indicators derived, rated, and chosen by in-country African experts followed by a thorough Delphi consensus process with a panel of international experts on palliative care indicators. Therefore, the current APCA Atlas also provides an up-to-date base of indicators specific to the African context, chosen by African experts. The Atlas offers a panoramic view utilising the World Health Organization¿s (WHO) palliative care public health strategy dimensions and palliative care professional activity (vitality) through a combination of methods including data collection from national experts in the field and peer-reviewed literature, ensuring data quality. These results provide the most comprehensive and reliable information on palliative care development, to date.
Autores: Bologensi D; Centeno, Carlos; Biasco G;
Bolognesi D, Centeno C, Biasco G. Specialisation in Palliative Medicine for Physicians in Europe 2014. A supplement of the EAPC Atlas of Palliative Care in Europe. Milan: EAPC Press; 2014. This booklet describes the existing programmes on specialisation in palliative medicine within the WHO European region.
Autores: Centeno, Carlos; Pons, Juan José; Lynch, T.; et al.
Autores: Centeno, Carlos; Lynch, T.; Donea, O.; et al.
Autores: Pastrana, T.; De Lima, L.; Pons, Juan José; et al.
Autores: Pastrana Urueña, T.; De Lima, L.; Wenk, R.; et al.
Autores: Centeno, Carlos, (Corrector); Centeno Cortes, B., (Traductor)
Autores: Saunders, C; Benito, E., (Coordinador); Centeno, Carlos, (Coordinador)
Autores: López Almazán, Carmen, (Coordinador); Zafra Galán, Eduardo, (Coordinador); Cuevas Cuerda, Mª Dolores, (Coordinador); et al.