Nuestros investigadores

Antonio Luís Noguera Tejedor

Medicina Paliativa
Facultad de Medicina. Universidad de Navarra
Servicio de Medicina Paliativa
Clínica Universidad de Navarra. Clínica Universidad de Navarra

Publicaciones científicas más recientes (desde 2010)

Autores: Pergolizzi, D.; Crespo, I.; Balaguer, A.; et al.
Revista: BMJ OPEN
ISSN 2044-6055  Vol. 10  Nº 2  2020  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: Mason, S. R., (Autor de correspondencia); Ling, J. L. ; Stanciulescu, L.; et al.
ISSN 1096-6218  Vol. 23  Nº 12  2020  págs. 1571 - 1585
The World Health Organization recommends that "palliative care should be integrated as a routine element of all Undergraduate Medical Education." However, the provision of training for medical undergraduates is variable; only 18% of 51 European countries have mandatory training in palliative medicine. EDUPALL is an ERASMUS+ funded international collaborative project to develop and pilot an undergraduate program for training in palliative medicine. The objective of this study was to critically review and revise current European Association for Palliative Care (EAPC) Recommendations for the Development of Undergraduate Curricula in Palliative Medicine and translating these into an updated curriculum document. Clinicians, academics, and researchers from Romania, Ireland, Germany, Austria, Spain, and the United Kingdom reviewed the EAPC recommendations using a variant of consensus methodology, Nominal Group Technique. From the updated document, four working-groups translated each recommendation into a specific learning objective, and developed associated learning outcomes, stratified by domain: attitude, cognition, and skills. The outcomes and objectives were organized into discrete teaching units and transferred into a curriculum template, identifying notional hours, teaching, and assessment strategies. To ensure quality control, the draft template was circulated to experts from 17 European countries, together with a brief survey instrument, for peer review purposes. All 17 reviewers returned overwhelmingly positive comments. There was large agreement that: the teaching units were logically organized; learning outcomes covered core training needs; learning objectives provided guidance for teaching sessions; learning modalities were appropriately aligned; and assessment strategies were fit for purpose. An updated and standardized curriculum was developed, which provides a platform for the sequential development of the next phases of the EDUPALL project.
Autores: Pallotti, M. C.; López Fidalgo, Jesús Fernando; Biasco, G.; et al.
ISSN 1096-6218  Vol. 23  Nº 9  2020  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.
Autores: Noguera Tejedor, Antonio Luís; Arantzamendi Solabarrieta, María; López Fidalgo, Jesús Fernando; et al.
ISSN 1660-4601  Vol. 16  Nº 24  2019 
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: Noguera Tejedor, Antonio Luís (Autor de correspondencia); Robledano, R.; Garralda Domezain, Eduardo
ISSN 1751-4258  Vol. 12  Nº 4  2018  págs. 495 - 503
Purpose of review The aim of this review is to understand how palliative care teaching (PCT) as a patient-centered learning model, influences medical undergraduate students' professional development. Recent findings To study PCT medical undergraduate students' learning experiences, we have employed the medical teaching concept, 'hidden curriculum,' as a way of describing attitudes and behavior conveyed implicitly by palliative care educators. Fifteen studies were selected: ten of those studies used a qualitative approach; two are theoretical explanations of the topic explored, one guideline, one review and just one quantitative study, made up the review. Medical undergraduate students reported that after PCT, they felt they had acquired better attitudes for effective integration with the patient, such as empathy or holistic care; ethical principles, such as respect or humanization of their clinical practice; and commitment to an improvement in competences, such as self-awareness or self-esteem. They also reported improved behavior in effective integration with patients, such as communication, caring for patients' families, and when addressing psychosocial, cultural and spiritual aspects; their commitment to improvement in competences, such as dealing with emotions and uncertainty; they learned team work as an effective way to interact within the health system; and to become more reliable, making themselves more available and dedicating enough time to each patient. Summary PCT seems to be an effective way of fostering medical undergraduate students' patient-centered professional development.
Autores: Barahona, E. ; Pinhao, R. ; Galindo, V. ; et al.
ISSN 0885-3924  Vol. 55  Nº 3  2018  págs. 968 - 972
Background. Although Memorial Delirium Assessment Scale (MDAS) is a successful tool for delirium evaluation and monitoring, it is nevertheless important to determine whether cutoff scores vary according to the studied population. The main objective of this study was to evaluate the diagnostic sensitivity of the recently validated Spanish version of the MDAS. The secondary objective was to analyze possible diagnostic differences when used in a hospice or general hospital setting. Methodology. A prospective study was conducted with advanced cancer patients in two settings (hospice and general hospital). A diagnosis of delirium was established according to clinical criteria and the Confusion Assessment Method. Sensitivity (S), specificity (Sp), positive predictive value, and negative predictive value were determined according to the receiver operating characteristics curve. The MDAS values for different centers were studied using nonparametric tests (Mann-Whitney). Results. A total of 67 patients were included, 28 of whom had been diagnosed with delirium (15/40 hospice and 13/27 general hospital). The mean MDAS scores were 13.6 and 5.5 for the delirium and nondelirium groups, respectively. A cutoff score of 7 gave the optimal screening diagnosis balance (S 92.6%, Sp 71.8%, positive predictive value 70.1%, and negative predictive value 93.3%). Diagnoses of anxiety and depression were not related with delirium (P <= 0.44). A diagnosis of dementia was related to delirium (P <= 0.052) but did not influence the diagnostic sensitivity of MDAS (P <= 0.26). No differences were found between hospice and general hospital settings as regards the diagnostic sensitivity of MDAS. Conclusion. A screening cutoff of 7 appears to be optimal for MDAS Spanish version. No differences were found between advanced cancer patients cared for in a hospice or general hospital. However, more research is required to define the MDAS cutoff for patients with advanced cancer and dementia. (C) 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.
Autores: Yennurajalingam, S., (Autor de correspondencia); Rodrigues, L. F.; Shamieh, O. M.; et al.
ISSN 1083-7159  Vol. 23  Nº 4  2018  págs. 501 - 506
Background. There are limited data on illness understanding and perception of cure among advanced cancer patients around the world. The aim of the study was to determine the frequency and factors associated with inaccurate perception of curability among advanced cancer patients receiving palliative care across the globe. Materials and Methods. Secondary analysis of a study to understand the core concepts in end-of-life care among advanced cancer patients receiving palliative care from 11 countries across the world. Advanced cancer patients were surveyed using a Patient Illness Understanding survey and Control Preference Scale. Descriptive statistics and multicovariate logistic regression analysis were performed. Results. Fifty-five percent (763/1,390) of patients receiving palliative care inaccurately reported that their cancer is curable. The median age was 58, 55% were female, 59% were married or had a partner, 48% were Catholic, and 35% were college educated. Sixty-eight percent perceived that the goal of therapy was "to get rid of their cancer", and 47% perceived themselves as "seriously ill". Multicovariate logistic regression analysis shows that accurate perception of curability was associated with female gender (odds ratio [OR] 0.73, p= .027), higher education (OR 0.37, p< .0001), unemployment status (OR 0.69, p= .02), and being from France (OR 0.26, p< .0001) and South Africa (OR 0.52, p= .034);
Autores: Noguera Tejedor, Antonio Luís; Bolognesi, D.; Garralda Domezain, 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: Hjermstad, MJ; Aass, N; Aielli, F; et al.
ISSN 2045-435X  Vol. 8  Nº 4  2018  págs. 456 - 467
Objectives Palliative care (PC) services and patients differ across countries. Data on PC delivery paired with medical and self-reported data are seldom reported. Aims were to describe (1) PC organisation and services in participating centres and (2) characteristics of patients in PC programmes. Methods This was an international prospective multicentre study with a single web-based survey on PC organisation, services and academics and patients¿ self-reported symptoms collected at baseline and monthly thereafter, with concurrent registrations of medical data by healthcare providers. Participants were patients ¿18 enrolled in a PC programme. Results 30 centres in 12 countries participated; 24 hospitals, 4 hospices, 1 nursing home, 1 home-care service. 22 centres (73%) had PC in-house teams and inpatient and outpatient services. 20 centres (67%) had integral chemotherapy/radiotherapy services, and most (28/30) had access to general medical or oncology inpatient units. Physicians or nurses were present 24 hours/7 days in 50% and 60% of centres, respectively. 50 centres (50%) had professorships, and 12 centres (40%) had full- time/part-time research staff. Data were available on 1698 patients: 50% females; median age 66 (range 21¿97); median Karnofsky score 70 (10¿ 100); 1409 patients (83%) had metastatic/ disseminated disease; tiredness and pain in the past 24 hours were most prominent. During follow-up, 1060 patients (62%) died; 450 (44%) <3 months from inclusion and 701 (68%)
Autores: Yennurajalingam, S., (Autor de correspondencia); Rodrigues, L. F.; Shamieh, O. M.; et al.
ISSN 0269-2163  Vol. 32  Nº 4  2018  págs. 870 - 880
Background: Understanding patients' decision control preferences is important in providing quality cancer care. Patients¿ decisional control preference can be either active (patients prefer to make decisions themselves), shared (collaborative between patient, their physician, and/or family), or passive (patients prefer that the decisions are made by either the physician and/or their family). Aim: To determine the frequency and predictors of passive decision control preferences among advanced cancer patients. We also determined the concordance between actual decision-making and decision control preferences and its association with patient satisfaction. Design: In this cross-sectional survey of advanced cancer patients referred to palliative care across 11 countries, we evaluated sociodemographic variables, Control Preference Scale, and satisfaction with the decisions and care. Results: A total of 1490 participants were evaluable. Shared, active, and passive decision control preferences were 33%, 44%, and 23%, respectively. Passive decision control preferences (odds ratio, p value) was more frequent in India (4.34, <0.001), Jordan (3.41, <0.001), and France (3.27, <0.001). Concordance between the actual decision-making and decision control preferences was highest in the United States (k=0.74) and lowest in Brazil (0.34).
Autores: Pallotti, M. C. , (Autor de correspondencia); Noguera Tejedor, Antonio Luís; Rhee, J. Y.; et al.
ISSN 2045-435X  Vol. 8  Nº 3  2018  págs. 356- +
Autores: Rojí Buqueras, María del Rocío; Noguera Tejedor, 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: Centeno Cortés, Carlos; Robinson, Carole; Noguera Tejedor, 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: Salas Benito, Diego; Centeno Cortés, Carlos; Rojí Buqueras, María del Rocío; et al.
ISSN 1137-6627  Vol. 40  Nº 2  2017  págs. 315 - 317
Autores: de la Cruz, M.A.; Noguera Tejedor, Antonio Luís; San Miguel Arregui, María Teresa; et al.
ISSN 1478-9523  Vol. 13  Nº 2  2015  págs. 211-216
Hospice patients at the end of life have a high rate of symptom distress and delirium. The Nu-DESC is not a reliable tool for screening delirium when scoring is conducted by a caregiver. Our study illustrates the need for routine use of assessment tools to improve care.
Autores: Noguera Tejedor, Antonio Luís (Autor de correspondencia); Carvajal Valcárcel, Ana; 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: Noguera Tejedor, Antonio Luís (Autor de correspondencia); Yennurajalingam, S.; Torres-Vigil, I.; et al.
ISSN 0885-3924  Vol. 47  Nº 5  2014  págs. 896-905
The vast majority preferred a shared or active decision-making process and wanted information about their diagnosis and prognosis. Older patients and those who wanted to know their diagnosis seemed to be more satisfied with the way treatment decisions were made.
Autores: Yennurajalingam, S.; Noguera Tejedor, Antonio Luís (Autor de correspondencia); Parsons, H.A.; et al.
ISSN 0269-2163  Vol. 27  Nº 7  2013  págs. 692-698
Most Hispanic family caregivers preferred the patient to make shared decisions. Hispanic Latin American caregivers more frequently preferred patients to assume a passive decisional role. Acculturation did not influence the preferences of Hispanic American caregivers.
Autores: Núñez Olarte, J.M.; Noguera Tejedor, Antonio Luís; Pérez De Lucas, N.; et al.
ISSN 1134-248X  Vol. 19  Nº 2  2012  págs. 48-52
We report the case of a 28 year-old patient with a giant cell sacral bone tumour with pelvic invasion for two years, who maintained an excellent functional status. During this time she was cared for by the Home Care Support Team, with two admissions to a chronic Palliative Care Unit. The patient was admitted to our acute Palliative Care Unit for the management of severe breakthrough pain in the right lower limb with 10/10 intensity, associated to severe toxicity induced by ketamine. The multiple pain crises were not adequately controlled with a combination of methadone, venlafaxine, gabapentin, acetaminophen, antiinflammatory drugs, steroids, diazepam, baclofen and ketamine. After an adequate clinical ¿ radiological identification of the origins of the pain crises, the pain was successfully controlled with a multimodal therapeutic approach. This approach included discontinuation of ketamine, opioid rotation to morphine, titration of baclofen doses, palliative radiotherapy and biphosphonates.
Autores: Duro Martínez, J.C.; de Miguel, C.; López-Morillo, E.; et al.
ISSN 1696-7240  Vol. 9  Nº 2-3  2012  págs. 467-481
Expone las opiniones y valoraciones de los profesionales de cuidados paliativos de la Comunidad de Madrid sobre la atención psicológica que se presta en los dispositivos específicos de cuidados paliativos en dicha Comunidad. Método: Metodología cualitativa utilizando las siguientes técnicas: observación participante, entrevistas abiertas individuales a Responsables de los distintos tipos de dispositivos, entrevistas grupales a Equipos de cada uno de dichos dispositivos y una reunión de grupo con profesionales de Unidades de Media y Larga Estancia de Hospitales Concertados. Resultados: La atención a las necesidades psicológicas se presta por parte de los profesionales de medicina y enfermería, de manera genérica, y por parte de los profesionales de psicología de manera específica. La frontera entre la atención a las necesidades psicológicas y a las necesidades espirituales y/o religiosas no aparece con nitidez. Parte de la complejidad de la atención la encuentran en aspectos relacionales y comunicacionales. La formación psicológica del profesional de Atención Primaria es insuficiente así como lo es también el número de profesionales de la psicología, y de trabajo social, especialmente en la atención domiciliaria. El trabajo sobre el duelo es una de las tareas más propias de los profesionales de la psicología especialmente en los casos en los que hay niños involucrados, siendo los `grupos de duelo¿ uno de los instrumentos más valorados. El síndrome del burnout requiere de at
Autores: Noguera Tejedor, Antonio Luís (Autor de correspondencia); Centeno Cortés, 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.