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Macedo JC, Rego F, Nunes R. Perceptions, Attitudes, and Knowledge toward Advance Directives: A Scoping Review. Healthcare (Basel) 2023; 11:2755. [PMID: 37893829 PMCID: PMC10606563 DOI: 10.3390/healthcare11202755] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 10/10/2023] [Accepted: 10/16/2023] [Indexed: 10/29/2023] Open
Abstract
(1) Background: Advance directives are an expression of a person's autonomy regarding end-of-life care. Several studies have shown that the level of completion in countries where advance directives are legalised is low. To better understand this phenomenon, it is important to know the perceptions, attitudes, and knowledge that the population has about this instrument. The aim of this article was to explore a population's perceptions and/or attitudes and/or knowledge toward advance directives. (2) Methods: A search was conducted in March 2023 in the ISI Web of Knowledge, Scopus, and PubMed databases using the following keywords: "advance care directives", "advance care planning", "perceptions", "attitudes", and "knowledge". Two hundred and twenty-four (224) articles were identified, and thirteen (13) were included for analysis. (3) Results: The selected articles point to a low level of knowledge toward advance directives: they recognise a strong positive attitude of the population toward the implementation of advance directives but a low level of achievement. (4) Conclusions: Studies on perceptions/attitudes/knowledge toward advance directives are important to understand the real needs of the population regarding this issue and to implement more adequate and effective promotion and dissemination measures.
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Affiliation(s)
- João Carlos Macedo
- Nursing School, University of Minho, Campus de Gualtar, 4710-057 Braga, Portugal
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Av. Bissaya Barreto, 3046-851 Coimbra, Portugal
- Research Centre for Justice and Governance (JusGov), School of Law, University of Minho, Campus de Gualtar, 4710-057 Braga, Portugal
| | - Francisca Rego
- Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal;
| | - Rui Nunes
- Center of Bioethics, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal;
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Díaz de Argote-Cervera P, Puerta-Carretero M, Bernabé-Villena M, Herrera-Martín E, Vinagre-Rea G, Martínez-González M. Análisis del grado de conocimiento e interés de los profesionales sanitarios de nefrología sobre la planificación anticipada de la asistencia sanitaria. ENFERMERÍA NEFROLÓGICA 2022. [DOI: 10.37551/52254-28842022027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
a tener que tomar decisiones continuamente. En este proceso los profesionales sanitarios no suelen preguntarles cómo querrían planificar el final de sus días. En una sociedad donde la “no limitación al esfuerzo terapéutico” parece una constante en nuestra práctica, el reflexionar sobre nuestros propios límites podría ayudarnos en la atención a los pacientes.Objetivo: Conocer el grado de conocimiento e interés por la Planificación Anticipada de la Asistencia Sanitaria (PAAS) en profesionales que atienden a pacientes con Enfermedad Renal Crónica.Material y Método: Estudio observacional descriptivo transversal mediante cuestionario autoadministrado a sanitarios participantes voluntarios a nivel nacional. El cuestionario incluía 22 preguntas sobre conocimiento e interés sobre la planificación anticipada de la asistencia sanitaria.Resultados: Respondieron 422 profesionales: 53,3% médicos; 45,0% enfermeras y 1,4% técnicos en cuidados auxiliares de enfermería. El 79,9% no conocen cuantos pacientes tienen registrado el Documento de Voluntades Anticipadas. El 63,5% han oído hablar de la Planificación Anticipada de la Asistencia Sanitaria. Un 28,7% conoce la diferencia entre la Planificación Anticipada de la Asistencia Sanitaria y el Documento de Voluntades Anticipadas. Un 96,2% afirma que tener esta información ayudaría a los pacientes a que estuvieran mejor atendidos en sus últimos días. El 97,6% de los profesionales piensan que está en nuestra mano hacer algo más, a un 94,5% les gustaría recibir formación.Conclusión: Existe falta de conocimiento y un gran interés por los profesionales sanitarios sobre la Planificación Anticipada de la Asistencia Sanitaria.
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Puente-Fernández D, Olivencia Peña P, Soto-Felipe C, Montoya-Juárez R, Roldán C, García-Caro MP. Quality of dying among elderly people diagnosed with dementia in nursing homes: A mixed methods study. J Psychiatr Ment Health Nurs 2022; 30:435-450. [PMID: 36066569 DOI: 10.1111/jpm.12871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 07/20/2022] [Accepted: 08/17/2022] [Indexed: 11/27/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT Nurses working at nursing homes can play a pivotal role in mental health as a high proportion of residents diagnosed with dementia are in these facilities. Many institutionalized residents diagnosed with dementia develop clinical complications and symptoms that reduce the quality of dying. A mixed-methods approach can help nurses with the difficult task of assessing the quality of dying among these residents and identify inconsistencies that cannot be found using scales alone, but no studies were found in this topic. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE Through the Quality of dying in Long-Term Care Scale (QoD-LTC), nurses described symptom management, quality of care, and end-of-life appearance as adequate and end-of-life communication as lacking. Generally speaking, the scores on the scale were consistent with the data from semi-structured interviews conducted with nurses. In the semi-structured interviews, some of the concepts on the scale, including 'dignity', 'holistic' care, 'good relationships with healthcare professionals', and 'a peaceful death', are complex and not fully incorporated into nurses' practice in nursing homes when assessing residents diagnosed with dementia. This could be improved by using the SENSES Model or person-centred care frameworks. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: There is evidence of shortcomings among professionals in the correct use of concepts linked to psychological wellbeing, communication, therapeutic relationship, safety and participation, preservation of dignity, decision-making, and resident autonomy, which can be addressed using specific theoretical approaches developed in the field of mental health nursing. ABSTRACT Introduction The complex nature of end-of-life assessment of individuals diagnosed with dementia would benefit from a mixed-methods approach that simultaneously assess the perception and response of nurses to standardized tools. Aim/Question To examine nursing professionals' perceptions of the quality of dying among residents diagnosed with dementia using the Quality of Dying in Long-Term Care settings (QoD-LTC) questionnaire and to identify consistencies and inconsistencies in their narratives. Method Mixed-methods study using concurrent triangulation with data integration for results and interpretation. Nurses from eight nursing homes assessed 117 residents diagnosed with dementia who died in the previous 3 months using the QoD-LTC scale. After informed consent was obtained (nurses/caregivers), 17 semi-structured scale-based interviews were conducted. Results Symptom management, quality of care, and end-of-life appearance were found to be adequate, while end-of-life communication was deemed insufficient. The qualitative and quantitative data were consistent for most of the items on the QoD-LTC. Discussion Concepts such as dignity, holistic care, good relationships, and peaceful death are complex and not fully incorporated into professional practice. Implications for Practice The results highlight the need for greater involvement of mental health nurses as well as improved communication, training, and specific tools tailored to residents diagnosed with dementia.
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Affiliation(s)
- Daniel Puente-Fernández
- Programa de doctorado en Medicina clínica y salud Pública, University of Granada, Granada, Spain.,Department of Nursing, University of Jaén, Jaén, Spain
| | | | | | - Rafael Montoya-Juárez
- Department of Nursing, Faculty of Health Sciences, University of Granada, Granada, Spain.,Instituto de Investigación Biosanitaria de Granada - IBS Granada, Granada, Spain.,Mind, Brain and Behaviour Research Centre (CIMCYC), University of Granada, Granada, Spain
| | - Concepción Roldán
- Department of Statistics and Operational Research, University of Granada, Granada, Spain
| | - María Paz García-Caro
- Department of Nursing, Faculty of Health Sciences, University of Granada, Granada, Spain.,Instituto de Investigación Biosanitaria de Granada - IBS Granada, Granada, Spain.,Mind, Brain and Behaviour Research Centre (CIMCYC), University of Granada, Granada, Spain
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Chaverra Castellar MI, Osorio Castaño JH. Voluntades anticipadas como referente ético de conocimiento en los enfermeros que laboran en servicios de oncología. REVISTA LATINOAMERICANA DE BIOÉTICA 2022. [DOI: 10.18359/rlbi.5694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
El propósito del presente artículo es identificar los conocimientos sobre la Voluntad Anticipada (VA) en enfermeros que laboran en servicios de oncología. Para ello, se utilizó como metodología un estudio observacional con intención analítica que midió el nivel de conocimiento a través de un cuestionario autodiligenciado. En él participaron 50 enfermeros, seleccionados por muestreo no probabilístico. Así, se analizaron las variables cualitativas con distribuciones de frecuencia, y las cuantitativas con estadística descriptiva y análisis bivariado. El nivel de conocimiento se categorizó así: 0 a 10 puntos (nivel bajo), 11 a 20 puntos (nivel medio), 21 a 30 puntos (nivel alto). Los resultados de la investigación arrojaron como dato que, para un grupo donde el 86 % eran mujeres, con promedio de edad de 37 años, el promedio de años de experiencia como enfermeros fue de 11.5 años. Por otra parte, el promedio de años de experiencia en el área de oncología fue de 6.2 años. De los que hacían parte de este último promedio, el 48 % tenían diplomado en oncología y el 46 % especialización. El 70 % de los participantes tenía un conocimiento medio, el 26 % un conocimiento alto, y el 4 %un nivel bajo. Cabe mencionar que solo el nivel de formación de postgrado se relacionó de manera significativa con el nivel de conocimientos. Como conclusión, se encontró que los profesionales en enfermería poseen un nivel de conocimiento medio sobre la legislación que aborda las voluntades anticipadas en Colombia y esto está relacionado con el nivel de formación.
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Martínez Ques ÁA, Braña Marcos B, Martín Arribas C, Vázquez Campo M, Rumbo Prieto JM, López Castro J, Herrero Olivera L, Gómez Salgado J. [Design and validation of an instrument about quality of the advance care planning for professionals]. GACETA SANITARIA 2022; 36:401-408. [PMID: 34991901 DOI: 10.1016/j.gaceta.2021.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 11/10/2021] [Accepted: 11/10/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To develop a questionnaire aimed to measure the quality of the advance care planning process in healthcare professionals and to assess its psychometric quality. METHOD Instrumental questionnaire validation study. SCOPE primary care centers and outpatients clinics from general hospitals in Ferrol, Ourense, Monforte-Lugo and Health Area V of the Health Service of Asturias. PARTICIPANTS physicians and nurses. Phases: (1) design of the first version of the questionnaire using the Delphi technique; (2) construction of the second version of 21 items, after judges' agreement and Kendall's W test; (3) pilot study: internal consistency using Cronbach's alpha and omega coefficient, retest-test by Pearson's correlation coefficient; (4) validation: Barlett's spherity test and Kaiser-Meyer-Olkin measurement, exploratory factor analysis with varimax rotation and study of the dimensions of the questionnaire (number, CCI and correlation), internal consistency using Cronbach's alpha. RESULTS Pilot study with 28 professionals. Reliability ɷ=0.917, α=0.841, and test-retest correlation coefficient of 0.785 (95% confidence interval: 0.587-0.894; p<0.001). Validation of the questionnaire (21 items) in 204 professionals. Ítem analysis and exploratory factor analysis (Barlett's test [χ2=1298,789] and KMO=0.808; p<0.001) yielded a five-factor model explaining 64.377% of the total variance, with 18 items grouped into 5 dimensions (information, preferences, behavioral intention, training and communication). Cronbach's alpha of the global questionnaire was 0.841. CONCLUSIONS The ProPAD-pro questionnaire has showed to be a valid and reliable instrument to assess the quality of the advance care planning process.
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Affiliation(s)
- Ángel Alfredo Martínez Ques
- Área Sanitaria de Orense, Verín y Barco de Valdeorras, Servicio Gallego de Salud (Sergas), Orense, España; Instituto de Investigación Sanitaria Galicia Sur (IIS Galicia Sur), Vigo, España
| | - Beatriz Braña Marcos
- Área Sanitaria V, Servicio de Salud del Principado de Asturias (SESPA), Gijón, España; Dirección General de Cuidados, Humanización y Atención Sociosanitaria, Consejería de Salud del Principado de Asturias, Oviedo, España; Grupo de Determinantes de la Salud y Profesión Enfermera, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, España.
| | | | - Miriam Vázquez Campo
- Área Sanitaria de Ourense, Verín y Barco de Valdeorras, Servicio Gallego de Salud (Sergas), Orense, España
| | - José María Rumbo Prieto
- Unidad de Docencia e Investigación, Área Sanitaria de Ferrol, Servicio Gallego de Salud (Sergas), Ferrol, España
| | - José López Castro
- Servicio de Medicina Interna, Área Sanitaria de Lugo, Cervo y Monforte de Lemos (Sergas), Lugo, España
| | - Laura Herrero Olivera
- Facultad de Filosofía, Universidad Nacional de Educación a Distancia, Madrid, España
| | - Juan Gómez Salgado
- Área de Medicina Preventiva y Salud Pública, Departamento de Sociología, Trabajo Social y Salud Pública. Facultad de Ciencias del Trabajo. Universidad de Huelva, Huelva, España; Programa de Posgrado de Seguridad y Salud, Universidad Espíritu Santo, Guayaquil, Ecuador
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Zuniga-Villanueva G, Ramos-Guerrero JA, Osio-Saldaña M, Casas JA, Marston J, Okhuysen-Cawley R. Quality Indicators in Pediatric Palliative Care: Considerations for Latin America. CHILDREN (BASEL, SWITZERLAND) 2021; 8:250. [PMID: 33806896 PMCID: PMC8004984 DOI: 10.3390/children8030250] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 03/15/2021] [Accepted: 03/16/2021] [Indexed: 11/16/2022]
Abstract
Pediatric palliative care is a growing field in which the currently available resources are still insufficient to meet the palliative care needs of children worldwide. Specifically, in Latin America, pediatric palliative care services have emerged unevenly and are still considered underdeveloped when compared to other regions of the world. A crucial step in developing pediatric palliative care (PPC) programs is delineating quality indicators; however, no consensus has been reached on the outcomes or how to measure the impact of PPC. Additionally, Latin America has unique sociocultural characteristics that impact the perception, acceptance, enrollment and implementation of palliative care services. To date, no defined set of quality indicators has been proposed for the region. This article explores the limitations of current available quality indicators and describes the Latin American context and how it affects PPC development. This information can help guide the creation of standards of care and quality indicators that meet local PPC needs while considering the sociocultural landscape of Latin America and its population.
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Affiliation(s)
- Gregorio Zuniga-Villanueva
- Department of Pediatrics, Tecnologico de Monterrey, Monterrey 64849, Mexico
- Division of Pediatric Palliative Medicine, McMaster University, Hamilton, ON L8N 3Z5, Canada
| | | | - Monica Osio-Saldaña
- Department of Global Studies, Universidad Nacional Autonoma de Mexico, Mexico City 04510, Mexico;
| | - Jessica A. Casas
- Department of Pediatric Palliative Care, Texas Children’s Hospital, Houston, TX 77030, USA; (J.A.C.); (R.O.-C.)
| | - Joan Marston
- Global Ambassador, International Children’s Palliative Care Network, Assagay 3624, South Africa;
| | - Regina Okhuysen-Cawley
- Department of Pediatric Palliative Care, Texas Children’s Hospital, Houston, TX 77030, USA; (J.A.C.); (R.O.-C.)
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Herreros B, Benito M, Gella P, Valenti E, Sánchez B, Velasco T. Why have Advance Directives failed in Spain? BMC Med Ethics 2020; 21:113. [PMID: 33198746 PMCID: PMC7667789 DOI: 10.1186/s12910-020-00557-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 10/29/2020] [Indexed: 11/25/2022] Open
Abstract
Background In Spain, there has been great effort by lawmakers to put Advance Directives (ADs) into practice since 2002. At the same time, the field of bioethics has been on the rise, a discipline that has spurred debate on the right of patients to exercise their autonomy. Despite all this, the implementation of ADs can be said to have failed in Spain, because its prevalence is very low, there is a great lack of knowledge about them and they have very little impact on clinical decisions. The purpose of this article is to analyze and discuss the main reasons for the failure of ADs in Spain. Main body The main reasons why ADs have no impact on clinical practice in Spain have been fundamentally four: (1) the training of health professionals about the end of life and AD is lacking; (2) there has been no public process to increase awareness about AD, and therefore people (with the exception of specific highly sensitized groups) know little about them; (3) the bureaucratic procedure to document and implement ADs is excessively complex and cumbersome, creating a significant barrier to their application; (4) in Spain, the remnants of a paternalistic medical culture continue to exist, which causes shared decision-making to be difficult. Conclusion Due to the four reasons mentioned above, AD have not been a useful tool to help honor patients’ autonomous decisions about their future care and, therefore, they have not achieved their objective. However, despite the difficulties and problems identified, it has also been observed that health care professionals and the Spanish public have a very positive view of AD. Having identified the problems which have kept AD from being successful, strategies must be developed to help improve their implementation into the future.
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Affiliation(s)
- Benjamín Herreros
- Instituto de Ética Clínica Francisco Vallés, Universidad Europea de Madrid, Madrid, Spain. .,Unidad de Medicina Interna, Hospital Universitario Fundación Alcorcón, Calle Budapest 1, 28922, Alcorcón, Madrid, Spain.
| | - María Benito
- Legal Medicine, Psychiatry and Pathology Department, Universidad Complutense , Plaza de Ramón y Cajal, s/n, 28040, Madrid, Spain
| | - Pablo Gella
- Instituto de Ética Clínica Francisco Vallés, Universidad Europea, Plaza de Francisco Morano, s/n, 28005, Madrid, Spain
| | - Emanuele Valenti
- Centre for Ethics in Medicine, Bristol Medical School, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Beatriz Sánchez
- Unidad de Medicina Interna, Hospital Universitario Fundación Alcorcón, Calle Budapest 1, 28922, Alcorcón, Madrid, Spain
| | - Tayra Velasco
- Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense, Plaza de Ramón y Cajal, s/n, 28040, Madrid, Spain
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