1
|
Cantero-García M, Llorente M, Gómez-Martínez S, González-Moreno J. Attitudes toward death and burnout syndrome in geriatrics and gerontology healthcare personnel. Rev Esp Geriatr Gerontol 2023; 58:101422. [PMID: 37897943 DOI: 10.1016/j.regg.2023.101422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 09/14/2023] [Accepted: 09/25/2023] [Indexed: 10/30/2023]
Abstract
INTRODUCTION Geriatric and gerontology healthcare workers are associated with a series of psychosocial risks such as death, bereavement and illness, and this implies a significant emotional and work overload, which can lead to negative attitudes toward death. OBJECTIVE The aims of this study were to assess attitudes toward death, the level of burnout and the relationship between geriatrics and gerontology professionals. METHOD A correlational, cross-sectional study was conducted, in which the 42 participants in the sample completed an online questionnaire including the Revised Profile of Attitudes to Death (PAM-R) and the Maslach Burnout Inventory-Human Services Survey (MBI-HSS). RESULTS The results obtained show that the predominant attitude toward death in the sample is that of neutral acceptance, and with regard to burnout syndrome, moderate average levels are found in the dimensions of emotional exhaustion and personal accomplishment, but a low level of depersonalisation. CONCLUSION Healthcare workers with attitudes of greater fear of death or acceptance of escape tend to experience higher levels of emotional exhaustion and depersonalisation, as do those with an attitude of death avoidance, who also have lower personal fulfillment.
Collapse
Affiliation(s)
- María Cantero-García
- Universidad a Distancia de Madrid (UDIMA), Madrid, Spain; Universidad Internacional de Valencia, Área de salud, Spain.
| | | | | | | |
Collapse
|
2
|
Blay C, Martori JC, Limón E, Oller R, Vila L, Gómez-Batiste X. [Find your 1%: prevalence and mortality of a community cohort of people with advanced chronic disease and palliative needs]. Aten Primaria 2019; 51:71-79. [PMID: 29157932 PMCID: PMC6837012 DOI: 10.1016/j.aprim.2017.07.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 07/27/2017] [Accepted: 07/31/2017] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To determine the prevalence and profiles of people with advanced chronic diseases in Primary Care and to analyse the elements related to their mortality in order to orient strategies for improvement in this level of care. DESIGN An observational, analytical and prospective study during 3 years conducted on a cohort of patients with palliative needs. LOCATION Three Primary Care teams of Osona (Catalonia). PARTICIPANTS A total of 251 people identified as advanced patients using a systematic population-based strategy that included the NECPAL tool. MAIN MEASUREMENTS Basic demographic and clinical profile (age, gender, type of residence, health stratification level and main disease); date, place, and cause of eventual deaths. RESULTS 1% of the adult Primary Care population suffer from advanced diseases, of which 56.6% are women, and with a median age of 85 years. Dementia or advanced frailty is observed in 49.3%, and only 13.7% have cancer. Just under one-quarter (24.3%) live in nursing homes. The accumulated mortality at 3 years is 62.1%, with a median survival of 23 months. Factors significantly associated with the likelihood of dying are cancer, female gender, and over-aging. Patients died at their home (47.3%), in an intermediate care hospital (37.2%), or in an acute care hospital (15.5%), depending on certain explanatory factors. CONCLUSIONS The prevalence and characteristics of advanced community-based disease coincide with that reported in the literature. Potentially, Primary Care is the reference level of care for these patients, especially if it incorporates nursing homes as a usual field of practice.
Collapse
Affiliation(s)
- Carles Blay
- Cátedra de Cuidados Paliativos, Universitat de Vic-Universitat Central de Catalunya, España; Institut Català de la Salut, Mataró, España.
| | - Joan Carles Martori
- Departamento de Economía y Empresa, Universitat de Vic-Universitat Central de Catalunya, España
| | - Esther Limón
- Cátedra de Cuidados Paliativos, Universitat de Vic-Universitat Central de Catalunya, España; Institut Català de la Salut, Mataró, España; Sociedad Española Medicina Familiar y Comunitaria. Sociedad Española de Cuidados Paliativos
| | - Ramon Oller
- Departamento de Economía y Empresa, Universitat de Vic-Universitat Central de Catalunya, España
| | - Laura Vila
- Institut Català de la Salut, Mataró, España; Programa de Prevenció i Atenció a la Cronicitat, Departament de Salut, Generalitat de Catalunya, España
| | - Xavier Gómez-Batiste
- Cátedra de Cuidados Paliativos, Universitat de Vic-Universitat Central de Catalunya, España
| |
Collapse
|
3
|
Morir en casa, un alternativa razonable a la hospitalización. Rev Clin Esp 2018; 218:296-297. [DOI: 10.1016/j.rce.2018.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 05/08/2018] [Indexed: 11/20/2022]
|
4
|
Geographical distribution and evolution of deaths in hospitals in Spain, 1996–2015. Rev Clin Esp 2018. [DOI: 10.1016/j.rceng.2018.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
5
|
Dying at home, a reasonable alternative to hospitalization. Rev Clin Esp 2018. [DOI: 10.1016/j.rceng.2018.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
6
|
Jiménez-Puente A, García Alegría J. Geographical distribution and evolution of deaths in hospitals in Spain, 1996-2015. Rev Clin Esp 2018; 218:285-292. [PMID: 29739618 DOI: 10.1016/j.rce.2018.03.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 03/19/2018] [Accepted: 03/20/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND AND OBJECTIVE The location where death occurs varies widely among societies. The aim of this study was to describe the evolution in the hospital mortality rate (HMR) in Spain over the course of 20years and its distribution by province during a more recent period and to explore its relationship with potential explanatory variables. METHODS This was an ecological study. The population mortality rates were obtained from the Natural Population Movement (Movimiento Natural de la Población), and the hospital mortality rates were obtained from the Specialised Care Information System (Sistema de Información en Atención Especializada), which includes information from all hospitals in Spain. We calculated the mortality rates for patients who were not surveyed and the HMR at the national level between 1996 and 2015 and for provinces between 2013 and 2015. The relationship between the provincial distribution of HMR and various demographic, socioeconomic and healthcare variables were analysed through simple and multiple linear regression. RESULTS The HMR in Spain increased from 49% in 1996 to 56% in 2007, having remained stable from 1996 to 2015. The variation among provinces was 40% to 70%. The multivariate analysis showed a higher HMR in the less rural provinces and in those with a larger availability of hospital beds. CONCLUSIONS There is considerable provincial heterogeneity in Spain in terms of the probability of dying in hospital or at home. This result could be partly explained by demographics (percentage of rural population) and the healthcare structure (number of hospital beds per population).
Collapse
Affiliation(s)
- A Jiménez-Puente
- Unidad de Evaluación, Agencia Sanitaria Costa del Sol, Marbella, Málaga, España; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), España.
| | - J García Alegría
- Área de Medicina, Agencia Sanitaria Costa del Sol, Marbella, Málaga, España; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), España
| |
Collapse
|
7
|
Herrera-Tejedor J. [Healthcare preferences of the very elderly: A review]. Rev Esp Geriatr Gerontol 2016; 52:209-215. [PMID: 27751613 DOI: 10.1016/j.regg.2016.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Revised: 07/29/2016] [Accepted: 08/24/2016] [Indexed: 10/20/2022]
Abstract
The preferences of the very elderly are not taken into account in healthcare planning. For this reason, a medical literature review was performed in order to fill the gap in appropriate information on this issue. The majority of them think that they receive good healthcare. They favour building a trusting relationship, with the physician handling their decision-making. They also maximise their quality of life at the expense of quantity, and give great importance to comfort and safety. Most of them express the wish to be cared for and die at home. But when an acute event occurs, they want to be transferred to hospital. More explicit communication must be encouraged between very elderly patients, providers, and families to meet their subjective needs, through on-going discussions, focused on expected outcomes and patient care goals. A healthcare system designed to look after them should be based on individual and flexible care, with coordination between healthcare services. Such a healthcare system could enable a growing number of them to die in their preferred conditions.
Collapse
Affiliation(s)
- Juan Herrera-Tejedor
- Unidad de Geriatría, Hospital Nuestra Señora del Prado, Talavera de la Reina, Toledo, España.
| |
Collapse
|
8
|
Variability in hospital mortality prior to admission in Spanish hospitals. Rev Clin Esp 2013. [DOI: 10.1016/j.rceng.2013.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
9
|
Variabilidad en la mortalidad hospitalaria previa al ingreso en España. Rev Clin Esp 2013; 213:194-9. [DOI: 10.1016/j.rce.2012.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Revised: 10/10/2012] [Accepted: 11/13/2012] [Indexed: 11/21/2022]
|
10
|
Análisis de la evolución de pacientes en probable situación de últimos días en un servicio de Urgencias. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.medipa.2012.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
11
|
Meñaca A, Evans N, Andrew EV, Toscani F, Finetti S, Gómez-Batiste X, Higginson IJ, Harding R, Pool R, Gysels M. End-of-life care across Southern Europe: A critical review of cultural similarities and differences between Italy, Spain and Portugal. Crit Rev Oncol Hematol 2012; 82:387-401. [DOI: 10.1016/j.critrevonc.2011.06.002] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2011] [Revised: 05/27/2011] [Accepted: 06/09/2011] [Indexed: 12/14/2022] Open
|
12
|
Gysels M, Evans N, Meñaca A, Andrew E, Toscani F, Finetti S, Pasman HR, Higginson I, Harding R, Pool R. Culture and end of life care: a scoping exercise in seven European countries. PLoS One 2012; 7:e34188. [PMID: 22509278 PMCID: PMC3317929 DOI: 10.1371/journal.pone.0034188] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2011] [Accepted: 02/28/2012] [Indexed: 11/18/2022] Open
Abstract
AIM Culture is becoming increasingly important in relation to end of life (EoL) care in a context of globalization, migration and European integration. We explore and compare socio-cultural issues that shape EoL care in seven European countries and critically appraise the existing research evidence on cultural issues in EoL care generated in the different countries. METHODS We scoped the literature for Germany, Norway, Belgium, The Netherlands, Spain, Italy and Portugal, carrying out electronic searches in 16 international and country-specific databases and handsearches in 17 journals, bibliographies of relevant papers and webpages. We analysed the literature which was unearthed, in its entirety and by type (reviews, original studies, opinion pieces) and conducted quantitative analyses for each country and across countries. Qualitative techniques generated themes and sub-themes. RESULTS A total of 868 papers were reviewed. The following themes facilitated cross-country comparison: setting, caregivers, communication, medical EoL decisions, minority ethnic groups, and knowledge, attitudes and values of death and care. The frequencies of themes varied considerably between countries. Sub-themes reflected issues characteristic for specific countries (e.g. culture-specific disclosure in the southern European countries). The work from the seven European countries concentrates on cultural traditions and identities, and there was almost no evidence on ethnic minorities. CONCLUSION This scoping review is the first comparative exploration of the cultural differences in the understanding of EoL care in these countries. The diverse body of evidence that was identified on socio-cultural issues in EoL care, reflects clearly distinguishable national cultures of EoL care, with differences in meaning, priorities, and expertise in each country. The diverse ways that EoL care is understood and practised forms a necessary part of what constitutes best evidence for the improvement of EoL care in the future.
Collapse
Affiliation(s)
- Marjolein Gysels
- Barcelona Centre for International Health Research, Universitat de Barcelona, Barcelona, Spain.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Pradilla HC, Correa Ospina OL, Alonso-Babarro A. Preferencia del lugar de muerte y factores relacionados en personas mayores de la isla mediterránea de Ibiza. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2011. [DOI: 10.5554/rca.v39i2.90] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
|
14
|
El lugar de la muerte en Andalucía: influencia de la edad, sexo y causa de defunción. Rev Clin Esp 2011; 211:127-32. [DOI: 10.1016/j.rce.2010.10.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2010] [Revised: 10/15/2010] [Accepted: 10/31/2010] [Indexed: 11/15/2022]
|
15
|
Conocimiento de la enfermedad y del testamento vital en pacientes con insuficiencia cardiaca. Rev Esp Cardiol 2010. [DOI: 10.1016/s0300-8932(10)70267-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
16
|
Antolín A, Ambrós A, Mangirón P, Alves D, Sánchez M, Miró O. [Grade of knowledge about the advance directive document by the chronic patient who comes to the emergency department]. Rev Clin Esp 2010; 210:379-88. [PMID: 20674892 DOI: 10.1016/j.rce.2010.01.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2009] [Revised: 01/13/2010] [Accepted: 01/25/2010] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evaluate the patient's and their caregiver's knowledge of the advance directive document (ADD) in patients with chronic diseases who come to the emergency department due to decompensation and their caregivers. To discover the patient's willingness and associated factors to draw up an ADD. MATERIAL AND METHODS A descriptive cohort study including patients with an acutely decompensated chronic evolving disease attending the ED medicine section at an urban tertiary teaching hospital was performed. The patients' demographic and clinical variables were recorded. After control of their symptoms, an anonymous structured oral interview was also administered. Dependent variables included were previous knowledge of the ADD, and the patient willingness to draw it up. The relationship among independent and dependent variables was analyzed. RESULTS A total of 380 people (190 patients and 190 carers) were analyzed. Compared with patients, carers were more frequently women (76% vs 42%, p<0.001), younger (58+/-15 vs 73+/-12, p<0.001), and had a better knowledge of the disease (88% vs 74%, p<0.001) and of the ADD (28% vs 16%, p<0.001). Only 5% of the patients had received ADD information from their physician. The only factor associated with the patients' previous knowledge of the ADD was to have completed at least secondary school (p<0.05). Forty-six percent of patients were favorable to the drawing up of an ADD. The only variable associated with such a willingness was to be 70 or younger (p<0.05). Eighty-eight percent of the patients were in favor of the distribution of information leaflets in the ED. CONCLUSIONS There is poor patient and carer knowledge regarding the ADD among patients with chronic diseases. Nonetheless, almost half of patients would be willing to draw up an ADD. EDs can contribute to improve the information about it.
Collapse
Affiliation(s)
- A Antolín
- Secció d'Urgencias Medicina, Area d'Urgències, Hospital Clínic, Barcelona, España.
| | | | | | | | | | | |
Collapse
|
17
|
Miró Ò, Alonso J, Coll-Vinent B. Fallecimiento de los pacientes en el hospital de agudos: ¿morir ingresado o morir en Urgencias? Rev Clin Esp 2008; 208:262-3; author reply 263. [DOI: 10.1157/13119925] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|