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Tan TT, Tan MP, Lam CL, Loh EC, Capelle DP, Zainuddin SI, Ang BT, Lim MA, Lai NZ, Tung YZ, Yee HA, Ng CG, Ho GF, See MH, Teh MS, Lai LL, Pritam Singh RK, Chai CS, Ng DLC, Tan SB. Mindful gratitude journaling: psychological distress, quality of life and suffering in advanced cancer: a randomised controlled trial. BMJ Support Palliat Care 2023; 13:e389-e396. [PMID: 34244182 DOI: 10.1136/bmjspcare-2021-003068] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 05/25/2021] [Indexed: 11/03/2022]
Abstract
CONTEXT Numerous studies have shown that gratitude can reduce stress and improve quality of life. OBJECTIVE Our study aimed to examine the effect of mindful gratitude journaling on suffering, psychological distress and quality of life of patients with advanced cancer. METHODS We conducted a parallel-group, blinded, randomised controlled trial at the University of Malaya Medical Centre, Malaysia. Ninety-two adult patients with advanced cancer, and an overall suffering score ≥4/10 based on the Suffering Pictogram were recruited and randomly assigned to either a mindful gratitude journaling group (N=49) or a routine journaling group (N=43). RESULTS After 1 week, there were significant reductions in the overall suffering score from the baseline in both the intervention group (mean difference in overall suffering score=-2.0, 95% CI=-2.7 to -1.4, t=-6.125, p=0.000) and the control group (mean difference in overall suffering score=-1.6, 95% CI=-2.3 to -0.8, t=-4.106, p=0.037). There were also significant improvements in the total Hospital Anxiety and Depression Scale score (mean difference=-3.4, 95% CI=-5.3 to -1.5, t=-3.525, p=0.000) and the total Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being score (mean difference=7.3, 95% CI=1.5 to 13.1, t=2.460, p=0.014) in the intervention group after 7 days, but not in the control group. CONCLUSION The results provide evidence that 7 days of mindful gratitude journaling could positively affect the state of suffering, psychological distress and quality of life of patients with advanced cancer. TRIAL REGISTRATION NUMBER The trial was registered with the Australian and New Zealand Clinical Trials Registry (ACTRN1261800172191) and conducted in accordance with the Declaration of Helsinki.
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Affiliation(s)
- Ting Ting Tan
- Medicine, University of Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Maw Pin Tan
- Medicine, University of Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Chee Loong Lam
- Medicine, University of Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Ee Chin Loh
- Medicine, University of Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - David Paul Capelle
- Medicine, University of Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | | | - Bin Ting Ang
- Medicine, University of Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Min Ai Lim
- Medicine, University of Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Natalie Zi Lai
- Medicine, University of Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Yu Zhen Tung
- Medicine, University of Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Hway Ann Yee
- Psychological Medicine, University of Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Chong Guan Ng
- Psychological Medicine, University of Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Gwo Fuang Ho
- Oncology, University of Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Mee Hoong See
- Surgery, University of Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Mei Sze Teh
- Surgery, University of Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Lee Lee Lai
- Nursing Science, University of Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | | | | | | | - Seng Beng Tan
- Medicine, University of Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia
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2
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Borelli E, Bigi S, Potenza L, Gilioli F, Artioli F, Porzio G, Porro CA, Efficace F, Bruera E, Luppi M, Bandieri E. Gratitude among advanced cancer patients and their caregivers: The role of early palliative care. Front Oncol 2022; 12:991250. [PMID: 36353529 PMCID: PMC9639866 DOI: 10.3389/fonc.2022.991250] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 09/20/2022] [Indexed: 07/30/2023] Open
Abstract
OBJECTIVE A cancer diagnosis represents a unique trauma, given its life-threatening, multidimensional, and uncertain nature. Gratitude is a construct representing the emotional state that arises when individuals recognize that a benefit has been received as a result of someone else's action or a spiritual entity's intervention. Based on the positive psychological wellbeing, gratitude has been associated with improved health outcomes even in the disease setting. Thus, the models of care that foster gratitude should be adopted in the clinical context. This study aims to explore whether and how gratitude may originate in patients with advanced cancer and their caregivers undergoing early palliative care (EPC). METHODS We analyzed 251 reports from 133 patients and 118 caregivers describing their clinical experience in two EPC units. The sources of gratitude were identified and ranked based on their frequencies. Words expressing gratitude and words referring to communication and spirituality were collected by means of the Linguistic Inquiry and Word Count software and correlated. RESULTS In total, 123 (92.5%) of 133 patients' and 97 (82.2%) of 118 caregivers' reports, respectively, included explicit or implicit expressions of gratitude. Gratitude was associated specifically with successful physical symptom management, emotional support, improved attitude toward death, better information, humanity, and the familiar environment. The use of words of gratitude in patients' reports was positively correlated with the use of words referring to communication (r = .215, p = .026) and spirituality (r = .612, p <.001). CONCLUSION Our results suggest that interventions within the EPC model based on doctor-patient-caregiver communication may allow patients and caregivers to experience a feeling of gratitude, and this may represent a resource to be exploited to improve their physical and psychosocial wellbeing.
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Affiliation(s)
- Eleonora Borelli
- Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Sarah Bigi
- Department of Linguistic Sciences and Foreign Literatures, Catholic University of the Sacred Heart, Milan, Italy
| | - Leonardo Potenza
- Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Hematology Unit and Chair, Azienda Ospedaliera Universitaria di Modena, Modena, Italy
| | - Fabio Gilioli
- Department of Internal Medicine and Rehabilitation, Unitá Sanitaria Locale (USL), Modena, Italy
| | - Fabrizio Artioli
- Oncology and Palliative Care Units, Civil Hospital Carpi, Unitá Sanitaria Locale (USL), Carpi, Italy
| | | | - Carlo Adolfo Porro
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Center for Neuroscience and Neurotechnology, University of Modena and Reggio Emilia, Modena, Italy
| | - Fabio Efficace
- Health Outcomes Research Unit, Italian Group for Adult Hematologic Diseases (GIMEMA), Rome, Italy
| | - Eduardo Bruera
- Palliative Care and Rehabilitation Medicine, UT MD Anderson Cancer Center, Houston, TX, United States
| | - Mario Luppi
- Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Hematology Unit and Chair, Azienda Ospedaliera Universitaria di Modena, Modena, Italy
| | - Elena Bandieri
- Oncology and Palliative Care Units, Civil Hospital Carpi, Unitá Sanitaria Locale (USL), Carpi, Italy
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3
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Rodríguez M, Feng A, Menjívar C, López-Saca M, Centeno C, Arantzamendi M. WhatsApp as a facilitator of expressions of gratitude for palliative care professionals. Int J Med Inform 2022; 166:104857. [PMID: 36037594 DOI: 10.1016/j.ijmedinf.2022.104857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 07/28/2022] [Accepted: 08/13/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Family members significantly value the professional and humane support that medical teams provide in the process of caring for patients with advanced diseases. Communication is currently changing, making it of interest to explore technology's possible influence on communication and on the care relationship. It remains unknown whether this can vary based on increased use of technology in patient care. Using communication technologies can facilitate recognition of professional support through the expression of gratitude aimed at healthcare professionals. The objective here is to describe expressions of gratitude sent via WhatsApp messages by patients who receive treatment from a palliative care team and their relatives. METHOD A generic qualitative methodology was used. The palliative care service studied used WhatsApp in the patient/family-professional relationship. A content analysis of 130 WhatsApp messages sent to the professionals and containing expressions of gratitude was carried out. Two researchers inductively performed the analysis. Analysis included aspects for which senders were most grateful and others, such as who the messages came from, whether they were reactive or spontaneous and to whom they were directed. RESULTS Almost all of the patients treated transmitted their gratitude via WhatsApp. It was also observed that family members were most grateful for features of the care received (i.e., affection, availability), the professional's support (i.e., accompaniment, comfort) and the professional's qualities (i.e., professionalism, kindness). They also appreciated symptom control and attempts to resignify loss; these aspects received the most expressions of gratitude in the messages. In turn, all the messages contain expressions of support for palliative care professionals, evidencing a patient/family-professional relationship. CONCLUSION The use of communication technologies like WhatsApp can contribute to the perception of professionals' availability and closeness and become a facilitator of expressions of gratitude that specify the aspects that family members most appreciate from the palliative care team, such as skills related to humane care and availability.
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Affiliation(s)
- Marco Rodríguez
- Hospice la Cima, Center for Palliative Medicine, El Salvador.
| | - Ancu Feng
- Hospice la Cima, Center for Palliative Medicine, El Salvador
| | | | | | - Carlos Centeno
- Institute for Culture and Society-ATLANTES, Universidad de Navarra, Pamplona, Spain; Clínica Universidad de Navarra, Palliative Medicine Department, Pamplona, Spain; IdISNA - Navarra Health Research Institute, Palliative Medicine, Pamplona, Spain.
| | - Maria Arantzamendi
- Institute for Culture and Society-ATLANTES, Universidad de Navarra, Pamplona, Spain; IdISNA - Navarra Health Research Institute, Palliative Medicine, Pamplona, Spain.
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Aparicio M, Centeno C, Robinson CA, Arantzamendi M. Palliative Professionals' Experiences of Receiving Gratitude: A Transformative and Protective Resource. QUALITATIVE HEALTH RESEARCH 2022; 32:1126-1138. [PMID: 35574986 PMCID: PMC9251753 DOI: 10.1177/10497323221097247] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Providing palliative care can be both challenging and rewarding. It involves emotionally demanding work and yet research shows that burnout is lower than in other fields of health care. Spontaneous expressions of gratitude from patients and family members are not uncommon and are highly valued. This study explored the experience of Spanish palliative professionals who received expressions of gratitude from their patients and families. A phenomenological approach was used to better understand the role of receiving gratitude in participants' lives. Interviews were transcribed verbatim and a phenomenological approach to analysis was undertaken using macro-thematic and micro-thematic reflection. Two team members independently engaged in this reflection with an inductive approach. The analysis was shared and discussed at periodic meetings to identify the key themes and sub-themes of the gratitude experience. Ten palliative professionals were interviewed. Participants engaged in a process of recognizing, internalizing, and treasuring the expressions of gratitude which they then used for reflection and growth. These expressions were a powerful and deeply meaningful resource that the palliative professionals revisited over time. Receiving expressions of gratitude invited a stronger sense of the value of one's self and one's work that was motivational and protective, particularly during challenging times.
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Affiliation(s)
- Maria Aparicio
- ATLANTES Global Observatory of Palliative
Care, Universidad de Navarra, Pamplona, Spain
- Clinical Nurse Specialist in Palliative Care at
St Christopher’s Hospice and Visiting Lecturer at St Christopher’s Centre for
Awareness and Response to End of life (StC CARE), London, UK
| | - Carlos Centeno
- ATLANTES Global Observatory of Palliative
Care, Universidad de Navarra, Pamplona, Spain
- Clínica Universidad de Navarra, Palliative Medicine Department, Pamplona, Spain
- IdiSNA, Instituto de Investigación Sanitaria de
Navarra, Pamplona, Spain
| | - Carole A. Robinson
- ATLANTES Global Observatory of Palliative
Care, Universidad de Navarra, Pamplona, Spain
- School of Nursing, Faculty of Health and
Social Development, University of British Columbia, Kelowna British Columbia, Canada
| | - María Arantzamendi
- ATLANTES Global Observatory of Palliative
Care, Universidad de Navarra, Pamplona, Spain
- IdiSNA, Instituto de Investigación Sanitaria de
Navarra, Pamplona, Spain
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5
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Hirschmann J, Kozato A, Sharma V, Villagra C, Wetmore J, Jandorf L, Pang JH, Reynolds M, Dodge L, Mejía S, Safer JD. An Analysis of Chaplains' Narrative Chart Notes Describing Spiritual Care Visits with Gender Affirmation Surgical Patients. Transgend Health 2022; 7:92-100. [PMID: 36644021 PMCID: PMC9829152 DOI: 10.1089/trgh.2020.0030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Purpose The benefit of spiritual care for patients is well described, but little is known about the role of spiritual care in transgender and nonbinary patients recovering from gender affirming surgeries (GASs). Methods A single-center retrospective chart review was performed on patients who underwent GAS in 2017. Demographic information, surgery type, and chaplains' narrative notes were examined. Results A total of 145 chaplain visits were identified in 103 inpatient stays among 98 patients at the Mount Sinai Center for Transgender Medicine and Surgery in New York. Analysis was performed on narrative notes authored by a single chaplain, which included 132 visits among 78 transfeminine and 11 transmasculine patients. Fifty-four patients (61%) expressed gratitude for the chaplain visit and/or hospital experience overall. Seven patients (8%) described movement between religious denominations over the course of their lives, and 7 (8%) described supportive belief systems. Fifty-seven patients (64%) had a family member or friend present during the perioperative process, 13 (15%) described support systems, and 9 (10%) described supportive practices, activities, and/or coping methods. Twenty-one patients (24%) expressed concerns about current symptoms or the recovery process, and 32 (36%) received a prayer or blessing from the chaplain. Fifty-two patients (58%) consented to a follow-up call. Conclusion Almost 50% of patients expressed gratitude for the chaplain's visit and more than half consented to a follow-up call from the chaplain, suggesting a chaplain can provide a welcome layer of support to postoperative GAS patients. The authors recommend integrating spiritual care into perioperative care.
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Affiliation(s)
- Jo Hirschmann
- Mount Sinai Center for Transgender Medicine and Surgery, Center for Spirituality and Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Address correspondence to: Jo Hirschmann, MAHL, Mount Sinai Center for Transgender Medicine and Surgery, Center for Spirituality and Health, Icahn School of Medicine at Mount Sinai, 10 Nathan D. Perlman Place, New York, NY 10003, USA,
| | - Aki Kozato
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Vansh Sharma
- Department of Psychiatry, Center for Spirituality and Health, Center for Stress, Resilience and Personal Growth, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Cristina Villagra
- Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - John Wetmore
- Mount Sinai Health System, New York, New York, USA
| | - Lina Jandorf
- Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - John Henry Pang
- Mount Sinai Center for Transgender Medicine and Surgery, Department of Surgery, Division of Plastic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Leanne Dodge
- Department of Spiritual Care and Education, Mount Sinai Beth Israel, New York, New York, USA
| | - Silvia Mejía
- Department of Spiritual Care and Education, Mount Sinai Beth Israel, New York, New York, USA
| | - Joshua D. Safer
- Mount Sinai Center for Transgender Medicine and Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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6
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Taffurelli C, Barello S, Cervantes Camacho V, Bertuol M, Savarese M, Artioli G. Taking care of dying patients through an 'interprofessional ecosystem': a grounded theory study on the experience of an interprofessional team in palliative care. Scand J Caring Sci 2020; 35:1169-1178. [PMID: 33200845 DOI: 10.1111/scs.12934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 10/19/2020] [Accepted: 10/25/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND The interprofessional approach is part of the philosophy in palliative care, and its benefits are already documented. However, there are no evidence regarding the process through which the interprofessional team faces the process of the patient's end-of-life and how this experience might be of value for the team's development itself. The aim of this study was to analyse and understand the psychosocial processes that occurs when an interprofessional team accompanies patients and their families to death in palliative care, with the ultimate aim to develop a substantive theory to describe this phenomenon. METHODS A Grounded Theory method, as theorized by Strauss and Corbin, was adopted for this study. Data were collected through semi-structured interviews and then independently analysed using constant comparison analysis. Fourteen healthcare professionals - belonging to different disciplines (doctor, nurse coordinator, nurse, nurse assistant, psychologist) - were interviewed in a Northern Italy palliative care facility. FINDINGS The core category of this study was identified to be the process of accompaniment of the dying patient as an interprofessional ecosystem. Moreover, the results showed four main factors determining the development of the core psychosocial process: from professionals' 'Hidden Amazement' to 'Onerous Happiness' where 'Weaving of Professional Resources' and 'Work Meaning' are the underlying conditions to catalyse the process itself. CONCLUSION Interprofessional care appears an essential value, which becomes the source of the team's strength when facing end-of-life experiences. Health policies and organisations should take the importance of the characteristics of the work environment more carefully. The meaning that professionals attribute to their work and to the team itself, indeed, it may have impact on the overall quality of care and contribute to sustain work engagement, even in stressful situations like end-of-life care.
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Affiliation(s)
| | - Serena Barello
- EngageMinds HUB - Consumer, Food & Health Engagement Research Center, Università Cattolica del Sacro Cuore, Milan, Italy.,Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | | | - Maria Bertuol
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Mariarosaria Savarese
- EngageMinds HUB - Consumer, Food & Health Engagement Research Center, Università Cattolica del Sacro Cuore, Milan, Italy.,Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Giovanna Artioli
- Department of Medicine and Surgery, University of Parma, Parma, Italy.,Palliative Care Unit - Azienda USL-IRCS of Reggio Emilia, Reggio Emilia, Italy
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7
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Aparicio M, Centeno C, Juliá G, Arantzamendi M. Gratitude from patients and relatives in palliative care-characteristics and impact: a national survey. BMJ Support Palliat Care 2019; 12:e562-e569. [PMID: 31471493 DOI: 10.1136/bmjspcare-2019-001858] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 07/23/2019] [Accepted: 07/31/2019] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To explore the expressions of gratitude (EoG) received from patients and relatives and their influence on palliative care professionals (PCPs). METHODS A national online survey was sent to a representative of PCPs of each service listed in the national directory of palliative care (PC) services (n=272) (ie, hospital PC support team, hospice, paediatrics, etc). The questionnaire was pilot tested with experts. It comprised three sections: the overall perspective of receiving gratitude in the service, the personal experience of its influence and sociodemographic questions. A mailing schedule was designed to enhance the response rate. RESULTS 186 representatives from all over Spain completed the questionnaire (68% response rate). 79% of service representatives reported that they almost always received EoG. These came mainly from families (93%). These EoG were very often put on display (84%) and shared with other health professionals (HPs) involved in care (45%). EoG evoked positive feelings in the team members. Based on their experience, respondents attributed different functions to these EoG: increased professional satisfaction (89%), a source of support in difficult times (89%), mood improvement, encouragement to continue and rewards for effort (88%). Services, where gratitude was more frequently received, were associated with PCPs who more frequently reported being proud of their work (p=0.039, Pearson's correlation test). CONCLUSIONS Gratitude from patients and relatives was frequent and significant to those who work in PC. HPs considered that EoG offer multiple beneficial effects and also a protective role in their practice against distress and an increase in resilience skills.
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Affiliation(s)
- Maria Aparicio
- ICS, ATLANTES, Universidad de Navarra, Pamplona, Spain .,Community Team, St Christopher's Hospice, London, UK
| | - Carlos Centeno
- ICS, ATLANTES, Universidad de Navarra, Pamplona, Spain.,IdiSNA, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
| | - Guillermo Juliá
- ICS, Statistics Unit, Universidad de Navarra - Campus Universitario, Pamplona, Spain
| | - Maria Arantzamendi
- ICS, ATLANTES, Universidad de Navarra, Pamplona, Spain.,IdiSNA, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
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