An overview of the spiritual importances of end-of-life care among the five major faiths of the United Kingdom

Spiritual Care Expectations Among Cancer and Noncancer Patients With Life-Threatening Illnesses

BACKGROUND

Spirituality is a core element in holistic nursing care. Therefore, it is necessary to understand the spiritual care expectations of cancer and noncancer patients with life-threatening illnesses.

OBJECTIVE

The aim of this study was to identify the spiritual care expectations of vulnerable patients with life-threatening illnesses.

INTERVENTIONS/METHODS

This study uses both quantitative and qualitative approaches, and data were collected from 232 patients. For quantitative data, we used the Nurse Spiritual Therapeutics Scale (NSTS), which comprises 20 items. Qualitative data were collected using an open-ended question. Quantitative data were analyzed using descriptive statistics, independent t tests, 1-way analysis of variance, and item and factor analysis. Qualitative data were analyzed using content analysis.

RESULTS

The mean score of spiritual care expectations ranged from 2.27 to 3.07. There was a significant difference in NSTS mean score between cancer and noncancer patients. In exploratory factor analysis, NSTS was extracted into 3 factors and items belonging to the 3 factors showed similarity between cancer and noncancer patients. Qualitative data using content analysis revealed the following 3 themes: "treat with respect," "religious support," and "comfort with presence." The 3 factors corresponded with 3 themes: factor I versus "treat with respect," factor II versus "religious ritual," and factor III versus "comfort with presence."

CONCLUSIONS

Spiritual care expectations of cancer and non-cancer patients with life-threatening illnesses were identified and the findings provide valuable data regarding the expectations of patients' spiritual care.

IMPLICATIONS FOR PRACTICE

Our findings emphasize integrating patient-reported outcomes with spiritual care to stimulate patient-centered care, thus promoting holistic palliative or end-of-life care.

Muslims and End-of-Life Healthcare in Non-Muslim Majority Nations: A Systematic Literature Review

CONTEXT

As Muslim populations in non-Muslim majority nations grow and age, they will increasingly require culturally appropriate healthcare. Delivering such care requires understanding their experiences with, as well as preferences regarding, end-of-life healthcare.

OBJECTIVES

To examine the experiences, needs, and challenges of Muslim patients and caregivers with end-of-life, hospice, and palliative care.

METHODS

A systematic literature review using five databases (MEDLINE, Scopus, Web of Science, CINAHL, Cochrane Library) and key terms related to Islam and end-of-life healthcare. Papers were limited to English-language empirical studies of adults in non-Muslim majority nations. After removing duplicates, titles, abstracts, and articles were screened for quality and reviewed by a multidisciplinary team.

RESULTS

From an initial list of 1867 articles, 29 articles met all inclusion criteria. Most studies focused on end-of-life healthcare not related to palliative or hospice services and examined Muslim patient and caregiver experiences rather than their needs or challenges. Content analysis revealed three themes: (1) the role of family in caregiving as a moral duty and as surrogate communicators; (2) gaps in knowledge among providers related to Muslim needs and gaps in patient/family knowledge about advance care planning; and (3) the influence of Islam on Muslim physicians' perspectives and practices.

CONCLUSION

There is scant research on Muslim patients' and caregivers' engagement with end-of-life healthcare in non-Muslim majority nations. Existing research documents knowledge gaps impeding both Muslim patient engagement with end-of-life care and the delivery of culturally appropriate healthcare.

Palliative team involvement in end-of-life care for Jewish and Muslim children in Jerusalem: A unique clinical and cultural context

OBJECTIVES

Pediatric palliative care services improve the quality of life for children with life-limiting and life-threatening diseases, although little has been published about variation based on cultural and religious factors. This article sets out to describe clinical and cultural characteristics of pediatric end-of-life patients in a majority Jewish and Muslim country with religious and legal constraints around end-of-life care.

METHODS

We conducted a retrospective chart review of 78 pediatric patients who died during a 5-year period and could potentially have utilized pediatric palliative care services.

RESULTS

Patients reflected a range of primary diagnoses, most commonly oncologic diseases and multisystem genetic disorders. Patients followed by the pediatric palliative care team had less invasive therapies, more pain management and advance directives, and more psychosocial support. Patients from different cultural and religious backgrounds had similar levels of pediatric palliative care team follow-up but certain differences in end-of-life care.

SIGNIFICANCE OF RESULTS

In a culturally and religiously conservative context that poses constraints on decision-making around end-of-life care, pediatric palliative care services are a feasible and important means of maximizing symptom relief, as well as emotional and spiritual support, for children at the end of life and their families.

Responding Well to Spiritual Worldviews: A Taxonomy for Clinical Ethicists

Every clinical ethics consultant, no matter their own spirituality, will meet patients, families, and healthcare professionals whose spiritualities anchor their moral worldviews. How might ethicists respond to those who rely on spirituality when making medical decisions? And further, should ethicists incorporate their own spiritual commitments into their clinical analyses and recommendations? These questions prompt reflection on foundational issues in the philosophy of medicine, political and moral theory, and methods of proper clinical ethics consultation. Rather than attempting to offer definitive answers to these questions, this essay prompts readers to consider their own answers to these questions. Specifically, it offers a taxonomic analysis of six (6) distinct responses: assessment, delegation, examination, translation, incorporation, and assertion. Furthermore, this essay describes the role of the ethicist's own spiritual commitments during the responses. Each section also names several strengths and weaknesses that ethicists ought to consider when evaluating the purpose and scope of each response. This paper prompts readers to consider circumstances under which they might promote, critique, or incorporate spiritual worldviews-their own and those of their patients-when offering clinical analyses and recommendations.

Supporting the Family After the Death of a Child or Adolescent

Whether death occurs in the context of a chronic illness or as the sudden loss of a previously healthy infant, child, or adolescent, the death of a child is a highly stressful and traumatic event. Psychosocial support for families after the death of a child embodies core medical values of professional fidelity, compassion, respect for human dignity, and promotion of the best interests of a grieving family. The pediatrician has an important role in supporting the family unit after the death of a child through a family-centered, culturally humble, trauma-informed approach. This clinical report aims to provide the pediatrician with a review of the current evidence on grief, bereavement, and mourning after the loss of a child and with practical guidance to support family caregivers, siblings, and the child's community. Pediatricians have an important role in helping siblings and helping families understand sibling needs during grief. Ways for pediatricians to support family members with cultural sensitivity are suggested and other helpful resources in the community are described.

Views, emotional Reaction, and Bereavement Healing Rituals of Saudi Male Nursing Students: A Qualitative Approach

AIM

The study described the perception and attitude of Saudi male nursing students towards death and dying.

METHODS

This qualitative study recruited Twelve male Saudi nursing students from Nursing Department at University, Riyadh, Saudi Arabia. Data collection was conducted using unstructured one-on-one online interviews from January to February 2021 using thematic approach to analyse the data.

RESULTS

The result of the study presented three themes. The first theme describes the Muslim Saudi male nursing student's religious beliefs and practices in terms of three concepts. The second theme is the emotional reaction of the participants. The third theme is bereavement healing rituals.

CONCLUSION

The knowledge on how nursing students with an Islamic belief view the concept of death and dying provides valuable and critical information on developing educational intervention as well as course and training contents that needs to be included in developing the competencies of these students.

Workforce diversity in specialist physicians: Implications of findings for religious affiliation in Anaesthesia & Intensive Care

BACKGROUND

Minority ethnic identification between physician and patient can reduce communication and access barriers, improve physician-patient relationship, trust, and health outcomes. Religion influences health beliefs, behaviours, treatment decisions, and outcomes. Ethically contentious dilemmas in treatment decisions are often entangled with religious beliefs. They feature more in medical specialties such as Anaesthesia & Intensive Care, with issues including informed consent for surgery, organ donation, transplant, transfusion, and end-of-life decisions.

METHODS

We investigate diversity in religious affiliation in the UK medical workforce, using data from the General Medical Council (GMC) specialist register and Health Education England (HEE) trainee applications to medical specialties. We performed conservative Bonferroni corrections for multiple comparisons using Chi-squared tests, as well as normalised mutual-information scores. Robust associations that persisted on all sensitivity analyses are reported, investigating whether ethnicity or foreign primary medical qualification could explain the underlying association.

FINDINGS

The only significant and robust association in both GMC and HEE datasets affecting the same religious group and specialty was disproportionately fewer Anaesthesia & Intensive Care physicians with a religious affiliation of "Muslim", both as consultants (RR 0.57[0.47,0.7]) and trainee applicants (RR 0.27[0.19,0.38]. Associations were not explained by ethnicity or foreign training. We discuss the myriad of implications of the findings for multi-cultural societies.

CONCLUSIONS

Lack of physician workforce diversity has far-reaching consequences, especially for specialties such as Anaesthesia and Intensive Care, where ethically contentious decisions could have a big impact. Religious beliefs and practices, or lack thereof, may have unmeasured influences on clinical decisions and on whether patients identify with physicians, which in turn can affect health outcomes. Examining an influencing variable such as religion in healthcare decisions should be prioritised, especially considering findings from the clinician-patient concordance literature. It is important to further explore potential historical and socio-cultural barriers to entry of training medics into under-represented specialties, such as Anaesthesia and Intensive Care.

Palliative Extubation: A Discussion of Practices and Considerations

Palliative extubation (PE), also known as compassionate extubation, is a common event in the critical care setting and an important aspect of end-of-life care.1 In a PE, mechanical ventilation is discontinued. Its goal is to honor the patient's preferences, optimize comfort, and allow a natural death when medical interventions, including maintenance of ventilatory support, are not achieving desired outcomes. If not done effectively, PE can cause unintended physical, emotional, psychosocial, or other stress for patients, families, and healthcare staff. Studies show that PE is done with much variability across the globe, and there is limited evidence of best practice. Nevertheless, the practice of PE increased during the coronavirus disease 2019 pandemic due to the surge of dying mechanically ventilated patients. Thus, the importance of effectively conducting a PE has never been more crucial. Some studies have provided guidelines for the process of PE. However, our goal is to provide a comprehensive review of issues to consider before, during, and after a PE. This paper highlights the core palliative skills of communication, planning, symptom assessment and management, and debriefing. Our aim is to better prepare healthcare workers to provide quality palliative care during PEs, most especially when facing future pandemics.

Polarization in public attitudes toward end-of-life decisions in Israel - A cross-sectional study

OBJECTIVES

End-of-life (EoL) processes are a complex socio-normative and ethical phenomenon. This study aimed to generate a database of public opinion in Israel concerning EoL processes and decisions and to identify differences in attitudes across subgroups in the population, particularly based on experience as a family caregiver of a dying patient.

METHODS

This cross-sectional study was performed in late March 2022. The study utilized an online sample of 605 adults over the age of 50 including those who accompanied a loved one to their death in the last 3 years. Participants were requested to provide their opinions and attitudes on several aspects of EoL decisions, including truth-telling, medically assisted dying, EoL procedures, pre-death actions, and family caregivers' engagement.

RESULTS

While only 27% and ∼30% of participants support artificial respiration or feeding (respectively) of terminally ill patients, 66% support analgesic treatment, even at the risk of shortening life. The data show an association between religiosity and agreement with life-extending procedures. For example, while 83% of seculars support medically assisted dying, only 59% and 26% of traditional and religious respondents support it. However, no statistically significant differences were observed in support of family involvement in EoL process in any sociodemographic variable.

SIGNIFICANCE OF RESULTS

The results of this study suggest that the Israeli public is relatively polarized on several issues about EoL processes, specifically patient autonomy and medically assisted dying. Yet, at the same time, there is a consensus among the Israeli public about certain EoL elements, particularly the importance of family caregivers in the EoL decision-making process.

Racial/Ethnic Differences in Provider-Engaged Religious Belief Discussions with Older Adults at the End of Life

The purpose of this study was to determine racial/ethnic differences in provider-engaged religious belief discussion with older adults in the final month of life. Data were derived from the combined 2012 to 2020 National Health and Aging Trends Study. Chi-square tests were used for bivariate analysis, and a binary logistic regression model was used to test the association between race/ethnicity and provider-engaged religious belief discussions at the end of life. After controlling for other explanatory factors during the analysis, results showed that providers were less likely to have religious belief discussions with Black and Hispanic older adults compared to Whites. The results of this study point to a significant gap in knowledge among healthcare providers whose diversity training may not be inclusive of religious/spiritual cultural humility. Implications for research, policy, and practice are provided.

Religious and Cultural Practices of Muslims Living in Central Anatolia on Death and Mourning: A Qualitative Study from Turkey

This study was conducted to determine the cultural practices of society regarding death and mourning. The sample of this qualitative study consisted of 31 adults who presented to a Family Health Center located in two different provincial centers in the Central Anatolia Region of Turkey. The main themes of "optimistic thinking", "pessimistic thinking" and "acceptance" emerged from the statements of the participants regarding death. It was determined that participants took part in cultural practices such as preparing for a burial and providing comfort to individuals who were about to die. This study sheds light on the cultural and religious practices of Muslim participants in Turkey regarding death and mourning.

The Good Death Among Black, Indigenous, and/or People of Color: Which Aspects of a Good Death Are Most Important?

A good death is one where a patient's preferences and wishes are fully respected. The purpose of this study was to determine which aspects of a good death are most important to Black/Indigenous, and/or people of color (BIPOC). Participants were recruited from Amazon Mechanical Turk, and then directed to complete a quantitative survey indicating the importance of each item on the Good Death Inventory. A logistic regression model was used to identify any differences in the importance of each item based on the racial background of the respondent. After accounting for other independent variables, the results showed that BIPOC were more likely to indicate that factors such as life completion, receiving all treatment possible, and religious/spiritual support were important aspects of a good death. Results indicate the need for culturally tailored tools that account for cultural differences in what constitutes a good death.

The Sacred Sites of Houston: A Novel Experiential Course for Undergraduate Medical Education on Religion and Spirituality

Medical schools are charged to deliver a curriculum on religion and spirituality (R/S), so a novel experiential course, the Sacred Sites of Houston, was developed. Sixty students completed the course consisting of 6 site visits. Post-course, participants described more general knowledge and knowledge of how each faith tradition describes medicine and health (p < 0.05 for all) except for Catholicism (p = 0.564 and p = 0.058). Ten course participants and 6 control non-course participants were interviewed following clinical rotations to assess the impact of the experiential course on R/S in the clinical setting. Themes from qualitative interviews such as R/S, barriers, interactions, and the course impact emerged. The importance of R/S in the patient-provider relationship and end-of-life care was prominent in course participant interviews compared to non-course participant control subjects. Participation in the course resulted in increased chaplain engagement and significant personal impact. These qualitative and quantitative findings indicate that an experiential course may be effective at addressing the deficit in R/S undergraduate medical education and help enhance the spiritually and religiously competent care of patients.

Awareness and attitudes towards advance care planning in primary care: role of demographic, socioeconomic and religiosity factors in a cross-sectional Lebanese study

OBJECTIVE

To assess awareness and attitudes towards engaging in advance care planning (ACP) and their relationship with demographic, socioeconomic and religiosity factors among Lebanese middle-aged to older-aged adults in primary care.

DESIGN

A cross-sectional survey study.

SETTING

Tertiary referral hospital in Beirut, Lebanon.

PARTICIPANTS

A total of 215 middle-aged to older-aged adults.

RESULTS

Out of 215 participants, 18.6% of participants knew about ACP; 94% favoured truth-telling; 87.4% favoured healthcare autonomy; 77.2% favoured documenting their own health values and preferences; and 29.3% were willing to undergo life-prolonging interventions. Among participants who were aware of ACP, 67.5% preferred ACP documentation and 85% had negative attitudes towards life-sustaining interventions. Women were more aware about ACP than men. Those who were willing to undergo life-prolonging interventions were found to be men and had higher religiosity scores.

CONCLUSION

Large deficit in ACP awareness was evident despite the high preference for healthcare autonomy. Medical and public health efforts should strive to enhance patients' ACP awareness and engagement in ACP while considering factors relevant to gender, culture and religiosity.

Faith-sensitive end of life care for children, young people and their families

This article is part of an at a glance series on palliation and end of life care in paediatrics and focuses on the provision of faith-sensitive end of life care. Particular religions are discussed, with some key points for care of patients from some of the most prevalent religions within the UK. This article is intended to give points for discussion and consideration, but health professionals are encouraged to speak to every patient and family on an individual level to ensure an understanding of their personal beliefs. Although there is a range of literature discussing faith during end-of-life care, there is litte that outlines the practical specifics and for this reason some of the supporting literature in this article is dated and, where possible, this has been supported with contemporary sources.

God, spirituality and religion in women dying from gynecological cancer

Thoughts of death and dying will prevail constantly in the minds of women with gynecologic cancer. Invariably, there is the hope that, when the end comes, there will be 'a good death'. End-of-life decisions, with particular emphasis on what the patient and her family constitute 'a good death' to be, will be influenced by emotional, psychological, mental, physical, spiritual and religious backgrounds. It is important to allow patients to resolve their despair by communicating their innermost thoughts. Spirituality and religious belief are important components that may play major roles in enabling patients to obtain peace and require the participation of all members of the health-care team managing the cases. Clinicians should appreciate the patient's concerns, beliefs, fears, spiritual and religious needs and be sensitive to comments that may indicate spiritual distress. Active listening and supportive dialogue may help patients work through existential issues and find peace. Patients who are in spiritual distress should be referred to certified and trained spiritual care professionals, chaplains, counselors and clergy.

Call to action: The need to expand spiritual care supports during the COVID-19 pandemic

Providing a 'good death' for patients dying in acute care is more challenging than ever with the COVID-19 pandemic. Spiritual care teams and palliative care providers strive to address the physical, psychosocial, and spiritual care needs at end of life-for both patients and their families, and often in concert with patients' own faith groups. During the strict lockdown policy imposed in Ontario, Canada during the pandemic, external faith groups, and religious rituals requiring direct contact were restricted. Delivering spiritual care in our "new normal" environment challenged us to think more broadly, beyond the walls of our own institutions, particularly when external resources exist outside of acute care centres, and are often of paramount importance to dying patients and their families in acute care.

Structure and process of palliative care provision: a nationwide study of public hospitals in Thailand

Background

The demand for palliative care in hospitals in Thailand has rapidly increased in recent years. Subsequently, the way in which palliative care systems should be arranged to facilitate the care process and patient preparation for their end stage of life is still an ongoing debate among policy makers and researchers. Although palliative care is provided in most facilities, there is no clear protocol for palliative care due to a lack of empirical evidence. Thus, this study attempts to analyse the situation and quality of palliative care provision in Thai public hospitals.

Methods

A cross-sectional study was conducted in 2018. A questionnaire with measures concerning hospital characteristics, the structure of palliative care provision, and processes related to achieving a good death was developed. The questionnaire was sent to all 862 public hospitals across 76 provinces, and the response rate was 62.88%. A structural equation model was specified to operationalize Donabedian’s framework. To our knowledge, this is the first nationwide study to investigate facility-level palliative care provision in Thailand.

Results

The study results confirmed the relationships between the structure and process of palliative care provision in hospitals. The sufficiency and competency of doctors and nurses and the variety of relaxation equipment were either directly or indirectly associated with the process components relevant to the response to the patient’s needs, effective communication, and respect for the patient’s dignity. In addition, the performance of palliative care research in hospitals was associated with the response to the patient’s needs and effective communication, while the allocation of physical areas was associated with effective communication.

Conclusion

This model can be used to evaluate the overall situation of palliative care provision at the national level. It could also contribute to the development of standard measurements for evidence-based palliative care quality improvement in hospitals.

Living with Metastatic Cancer: A Roadmap for Future Research

Living with metastatic cancer, or metavivorship, differs from cancer survivorship and has changed as novel treatments have increased survival time. The purpose of this narrative review is to describe factors that impact challenges in metavivorship within a conceptual framework to guide future research. This review focuses on the specific metavivorship outcomes of progressive disease, survival time, symptoms, distress, financial toxicity, and quality of life. We describe the predisposing, precipitating, and perpetuating (3P) model of metavivorship. Understanding the biological, psychological, and social 3P factors that contribute to the development and maintenance of challenges in metavivorship provides a roadmap for future research. Implications of this model include prevention by targeting predisposing factors, management of precipitating factors after onset of metastatic disease, and treatment of perpetuating factors to reduce symptoms and improve quality of life during the chronic phase of metavivorship. This can be accomplished through biopsychosocial screening efforts, monitoring of patient-reported outcomes, education and communication interventions, interdisciplinary symptom management, advance care planning, and behavioral interventions to cultivate psychological resilience.

Preferences and Experiences of Muslim Patients and Their Families in Muslim-Majority Countries for End-of-Life Care: A Systematic Review and Thematic Analysis

BACKGROUND

Care for people with progressive illness should be person centered and account for their cultural values and spiritual beliefs. There are an estimated 1.7 billion Muslims worldwide, largely living in low-income and middle-income countries.

AIMS

This study aimed to identify, appraise, and integrate the evidence for the experiences and preferences of Muslim patients and/or families for end-of-life care in Muslim-majority countries.

DESIGN

Systematic review.

DATA SOURCES

PsychINFO, MEDLINE, Embase, Global Health, CINAHL, Cochrane Library and Registry of Clinical Trials, PubMed, Applied Social Sciences Index and Abstracts (ASSIA), Social Services Abstracts, Sociological Abstracts, Social Policy & Practice, and Scopus were searched until December 2018. Handsearching was performed, and gray literature was included. Qualitative studies analyzed using thematic analysis and quantitative component provided triangulation.

RESULTS

The initial search yielded n = 5098 articles, of which n = 30 met the inclusion criteria. A total of 5342 participants (4345 patients; 81.3%) were included; 97.6% had advanced cancer. Most (n = 22) studies were quantitative. Three themes and subthemes from qualitative studies were identified using thematic analysis: selflessness (burden to others and caregiver responsibilities), ambivalence (hope and hopelessness), and strong beliefs in Islam (beliefs in death and afterlife and closeness to Allah). Qualitative studies reported triangulation; demonstrating conflicts in diagnosis disclosure and total pain burden experienced by both patients and families.

CONCLUSION

Despite the scarce evidence of relatively low quality, the analysis revealed core themes. To achieve palliative care for all in line with the total pain model, beliefs must be identified and understood in relation to decision-making processes and practices.

Perceptions on good-life, good-death, and advance care planning in Koreans with non-cancerous chronic diseases

AIMS

This study explored perceptions on a good-life, good-death, and advance care planning in Koreans with non-cancerous chronic diseases with the goal to develop a culture-specific advance care planning intervention in this population.

DESIGN

A qualitative descriptive design was used.

METHODS

Data collections were conducted between September 2017 - June 2018. Twenty-nine patients aged 41-82 years (85.8% men) participated in the interviews lasting 40-60 min. The verbatim transcriptions of the semi-structured interview data were analysed using conventional content analysis.

RESULTS

Good-life was described as 'present with physical and financial independence,' 'not burdensome to the family,' 'completed life responsibility', and 'helping others.' Some participants described good-death as 'prepared death' while others considered it as 'sudden death during sleep.' All participants wanted to have a painless death and not burden the family. Advance care planning was a new concept to many participants. It was likened to 'insurance.' Some participants believed that decision-making on life-sustaining treatment should be done by their family, not themselves, because of economic or emotional distress. Some participants wanted to discuss medical and non-medical care services to reduce the burden on self and family.

CONCLUSION

Family is key when it comes to the meaning of good-life and good-death. Cultural adaptation is necessary to meet the advance care planning needs of Koreans with non-cancerous chronic diseases.

IMPACT

Successfully implementing advance care planning in Koreans with non-cancerous chronic diseases depends on how it is adapted to the disease-specific characteristics compared with cancer, and the cultural norms and social context. Nurses need to be prepared to offer advance care planning to persons with non-cancerous chronic diseases based on a keen sense of and empathetic cultural competence.

Withdrawal of treatment in a pediatric intensive care unit at a Children's Hospital in China: a 10-year retrospective study

Background

Published data and practice recommendations on end-of-life care generally reflect Western practice frameworks; there are limited data on withdrawal of treatment for children in China.

Methods

Withdrawal of treatment for children in the pediatric intensive care unit (PICU) of a regional children’s hospital in eastern China from 2006 to 2017 was studied retrospectively. Withdrawal of treatment was categorized as medical withdrawal or premature withdrawal. The guardian’s self-reported reasons for abandoning the child’s treatment were recorded from 2011.

Results

The incidence of withdrawal of treatment for children in the PICU decreased significantly; for premature withdrawal the 3-year average of 15.1% in 2006–2008 decreased to 1.9% in 2015–2017 (87.4% reduction). The overall incidence of withdrawal of care reduced over the time period, and withdrawal of therapy by guardians was the main contributor to the overall reduction. The median age of children for whom treatment was withdrawn increased from 14.5 months (interquartile range: 4.0–72.0) in 2006 to 40.5 months (interquartile range: 8.0–99.0) in 2017. Among the reasons given by guardians of children whose treatment was withdrawn in 2011–2017, “illness is too severe” ranked first, accounting for 66.3%, followed by “condition has been improved” (20.9%). Only a few guardians ascribed treatment withdrawal to economic reasons.

Conclusions

The frequency of withdrawal of medical therapy has changed over time in this children’s hospital PICU, and parental decision-making has been a large part of the change.

[The role of the family doctor in the palliative care of chronic and terminally ill patients]

The objective of this work was to identify the role of family physicians in the care of patients and their families in the approach to the end of life. Nowadays, with the increase in the demand for care of patients with terminal illnesses, there is also evidence on the lack of physicians with the profile and skills to fulfil this coverage deficit. A review of the literature was carried out in five databases from January 2015 to May 2018, and concluded that family doctors, based on their professional skills, ability to engage with the patients, their families, and their performance in the coordination of medical resources, are in an ideal position to attend and solve complex problems of patients at the end of life. In the present review, the specific roles of family physicians in clinical and psychosocial areas, and also the difficulties in facing the challenges in the care of patients and families undergoing the end of life process are described.

Educational Intervention Enhances Clinician Awareness of Christian, Jewish, and Islamic Teachings around End-of-Life Care

BACKGROUND

Patients' religious and spiritual values impact their goals and perception of illness, especially at the end of life (EOL). According to the Joint Commission, identifying spiritual beliefs may improve cultural competency and patient-centered care. However, clinicians may be uncomfortable discussing spirituality and unaware of basic religious teachings.

OBJECTIVES

To assess clinician understanding and knowledge of key Christian, Jewish, and Islamic teachings around EOL care before and after a one-hour educational intervention through video podcast.

DESIGN

After literature review and consultation with religious leaders, a pre- and post-test (10 questions per religion plus demographic questions) to assess knowledge of Christian, Jewish, and Islamic teachings and an educational video podcast were developed. The pretest was administered to healthcare providers, followed by a one-hour educational intervention through a video podcast. Next, a post-test was administered.

SUBJECTS

Seventy-three healthcare providers participated in this study.

MEASUREMENTS

Differences between pretest and post-test scores were analyzed employing paired t-test tests using SPSS software.

RESULTS

The median score on the pretest was Christian: 6 [2-9], Jewish: 6 [4-10], and Islamic: 6 [2-8]. After the educational intervention, the median Christian, Jewish, and Islamic scores improved to 8 [4-10], 9 [6-10], and 10 [3-10], respectively (p < 0.0001). Additionally, the total pretest median score improved from 17 [10-24] to 27 [16-30].

CONCLUSIONS

A one-hour educational intervention through video podcast significantly improved understanding of Christian, Jewish, and Islamic teachings around EOL care. The video podcast enabled easy distribution of the educational session to multiple facilities and providers. Additional research is needed to determine the longitudinal outcomes and impact on patient outcomes of this intervention.