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Bernard M, Arantzamendi M. Positive psychology and palliative care: A call for an integrative approach. Palliat Support Care 2024:1-3. [PMID: 38587046 DOI: 10.1017/s1478951524000452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Affiliation(s)
- Mathieu Bernard
- Palliative and Supportive Care Service, Chair of Palliative Psychology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Maria Arantzamendi
- ATLANTES Global Observatory of Palliative Care, Institute for Culture and Society (ICS), University of Navarra, Pamplona, Navarra, Spain
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Mosoiu D, Payne S, Predoiu O, Arantzamendi M, Ling J, Tserkezoglou A, Mitrea N, Dionisi M, Martínez M, Mason S, Ancuta C, Centeno C. Core Palliative Care Research Competencies Framework for Palliative Care Clinicians. J Palliat Med 2024; 27:471-480. [PMID: 38010819 DOI: 10.1089/jpm.2023.0399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023] Open
Abstract
Background: Understanding the principles and practice of research by health care professionals helps to improve the evidence base for palliative care practice and service delivery. Research is a core competency in palliative care that enables the identification and addressing of problems for patients and their families, establishes best practice and improves ways to manage pain, other symptoms, and concerns. This work was undertaken in the research for all palliative care clinicians (RESPACC) Erasmus+ project. Aim: To identify and develop a set of core research competencies within a structured framework for all members of the multidisciplinary palliative team. Design: A multi-method approach was used including rapid review of literature, Nominal Group Technique, and expert consultation. A quiz to self-assess research competencies outlined within the Framework was produced. Results: The Framework includes 17 competencies organized in 7 domains: The clinical context, Scientific thinking and research design, Ethics and regulatory framework for research, Study and site management, Data management and informatics, Communication and relationships, and Research leadership. In the consultation process 6 of the 17 competencies were considered as required by each individual team member, and 3 to be present within the palliative care team. Conclusion: Using a multi-method approach, the first Palliative Care Research Framework identifying core research competencies for palliative care clinicians has been developed. The aim of the framework was not to transform palliative care clinicians into researchers, but to ensure that clinicians understand the important role of research and its integration into clinical practice.
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Affiliation(s)
- Daniela Mosoiu
- Faculty of Medicine, Transilvania University, Brasov, Romania
- HOSPICE Casa Sperantei, Education and National Development Department, Brasov, Romania
| | - Sheila Payne
- International Observatory on End-of-Life Care, Faculty of Health and Medicine, Lancaster University, Lancaster, United Kingdom
| | - Oana Predoiu
- HOSPICE Casa Sperantei, Education and National Development Department, Brasov, Romania
| | - Maria Arantzamendi
- Institute for Culture and Society, ATLANTES Global Observatory of Palliative Care, University of Navarra, Pamplona (Navarra), Spain
- Navarra Medical Research Institute (IdiSNA)
| | - Julie Ling
- European Association for Palliative, Head Office team Department, Vilvoorde, Belgium
| | | | - Nicoleta Mitrea
- Faculty of Medicine, Transilvania University, Brasov, Romania
- HOSPICE Casa Sperantei, Education and National Development Department, Brasov, Romania
| | - Mary Dionisi
- "Galilee" Palliative Care Unit, Senior Management Team, Athens, Greece
| | - Marina Martínez
- Navarra Medical Research Institute (IdiSNA)
- Clinica Universidad de Navarra, Department of Palliative Medicine, Pamplona (Navarra), Spain
| | - Stephen Mason
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Camelia Ancuta
- HOSPICE Casa Sperantei, Education and National Development Department, Brasov, Romania
| | - Carlos Centeno
- Institute for Culture and Society, ATLANTES Global Observatory of Palliative Care, University of Navarra, Pamplona (Navarra), Spain
- Navarra Medical Research Institute (IdiSNA)
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Arantzamendi M, Sapeta P, Belar A, Centeno C. How palliative care professionals develop coping competence through their career: A grounded theory. Palliat Med 2024; 38:284-296. [PMID: 38380528 PMCID: PMC10955801 DOI: 10.1177/02692163241229961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
BACKGROUND Palliative care professionals face emotional challenges when caring for patients with serious advanced diseases. Coping skills are essential for working in palliative care. Several types of coping strategies are mentioned in the literature as protective. However, little is known about how coping skills are developed throughout a professional career. AIM To develop an explanatory model of coping for palliative care professionals throughout their professional career. DESIGN A grounded theory study. Two researchers conducted constant comparative analysis of interviews. SETTING/PARTICIPANTS Palliative care nurses and physicians across nine services from Spain and Portugal (n = 21). Theoretical sampling included professionals who had not continued working in palliative care. RESULTS Professionals develop their coping mechanisms in an iterative five-stage process. Although these are successive stages, each one can be revisited later. First: commencing with a very positive outlook and emotion, characterized by contention. Second: recognizing one's own vulnerability and experiencing the need to disconnect. Third: proactively managing emotions with the support of workmates. Fourth: cultivating an integrative approach to care and understanding one's own limitations. Fifth: grounding care on inner balance and a transcendent perspective. This is a transformative process in which clinical cases, teamwork, and selfcare are key factors. Through this process, the sensations of feeling overwhelmed sometimes can be reversed because the professional has come to understand how to care for themselves. CONCLUSIONS The explicative model presents a pathway for personal and professional growth, by accumulating strategies that modulate emotional responses and encourage an ongoing passion for work.
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Affiliation(s)
- Maria Arantzamendi
- Universidad de Navarra, Institute for Culture and Society-ATLANTES Global Observatory of Palliative Care, Pamplona, Navarra, Spain
- IdISNA-Instituto de Investigación Sanitaria de Navarra. Medicina Paliativa
| | - Paula Sapeta
- Dr. Lopes Dias High School of Health—Castelo Branco Polytechnic Institute, Castelo Branco, Portugal
| | - Alazne Belar
- Universidad de Navarra, Institute for Culture and Society-ATLANTES Global Observatory of Palliative Care, Pamplona, Navarra, Spain
- IdISNA-Instituto de Investigación Sanitaria de Navarra. Medicina Paliativa
| | - Carlos Centeno
- Universidad de Navarra, Institute for Culture and Society-ATLANTES Global Observatory of Palliative Care, Pamplona, Navarra, Spain
- IdISNA-Instituto de Investigación Sanitaria de Navarra. Medicina Paliativa
- Clínica Universidad de Navarra, Pamplona, Navarra, Spain
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Belar A, Arantzamendi M, Larkin P, Saralegui I, Santesteban Y, Alonso N, Martínez M, Centeno C. The state of transience, and its influence on the wish to die of advanced disease patients: insights from a qualitative phenomenological study. BMC Palliat Care 2024; 23:57. [PMID: 38408953 PMCID: PMC10895803 DOI: 10.1186/s12904-024-01380-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 02/09/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND The experience of Wish to Die is common in patients living with Advanced Disease. It has been studied worldwide and qualitative studies have contributed to the understanding of the complexity of the phenomenon of the WTD but a deeper understanding on the individual's views is still needed. The objective of this study was to identify common characteristics of the experience of wish to die in advanced disease. METHODS A phenomenological study was carried out with multicenter participation of patients with advanced disease who had expressed their wish to die to health professionals. Semi-structured interviews were employed to obtain an in-depth perspective of each patient's lived experience. A phenomenological analysis of the data collected was performed to describe and explore the characteristic aspects of the phenomenon under study. RESULTS Fourteen patients with advanced disease were interviewed. Most of them had cancer. In the analysis of the patients' accounts of their experiences, three common characteristics were identified: a) experiencing a state of transience; b) the attempt to reconnect with oneself; and c) additional disease-related aspects that influence the wish to die. Patients expressed the need for a safe space to address the wish to die and the importance of receiving care that considers both 'being' and 'doing'. CONCLUSIONS Patients with advanced disease and wish to die experience a state of transience where the patient lives and ephemeral state of existence. Interventions focused on reinforcing the intrinsic value of the individual emerge as essential components of a compassionate accompaniment of those facing the wish to die.
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Affiliation(s)
- Alazne Belar
- Institute for Culture and Society, University of NavarraIdiSNA, Pamplona, Spain.
| | - Maria Arantzamendi
- Institute for Culture and Society, University of NavarraIdiSNA, Pamplona, Spain.
| | - Philip Larkin
- Palliative and Supportive care service, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland
| | | | | | | | | | - Carlos Centeno
- Institute for Culture and Society, University of Navarra, Clínica Universidad de Navarra, IdiSNA, Pamplona, Spain
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Van der Elst M, Payne S, Arantzamendi M, Preston N, Hasselaar J, Centeno C, Belar A, Jaspers B, Brunsch H, Surges S, Adile C, Menten J. An analysis of the experiences of bereaved relatives and health care providers following palliative sedation: a study protocol for a qualitative international multicenter case study. BMC Palliat Care 2022; 21:227. [PMID: 36550539 PMCID: PMC9783747 DOI: 10.1186/s12904-022-01117-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Patients at the end-of-life may experience refractory symptoms of which pain, delirium, vomiting and dyspnea are the most frequent. Palliative sedation can be considered a last resort option to alleviate one or more refractory symptoms. There are only a limited number of (qualitative) studies exploring the experiences of relatives of sedated patients and their health care professionals (HCPs). The aims of this study protocol are: 1) to elicit the experiences of bereaved relatives and health care professionals of patients treated with palliative sedation and 2) to explore the understanding of the decision-making process to start palliative sedation across care settings in 5 European countries. METHODS This study protocol is part of the larger HORIZON 2020 Palliative Sedation project. Organisational case study methodology will be used to guide the study design. In total, 50 cases will be conducted in five European countries (10 per country). A case involves a semi-structured interview with a relative and an HCP closely involved in the care of a deceased patient who received some type of palliative sedation at the end-of-life. Relatives and health care professionals of deceased patients participating in a linked observational cohort study of sedated patients cared for in hospital wards, palliative care units and hospices will be recruited. The data will be analyzed using a framework analysis approach. The first full case will be analyzed by all researchers after being translated into English using a pre-prepared code book. Afterwards, bimonthly meetings will be organized to coordinate the data analysis. DISCUSSION The study aims to have a better understanding of the experiences of relatives and professional caregivers regarding palliative sedation and this within different settings and countries. Some limitations are: 1) the sensitivity of the topic may deter some relatives from participation, 2) since the data collection and analysis will be performed by at least 5 different researchers in 5 countries, some differences may occur which possibly makes it difficult to compare cases, but using a rigorous methodology will minimize this risk.
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Affiliation(s)
- M. Van der Elst
- grid.5596.f0000 0001 0668 7884Department of Oncology, Laboratory of Experimental Radiotherapy, Katholieke Universiteit Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - S. Payne
- grid.9835.70000 0000 8190 6402International Observatory On End of Life Care, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, LA1 4AT UK
| | - M. Arantzamendi
- grid.5924.a0000000419370271Institute for Culture and Society-ATLANTES, Universidad de Navarra, Calle Universidad 6, Navarra 31009 Pamplona, Spain ,grid.508840.10000 0004 7662 6114IdISNA- Instituto de Investigación Sanitaria de Navarra. Palliative Medicine, Pamplona, Spain
| | - N. Preston
- grid.9835.70000 0000 8190 6402International Observatory On End of Life Care, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, LA1 4AT UK
| | - J. Hasselaar
- grid.5590.90000000122931605Department of Anesthesiology, Pain and Palliative Medicine, Radboud University and Radboudumc, Geert Grote Plein 10, HB6500 Nijmegen, Netherlands
| | - C. Centeno
- grid.5924.a0000000419370271Institute for Culture and Society-ATLANTES, Universidad de Navarra, Calle Universidad 6, Navarra 31009 Pamplona, Spain ,grid.508840.10000 0004 7662 6114IdISNA- Instituto de Investigación Sanitaria de Navarra. Palliative Medicine, Pamplona, Spain ,grid.411730.00000 0001 2191 685XClínica Universidad de Navarra, Palliative Medicine Department, Pamplona, Spain
| | - A. Belar
- grid.5924.a0000000419370271Institute for Culture and Society-ATLANTES, Universidad de Navarra, Calle Universidad 6, Navarra 31009 Pamplona, Spain ,grid.508840.10000 0004 7662 6114IdISNA- Instituto de Investigación Sanitaria de Navarra. Palliative Medicine, Pamplona, Spain
| | - B. Jaspers
- grid.15090.3d0000 0000 8786 803XDepartment of Palliative Medicine, Universitätsklinikum Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - H. Brunsch
- grid.15090.3d0000 0000 8786 803XDepartment of Palliative Medicine, Universitätsklinikum Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - S. Surges
- grid.15090.3d0000 0000 8786 803XDepartment of Palliative Medicine, Universitätsklinikum Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - C. Adile
- grid.10776.370000 0004 1762 5517La Maddalena Cancer Center, Via San Lorenzo 312, 90146 Palermo, Italy
| | - J. Menten
- grid.5596.f0000 0001 0668 7884Department of Oncology, Laboratory of Experimental Radiotherapy, Katholieke Universiteit Leuven, Herestraat 49, 3000 Leuven, Belgium
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Belar A, Arantzamendi M, Menten J, Payne S, Hasselaar J, Centeno C. The Decision-Making Process for Palliative Sedation for Patients with Advanced Cancer-Analysis from a Systematic Review of Prospective Studies. Cancers (Basel) 2022; 14:301. [PMID: 35053464 PMCID: PMC8773810 DOI: 10.3390/cancers14020301] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 12/29/2021] [Accepted: 01/05/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The involvement of patients in decision making about their healthcare plans is being emphasized. In the context of palliative sedation, it is unclear how these decisions are made and who are involved in. The aim of the study is to understand how this decision-making is taken. METHOD Information from a systematic review on clinical aspects of palliative sedation prospective studies were included. PubMed, CINAHL, Cochrane, MEDLINE, and EMBASE were searched (January 2014-December 2019). Data extraction and analysis regarded: (a) When and by whom the decision-making process is initiated; (b) patient involvement; (c) family involvement and (d) healthcare involvement. RESULTS Data about decision making were reported in 8/10 included articles. Palliative sedation was reported in 1137 patients (only 16 of them were non-cancer). Palliative sedation was introduced by the palliative care team during the disease process, at admission, or when patients experienced refractory symptoms. Only two studies explicitly mentioned the involvement of patients in decision making. Co-decision between families and the regular health care professionals was usual, and the health care professionals involved had been working in palliative care services. CONCLUSION Patient participation in decision making appeared to be compromised by limited physical or cognitive capacity and family participation is described. The possibility of palliative sedation should be discussed earlier in the disease process.
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Affiliation(s)
- Alazne Belar
- Institute for Culture and Society-Atlantes, Universidad de Navarra, 31009 Pamplona, Spain; (A.B.); (C.C.)
- IdiSNA—Instituto de Investigacion Sanitaria de Navarra, 31008 Pamplona, Spain
| | - Maria Arantzamendi
- Institute for Culture and Society-Atlantes, Universidad de Navarra, 31009 Pamplona, Spain; (A.B.); (C.C.)
- IdiSNA—Instituto de Investigacion Sanitaria de Navarra, 31008 Pamplona, Spain
| | - Johan Menten
- Department of Oncology, Laboratory of Experimental Radiotherapy, Katholieke Universiteit, 3000 Leuven, Belgium;
| | - Sheila Payne
- Division of Health Research, Lancaster University, Lancaster LA1 4YW, UK;
| | - Jeroen Hasselaar
- Department of Anaesthesiology, Pain and Palliative Medicine, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands;
| | - Carlos Centeno
- Institute for Culture and Society-Atlantes, Universidad de Navarra, 31009 Pamplona, Spain; (A.B.); (C.C.)
- IdiSNA—Instituto de Investigacion Sanitaria de Navarra, 31008 Pamplona, Spain
- Departamento Medicina Paliativa, Clínica Universidad de Navarra, 31001 Pamplona, Spain
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Belar A, Martinez M, Centeno C, López-Fidalgo J, Santesteban Y, Lama M, Arantzamendi M. Wish to die and hasten death in palliative care: a cross-sectional study factor analysis. BMJ Support Palliat Care 2021:bmjspcare-2021-003080. [PMID: 34649837 DOI: 10.1136/bmjspcare-2021-003080] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 08/05/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVES The wish to die (WTD) is a complex experience sometimes accompanied by intention to hasten death. The aim of this study is to identify the predictive factors for WTD and hastening death intention (HDI) in Spanish patients with advanced illness. METHODS This is a subanalysis of a larger cross-sectional study conducted on patients experiencing advanced illness (N=201). Sociodemographic data and data related to symptom burden (Edmonton Symptom Assessment System-Revised), depressive and anxious symptoms (Hospital Anxiety and Depression Scale), demoralisation (Spanish version of the Demoralisation Scale), perceived loss of dignity (Patient Dignity Inventory) and WTD (Assessing Frequency and Extent of Desire to Die) were collected. The analysis used univariate and multivariate logistic regression. RESULTS The prevalence of WTD in the sample was 18%, with 8 out of 36 patients reporting HDI. The independent factors predictive of WTD were (1) knowledge of approximate prognosis (OR=4.78; 95% CI 1.20 to 10.8; p=0.001); (2) symptom burden (OR=1.05; 95% CI 1.00 to 1.09; p=0.038); and (3) the Demoralisation Scale subsection 'lack of meaning and purpose in life' (OR=1.61; 95% CI 1.30 to 1.99; p=0.000). An independent predictive factor for HDI was the Demoralisation Scale subsection 'patients' distress and coping abilities' (OR=1.47; 95% CI 1.04 to 2.08; p=0.028), while having religious beliefs was a protective factor (OR=0.13; 95% CI0.17 to 0.97; p=0.047). CONCLUSIONS Demoralisation was found to be the only common triggering factor for WTD and HDI, although experiences share certain features. Identification of the predictive factors for WTD and HDI may contribute to their prevention and management.
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Affiliation(s)
- Alazne Belar
- Instituto Cultura y Sociedad, Universidad de Navarra, Pamplona, Spain
- IdiSNA, Pamplona, Spain
| | - Marina Martinez
- IdiSNA, Pamplona, Spain
- Medicina Paliativa, Clínica Universidad de Navarra, Pamplona, Spain
| | - Carlos Centeno
- Instituto Cultura y Sociedad, Universidad de Navarra, Pamplona, Spain
- IdiSNA, Pamplona, Spain
| | - Jesús López-Fidalgo
- Institute of Data Science and Artificial Intelligence, Universidad de Navarra, Pamplona, Spain
| | | | - Marcos Lama
- Servicio Navarro de Salud - Osasunbidea, Pamplona, Spain
| | - Maria Arantzamendi
- Instituto Cultura y Sociedad, Universidad de Navarra, Pamplona, Spain
- IdiSNA, Pamplona, Spain
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Reigada C, Centeno C, Gonçalves E, Arantzamendi M. Palliative Care Professionals' Message to Others: An Ethnographic Approach. Int J Environ Res Public Health 2021; 18:ijerph18105348. [PMID: 34067892 PMCID: PMC8156736 DOI: 10.3390/ijerph18105348] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 05/14/2021] [Accepted: 05/16/2021] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Palliative care continues to be misunderstood within the world of healthcare. Palliative care professionals are key agents for promoting a greater understanding of their field. This study aims to examine the messages, both implicit and explicit, that palliative care professionals transmit about themselves and their work within their teams and to other health professionals. METHODS Focused ethnographic secondary analysis, exploring the interactions of palliative care professionals as it happens at everyday work. An inductive thematic analysis was developed from 242 h of observation of the daily work practices of palliative care professionals, focusing on their interactions with others. The data was coded without predefined categories, and the analysis was performed independently by two researchers. RESULTS Palliative professionals communicate that they are part of an active team working in an organized manner. They value and feel proud of their work. Despite the intensity of their work, these professionals are always available to others, to whom they demonstrate a clear professional identity. They convey their expertise in alleviating suffering, respectful behavior and collaborative ability. CONCLUSION Professionals, in their daily work, communicate through their messages the essence of palliative care. It is essential that palliative care professionals perceive themselves as potential influencers and explicitly transmit the reasons for their intervention. Otherwise, others will perpetuate the myths, misunderstandings, and lack of a positive reputation for palliative care.
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Affiliation(s)
- Carla Reigada
- ATLANTES Research Group, Institute for Culture and Society, University of Navarra, 31009 Pamplona, Spain; (C.C.); (M.A.)
- Health Research Institute of Navarra (IdiSNA), 31009 Pamplona, Spain
- Correspondence:
| | - Carlos Centeno
- ATLANTES Research Group, Institute for Culture and Society, University of Navarra, 31009 Pamplona, Spain; (C.C.); (M.A.)
- Health Research Institute of Navarra (IdiSNA), 31009 Pamplona, Spain
- Palliative Medicine Department, Clínica Universidad de Navarra, 31009 Pamplona, Spain
| | - Edna Gonçalves
- Palliative Care Service, Centro Hospitalar Universitário de São João, E.P.E., 4200-319 Porto, Portugal;
| | - Maria Arantzamendi
- ATLANTES Research Group, Institute for Culture and Society, University of Navarra, 31009 Pamplona, Spain; (C.C.); (M.A.)
- Health Research Institute of Navarra (IdiSNA), 31009 Pamplona, Spain
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Arantzamendi M, Belar A, Payne S, Rijpstra M, Preston N, Menten J, Van der Elst M, Radbruch L, Hasselaar J, Centeno C. Clinical Aspects of Palliative Sedation in Prospective Studies. A Systematic Review. J Pain Symptom Manage 2021; 61:831-844.e10. [PMID: 32961218 DOI: 10.1016/j.jpainsymman.2020.09.022] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/14/2020] [Accepted: 09/16/2020] [Indexed: 11/25/2022]
Abstract
CONTEXT Near the end of life when patients experience refractory symptoms, palliative sedation may be considered as a last treatment. Clinical guidelines have been developed, but they are mainly based on expert opinion or retrospective chart reviews. Therefore, evidence for the clinical aspects of palliative sedation is needed. OBJECTIVES To explore clinical aspects of palliative sedation in recent prospective studies. METHODS Systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and registered at PROSPERO. PubMed, CINAHL, Cochrane, MEDLINE, and EMBASE were searched (January 2014-December 2019), combining sedation, palliative care, and prospective. Article quality was assessed. RESULTS Ten prospective articles were included, involving predominantly patients with cancer. Most frequently reported refractory symptoms were delirium (41%-83%), pain (25%-65%), and dyspnea (16%-59%). In some articles, psychological and existential distress were mentioned (16%-59%). Only a few articles specified the tools used to assess symptoms. Level of sedation assessment tools were the Richmond Agitation Sedation Scale, Ramsay Sedation Scale, Glasgow Coma Scale, and Bispectral Index monitoring. The palliative sedation practice shows an underlying need for proportionality in relation to symptom intensity. Midazolam was the main sedative used. Other reported medications were phenobarbital, promethazine, and anesthetic medication-propofol. The only study that reported level of patient's discomfort as a palliative sedation outcome showed a decrease in patient discomfort. CONCLUSION Assessment of refractory symptoms should include physical evaluation with standardized tools applied and interviews for psychological and existential evaluation by expert clinicians working in teams. Future research needs to evaluate the effectiveness of palliative sedation for refractory symptom relief.
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Affiliation(s)
- Maria Arantzamendi
- Instituto Cultura y Sociedad, ATLANTES, Universidad de Navarra, Pamplona, Spain; IdISNA, Pamplona, Spain
| | - Alazne Belar
- Instituto Cultura y Sociedad, ATLANTES, Universidad de Navarra, Pamplona, Spain; IdISNA, Pamplona, Spain.
| | - Sheila Payne
- Division of Health Research, Lancaster University, Lancaster, United Kingdom
| | - Maaike Rijpstra
- Department of Anaesthesiology, Pain, Palliative Medicine, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Nancy Preston
- Division of Health Research, Lancaster University, Lancaster, United Kingdom
| | - Johan Menten
- Department of Oncology, Laboratory of experimental radiotherapy, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Michael Van der Elst
- Department of Oncology, Laboratory of experimental radiotherapy, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Lukas Radbruch
- Department of Palliative Medicine, Universitaetsklinikum Bonn, Bonn, Germany
| | - Jeroen Hasselaar
- Department of Anaesthesiology, Pain, Palliative Medicine, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Carlos Centeno
- Instituto Cultura y Sociedad, ATLANTES, Universidad de Navarra, Pamplona, Spain; IdISNA, Pamplona, Spain; Clínica Universidad de Navarra, Departamento Medicina Paliativa, Pamplona, Spain
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11
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Arantzamendi M, García-Rueda N, Carvajal A, Robinson CA. People With Advanced Cancer: The Process of Living Well With Awareness of Dying. Qual Health Res 2020; 30:1143-1155. [PMID: 30539681 PMCID: PMC7307002 DOI: 10.1177/1049732318816298] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Literature suggests that it is possible to live well with advanced cancer but little is known about the process. In this article, we present a secondary analysis of experiences of living with advanced cancer (n = 22) that refines the theory of "Living Well with Chronic Illness" for a different context and population. The refined theory explains the experience of living well with advanced cancer illuminating a five-phase iterative process: struggling, accepting, living with advanced cancer, sharing the illness experience, and reconstructing life. These five phases revolve around the core concept of Awareness of Dying, which varied from awareness of the possibility of dying, to accepting the possibility of dying, to acceptance that "I am dying." Awareness of Dying led to a focus on living well with advanced cancer and movement towards living a life rather than living an illness.
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Affiliation(s)
- Maria Arantzamendi
- Universidad de Navarra, ICS, Grupo
ATLANTES, Pamplona, Spain
- IdisNA—Instituto de Investigación
Sanitaria de Navarra, Pamplona, Spain
- Maria Arantzamendi, Universidad de
Navarra, Institute for Culture and Society, ATLANTES Research Program,
Edificio de Bibliotecas, 31009, Spain.
Pamplona, Spain
| | - Noelia García-Rueda
- IdisNA—Instituto de Investigación
Sanitaria de Navarra, Pamplona, Spain
- Universidad de Navarra, Faculty of
Nursing, Pamplona, Spain
| | - Ana Carvajal
- IdisNA—Instituto de Investigación
Sanitaria de Navarra, Pamplona, Spain
- Universidad de Navarra, Faculty of
Nursing, Pamplona, Spain
| | - Carole A. Robinson
- Universidad de Navarra, ICS, Grupo
ATLANTES, Pamplona, Spain
- University of British Columbia,
Faculty of Health and Social Development, School of Nursing, Kelowna,
British Columbia, Canada
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12
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Belar A, Arantzamendi M, Santesteban Y, López-Fidalgo J, Martinez M, Lama M, Rullán M, Olza I, Breeze R, Centeno C. Cross-sectional survey of the wish to die among palliative patients in Spain: one phenomenon, different experiences. BMJ Support Palliat Care 2020; 11:156-162. [PMID: 32581007 PMCID: PMC8142449 DOI: 10.1136/bmjspcare-2020-002234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 05/15/2020] [Accepted: 05/25/2020] [Indexed: 12/02/2022]
Abstract
Objective Cultural backgrounds and values have a decisive impact on the phenomenon of the wish to die (WTD), and examination of this in Mediterranean countries is in its early stages. The objectives of this study were to establish the prevalence of WTD and to characterise this phenomenon in our cultural context. Methods A cross-sectional study with consecutive advanced inpatients was conducted. Data about WTD (Assessing Frequency & Extent of Desire to Die (AFFED) interview) and anxiety and depression (Edmonton Symptom Assessment
System-revised (ESAS-r)) were collected through two face-to-face clinical encounters. Data were analysed with descriptive statistics, χ2 and analysis of variance. Results 201 patients participated and 165 (82%) completed both interviews. Prevalence of WTD was 18% (36/201) in the first interview and 16% (26/165) in the second interview (p=0.25). After the first interview, no changes in depression (p=0.60) or anxiety (p=0.90) were detected. The AFFED shows different experiences within WTD: 11% of patients reported a sporadic experience, while 7% described a persistent experience. Thinking about hastening death (HD) appeared in 8 (22%) out of 36 patients with WTD: 5 (14%) out of 36 patients considered this hypothetically but would never take action, while 3 (8%) out of 36 patients had a more structured idea about HD. In this study, no relation was detected between HD and frequency of the appearance of WTD (p=0.12). Conclusions One in five patients had WTD. Our findings suggest the existence of different experiences within the same phenomenon, defined according to frequency of appearance and intention to hasten death. A linguistically grounded model is proposed, differentiating the experiences of the ‘wish’ or ‘desire’ to die, with or without HD ideation.
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Affiliation(s)
- Alazne Belar
- Instituto Cultura y Sociedad, Universidad de Navarra, Pamplona, Navarra, Spain.,IdiSNA, Pamplona, Navarra, Spain
| | - Maria Arantzamendi
- Instituto Cultura y Sociedad, Universidad de Navarra, Pamplona, Navarra, Spain .,IdiSNA, Pamplona, Navarra, Spain
| | - Yolanda Santesteban
- Obra Social LaCaixa, Hospital San Juan de Dios Pamplona, Pamplona, Navarra, Spain
| | - Jesús López-Fidalgo
- Institute of Data Science and Artificial Intelligence, Universidad de Navarra, Pamplona, Navarra, Spain
| | - Marina Martinez
- IdiSNA, Pamplona, Navarra, Spain.,Clínica Universidad de Navarra, Servicio de Medicina Paliativa, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
| | - Marcos Lama
- Servicio Navarro de Salud - Osasunbidea, Pamplona, Navarra, Spain
| | - Maria Rullán
- Instituto Cultura y Sociedad, Universidad de Navarra, Pamplona, Navarra, Spain
| | - Inés Olza
- Instituto Cultura y Sociedad, Universidad de Navarra, Pamplona, Navarra, Spain
| | - Ruth Breeze
- Instituto Cultura y Sociedad, Universidad de Navarra, Pamplona, Navarra, Spain
| | - Carlos Centeno
- Instituto Cultura y Sociedad, Universidad de Navarra, Pamplona, Navarra, Spain.,IdiSNA, Pamplona, Navarra, Spain.,Clínica Universidad de Navarra, Servicio de Medicina Paliativa, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
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13
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Reigada C, Arantzamendi M, Centeno C. Palliative care in its own discourse: a focused ethnography of professional messaging in palliative care. BMC Palliat Care 2020; 19:88. [PMID: 32571288 PMCID: PMC7310281 DOI: 10.1186/s12904-020-00582-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 05/20/2020] [Indexed: 11/19/2022] Open
Abstract
Background Despite 50 years of modern palliative care (PC), a misunderstanding of its purpose persists. The original message that PC is focused on total care, helping to live until the person dies, is being replaced and linked to feelings of fear, anxiety and death, instead of compassion, support or appropriate care. Society is still afraid to speak its name, and specialized units are identified as “places of death” as opposed to “places of life” meant to treat suffering. This issue is prohibitive to the implementation and development of PC policies worldwide. It is imperative to identify what message PC professionals are relaying to patients and other health care specialists and how that message may condition understandings of the right to access PC. Methods A qualitative study, employing focused ethnography and participant observation (PO) of the daily interaction of PC professionals with patients and family members in three different PC services. Two researchers independently conducted a thematic analysis, followed by member checking with participants. Results A total of 242 h of participant observation revealed the following messages sent by PC professionals in their daily interaction with patients and families: i) We are focused on your wellbeing; ii) You matter: we want to get to know you; iii) Your family is important to us. Conclusion The complexity of PC discourses contributes to the difficulty of identifying a clear universal message between PC professionals, patients and families. The PC professionals observed transmit a simple message focused on their actions rather than their identity, which may perpetuate some social/cultural misunderstandings of PC. It seems there is a common culture, based on the same values and attitudes, within the messages that PC professionals transmit to patients and their families. PC teams are characterised by their availability.
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Affiliation(s)
- Carla Reigada
- ATLANTES Research Group; Institute for Culture and Society, University of Navarra, Campus Universitario, 31009, Pamplona, Spain. .,Health Research Intitute of Navarra (IdiSNA), Pamplona, Spain.
| | - Maria Arantzamendi
- ATLANTES Research Group; Institute for Culture and Society, University of Navarra, Campus Universitario, 31009, Pamplona, Spain.,Health Research Intitute of Navarra (IdiSNA), Pamplona, Spain
| | - Carlos Centeno
- ATLANTES Research Group; Institute for Culture and Society, University of Navarra, Campus Universitario, 31009, Pamplona, Spain.,Health Research Intitute of Navarra (IdiSNA), Pamplona, Spain.,Palliative Medicine Department, Clinica Universidad de Navarra, Pamplona, Spain
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14
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Pergolizzi D, Crespo I, Balaguer A, Monforte-Royo C, Alonso-Babarro A, Arantzamendi M, Belar A, Centeno C, Goni-Fuste B, Julià-Torras J, Martinez M, Mateo-Ortega D, May L, Moreno-Alonso D, Nabal Vicuña M, Noguera A, Pascual A, Perez-Bret E, Rocafort J, Rodríguez-Prat A, Rodriguez D, Sala C, Serna J, Porta-Sales J. Proactive and systematic multidimensional needs assessment in patients with advanced cancer approaching palliative care: a study protocol. BMJ Open 2020; 10:e034413. [PMID: 32024792 PMCID: PMC7045209 DOI: 10.1136/bmjopen-2019-034413] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 01/09/2020] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The benefits of palliative care rely on how healthcare professionals assess patients' needs in the initial encounter/s; crucial to the design of a personalised therapeutic plan. However, there is currently no evidence-based guideline to perform this needs assessment. We aim to design and evaluate a proactive and systematic method for the needs assessment using quality guidelines for developing complex interventions. This will involve patients, their relatives and healthcare professionals in all phases of the study and its communication to offer clinical practice a reliable approach to address the palliative needs of patients. METHODS AND ANALYSIS To design and assess the feasibility of an evidence-based, proactive and systematic Multidimensional needs Assessment in Palliative care (MAP) as a semistructured clinical interview guide for initial palliative care encounter/s in patients with advanced cancer. This is a two-phase multisite project conducted over 36 months between May 2019 and May 2022. Phase I includes a systematic review, discussions with stakeholders and Delphi consensus. The evidence gathered from phase I will be the basis for the initial versions of the MAP, then submitted to Delphi consensus to develop a preliminary guide of the MAP for the training of clinicians in the feasibility phase. Phase II is a mixed-methods multicenter feasibility study that will assess the MAP's acceptability, participation, practicality, adaptation and implementation. A nested qualitative study will purposively sample a subset of participants to add preliminary clues about the benefits and barriers of the MAP. The evidence gathered from phase II will build a MAP user guide and educational programme for use in clinical practice. ETHICS AND DISSEMINATION Ethical approval for this study has been granted by the university research ethics committee where the study will be carried out (approval reference MED-2018-10). Dissemination will be informed by the results obtained and communication will occur throughout.
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Affiliation(s)
- Denise Pergolizzi
- School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Iris Crespo
- Department of Basic Sciences, School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Albert Balaguer
- School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain
- Universitat Internacional de Catalunya, Hospital Universitari General de Catalunya, Barcelona, Spain
| | - Cristina Monforte-Royo
- Nursing Department, School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain
| | | | | | | | - Carlos Centeno
- Clínica Universidad de Navarra, Pamplona, Spain
- Instituto de Cultura y Sociedad, Universidad de Navarra, IdiSNA, Pamplona, Spain
| | - Blanca Goni-Fuste
- Nursing Department, School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain
| | | | | | | | - Luis May
- Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | | | - Maria Nabal Vicuña
- Palliative Care Supportive Team, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - Antonio Noguera
- Clínica Universidad de Navarra, Pamplona, Spain
- Instituto de Cultura y Sociedad, Universidad de Navarra, IdiSNA, Pamplona, Spain
| | | | | | | | - Andrea Rodríguez-Prat
- Department of Humanities, School of Humanities, Universitat Internacional de Catalunya, Barcelona, Spain
| | | | - Carme Sala
- Consorci Sanitari de Terrassa, Terrassa, Spain
| | - Judith Serna
- Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Josep Porta-Sales
- Nursing Department, School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain
- Institut Català d'Oncologia Girona, Girona, Spain
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15
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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16
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Belar A, Arantzamendi M, Rodríguez-Núñez A, Santesteban Y, Martinez M, López-Saca M, Consigli S, López-Fidalgo J, Centeno C. Multicenter Study of the Psychometric Properties of the New Demoralization Scale (DS-II) in Spanish-Speaking Advanced Cancer Patients. J Pain Symptom Manage 2019; 57:627-634. [PMID: 30472315 DOI: 10.1016/j.jpainsymman.2018.11.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 11/12/2018] [Accepted: 11/14/2018] [Indexed: 12/21/2022]
Abstract
CONTEXT Demoralization is a state of existential distress in patients with advanced illness, typically with coping difficulties, feelings of loss of sense, and purpose in life and despair, among other things. The New Demoralization Scale (DS-II) is an evaluation tool for this syndrome, which has recently been reformulated on a shorter scale. OBJECTIVES The objective of this study was to obtain a Spanish version of the DS-II and to assess its psychometric properties in advanced cancer patients in Spain and a number of Latin American countries. METHODS Following a translation-back translation process, a validation study and a confirmatory analysis using structural equation models with their corresponding latent constructs were undertaken. Patients completed the DS-II in Spanish (DS-II (es)), the Hospital Anxiety and Depression Scale, and the Edmonton Symptom Assessment System-revised. Reliability was studied according to internal consistency; construct validity and concurrent validity with the Hospital Anxiety and Depression Scale and the Edmonton Symptom Assessment System-revised; discriminant validity using the Karnofsky Performance Status scale; and feasibility, with response ratio and required time. Cutoff points were established, and sensitivity and specificity were studied. RESULTS The DS-II (es) was obtained. One hundred fifty patients completed the validation study. The confirmatory analysis showed coherence, and all items correlated positively with their subscales and with the overall scale. Cronbach's alpha for the DS-II (es) was 0.88, for the sense and purpose subscale 0.83, and for the coping ability 0.79. Demoralization correlated significantly with emotional distress (rho = 0.73, P < 0.001). The tool distinguished between patients with diverse functional levels (rho = -0.319, P = 0.001). Cutoff points at 10 and 20 out of 32 were established. The scale showed high sensitivity (81.97%) and specificity (80.90%). The prevalence of demoralization was 33% in our sample. CONCLUSION The Spanish version of the new Kissane DS-II demoralization scale has shown to be valid, reliable, and feasible with adequate psychometric properties.
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Affiliation(s)
- Alazne Belar
- Universidad de Navarra, ICS, ATLANTES, Pamplona, Spain; IdiSNA, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
| | - Maria Arantzamendi
- Universidad de Navarra, ICS, ATLANTES, Pamplona, Spain; IdiSNA, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain.
| | | | | | - Marina Martinez
- Clínica Universidad de Navarra, Pamplona, Spain; IdiSNA, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
| | - Mario López-Saca
- Universidad Dr. José Matías Delgado, Antiguo Cuscatlán, El Salvador
| | - Sara Consigli
- Hospital Universitario Austral, Buenos Aires, Argentina
| | | | - Carlos Centeno
- Universidad de Navarra, ICS, ATLANTES, Pamplona, Spain; Clínica Universidad de Navarra, Pamplona, Spain; IdiSNA, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
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17
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Comoretto N, Larumbe A, Arantzamendi M, Centeno C. Palliative care consultants’ ethical concerns with advanced cancer patients participating in phase 1 clinical trials. A case study. Progress in Palliative Care 2017. [DOI: 10.1080/09699260.2017.1364894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Nunziata Comoretto
- ATLANTES Research Program, Institute for Culture and Society (ICS), University of Navarra, Pamplona, Spain
| | - Ana Larumbe
- Palliative Medicine and Symptom Control Unit, University of Navarra School of Medicine, Pamplona, Spain
| | - Maria Arantzamendi
- ATLANTES Research Program, Institute for Culture and Society (ICS), University of Navarra, Pamplona, Spain
| | - Carlos Centeno
- ATLANTES Research Program, Institute for Culture and Society (ICS), University of Navarra, Pamplona, Spain
- Palliative Medicine and Symptom Control Unit, University of Navarra School of Medicine, Pamplona, Spain
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18
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Martín J, Carvajal A, Arantzamendi M. Instrumentos para valorar al paciente con insuficiencia cardíaca avanzada: una revisión de la literatura. An Sist Sanit Navar 2015. [DOI: 10.4321/s1137-66272015000300008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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19
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Martín J, Carvajal A, Arantzamendi M. [Assessment instruments for patients with advanced heart failure: a review of the literature]. An Sist Sanit Navar 2015; 38:439-452. [PMID: 26786371 DOI: 10.23938/assn.0284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
A quarter of the people with heart failure are at an advanced stage of the disease, during which they experience numerous common and distressing symptoms that have an impact on all spheres of their life. In this context, there is a need for frequent assessment and clinical monitoring of patients. The aim of this review is to identify the instruments used in assessing patients with advanced heart failure. For the purposes of this study, any type of questionnaire, scale or functional test used to assess some aspect of these patients was considered to be an instrument. Forty-nine tools were identified that make it possible to assess symptoms, psychological, cognitive and spiritual aspects and quality of life. The information provided on the most used instruments and their availability and applicability is a first step for their possible integration into daily clinical practice. Thus, professionals who work with these patients can improve the identification of specific needs, enabling their subsequent management and monitoring.
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Affiliation(s)
- J Martín
- Facultad de Enfermería, Universidad de Navarra, Pamplona, 31008, Spain.
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20
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Mujika A, Arantzamendi M, Lopez-Dicastillo O, Forbes A. Nurses and smoking: a qualitative study. Eur J Public Health 2014. [DOI: 10.1093/eurpub/cku164.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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21
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Ballesteros M, Centeno C, Arantzamendi M. A qualitative exploratory study of nursing students' assessment of the contribution of palliative care learning. Nurse Educ Today 2014; 34:e1-e6. [PMID: 24461389 DOI: 10.1016/j.nedt.2013.12.010] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Revised: 11/20/2013] [Accepted: 12/26/2013] [Indexed: 06/03/2023]
Abstract
OBJECTIVE We explored the contribution of optional palliative care (PC) learning to the training of undergraduate nursing students. DESIGN This is a qualitative, exploratory study. PARTICIPANTS PC students from two universities (n=236) responded to the open question: What was the contribution of the PC course to your training? METHODS A thematic analysis of the respondents' answers was performed with investigator triangulation. FINDINGS Four themes were identified. Firstly, the PC course provided a comprehensive view of the nursing discipline. Secondly, the course helped the students to know how to interact with, communicate with and better understand patients. Thirdly, the contribution of the course to the students' personal growth prompted them to reflect personally on death, thus promoting self-awareness. Finally, the students considered the PC course to be of great importance in the nursing curriculum. CONCLUSION Nursing students believed that a PC course was an essential component in their training, which contributed favourably to their personal and professional development.
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Affiliation(s)
- Montserrat Ballesteros
- University of Navarra, Institute for Culture and Society (ICS), ATLANTES Research Program, Pamplona, Spain; Nursing Department of the University of Valladolid, Spain.
| | - Carlos Centeno
- University of Navarra, Institute for Culture and Society (ICS), ATLANTES Research Program, Pamplona, Spain; University of Navarra, Clínica Universidad de Navarra, Department of Palliative Medicine and Symptom Management, Pamplona, Spain.
| | - Maria Arantzamendi
- University of Navarra, Institute for Culture and Society (ICS), ATLANTES Research Program, Pamplona, Spain; Faculty of Nursing, Pamplona, Spain.
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22
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Arantzamendi M, Addington-Hall J, Saracibar M, Richardson A. Spanish nurses’ preparedness to care for hospitalised terminally ill patients and their daily approach to caring. Int J Palliat Nurs 2012; 18:597-605. [DOI: 10.12968/ijpn.2012.18.12.597] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Maria Arantzamendi
- School of Nursing, University of Navarra, C/Irunlarrea, 1 31.008, Pamplona, Spain
| | | | | | - Alison Richardson
- Cancer Nursing and End of Life Care, University of Southampton & Southampton University Hospitals NHS Trust
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Corchon S, Watson R, Arantzamendi M, SaracÃbar M. Design and validation of an instrument to measure nursing research culture: the Nursing Research Questionnaire (NRQ). J Clin Nurs 2010; 19:217-26. [DOI: 10.1111/j.1365-2702.2009.03049.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
AIM This paper is a report of a review undertaken to identify, critically analyse and synthesize the psychosocial experience of cancer recurrence for survivors and family members. BACKGROUND Recurrence of cancer is an event after which life changes for families. Individuals move from being short- or long-term survivors of cancer to being patients once more. Families move from a state of fear of recurrence to one of uncertainty and distress as a result of the new crisis. DATA SOURCES MEDLINE, CINAHL and CancerLit databases were searched for the period January 1980-2007. Reference lists of papers were conducted for relevant studies. The search terms recurrence, recurrent cancer, experience, survivor and family were searched for separately and in combination. REVIEW METHODS A narrative review was conducted. Data were categorized in terms of issues during survivorship and concerns after recurrence. RESULTS Three main categories were identified that explained survivors' and families' experiences of recurrent cancer: (1) fear of recurrence during survivorship, (2) when cancer recurs: families facing new challenges and (3) distress because of recurrence. CONCLUSION Recurrence is a distressing experience for survivors and families because they have to face again psychosocial effects of cancer, such as uncertainty, distress and concerns about death. Care should not be addressed simply to survivors, but should include the general well-being of families beyond their survivorship and support to manage better psychosocial issues occurring when a member has a recurrence of cancer.
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Affiliation(s)
- Cristina G Vivar
- Department of Community Nursing and Maternal & Child Health Care, School of Nursing, University of Navarra, Spain.
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Abstract
This study explored the perceptions of a group of registered oncology nurses about the psychological needs of patients with cancer receiving chemotherapy and how the nurses meet these. Eight nurses who provided chemotherapy and were working in a local oncology centre participated. A semi-structured interview was used to explore nurses' perceptions, and how they meet these patients' needs. The analysis of interview transcripts revealed that these nurses agreed that patients with cancer receiving chemotherapy had psychological needs. Moreover, they were conscious that some of the physical side-effects could have a psychological impact on the patients. Although nurses did not use any assessment tool for psychological assessment, they identified two main stages during the treatment when patients needed more psychological support: at the beginning and at the end of the chemotherapy. They explained how they tried to meet patients' psychological needs but they also mentioned several factors that influenced the psychological support that patients received.
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