Dificultades y factores favorables para la atención al final de la vida en residencias de ancianos: un estudio con grupos focales

Sánchez-García, María Remedios; Moreno-Rodríguez, Marina; Hueso‐Montoro, César; Campos-Calderón, Concepción; Varella-Safont, Ana; Montoya‐Juárez, Rafael

doi:10.1016/j.aprim.2016.09.004

Cited by 14 publications

(18 citation statements)

References 22 publications

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“…Regarding the item “[RESIDENT] had treatment preferences in writing”, although there is legislation in Spain regulating this practice and advance directives are seen as a positive tool by health professionals, there is evidence that advance directives are not being implemented systematically [ 42 ], and a large percentage of the population is unaware of their existence and have never been informed by their doctor about them [ 43 ]. The expert group proposed the modification of this item to note the verbal expression of wishes, even if these were not documented, to better reflect cultural practices.…”

Section: Discussionmentioning

confidence: 99%

Cultural Adaptation and Validation of the Quality of Dying in Long-Term Care Scale (QoD-LTC) for Spanish Nursing Homes

Puente‐Fernández

Jimeno-Ucles²,

Mota-Romero

et al. 2021

IJERPH

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Background: There is a need for instruments that can evaluate the psychosocial quality of dying in nursing homes. The aim of this study was to adapt and validate the Quality of Dying in Long-Term Care scale (QoD-LTC) to the Spanish context. Methods: Descriptive cross-sectional study. Fourteen nurses from 7 facilities in southern Spain assessed 153 residents who died in the centers; validity, reliability, and feasibility were evaluated. Results: The Spanish version consists of 11 items with acceptable reliability (α = 0.681). Three factors model was validated by principal components analysis. A mean of 180.62 (SD = 86.66) seconds is needed to fill it in. An inter-observer 0.753 (95% CI: 0.391–0.900, p< 0.001) and intra-observer 0.855 (95% CI: 0.568–0.951 p = 0.001) reliability were observed. Weak correlation was observed; positive with mono-item question (0.322) and negative with Eastern Cooperative Oncology Group (ECOG) with a value of (−0.321) and Integrated Palliative outcome scale (IPOS) with a value of (−0.252). Conclusions: The QoD-LTC scale presents an adequate factorial structure, internal consistency, and feasibility to evaluate psychosocial quality of dying in nursing homes. It can be used as a quality indicator.

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Section: Discussionmentioning

confidence: 99%

Cultural Adaptation and Validation of the Quality of Dying in Long-Term Care Scale (QoD-LTC) for Spanish Nursing Homes

Puente‐Fernández

Jimeno-Ucles²,

Mota-Romero

et al. 2021

IJERPH

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“…Sin embargo, esta percepción tan positiva de su práctica, resulta contradictoria con la inferior calidad de los cuidados que se les supone a las RA 5,15,17 , así como con las dificultades encontradas por los profesionales en estos centros, Sánchez-García y col 17 , encontraron que los profesionales de RA entrevistados señalaron dificultades en aspectos de la atención al final de la vida tales como la toma de decisiones, la relación con las familias, la relación con otros profesionales y la falta de recursos. Condelius y Andersson 18 señalaron las barreras existentes en el acceso a las RA en la última fase de la vida como consecuencia, entre otras, de desacuerdos entre los profesio-nales de AP y los cuidadores familiares.…”

Section: Discussionunclassified

“…Otras dificultades señaladas por otros estudios han sido la falta de planificación anticipada de decisiones 15 y la falta de integración de los pacientes atendidos en RA en sistemas más amplios de cuidados al final de la vida 16 . En uno de los pocos estudios publicados sobre la materia en nuestro ámbito, realizado con grupos focales en RA 17 , profesionales de estos cen-tros, señalaban los problemas principales de comunicación, la falta de formación y de coordinación con otros centros.…”

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Perceptions of health care professionals about end-of-life care, obstacles and ethical dilemmas in hospitals, primary care and nursing homes.

Mancilla

Montoya‐Juárez²,

Martí‐García³

et al. 2018

An Sist Sanit Navar

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“…The process for documentating and executing ADs in Spain is not easy for health care professionals or patients either, and that makes it difficult to make their use more widespread [ 43 ]. Usually, although it depends on the Autonomous Communities, the document cannot be accessed through the patient’s clinical record, and in order to consult the corresponding ADs Register, health care professionals must possess a set of personal passwords which expire periodically.…”

Section: Main Textmentioning

confidence: 99%

Why have Advance Directives failed in Spain?

et al. 2020

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Background In Spain, there has been great effort by lawmakers to put Advance Directives (ADs) into practice since 2002. At the same time, the field of bioethics has been on the rise, a discipline that has spurred debate on the right of patients to exercise their autonomy. Despite all this, the implementation of ADs can be said to have failed in Spain, because its prevalence is very low, there is a great lack of knowledge about them and they have very little impact on clinical decisions. The purpose of this article is to analyze and discuss the main reasons for the failure of ADs in Spain. Main body The main reasons why ADs have no impact on clinical practice in Spain have been fundamentally four: (1) the training of health professionals about the end of life and AD is lacking; (2) there has been no public process to increase awareness about AD, and therefore people (with the exception of specific highly sensitized groups) know little about them; (3) the bureaucratic procedure to document and implement ADs is excessively complex and cumbersome, creating a significant barrier to their application; (4) in Spain, the remnants of a paternalistic medical culture continue to exist, which causes shared decision-making to be difficult. Conclusion Due to the four reasons mentioned above, AD have not been a useful tool to help honor patients’ autonomous decisions about their future care and, therefore, they have not achieved their objective. However, despite the difficulties and problems identified, it has also been observed that health care professionals and the Spanish public have a very positive view of AD. Having identified the problems which have kept AD from being successful, strategies must be developed to help improve their implementation into the future.

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Dificultades y factores favorables para la atención al final de la vida en residencias de ancianos: un estudio con grupos focales

Abstract: It is necessary to improve communication among nursing homes professionals, families, patients and other health workers.

Cited by 14 publications

References 22 publications

Cultural Adaptation and Validation of the Quality of Dying in Long-Term Care Scale (QoD-LTC) for Spanish Nursing Homes

Cultural Adaptation and Validation of the Quality of Dying in Long-Term Care Scale (QoD-LTC) for Spanish Nursing Homes

Perceptions of health care professionals about end-of-life care, obstacles and ethical dilemmas in hospitals, primary care and nursing homes.

Why have Advance Directives failed in Spain?

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