The Communication and Bioethical Training (CoBiT) Program for assisting dialysis decision-making in Spanish ACKD units.

Healthcare professionals currently working in Advanced Chronic Kidney Disease (ACKD) units must cope with difficult situations regarding assisting patients with the dialysis decision-making process, and they are often untrained for these conversations. Although we have evidence from the literature that these skills can be learned, few professionals feel confident in this area. A Communication and Bioethical Training (CoBiT) Program for ACKD staff (physicians, nurses and allied health professionals) was developed to improve their ability and self-confidence in conducting these conversations. A four-stage study was conducted: (1) development of the CoBiT program, beginning with the creation of an interdisciplinary focus group (N = 10); (2) design of a questionnaire to assess self-confidence based on the areas identified by the focus group. The face validity of the instrument was tested using an inter-judge methodology (N = 6); (3) design of the format and contents of the program; (4) piloting the program. Thirty-six health professionals took an 8-h workshop based on role-playing methodology. Participants assessed their self-confidence in their communication skills before and after the program using self-report measures. The results show that after the program, participants reported significantly higher levels of self-confidence measured with a five-point Likert scale (p < 0.001). Participants felt that communication with colleagues of other professions significantly increased after the workshop (p = 0.004). The CoBiT program improves ACKD Unit healthcare professionals' self-confidence in their ability to perform a specific communication task.

Testing the consistency and feasibility of the standard Malmquist-Luenberger index: Environmental productivity in world air emissions.

Over the last twenty years an increasing number of studies have relied on the standard definition of the Malmquist-Luenberger index proposed by Chung et al. (1997) [J. Environ. Manage., 51, 229-240], to assess environmental sensitive productivity change. While recent contributions have shown that it suffers from relevant drawbacks related to inconsistencies and infeasibilities, no one has studied systematically the performance of the original model, and to what extent the existing results are unreliable. We introduce the optimization techniques that implement the model by Aparicio et al. (2013) [Eur. J. Oper. Res., 229(3), 738-742] solving these problems, and using a country level database on air pollutants systematically compare the results obtained with both approaches. Over the 1995-2007 period environmental productivity stagnation prevails across developed and developing countries, and while increasing technical progress takes place in the later years, it is offset by declining efficiency. Results show also that inconsistencies and infeasibilities in the original model are increasing in the number of undesirable outputs included, reaching remarkable values that seriously question the reliability of results, and compromise any environmental policy recommendation based on them.

Enhancing psychosocial and spiritual palliative care: Four-year results of the program of comprehensive care for people with advanced illnesses and their families in Spain.

OBJECTIVE: We aimed to describe the overall quantitative and qualitative results of a "La Caixa" Foundation and World Health Organization Collaborating Center Program entitled "Comprehensive Care for Patients with Advanced Illnesses and their Families" after four years of experience. METHOD: Qualitative and quantitative methods were employed to assess the program. Quasiexperimental, prospective, multicenter, single-group, and pretest/posttest methods were utilized to assess the quantitative data. The effectiveness of psychosocial interventions was assessed at baseline (visit 1) and after four follow-up visits. The following dimensions were assessed: mood state, discomfort, anxiety, degree of adjustment or adaptation to disease, and suffering. We also assessed the four dimensions of the spiritual pain scale: faith or spiritual beliefs, valuable faith or spiritual beliefs, meaning in life, and peace of mind/forgiveness. Qualitative analyses were performed via surveys to evaluate stakeholder satisfaction. RESULTS: We built 29 psychosocial support teams involving 133 professionals-mainly psychologists and social workers. During the study period, 8,964 patients and 11,810 family members attended. Significant improvements were observed in the psychosocial and spiritual dimensions assessed. Patients, family members, and stakeholders all showed high levels of satisfaction. SIGNIFICANCE OF RESULTS: This model of psychosocial care could serve as an example for other countries that wish to improve psychosocial and spiritual support. Our results confirm that specific psychosocial interventions delivered by well-trained experts can help to ease suffering and discomfort in end-of-life and palliative care patients, particularly those with high levels of pain or emotional distress.

Technological, institutional, and geographical peripheries: regional development and risk of poverty in the European regions.

In this paper, we analyze the interrelation between technological, institutional, and geographical peripheries. By distinguishing between the quality and quantity of access to information and communication technologies, together with institutional and geographical factors, and using a sample of 229 European regions during the period 2007-2018, we find that the diffusion and quality of information and communication technologies foster economic development and decrease the risk of social exclusion. A similar effect is found for institutional and geographical factors, suggesting that the interplay of these three determinants may be crucial to set up place-based policies. Supplementary Information: The online version contains supplementary material available at 10.1007/s00168-022-01127-9.

Effects of COVID-19 on trade flows: Measuring their impact through government policy responses.

This paper examines the impact of COVID-19 on bilateral trade flows using a state-of-the-art gravity model of trade. Using the monthly trade data of 68 countries exporting across 222 destinations between January 2019 and October 2020, our results are threefold. First, we find a greater negative impact of COVID-19 on bilateral trade for those countries that were members of regional trade agreements before the pandemic. Second, we find that the impact of COVID-19 is negative and significant when we consider indicators related to governmental actions. Finally, this negative effect is more intense when exporter and importer country share identical income levels. In the latter case, the highest negative impact is found for exports between high-income countries.

Proper information during the surgical decision-making process lowers the anxiety of patients with high-grade gliomas.

PURPOSE: We aim to analyse the relationship between the quality of information during the decision-making process regarding surgery to treat high-grade gliomas and the level of anxiety of the patients. METHODS: This is a transversal, descriptive and correlational study on 26 patients with a clinical and radiological diagnosis of high-grade glioma. They scored the quality (in terms of comprehension and satisfaction) of information received about the treatment options and prognosis during the surgical decision-making process, and the Hospital Anxiety and Depression Scale questionnaire (HADS) was applied immediately afterward. RESULTS: Lower levels of anxiety were observed in patients who showed a desire to receive information regarding their illness, those with a higher degree of comprehension, and those with a higher level of satisfaction with the information provided. CONCLUSIONS: An improvement in the communication process contributes to a decrease in the levels of anxiety, and consequently to enhancement of the well-being of these patients.

Development and validation of a new tool for the assessment and spiritual care of palliative care patients.

CONTEXT: Spiritual assessment tools and interventions based on holistic approaches are needed to promote healing. Such tools must be adapted to the wide cultural backgrounds of contemporary Western society. OBJECTIVES: To develop and validate a new brief measure, simultaneously featuring clinical applicability and adequate psychometric properties. The tool uses six initial questions to establish a climate of trust with patients before they complete an eight-item, five-point Likert scale. The questionnaire is based on a model of spirituality generated by the Spanish Society of Palliative Care (SECPAL) Task Force on Spiritual Care (Grupo de Espiritualidad de la SECPAL), which aims to recognize, share, and assess the spiritual resources and needs of palliative care patients. METHODS: Multidisciplinary professionals from 15 palliative care teams across Spain interviewed 108 patients using the Grupo de Espiritualidad de la SECPAL questionnaire. Confirmatory factor analysis techniques were used to study the new tool factor structure and reliability. Additionally, concurrent criterion validity coefficients were estimated considering spiritual well-being, anxiety, depression, resilience, and symptoms. Descriptive statistics on questionnaire applicability were reported. RESULTS: Analyses supported a three-factor structure (intrapersonal, interpersonal, transpersonal) with an underlying second-order factor representing a spirituality construct. Adequate reliability results and evidence for construct validity were obtained. CONCLUSION: The new questionnaire, based on empirical research and bedside experience, showed good psychometric properties and clinical applicability.

Trajectory variance and autocorrelations within single-sperm tracks as population-level descriptors of sperm track complexity, predictability, and energy-generating ability.

The objectives of the present study were to develop an alternative theoretical approach to the analysis of sperm motility and to develop motility parameters that would complement those more commonly used in current computer-assisted semen analysis procedures. We have defined a set of parameters and have tested them using boar spermatozoa undergoing bicarbonate-induced motility activation. The new parameters were calculated for a series of (x,y) coordinates of sperm head positions recorded at each move along the trajectory. The parameters were: mean velocity (MV), immobility ratio, fractal dimension (FD), the variance of the steplengths (VAR), and 2 autocorrelation function coefficients of the step-length time series for lags 1 and 2 (C(1) and C(2)). MV measures the average speed along the trajectory, and VAR is a measure of displacement variability that can be related to the specific mean (per step) kinetic energy of the spermatozoon. All of the parameters except MV and FD were affected by the sampling frequency (25 vs 50 Hz); inappropriately high sampling frequency in relation to magnification resulted in step-lengths between successive frames that were below the resolution threshold of the imaging system. The autocorrelation functions were especially informative; discrimination between sperm subpopulations was obvious within simple histogram formats, and complex statistical analyses were not needed for their identification.

[Quality of life and adherence to nebulised antibiotic therapy using a new device in non-cystic fibrosis bronchiectasis]. / Calidad de vida y adherencia a la antibioterapia nebulizada mediante un nuevo dispositivo en bronquiectasias no debidas a fibrosis quística.

AIMS: Analysis of psychological variables, quality of life, depression and anxiety, subjective perception of compliance, level of satisfaction with the electronic device, and objective verification) in order to study the therapeutic adherence, in non-cystic fibrosis bronchiectasis (NCFB) colonized by Pseudomonas aeruginosa. METHODS: A cross-sectional descriptive study was conducted on 22 NCFB stable patients colonised by Pseudomonas aeruginosa (two groups of 11 subjects: GROUP 1, Pari-LC plus nebuliser device, and GROUP 2, with the I- neb device), both containing sodium colistemethate. Different variables, were obtained, such as, self-perceived health (St George questionnaire), state of mind (HADS scale), and subjective perception of therapeutic compliance and objective verification by using the device software. RESULTS: There were no significant differences in questionnaire results. The therapeutic support in GROUP 2, could be proved objectively (up to 60%) using specific software, and the excellent tolerability using a specific questionnaire created for the study. CONCLUSIONS: These types of aerosol devices demonstrate a high level of therapeutic support, that can be measured objectively and is different from what the patients subjectively indicates.

El trabajo en equipo de los equipos multidisciplinares de cuidados paliativos: análisis de la realidad española / No disponible

Resumen: El objetivo es estudiar la realidad de los equipos y del trabajo en equipo de los profesionales de Cuidados Paliativos (CP) en España. Se ha utilizado metodología cuantitativa (encuesta diseñada ad hoc, on-line a 452 profesionales) y cualitativa (3 grupos de discusión y 15 entrevistas en profundidad) más la consiguiente revisión bibliográfica. Se plantearon 4 hipótesis: las tres primeras decían que existen diferencias en la valoración de los profesionales de CP en cuanto al trabajo en equipo a) entre Comunidades Autónomas (confirmada); b) entre profesionales de distintas disciplinas (rechazada); c) y en el tipo de dispositivo asistencial (rechazada); y, en cuarto lugar, que en torno a los modelos teóricos de funcionamiento y relación interprofesional, los profesionales desconocen básicamente sus características, sus potencialidades y sus diferencias, lo que dificulta conocer el estado de la cuestión en los diferentes equipos y describir criterios y estándares apropiados (confirmada). Es más, aunque se conozca la diferencia en nomenclatura entre multidisciplinar, interdisciplinar o transdisciplinar, por citar un ejemplo, no se matiza a fondo sobre aspectos diferenciales entre los mismos. En un equipo intervienen permanentemente el poder y los afectos. Son claves la gestión y distribución de los mismos. Desde ahí, la tesis recoge el parecer de los profesionales de cómo las instituciones han de planificar mejor recursos, tiempos y herramientas para dinamizar los equipos, su necesidad de formación específica frente a ello, la necesidad de mejorar las estrategias de participación, de clarificar los modelos de intervención desde lo que se funciona, de aprovechar el talento de los profesionales en la trama relacional, de propiciar su participación en la planificación y establecimiento de objetivos, de promover una dinámica auténtica de autocuidado, de prevención y gestión adecuada de los conflictos, de revisar la relevancia de la feminización y las diferencias generacionales, de revisar procedimientos como las reuniones, los procesos de transmisión de información,etc. La tesis destaca la necesidad de ir profundizando en el modelo de funcionamiento interno entre profesionales de distintas disciplinas, porque las diferencias son muy marcadas si se trata de uno multidisciplinar, interdisciplinaro transdisciplinar. No es lo mismo informar, que colaborar, que coordinar, que tomar decisiones conjuntas, etc. El trabajo en equipo, como la comunicación difícil o los opiáceos, es una herramienta, una mediación. Tenemos la responsabilidad de optimizarla para conseguir los objetivos paliativos

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Cuestionarios de evaluación e intervención espiritual en cuidados paliativos: una revisión crítica / Evaluation and spiritual intervention questionnaires in palliative care: a critical review

OBJETIVO: El presente estudio tiene 2 objetivos. El primero, ofrecer una revisión de las herramientas de medida de espiritualidad en el contexto español de los cuidados paliativos. El segundo, comparar el constructo de los instrumentos revisados desde la perspectiva antropológica del modelo de espiritualidad propuesto por el Grupo de Espiritualidad de la Sociedad Española de Cuidados Paliativos. MÉTODO: La revisión sigue 5 pasos: 1. identificar las medidas de espiritualidad que se han utilizado en estudios relevantes; 2. conocer aquellos instrumentos con propiedades psicométricas adecuadas; 3. clasificar las medidas en función del tipo de instrumento; 4. identificar los instrumentos de medida de espiritualidad que han sido validados en población española; y 5. estudiar el contenido espiritual de las medidas validadas transculturalmente. RESULTADOS: Las bases de datos consultadas recogían 751 artículos científicos, 128 de los cuales se identificaron como relevantes. De estos, se obtuvieron 57 herramientas de medida de espiritualidad, que se categorizaron en: medidas multidimensionales generales (n = 22), medidas funcionales de espiritualidad (n = 21) y medidas sustantivas de espiritualidad (n = 14). De estas, 9 habían sido validadas transculturalmente. El análisis del contenido espiritual de los 9 instrumentos mostró la presencia de las dimensiones de la espiritualidad definidas por el Grupo de Espiritualidad: intra, inter y transpersonal. DISCUSIÓN: Los resultados encontrados se ponen en relación con la literatura actual, evidenciándose algunas de las limitaciones que detentan actualmente los instrumentos de medida y cómo estas se intentan paliar con el nuevo modelo que aporta el Grupo de Espiritualidad de la Sociedad Española de Cuidados Paliativos

AIM: The current study has 2 AIMS: The first one is to present a review of the measures of spirituality in the Spanish palliative care context. The second, to compare the construct of the tools reviewed from the anthropological approach provided by the spirituality model of the Spirituality Group of the Spanish Society for Palliative Care. METHOD: The review followed 5 steps: 1. To identify the spirituality measures used in relevant studies; 2. To determine the tools with the appropriate psychometric properties; 3. To classify these measures depending on the type of tool; 4. To identify the spirituality measures that have been validated in a Spanish sample; and 5. To study the spiritual content of the transculturally validated measures. RESULTS: The data bases collected 751 scientific papers, 128 of which were identified as relevant. Among them, 57 spirituality measures were obtained, which were categorised into: general multidimensional measures (n = 22), functional spirituality measures (n = 21), and substantive spirituality measures (n = 14). Among these, 9 tools were transculturally validated. The spiritual content analysis of these 9 tools showed the presence of the spirituality dimensions defined by the Spirituality Group: intra-, inter-, and trans-personal. DISCUSSION: The results found were put in relationship with the current literature, and some of the limitations of the measurement tools are shown, and also how the Spirituality Group of the Spanish Society for Palliative Care attempts to mitigate them

Calidad de vida y adherencia a la antibioterapia nebulizada mediante un nuevo dispositivo en bronquiectasias no debidas a fibrosis quística / Quality of life and adherence to nebulised antibiotic therapy using a new device in non-cystic fibrosis bronchiectasis

Objetivo Análisis de las variables psicológicas: calidad de vida autopercibida, ansiedad y depresión; percepción subjetiva de cumplimiento; grado de satisfacción con el nebulizador electrónico y comprobación objetiva que permitan estudiar la adherencia terapéutica, en pacientes con BQNFQ, colonizados por Pseudomonas aeruginosa, a través de un programa multidisciplinar. Métodos Consistió en un estudio descriptivo transversal de 22 pacientes estables con BQNFQ colonizados por Pseudomonas aeruginosa (2 grupos de 11 pacientes: GRUPO 1, nebulizador Pari-LC plus, y GRUPO 2, I-neb) tratados con colistemetato de sodio. Entre otras variables recogimos: salud autopercibida (cuestionario St. George), estado de ánimo (cuestionario HADS), percepción subjetiva de cumplimiento terapéutico y medida objetiva del cumplimiento mediante lectura del software del aparato. Resultados No existieron diferencias significativas en los resultados de los cuestionarios. En el GRUPO 2 comprobamos, objetivamente, la adhesión terapéutica (>70%) y la buena tolerabilidad del nuevo dispositivo mediante un cuestionario específico creado para el estudio. Conclusiones Este tipo de nebulizadores, además de mejorar la adherencia terapéutica, permite su medida objetiva, que contrasta con la indicada subjetivamente por el paciente (AU)

Aims Analysis of psychological variables, quality of life, depression and anxiety, subjective perception of compliance, level of satisfaction with the electronic device, and objective verification) in order to study the therapeutic adherence, in non-cystic fibrosis bronchiectasis (NCFB) colonized by Pseudomonas aeruginosa. Methods A cross-sectional descriptive study was conducted on 22 NCFB stable patients colonised by Pseudomonas aeruginosa (two groups of 11 subjects: GROUP 1, Pari-LC plus nebuliser device, and GROUP 2, with the I- neb device), both containing sodium colistemethate.. Different variables, were obtained, such as, self-perceived health (St George questionnaire), state of mind (HADS scale), and subjective perception of therapeutic compliance and objective verification by using the device software. Results There were no significant differences in questionnaire results. The therapeutic support in GROUP 2, could be proved objectively (up to 60%) using specific software, and the excellent tolerability using a specific questionnaire created for the study. Conclusions These types of aerosol devices demonstrate a high level of therapeutic support, that can be measured objectively and is different from what the patients subjectively indicates (AU)

Propiedades psicométricas preliminares de un cuestionario multidimensional de adaptación a la enfermedad para pacientes onco-hematológicos (CMAE-OH) adaptado a pacientes renales en diálisis (CMAE-RD) / No disponible

Este trabajo tiene como objetivo la adaptación de un cuestionario empleado para la evaluación de necesidades y recursos en pacientes con enfermedad onco-hematológica, el CMAE-OH de Arranz y Ulla (2008) a pacientes renales en diálisis. Para ello realizamos tres estudios secuenciales. El primero de ellos es un estudio interjueces, para determinar la validez del cuestionario. El segundo es un estudio piloto para poner a prueba su funcionamiento en pacientes renales. El tercer estudio, consistirá en el empleo de la herramienta en una muestra mayor para determinar las propiedades psicométricas del instrumento. Tras la adaptación del cuestionario, concluimos que la herramienta es útil y adecuada para la evaluación de necesidades y recursos en los pacientes renales en diálisis, así como lo era para el caso de los pacientes oncológicos. Partimos de la adaptación de esta herramienta para iniciar una reflexión acerca de la cercanía, más que el distanciamiento, entre la psicooncología y otras subdisciplinas del ámbito de la Psicología de la Salud como la psiconefrología (AU)

The aim of this research is to adapt a questionnaire designed for the assessment of needs and resources in patients with onco-haematological diseases - the CMAE-OH- to renal patients under dialysis treatment. We have conducted three different studies. The first one is an inter-judges study to determine the face validity of the tool. The second is a pilot study, to know how the designed tool works when used in renal patients under dialysis. The third study consists of the usage of the questionnaire in a biggest sample to determine the psychometric properties of the tool. After the adaptation of the tool we conclude that the questionnaire we have adapt it is useful to assess needs and resources in renal patients under dialysis, as well as CMAE-OH was when used with oncological patients. On the basis of our study, we reflexionate about the closeness between psychooncology and other subdisciplines in the area of health psychology like psychonephrology (AU)

Hacia un modelo de toma de decisiones compartida para el final de la vida / No disponible

La toma de decisiones es una práctica diaria de todos los seres humanos. En dicha práctica los criterios que se utilizan se conforman en base a experiencias pasadas, modelos cotidianos o incluso inercias nunca cuestionadas. En el ámbito clínico, sin embargo, debe exigirse un quehacer crítico a la hora de discernir los procedimientos y criterios óptimos para la toma de decisiones, requiriéndose análisis y juicios efectivos y ágiles. A nuestro entender, un planteamiento altamente interesante para abordar decisiones en el ámbito del final de la vida es el de Toma de Decisiones Compartidas (TDC). En el presente texto se pretende, en un primer momento, conceptualizar las variables consideradas más relevantes en dicho modelo, para proponer posteriormente un protocolo que actúe como herramienta facilitadora de la toma de decisiones complicadas a las que pueden verse expuestos los pacientes y sus familiares (AU)

Decision making is a task all human beings have to face up to daily. The underlying basis for this practice is formed and marked by former experiences, every day applied or even automatized models that are never questioned. In the clinical setting, however, a critical reflexion is necessary when deciding procedures and criterias for making decisions, requiring analysis and effective and agile decisions. In our view, a highly interesting approach to tackle decisions in the ambit of the end-of-life is the Shared Decision-Making. In this paper we intend, at first, to conceptualize the most relevant variables according to that model, and then to propose a protocol to act as a facilitating tool for making difficult decisions to which the patients and their families may be exposed to (AU)

Estudio de las micro-malas noticias en pacientes hematológicos hospitalizados. La comunicación médica diaria / A Study about Micro-Bad News in Haematooncological hospitalized patients. The daily medical communication

En el campo del estrés se ha observado que no sólo los sucesos vitales estresantes tienen un impacto sobre el individuo sino también los pequeños microestresores diarios. En el ámbito de la Psicooncologia se ha prestado especial interés al impacto generado por la comunicación de Malas Noticias en momentos puntuales del proceso de enfermedad. Los pacientes, además, se ven afectados negativamente cada día por otro tipo de informaciones relacionadas con la enfermedad y los tratamientos que no son el diagnóstico, la falta de eficacia de los tratamientos o un mal pronóstico. Este tipo de mensajes se han denominado Micro-Malas Noticias (MMN) y este estudio pretende explorar las características de esa fuente de estrés cotidiana para pacientes hospitalizados. Los resultados hallados del análisis de las 500 MMN evaluadas muestran que más de la mitad de los pacientes (N

Literature has shown that accumulated daily hassles can also impact as life events do. In Psychooncology, studies have mainly focused on impact generated by breaking Bad News at isolated moments. During the disease process, patients do not only receive bad new related to diagnosis, non-effective treatments or bad prognosis but also another daily comments which can affect them negatively. This kind of messages have been named Micro-Bad News (MBN). The present study tries to explore the main characteristics of this daily source of stress for inpatients. After analyzing 500 MBN, results show that more than half of the sample (N=296) receive at least one MBN during the hospital admission. MBN are usually known but unexpected at that moment. MBN´s content is related to information about the patient´s private sphere (as changes in the space/time expectations) and the possibility of suffer fisical damage (mainly by diagnosis tests experienced as unpleasant by the patient). Finally, some recommendations are proposed in the base of the results to archive an quality integrative assistance for inpatients (AU)

Intervención psicológica en un caso de leucemia mieloide aguda con problemas de adaptación a la hospitalización y trastorno psicótico inducido por substancias / Psychological intervention in some hospitalary-adaptation problems and in a substance-induced psychotic disorder experienced by an acute myeloid leukaemia inpatien

El diagnóstico de una enfermedad hemato-oncológica supone un impacto físico, psicológico, emocional y social que genera sufrimiento en el individuo y en su entorno. El modelo de intervención psicológica preventiva trata de disminuir el malestar emocional y maximizar la adaptación y el bienestar a través de empoderar al paciente y aumentar su percepción de control. En el presente artículo se expone el caso de un joven con Leucemia Mieloide Aguda, con experiencia de malestar psicofisiológico, déficit en apoyo social, problemas de adaptación y de escasa comprensión inicial de información médica, determinados por la enfermedad e influyentes en la misma, con consecuentes riesgos de empeoramiento del estado de salud. El trastorno psicótico inducido por cannabis con ideas delirantes respecto al personal sanitario fue una de las complicaciones psicopatológicas principales, que en caso de no haberse detectado precozmente, podría haber influido seriamente en la adherencia al tratamiento médico y en la relación de ayuda. Al superar progresivamente las diferentes situaciones amenazantes, se produjeron en el paciente cambios positivos tanto del concepto de sí mismo, como de las relaciones interpersonales y de la propia filosofía de vida, llevándole a una mejor adaptación a la enfermedad. En conclusión, el objetivo fundamental de la actuación terapéutica no es únicamente minimizar el impacto negativo de la enfermedad o abordar las complicaciones psicopatológicas, sino también, favorecer que el paciente utilice sus mejores estrategias para aumentar su bienestar en tal situación (AU)

Hemato-oncological disease involve some physical, psychological, emotional and social impacts producing individual and global suffering. Preventive psychological interventions minimize stress and provide adaptation and well-being by empowering patient resources and increasing control perception. In this article we expose an acute myeloid leukemia impatient, whose experience of psychophysiological distress stemmed form a lack of social support, form adaptation problems and from scarce understanding of medical information as well as form consecutive risks of worsening in health. After overcoming gradually different threatening situations, some positive changes in self-concept, in the interpersonal relationships and in his own philosophy of life occurred. This led the patient to a better adaptation to the illness. In conclusion, the main goal of the therapeutic intervention does not only deal with decreasing the negative impact of the disease or tacking the psychopathological difficulties but also helping the patient to use his best strategies to improve well-being (AU)

El duelo en padres del niño oncológico / Bereavement in parents of oncological children

El duelo por el fallecimiento de un hijo tiene características particulares por el carácter antinatural de la pérdida y por el valor identificante del vínculo entre padres e hijos. La pérdida del hijo sacude estas identidades y sume a los dolientes en un profundo dolor y un desconcierto total ante la ruptura con el pasado y la pérdida de expectativas con el futuro. Las vivencias que cada miembro del núcleo familiar han tenido con el fallecido, influirán de manera directa sobre el desarrollo y la superación del duelo tanto a nivel individual como familiar. Por esta razón, el abordaje debe ser personalizado y sensible a las necesidades de las distintas estructuras familiares que se dan en una sociedad plural. Es importante que las instituciones sanitarias, desde los Servicios Oncológico-Pediátricos, tomen conciencia y promuevan un auténtico trabajo preventivo antes del fallecimiento del niño. Del mismo modo, será preciso ofertar ante la muerte de un hijo (claro factor de riesgo de duelo complicado), la ayuda profesional de psicólogos debidamente preparados (AU)

ereavement for the death of a son / a daughter has special features for the unnatural nature of loss and the identifier value of the bond between parents and children. This loss shakes these identities and joins the mourners in a deep pain and a total embarrassment to the break with the past and loss of future expectations. The experiences that each member of the family have had with the deceased, will have a direct influence on the development and overcoming of grief for both the individual and family. For this reason, the approach should be customized and responsive to the needs of different family structures that exist in a pluralistic society. It is important that health care institutions, from Cancer-Pediatric Services, aware and promoting genuine preventive work before the death of the child. Similarly, will be bidding to the death of a child (clear risk factor for complicated grief), professional help from psychologists adequately prepared (AU)

Psicólogos en cuidados paliativos: la sin razón de un olvido / Psychologist in palliative care: The injustice of an oblivion

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Las instrucciones previas en funcionamiento: una herramienta legal con valor psicoterapéutico / Living Wills in functioning: A legal tool with therapeutic aims

A pesar de los importantes avances en la curación y/o tratamiento de enfermedades, la muerte sigue siendo un hecho irremediable para el ser humano. Por tanto, conviene recordar que ayudar a bien morir es también uno de los fines de la Medicina actual. Desde la Psicooncología, las Instrucciones Previas (IIPP) se conceptualizan como una herramienta legal con objetivos psicoterapéuticos. Se trata de una vía para abril el diálogo sobre cuestiones relacionadas con la muerte y un instrumento para la deliberación moral y toma de decisiones. Realizadas dentro de un contexto terapéutico de confianza mutua, las IIPP se convierten en un facilitador, a medio plazo, del bienestar del paciente y de su familia (AU)

In spite of important advances in diseases treatment, death is still unavoidable for human-being. Therefore, it should be taken into account that, “well-dying” is one of the goals of Medicine. From Psychooncology, Living Wills (LV) are a way to open dialogue about topics related to death and a valious instrument for moral deliberation and decision making process. If LV are developed in a therapeutic context of mutual trust, they become a helper of well-being for patient and family (AU)