Competencies for quality spiritual care in palliative care in Latin America: from the Spirituality Commission of the Latin American Association for Palliative Care.

Spiritual care is an essential part of quality palliative care. However, the literature regarding spiritual care competencies in Latin America is limited. Herein we propose the basic quality standards for spiritual care in palliative care according to best professional practices and provide a common vocabulary and required competencies for quality clinical spiritual care. Both elements, quality standards and a common vocabulary, are part of an essential step implementing continuous educational initiatives among interdisciplinary palliative care teams in Latin America. Members of the Spirituality Commission of the Latin American Association for Palliative Care and three members of independent professional palliative care organizations identified and reviewed our proposed spiritual care competencies and created a consensus document describing the competencies for general spiritual care. In the context of palliative care in Latin America, general spiritual care is provided by members of interdisciplinary teams. We proposed six competencies for high-quality general spiritual care and their observable behaviors that every member of an interdisciplinary palliative care team should have to provide quality clinical spiritual care in their daily practice: (I) personal, spiritual, and professional development; (II) ethics of spiritual care; (III) assessment of spiritual needs and spiritual care interventions; (IV) empathic and compassionate communication; (V) supportive and collaborative relationships among the interdisciplinary team; and (VI) inclusivity and diversity.

Los derechos humanos y los cuidados paliativos: autoevaluación sobre la formación en cuidados paliativos en un grupo de residentes de medicina / Human rights and palliative care: self-assessment training in palliative care in a group of medical residents

La demanda social por los aspectos paliativos de la Medicina se ha incrementado notablemente en los últimos años debido, entre otros factores, al envejecimiento de la población y al aumento de los enfermos con cáncer y otras enfermedades crónicas con mal pronóstico de vida. Todo paciente con enfermedad terminal tiene el derecho a una asistencia integral, que le posibilite calidad de vida y una muerte digna. El discurso médico que enfoca sólo lo patológico se ve reflejado en la práctica médica en el corte entre la enfermedad y el hombre que la padece. La relación médico-paciente con enfermedad avanzada no puede reducirse al control de síntomas físicos, sino que demanda una atención integral, abarcativa de los aspectos bio-psico-sociales y espirituales. Hay estudios que señalan que los médicos recién egresados no están preparados suficientemente para asistir a estos pacientes. El ejercicio de la profesión en sí, no los capacita para enfrentar el sufrimiento y la muerte. Uno de los retos actuales de la Medicina es mejorar la atención de los enfermos incurables en su fase avanzada. A tal fin, las Facultades de Medicina, entre otras, deberían incorporar en sus planes de estudio, conocimientos, estrategias y habilidades que capaciten a estudiantes y residentes en el manejo óptimo de los síntomas, brindando información adecuada, proporcionando soporte emocional y trabajando en equipo interdisciplinario. El objetivo de este trabajo es determinar que proporción de un grupo de residentes de Medicina, han tenido formación en Cuidados Paliativos durante los estudios de pre y post-grado y cómo valoran esa formación.

The social demand for the palliative aspects of Medicine has increased significantly in the last years, among other reasons, as a result of an ageing population and an increase in cancer patients as well as other chronic diseases with poor life prognosis. Every terminally ill patient is entitled to an overall assistance that grants them a better quality of life and a dignified death. The physician’s speech, which only focuses on the pathological, is reflected on the medical practice in the breach between the illness and the person suffering it. The relationship doctor-patient with advanced disease cannot be confined to controlling physical symptoms only, it also calls for an overall, holistic assistance that contemplates bio-psycho-social and spiritual aspects. Current research stresses the fact that recent graduate doctors are not sufficiently trained to assist these patients. The profession as such does not prepare them to cope with suffering and death. One of the present challenges of Medicine is to improve the assistance to the terminally ill in their advanced stages. For that reason, the Medical Schools among others, should include knowledge, strategies and skills in their curricula with a view to training students and residents to deal with symptoms, to deliver information, to provide emotional support and to work as an interdisciplinary team in the best possible way.