Spiritual Care[Givers] Competence in Palliative Care: A Scoping Review.

To deliver spiritual care, professionals must be skilled in physical, mental, social, and spiritual care. Spiritual care competence includes knowledge, behaviors, attitudes, and skills that enable successful or efficient care. This review aims to identify the scope of competence and the specific skills, knowledge, and attitudes used in providing spiritual care to people needing palliative care, and the main challenges and facilitators. A scoping review was developed using the Joanna Briggs Institute methodology. Six databases (Web of Science; MEDLINE/Pubmed; Scopus; CINAHL; MedicLatina and SciELO) were searched in September 2023, with an update in January 2024. The resulting 30 articles were analyzed using a content analysis approach. Information was categorized into three domains: cognitive, affective, and functional (based on three personal resources: intrapersonal, interpersonal, and transpersonal). Palliative care professionals face a lack of training and insufficient preparation to deliver spiritual care. Spiritual care competence depends on professional spiritual development and experience, spiritual intelligence (cognitive), spiritual humility (affective), and having a critical and reflexive mind (functional). In the future, palliative care should seek to improve competent spiritual care. This review could help clarify the real configuration of competent spiritual care and lead to improvements in a professional's empowerment when delivering effective spiritual care to patients and families.

SPACEE Protocol: "Spiritual Care Competence" in PAlliative Care Education and PracticE: Mixed-Methods Research in the Development of Iberian Guidelines.

Spiritual care requires understanding the spiritual experiences of patients and recognizing their resources and needs. Therefore, educators and practitioners should develop their knowledge and understanding in this regard. Spiritual care helps people overcome their anxieties, worries, and suffering; reduces stress; promotes healing; and encourages patients to find inner peace. To provide comprehensive and appropriate care while upholding human/ethical virtues, the spiritual dimension must be a priority. We aim to develop spiritual care competence guidelines for Palliative Care (PC) education and practice in Portugal and Spain. The study detailed in this protocol paper will include three phases. In phase I, the phenomenon will be characterized and divided into two tasks: (1) a concept analysis of "spiritual care competence"; and (2) a systematic review of interventions or strategies used to integrate spiritual care in PC education and practice. Phase II will entail a sequential explanatory approach (online survey and qualitative interviews) to deepen understanding of the perceptions and experiences of educators, practitioners, and patients/family carers regarding spiritual care in PC education and practice and generate ideas for the next steps. Phase III will comprise a multi-phased, consensus-based approach to identify priority areas of need as decided by a group of experts. Results will be used to produce guidelines for integrating spirituality and spiritual care competence within PC education and practice and synthesized in a white book for PC professionals. The value of this improved examination of spiritual care competence will ultimately depend on whether it can inform the development and implementation of tailored educational and PC services. The project will promote the 'spiritual care' imperative, helping practitioners and patients/family carers in their preparedness for End-of-Life care, as well as improving curricular practices in this domain.

La presencia: el poder terapéutico de habitar el presente en la práctica clínica / Presence: the therapeutic power of inhabiting the present in clinical practice

Como agentes de salud discípulos de una cosmovisión eminentemente materialista y con escasa atención a nuestro mundo interior, los profesionales sanitarios, a menudo desconocemos del potencial de nuestra presencia en el marco del encuentro terapéutico. Este artículo pretende profundizar sobre nuestra capacidad de estar presentes frente al desconocido que sufre, entendida como una condición inherente a todo ser humano y como una facultad que todos podemos reconocer, explorar y cultivar para ponerla al servicio de nosotros mismos y de aquellos a quienes acompañamos. Desde el reconocimiento del profesional como su propia herramienta terapéutica, se introducen los riesgos y oportunidades de la relación de ayuda, el rol de las emociones en el encuentro, el concepto de presencia terapéutica y el papel de la autoconciencia del profesional. Se recogen algunas referencias expertas sobre la presencia terapéutica. Se describen las bases neurofisiológicas y las características de la presencia y su papel en la co-regulación con el paciente. Y finalmente se hacen algunas propuestas para el cultivo de la presencia (AU)

As health agents, disciples of an eminently materialistic worldview, and with little attention to our inner world, health professionals are often unaware of their presence’s potential in the framework of the therapeutic encounter. This paper aims to deepen in their ability to be present in front of an unknown suffering person, understanding this ability as an inherent condition of every human being and as a faculty that we can all recognize, explore and cultivate in order to serve ourselves and those we care for. The risks and opportunities of the helping relationship, the role of emotions in the encounter, the concept of the therapeutic presence and the role of the professional’s self-awareness are introduced from the recognition of the professional as their own therapeutic tool. Some expert references on the therapeutic presence are also collected. The neurophysiological bases and the characteristics of the presence and their role on the co-regulation with the patient are described. Finally, some proposals are given for the presence cultivation (AU)

El autocuidado en los profesionales sanitarios durante la pandemia: una oportunidad para su cultivo / Healthcare professionals self-care in pandemic times: an opportunity for self-development

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Evaluación cuantitativa de la atención recibida por los pacientes crónicos avanzados en un hospital comarcal / A quantitative assessment of the care received by advanced chronic patients in a regional hospital

OBJETIVO: Valorar la necesidad potencial de cuidados paliativos durante el último mes de vida de una muestra de pacientes fallecidos en un hospital comarcal de Mallorca, y cuantificar los procesos diagnósticos y terapéuticos que reciben durante su estancia hospitalaria, estimando también el coste económico. MÉTODOS: Se realizó un estudio observacional retrospectivo sobre 119 pacientes fallecidos que cumplieron los criterios de inclusión. Un profesional experto en cuidados paliativos revisó la historia clínica cuantificando el uso de servicios y los procedimientos aplicados. Para la estimación de los costes se utilizaron los Grupos Relacionados con el Diagnóstico. RESULTADOS: El análisis de datos se realizó sobre 62 mujeres y 57 hombres, con una edad media de 78,15 ± 12,62 años. La prevalencia de pacientes fallecidos que cumplieron criterios de necesidad de atención paliativa fue del 88,81 %, con una identificación previa de pacientes paliativos del 6,7 %. El cáncer apareció como diagnóstico en 44 casos. La media de pruebas de imagen realizadas fue de 3,61 ± 2,70, analíticas de sangre de 7,46 ± 7,69 y tratamientos con antibióticos de 1,51 ± 1,60. El coste total medio de la atención prestada a la muestra fue de 5.662,44 €. CONCLUSIONES: Los resultados evidencian la elevada prevalencia de pacientes con necesidad de atención paliativa entre el total de fallecidos y una baja identificación previa. Se observa una alta frecuentación de los servicios hospitalarios y una alta aplicación de procedimientos invasivos en el último mes de vida, con el elevado coste económico y potencial de sufrimiento que supone

OBJECTIVE: To assess the potential need for palliative care during the last month of life in patients who passed away at a regional hospital in Mallorca, and to quantify the diagnostic and therapeutic procedures they underwent during their stay with an estimation of the costs incurred. METHODS: A retrospective observational study was conducted on 119 deceased patients meeting the inclusion criteria. An expert in palliative care reviewed their medical records and quantified the services and procedures that were provided. Costs were estimated based on diagnosisrelated groups (DRGs). RESULTS: Data were analyzed for 62women and 57 men, with a mean age of 78.15 ± 12.62 years. The prevalence of deceased patients who met the criteria for palliative care need was 88.81 %, with prior identification of palliative patients at 6.7 %. Cancer was found to be the diagnosis in 44 cases. The mean number of imaging tests was 3.61 ± 2.70, that of blood tests was 7.46 ± 7.69, and that of antibiotic treatments was 1.51 ± 1.60. The average total cost of care was € 5,662.44. CONCLUSIONS: Our results reveal a high prevalence of patients with palliative care need among the total number of deceased subjects, and a low rate of prior identifications. Frequentation of hospital services was found to be high, as was the use of invasive procedures in the last month of life, which potentially entails high costs and patient suffering

A Brief Measure for the Assessment of Competence in Coping With Death: The Coping With Death Scale Short Version.

CONTEXT: The coping with death competence is of great importance for palliative care professionals, who face daily exposure to death. It can keep them from suffering compassion fatigue and burnout, thus enhancing the quality of the care provided. Despite its relevance, there are only two measures of professionals' ability to cope with death. Specifically, the Coping with Death Scale (CDS) has repeatedly shown psychometric problems with some of its items. OBJECTIVE: The aim of this study was to develop and validate a short version of the CDS. METHODS: Nine items from the original CDS were chosen for the short version. Two cross-sectional surveys were conducted in Spanish (N = 385) and Argentinian (N = 273) palliative care professionals. The CDS and the Professional Quality of Life Scale were used in this study. Statistical analyses included two confirmatory factor analyses (CFAs), followed by a standard measurement invariance routine. Reliability estimates and evidence of validity based on relations with other measures were also gathered. RESULTS: CFA models had excellent fit in both the Spanish (χ2(27) = 107.043, P < 0.001; Comparative Fit Index [CFI] = 0.978; Tucker-Lewis Index [TLI] = 0.970; Root Mean Square Error of Approximation [RMSEA] = 0.093 [0.075, 0.112]; Standardized Root Mean Square Residual = 0.030) and Argentinian (χ2(27) = 102.982, P < 0.001; CFI = 0.963; TLI = 0.950; RMSEA = 0.106 [0.085, 0.128]) samples. A standard measurement invariance routine was carried out. The most parsimonious model (χ2(117) = 191.738, P < 0.001; CFI = 0.987; TLI = 0.992; RMSEA = 0.046 [0.034, 0.058]; Standardized Root Mean Square Residual = 0.043) offered evidence of invariance across countries, with no latent mean differences. Evidence of reliability and evidence of validity based on relations with other measures were also appropriate. CONCLUSION: Results indicated the psychometric boundaries of the short version of the CDS.

Evaluación de una intervención mindfulness en equipos de cuidados paliativos / Evaluation of a mindfulness intervention in palliative care teams

El objetivo de este estudio es evaluar los resultados de un programa breve de entrenamiento en mindfulness sobre la atención plena, la autocompasión y la calidad de vida profesional en equipos de cuidados paliativos. Para ello se llevó a cabo un estudio preexperimental pre-post. Participaron 36 profesionales de equipos de cuidados paliativos de Madrid (España). Se midió mindfulness, autocompasión y calidad de vida profesional. Las mediciones se realizaron al inicio y a las dos semanas de finalizada la intervención, que duró seis semanas. Los resultados de aplicación del programa se evaluaron mediante análisis de varianza multivariados (MANOVA). Tras la intervención se observó una mejoría en los niveles de mindfulness, de autocompasión y de riesgo de burnout, independientemente de la categoría profesional. La aplicación de esta intervención psicosocial breve de mindfulness en un grupo de profesionales de cuidados paliativos se ha asociado con un aumento de los niveles de autoconciencia y autocompasión y con una disminución de la percepción de burnout

The aim of this study is to assess the outcome of a brief mindfulness training program on mindful attention, self-compassion, and professionals' quality of life in palliative care teams. A pre-post pre-experimental study was carried out. Thirty-six professionals from palliative care teams from Madrid (Spain) participated in the study. Mindfulness, self-compassion, and professionals' quality of life were assessed. Evaluations were carried out at the beginning of the intervention and two weeks after the intervention, which lasted six weeks. The program's results were assessed using multivariate analyses of variance (MANOVA). After the intervention, there was an improvement of mindfulness, self-compassion, and burnout risk levels lowered, regardless of the profession. This mindfulness based short psychosocial intervention in a group of palliative care professionals was associated to an improvement of self-awareness levels and self-compassion, and a decrease of perceived burnout risk

Validación confirmatoria de la Escala de Afrontamiento de la Muerte en profesionales de cuidados paliativos / Confirmatory validation of the Coping with Death Scale in palliative care professionals

OBJETIVO: Este estudio tiene un doble objetivo. En primer lugar, estudiar las propiedades psicométricas de la Escala de Afrontamiento de la Muerte en una muestra nacional de profesionales de cuidados paliativos. En segundo lugar, comparar esta competencia de los profesionales frente a otros colectivos en los que se ha evaluado el afrontamiento de la muerte previamente. MÉTODO: Diseño y emplazamiento: Mediante una encuesta on-line se invitó a participar a profesionales de cuidados paliativos de toda España. PARTICIPANTES: 433 respondieron y 385 de estos cumplieron los CRITERIOS DE INCLUSIÓN: MEDICIONES PRINCIPALES: Se evaluó la competencia en afrontamiento de la muerte, autoconciencia, satisfacción y fatiga de la compasión y bienestar psicológico. Se llevaron a cabo estimaciones de consistencia interna, un análisis factorial confirmatorio para el estudio de la validez factorial y correlaciones con los constructos relacionados para conocer la validez predictiva del instrumento. Resultado: Los análisis de fiabilidad mostraron un mal comportamiento psicométrico en 4 de los ítems de la escala, similar al que habían mostrado en estudios anteriores. Tras eliminarlos, se estimó y evaluó el análisis factorial confirmatorio con resultados adecuados. Las correlaciones con la autoconciencia y las dimensiones de calidad de vida y bienestar psicológico fueron todas en la dirección apuntada por la literatura. Interpretación y CONCLUSIONES: Este estudio avala las adecuadas propiedades psicométricas de la Escala de Afrontamiento de la Muerte de Bugen en profesionales de la salud en el contexto de los cuidados paliativo

AIM: The aim of this study was twofold. First, to study the psychometric properties of the Coping with Death Scale in a nationwide sample of palliative care professionals. Second, to compare the competence of these professionals to other groups' coping with death competence previously assessed. METHOD: Design and site: Through an on-line questionnaire, palliative care professionals from all over Spain were invited to participate. PARTICIPANTS: 433 completed the questionnaire and 385 meet the inclusion criteria. Measurements: Coping with death competence, self-awareness, compassion satisfaction and fatigue, and well-being were assessed. Internal consistency estimations, a confirmatory factor analysis for studying factorial validity, and correlations with other related constructs, in order to deepen in predictive validity were performed. RESULTS: Reliability analyses showed poor psychometric behaviour for 4 items of the scale, similar to the previously found in other studies. After removing these items, a confirmatory factor analysis was estimated and tested, with suitable RESULTS: Correlations with self-awareness and the dimensions of quality of life and psychological well-being were similar to those reported in the literature. Interpretation and CONCLUSIONS: This study supports the psychometric properties of Bugen's Coping with Death Scale in healthcare professionals in an emotionally exhausting context, such as that of palliative care

Strengthening primary health care teams with palliative care leaders: protocol for a cluster randomized clinical trial.

BACKGROUND: The objective of the Balearic Islands Palliative Care (PC) Program is to improve the quality of PC through a shared model consisting of primary health care professionals, home-based PC teams, and PC units in hospitals. According to the World Health Organization (WHO), patients with advanced cancer and other terminal diseases benefit from early identification and proactive PC. We will evaluate the effectiveness of an intervention in which a PC leader is established in the primary health care center, and assess the effect of this intervention on the early identification of patients in need of PC, the efficient use of health care services, and direct health care costs. METHODS: Design: A two-arm cluster randomized clinical trial of 30 Primary Health Care Centers (PHCC) in Mallorca (Spain), in which each center was randomized to an intervention arm or a usual care arm. We expect that the number of patients identified as suitable for PC (including non-oncological PC) is at least 5% greater in the intervention arm. SAMPLE SIZE: A total of 4640 deceased patients. Outcomes will be assessed by a blinded external review of the electronic records. INTERVENTIONS: General practitioners (GPs) and nurse leaders in PC for each PHCC will be appointed. These leaders will help promote PC training of colleagues, improve symptom management and psychological support of patients, and evaluate the complexity of individual cases so that these cases receive assistance from PC home-based teams. MEASUREMENTS: Early identification (>90 days before death), evaluation of case complexity, level of case complexity (with referral to a home-based PC team), use and cost of hospital and primary care services, and quality of life during the last month of life (≥2 emergency room visits, ≥2 hospital admissions, ≥14 days of hospitalization). DISCUSION: PC leaders in primary care teams will improve the early identification of patients eligible for PC. This initiative could improve the quality of end-of-life care and utilization of hospital resources. TRIAL REGISTRATION: ISRCTN Registry identifier: ISRCTN92479122 . Retrospectively registered on 28 February 2017.

Evaluación psicométrica en profesionales de enfermería de cuidados paliativos / Psychometric Evaluation of Nursing Professionals Involved in Palliative Care / Avaliação psicométrica em profissionais de enfermagem de cuidados paliativos

RESUMEN Objetivo: validar las escalas de Bienestar Psicológico de Ryff en enfermería y relacionarlas con variables clave en calidad de vida laboral. Materiales y métodos: participaron por encuesta electrónica, autoadministrada anónima, 433 profesionales, 33,1% de ellos profesionales de enfermería (n = 123) en quienes se realizó el estudio. Además de los datos sociodemográficos, se recogió información sobre bienestar psicológico, atención consciente, afrontamiento de la muerte y calidad de vida. La validez de constructo fue evaluada con análisis factorial confirmatorio. Se estimó fiabilidad y se recogieron evidencias de validez externa. Resultados: el modelo mostró ajuste adecuado: X2(362) = 438,59 (p = 0,01), CFI = 0,98, RMSEA = 0,05 (0,03-0,06) y fiabilidad adecuada para todas las dimensiones, excepto autonomía. Las dimensiones de bienestar se relacionaron moderada y positivamente con autoconciencia, afrontamiento ante la muerte y satisfacción por compasión, y negativamente con fatiga por compasión y burnout. Se destacan las relaciones entre dominio del entorno y burnout (-0,54) y propósito en la vida con satisfacción (0,54) y con afrontamiento de la muerte (0,50). Conclusiones: los resultados apoyan el uso de estas escalas en enfermería, pues muestran adecuada fiabilidad y validez, y varias de ellas explican hasta una cuarta parte de indicadores relevantes en salud laboral como burnout o satisfacción vital.

ABSTRACT Objective: The study was intended to validate Ryff's psychological well-being scales in nursing and to relate them to key variables in the quality of life at work. Materials and method: Four hundred thirty-three (433) professionals took part through an anonymous, self-administered electronic survey; 33.1% were nursing professionals (n = 123) and the authors focused on them. In addition to sociodemographic data, information was collected on psychological well-being, mindfulness, coping with death, and quality of life. Construct validity was evaluated through confirmatory factor analysis. Reliability was estimated and evidence of external validity was collected. Results: The model showed adequate adjustment: X2(362) = 438.59 (p = 0.01), CFI = 0.98, RMSEA = 0.05 [0.03-0.06] and adequate reliability for all the dimensions except autonomy. The dimensions of well-being were moderately and positively with self-awareness, coping with death, and satisfaction from compassion, and negatively with fatigue from compassion and burnout. The association between dominance of the environment and burnout (-0.54), purpose in life and satisfaction (0.54) and coping with death (0.50) stood out. Conclusions: The results support the use of these scales in nursing, since they demonstrate adequate reliability and validity. In fact, several of them explain up to a quarter of the relevant indicators in occupational health, such as burnout or satisfaction with life.

RESUMO Objetivos: validar as escalas de Bem-estar Psicológico de Ryff em enfermagem e relacioná-las com variáveis fundamentais em qualidade de vida no trabalho. Materiais e método: participaram por enquete eletrônica autoadministrada anônima 433 profissionais - 33,1 % profissionais de enfermagem (n=123), nos quais nos focamos. Além de informação sociodemográfica, coletou-se informação sobre bem-estar psicológico, atenção consciente, enfrentamento da morte e qualidade de vida. A validade de constructo foi avaliada com análise fatorial confirmatória. Estimou confiabilidade e coletaram-se evidências de validade externa. Resultados: o modelo mostrou ajuste adequado: X2(362) = 438,59 (p = 0,01), CFI = 0,98, RMSEA = 0,05 [0,03-0,06] e confiabilidade adequada para todas as dimensões, exceto autonomia. As dimensões do bem-estar foram relacionadas moderada e positivamente com autoconsciência, enfretamento da morte e satisfação por compaixão, e negativamente com fatiga por compaixão e burnout. Destacam-se as relações entre domínio do ambiente e burnout (-0,54), propósito na vida com satisfação (0,54) e com enfrentamento da morte (0,50). Conclusões: os resultados apoiam o uso dessas escalas em enfermagem, pois mostram adequada confiabilidade e validade, e várias delas explicam até um quarto de indicadores relevantes em saúde do trabalho, como burnout ou satisfação vital.

Compassion Satisfaction, Compassion Fatigue, and Burnout in Spain and Brazil: ProQOL Validation and Cross-cultural Diagnosis.

CONTEXT: Palliative care professionals' quality of life has emerged as a growing issue of interest in health care literature, centered on concerns about professionals' compassion within a context of work characterized by pain and death. OBJECTIVES: The aim of this study was threefold: 1) to study the psychometric properties of both the Spanish and the Portuguese versions of the ProQOL scale, by means of confirmatory factor analyses; 2) to offer a diagnosis of compassion satisfaction and compassion fatigue levels of Spanish and Brazilian palliative care professionals; and 3) to compare levels in ProQOL between countries. METHODS: Two surveys with a cross-sectional design were carried out; 161 Brazilian palliative care professionals and 385 Spanish participated in this study. RESULTS: Confirmatory factor analysis for both the Spanish and the Portuguese versions showed an adequate fit. Reliability estimates were also adequate, with problems with the burnout dimension. Spanish and Brazilian palliative care professionals showed high levels of compassion satisfaction (specially, for the Brazilian samples), medium levels of secondary traumatic stress, and low levels of burnout. Finally, statistically significant differences in Spanish and Brazilian levels of compassion satisfaction and secondary traumatic stress were found, but not in burnout. CONCLUSION: The ProQOL shows psychometric goodness in its Spanish and Portuguese versions, although some items should be revised. The ProQOL is also useful for diagnosis and is sensitive enough to distinguish nuances as that found between Brazilian and Spanish professionals.

El acompañamiento espiritual en cuidados paliativos / Spiritual support in palliatrive care

Los profesionales sanitarios y especialmente los que trabajamos en oncología y cuidados paliativos somos frecuentemente interpelados por el sufrimiento de nuestros pacientes. El modelo biomédico, es insuficiente para entenderlo y atenderlo. Para ello se requiere ampliar la perspectiva, hacia una visión más abierta que incluya nuestra dimensión espiritual. La espiritualidad es un universal humano, y se expresa como el dinamismo que impulsa nuestro anhelo inagotable de plenitud y felicidad, que caracteriza la condición humana y que se expresa en la red de relaciones que cada persona establece. La enfermedad grave y la proximidad de la muerte son oportunidades de apertura a esta dimensión y de sanación. El profesional que conoce este proceso puede acercarse desde la hospitalidad, presencia y compasión y acompañar este itinerario. En este articulo intentamos explorar de forma resumida qué entendemos por espiritualidad, espiritualidad en clínica, necesidades y recursos espirituales, el itinerario de la persona que atraviesa un proceso de sufrimiento, perdida y/o muerte y las actitudes y herramientas de los profesionales para explorar, atender y acompañar en este espacio difícil y hasta ahora poco transitado

Healthcare professionals, and specially the ones in oncology and palliative care, are frequently questioned about our patients’ suffering. The biomedical model is not enough for understanding and caring for it. Therefore, the perspective needs to be widened through a more open vision that includes our spiritual dimension. Spirituality is a human universal, that expresses as the dynamism that boosts our infinite desire of plenitude and happiness, that characterizes human condition and that is expressed in the net of relationships stablished by each person. Severe illness and proximity to death are opportunities of an opening to this dimension and of healing. Professionals that know this process can approach from hospitality, presence and compassion, and accompany patients in this journey. In this paper, we try to explore in a synthesized way, what is understood by spirituality, clinical spirituality, spiritual resources and needs, the journey of a person going through a suffering, loose or dying process, and the attitudes and tools of professionals to explore and accompany in this difficult and not very busy path

Cuestionarios de atención espiritual en cuidados paliativos: revisión de la evidencia para su aplicación clínica / Questionnaires on spiritual care in palliative care: overview of their clinical applicability

Objetivo: Revisar los cuestionarios de evaluación de necesidades y recursos espirituales en cuidados paliativos más recientes y evaluar su aplicabilidad clínica en nuestro entorno. Método: Revisión sistemática, siguiendo las guías PRISMA de las publicaciones realizadas durante 2015-2016 de trabajos sobre espiritualidad. Los artículos debían estar centrados en el cuidado espiritual o la evaluación de la espiritualidad, basados en población de cuidados paliativos; y sometidos a revisión por pares. Resultado: de los 42 artículos identificados, tras evaluación independiente de dos observadores, 15 cumplieron criterios de selección. Estos se analizan respecto sus características, propiedades psicométricas y aplicabilidad. Conclusiones: La necesidad de mejorar la atención espiritual en el proceso de morir ha llevado a la aparición de múltiples herramientas de evaluación y acompañamiento espiritual. Su uso debe ponderarse con la experiencia del clínico y su aplicabilidad según el entorno cultural en el que se ha construido y sus propiedades psicométricas

Objective: review of the more recent questionnaires assessing spiritual needs and resources in palliative care, and determine their clinical applicability in our environment. Methods: systematic review, following PRISMA guidelines, of all publications about spirituality appeared on 2015-2016. Papers had to be focused on spiritual care or spirituality assessment, based on a palliative care population, and gone through a peer review. Results: a total of 42 publications were identified, but after the evaluation of two independent observers, only 15 fulfilled the selection criteria. The selected papers were analyzed according to their characteristics, psychometric properties and applicability. Conclusions: the need of improving spiritual care in the dying process lead to the advent of many assessment and spiritual care tools. Their use has to be considered together with the clinician experience, their applicability on the cultural context and their psychometric properties

Evaluation tools for spiritual support in end of life care: increasing evidence for their clinical application.

PURPOSE OF REVIEW: To summarize current evidence on evaluation tools for spiritual care, paying special attention to recent validations and new instruments, systematic reviews, recent consensus on spiritual care and its measurement, plus other emergent topics. RECENT FINDINGS: The systematic review resulted in 45 identified studies, 14 of which were considered: five works addressed the need for development and validation of spiritual tools; three studies reviewed tools for spirituality assessment, interventions, or related concepts; three more covered the efforts to define guidelines and priorities for spiritual care and its measurement. Other topics such as pediatric spiritual care, the use of new technologies, or nationwide surveys, also arose. SUMMARY: Recent contributions outline usability traits such as to shorten scales and measurement protocols for maximum respect of patients' quality of life. Other works addressed complicated grief or satisfaction with attention to spiritual care, transcending the patients, family and professionals' focus in on a sort of combined perspective. Further attention to culturally based specific models supporting questionnaires, a deeper understanding of quality of the spiritual care, both for patients and families, or further research on the relation between spiritual care and life span should be welcomed.

Validation of a New Instrument for Self-care in Spanish Palliative Care Professionals Nationwide.

Self-care is a cornerstone issue for those who deal with stressful events, as it is the case of palliative care professionals. It has been related to awareness, coping with death and quality of life, among others, but no measurement instruments have been used in palliative care professionals. This research presents and validates a brief new measure with clinical and psychometric good properties, called Professional Self-Care Scale (PSCS). The PSCS assesses professionals' self-care in three areas: physical self-care, inner self-care, and social self-care. Data come from a cross-sectional survey in a sample of 385 professionals of palliative care. The Mindful Attention Awareness Scale, the Coping with Death Scale, and the Professional's Quality of Life measure were also used. Results of the CFA showed adequate fit (χ2(24, N = 385) = 140.66, p < .01; CFI = .91; GFI = .93; SRMR = .09; and RMSEA = .10). Evidence pointed better reliability indices for the 3-item physical and inner factors of self-care than for the social dimension (Rho and GLB of .64, .90, and .57, respectively). Evidence regarding validity was consistent with previous literature. When levels of self-care were examined, women showed higher levels of inner and social self-care (F(3, 371) = 3.19, p = .02, η2 = .03, as also did psychologists when compared to doctors and nurses (F(9, 1074) = 2.00, p = .04, η2 = .02. The PSCS has shown adequate psychometric properties, and thus it could be used as diagnostic instrument when studying professionals' health.

Bienestar emocional y espiritualidad al final de la vida / Emotional and spiritual well-being at the end of life

OBJETIVO: La atención al conjunto de las necesidades físicas, sociales, psicológicas y espirituales de los pacientes es un elemento clave para la disminución del sufrimiento en el marco de los cuidados paliativos. MATERIAL Y MÉTODOS: Desde el modelo antropológico planteado por el Grupo de Espiritualidad de la SECPAL y mediante un nuevo cuestionario desarrollado para evaluar la espiritualidad en 3 niveles: intrapersonal (sentido), interpersonal (armonía) y transpersonal (pertenencia), se han estudiado los recursos y las necesidades espirituales, así como las relaciones entre espiritualidad y funcionamiento emocional, atendiendo a aspectos como ansiedad, depresión y resiliencia. Esta investigación se basa en una muestra de 121 pacientes en situación de cuidados paliativos distribuidos a lo largo de la geografía estatal. Para ello se han llevado a cabo estadísticos descriptivos, correlaciones de Pearson y un modelo de ecuaciones estructurales con un factor y 6 variables observables que ofrece un marco multivariante para la reflexión sobre dichas relaciones. RESULTADOS: Los resultados indican valores similares a los de otras muestras en las variables relativas al bienestar emocional y correlaciones estadísticamente significativas entre espiritualidad, depresión, ansiedad y resiliencia. El modelo se ajustó correctamente, indicando alta capacidad de predicción del grado de espiritualidad sobre la depresión y la ansiedad, en sentido negativo, y una relación positiva entre espiritualidad y resiliencia. CONCLUSIONES: Las conclusiones ponen en relación estos resultados con la literatura previa, aportando evidencia de la importancia que la espiritualidad tiene para el bienestar emocional de los pacientes

OBJECTIVE: The study of the physical, social, psychological and spiritual needs of the patient is a key element in the decreasing of suffering within the palliative care framework. MATERIAL AND METHODS: From the anthropological model proposed by the SECPAL Spirituality Group, and using a new measurement tool developed to assess the spirituality within three levels: intrapersonal (meaning), interpersonal (membership), and transpersonal (harmony), the resources and spiritual needs, together with the relationships between this spirituality and the emotional functioning, including anxiety, depression and resilience. The research is based on a sample of 121 palliative care patients, distributed throughout the country. Several descriptive analyses have been developed for this purpose. Pearson's correlations and a structural equations model with a factor and six observable variables, a technique which offers a multivariate framework to evaluate the results. RESULTS: The results showed values in emotional well-being similar to findings in other studies, with statistically significant correlations between spirituality, depression, anxiety and resilience. The data fit the model properly, indicating high predictive power of the spirituality level on depression and anxiety, in a negative way, and a positive relationship between spirituality and resilience. CONCLUSIONS: Conclusions show that these results are similar to those in previously published studies, providing evidence on the importance of spirituality for the emotional well-being of the patient

Palliative Care Professionals' Inner Life: Exploring the Relationships Among Awareness, Self-Care, and Compassion Satisfaction and Fatigue, Burnout, and Coping With Death.

CONTEXT: Professionals working in the landscape of death and dying frequently are exposed to existential issues, psychological challenges, and emotional distress associated with care at the end of life. Identifying factors that help professionals cope with frequent exposure to issues related to mortality could enhance palliative care providers' and patients' quality of life. OBJECTIVES: To improve our understanding of the factors associated with professionals' inner life, through the assessment of an adapted version of Kearney and Kearney's awareness model of self-care. The main assumptions of the study were that competence in coping with death and awareness would be positively related to compassion satisfaction and negatively to compassion fatigue and burnout; moreover, participating in a specific training program aimed at facing suffering and death, and self-care would positively predict coping with death. METHODS: A cross-sectional online survey of Spanish palliative care professionals was conducted through the member e-mail list of the Spanish Society of Palliative Care. A total of 387 professionals completed the survey, which included demographic data, and personal and professional scales on the mentioned constructs. RESULTS: Data fit reasonably well with the estimated model. Whereas the hypothesis relating spiritual training to coping with death was not supported by the data, all other aspects of the hypotheses were supported, namely self-care and awareness positively predicted professionals' competence in coping with death, and this, together with awareness, positively predicted compassion satisfaction and negatively predict compassion fatigue and burnout. CONCLUSION: The awareness-based model of self-care was successfully tested in a multidisciplinary sample of Spanish palliative care professionals. This research applies a quantitative evaluation of the model, providing evidence of a constellation of key variables for health professionals' quality of life, such as specific training, self-care, awareness and coping with death competency.

Validation of a new instrument for self-care in Spanish palliative care professionals nationwide

Self-care is a cornerstone issue for those who deal with stressful events, as it is the case of palliative care professionals. It has been related to awareness, coping with death and quality of life, among others, but no measurement instruments have been used in palliative care professionals. This research presents and validates a brief new measure with clinical and psychometric good properties, called Professional Self-Care Scale (PSCS). The PSCS assesses professionals’ self-care in three areas: physical self-care, inner self-care, and social self-care. Data come from a cross-sectional survey in a sample of 385 professionals of palliative care. The Mindful Attention Awareness Scale, the Coping with Death Scale, and the Professional’s Quality of Life measure were also used. Results of the CFA showed adequate fit (χ2(24, N = 385) = 140.66, p < .01; CFI = .91; GFI = .93; SRMR = .09; and RMSEA = .10). Evidence pointed better reliability indices for the 3-item physical and inner factors of self-care than for the social dimension (Rho and GLB of .64, .90, and .57, respectively). Evidence regarding validity was consistent with previous literature. When levels of self-care were examined, women showed higher levels of inner and social self-care (F(3, 371) = 3.19, p = .02, η2 = .03, as also did psychologists when compared to doctors and nurses (F(9, 1074) = 2.00, p = .04, η2 = .02. The PSCS has shown adequate psychometric properties, and thus it could be used as diagnostic instrument when studying professionals’ health (AU)

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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

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.