What does it mean to be the main caregiver to a terminally ill family member in Lithuania?: A qualitative study.

INTRODUCTION: Family caregivers are a great resource for providing dignified end-of-life care for terminally ill patients. Framed from the perspective of role theory and the relational nature of providing and receiving care, study objectives were as follows: (1) to capture caregivers' understanding of the process of taking on the role of main caregiver, (2) to conceptualize their understanding of the functions that they assume while being the main caregivers, and (3) to understand how they experienced the consequences they confronted. METHODS: The research team employed the methodological strategy of descriptive thematic analysis using a semi-structured interview guide. The sample consisting of 33 family caregivers was recruited using purposeful and snowball sampling strategies in 2020. Interview data was analyzed using content-driven inductive thematic analysis. RESULTS: The data analysis revealed four main themes that structure the process of becoming the main care giver of a terminally ill family member and the meaning of the caregiver role: (1) inaccessibility and mistrust of public care services for persons with terminal illness, (2) moral obligations and responsibilities of immediate family and friends, (3) cultural traditions, (4) the caregiver feels responsible for everything. The themes describe the social role of family caregiver in social context, address the process of taking on the role of caregiver and living with systemic corruption. CONCLUSIONS: Recognition of caregiving experiences is essential in planning better systems, in direct practice and in confronting corruption. The study suggests the need for open communication, accessibility of quality services, and the recognition of caregivers as care-team members. The larger implication is that the increasing numbers of distressed caregivers and aging populations can be considered as public health populations, and thus addressable through public health methods.

Dignity Violations and Barriers to Dignity Assurance for Terminally Ill Patients at the End of Life: A Cross-Sectional Analysis.

Background and Objectives: Investigation into forms of behavior that violate dignity is not the typical way to look for means of dignity preservation, but it may be the optimal way to prevent improper behavior. Numerous studies document that maintaining and improving patient dignity at the end of life require an understanding of factors posing threats to dignity in health care organizations. This study aimed to assess associations between dignity-violating behaviors and barriers to the assurance of dignity in health care settings from the perspective of health professionals. Materials and Methods: An anonymous survey of health professionals was conducted in Lithuania in May 2021 by using a convenience sampling method (N = 168). Two scales were developed and included in the questionnaire. One scale measured respondents' perceptions of Dignity Violations that they had witnessed. The other scale measured their opinions about Barriers to Dignity Assurance of terminally ill patients in clinical settings. Data analysis began with descriptive statistics, followed by exploratory principal component analysis (PCA) to identify the underlying structure of each scale. The variables assigned to distinct components in the PCA were combined into reflective latent variables in a path model. The path model of the relationships between the latent constructs was tested for significant links by implementing the partial least squares structural equation modeling technique. Results: Dehumanization, Humiliation, Inattentiveness, Control, Demonization, and Manipulation were identified as major forms of dignity-violating behavior. In addition, Organizational Barriers and Patient as an Obstacle were identified as two major types of barriers to the assurance of patient dignity. Both organizational and patient-oriented barriers were directly or indirectly associated with all forms of violations of patient dignity. Conclusions: The Dignity Violations scale showed potential for estimating professionals' observations of dignity violations in health care settings. Perceived high workloads, staff shortages, insufficient resources, and lack of organizational support were identified as negative organizational factors that may result in increased risk of seeing patients as obstacles to providing care that preserves the dignity of terminally ill patients.

Being Heard: A Qualitative Study of Lithuanian Health Care Professionals' Perceptions of Dignity at the End-of-Life.

Background: The literature on professionals' perceptions of dignity at the end-of-life (EOL) shows that there is a need for studies set in different cultural contexts. Lithuania represents one of these little-studied contexts. The aim of this study is to understand professionals' attitudes, experiences, and suggestions concerning EOL dignity to provide knowledge upon which efforts to improve EOL care can be grounded. The research questions are "How do Lithuanian health care professionals understand the essence of dignity at the end-of-life of terminally ill patients?" and "How do they believe that dignity at the EOL can be enhanced?". Materials and Methods: The study was exploratory and descriptive. It employed an interpretive phenomenological method to understand the essence of the phenomenon. Lightly structured interviews were conducted with professionals who had EOL experience, primarily with elderly and late middle-aged patients. from medicine, nursing, social work, and spiritual services. The interviews were primarily conducted by audiovisual means due to pandemic restrictions. Using a constant comparative method, the research team systematically codified text and developed themes by consensus after numerous analytic data iterations. Results: Four primary themes about EOL dignity were identified: Physical Comfort, Place of Care and Death, Effects of Death as a Taboo Topic, and Social Relations and Communication. A fifth, overarching theme, Being Heard, included elements of the primary themes and was identified as a key component or essence of dignity at the EOL. Conclusions: Patient dignity is both a human right and a constitutional right in Lithuania, but in many settings, it remains an aspiration rather than a reality. Being Heard is embedded in internationally recognized patient-centered models of EOL care. Hearing and acknowledging individuals who are dying is a specific skill, especially with elderly patients. Building the question "Is this patient being heard?" into practice protocols and conventions would be a step toward enhancing dignity at the EOL.

Are advance directives helpful for good end of life decision making: a cross sectional survey of health professionals.

BACKGROUND: This paper joins the debate over changes in the role of health professionals when applying advance directives to manage the decision-making process at the end of life care. Issues in relation to advance directives occur in clinical units in Lithuania; however, it remains one of the few countries in the European Union (EU) where the discussion on advance directives is not included in the health-care policy-making agenda. To encourage the discussion of advance directives, a study was designed to examine health professionals' understanding and preferences related to advance directives. In addition, the study sought to explore the views of health care professionals of the application of Advance Directives (AD) in clinical practice in Lithuania. METHODS: A cross-sectional survey was conducted by interviewing 478 health professionals based at major health care centers in Kaunas district, Lithuania. The design of the study included the use of a questionnaire developed for this study and validated by a pilot study. The collected data were analyzed using standard descriptive statistical methods. RESULTS: The analysis of knowledge about AD revealed some statistically significant differences when comparing the respondents' profession and gender. The analysis also indicated key emerging themes among respondents including tranquility of mind, the longest possible life expectancy and freedom of choice. Further, the study findings revealed that more than half of the study participants preferred to express their will while alive by using advance directives. CONCLUSIONS: The study findings revealed a low level of knowledge on advance directives among health professionals. Most health professionals agreed that AD's improved end-of-life decision making while the majority of physicians appreciated AD as the best tool for sharing responsibilities in clinical practice in Lithuania. More physicians than nurses preferred the presence of advance directives to support their decision making in end-of-life situations.

Determination of death: Metaphysical and biomedical discourse.

The prominence of biomedical criteria relying on brain death reduces the impact of metaphysical, anthropological, psychosocial, cultural, religious, and legal aspects disclosing the real value and essence of human life. The aim of this literature review is to discuss metaphysical and biomedical approaches toward death and their complimentary relationship in the determination of death. A critical appraisal of theoretical and scientific evidence and legal documents supported analytical discourse. In the metaphysical discourse of death, two main questions about what human death is and how to determine the fact of death clearly separate the ontological and epistemological aspects of death. During the 20th century, various understandings of human death distinguished two different approaches toward the human: the human is a subject of activities or a subject of the human being. Extinction of the difference between the entities and the being, emphasized as rational-logical instrumentation, is not sufficient to understand death thoroughly. Biological criteria of death are associated with biological features and irreversible loss of certain cognitive capabilities. Debating on the question "Does a brain death mean death of a human being?" two approaches are considering: the body-centrist and the mind-centrist. By bridging those two alternatives human death appears not only as biomedical, but also as metaphysical phenomenon. It was summarized that a predominance of clinical criteria for determination of death in practice leads to medicalization of death and limits the holistic perspective toward individual's death. Therefore, the balance of metaphysical and biomedical approaches toward death and its determination would decrease the medicalization of the concept of death.

Twenty years of human research ethics committees in the Baltic States.

Two decades have passed since the first attempts were made to establish systematic ethical review of human research in the Baltic States. Legally and institutionally much has changed. In this paper we provide an historical and structural overview of ethical review of human research and identify some problems related to the role of ethical review in establishing quality research environment in these countries. Problems connected to (a) public availability of information, (b) management of conflicts of interest, (c) REC composition and motivation of REC members, and (d) differing levels of stringency of ethical review for different types of studies, are identified. Recommendations are made to strengthen cooperation among the Baltic RECs.

Changes in nursing ethics education in Lithuania.

The post-Soviet scene in Lithuania is one of rapid change in medical and nursing ethics. A short introduction to the current background sets the scene for a wider discussion of ethics in health care professionals' education. Lithuania had to adapt rapidly from a politicized nursing and ethics curriculum to European regulations, and from a paternalistic style of care to one of engagement with choices and dilemmas. The relationships between professionals, and between professionals and patients, are affected by this in particular. This short article highlights these issues and how they impact on all involved.

The development of medical sociology in the post-Soviet society: the case of Lithuania.

This article explores the historical development of medical sociology and analyses the social problems that have had impacted the changes of health care institutionalization particularly in Lithuania during the Soviet and post-soviet period. Approaching the interaction between sociology and public health sciences, it is intended to apply the concept of medical sociology and its determinants in the context of health care and education systems. By analyzing the case past of medical sociology in Lithuania, we claim that its prospects should be associated with the study of new challenges in the biomedical sciences. In order to improve the importance of medical sociology in developing democracies we should focus on the questions, for instance, to what extent modern biotechnologies should be applied, how to improve the situation with patients' rights, and how to combine the knowledge of social sciences and biomedicine in order to improve the quality of healthcare services and to ensure better functioning of the healthcare system in particular district.

The patient role in decision-making in Lithuanian health care.

UNLABELLED: The objective of the study is to explore the attitudes of Lithuanian citizens to health care system and to evaluate their social role in decision-making about their health care. MATERIAL AND METHODS: The national cross-sectional survey was conducted March 1-7, 2004. Multi-stage random sampling across the country included adult Lithuanian residents, interviewed in their home (n=1007). The response rate was 56.5%. The attitudes of citizens were evaluated using an anonymous questionnaire, originally developed and adopted with the reference to experience of previously conducted studies. RESULTS: Majority of polled women and men (84.6% and 72.6%) recognized health as very important value in their life and as the most important among other social values. The overall mean of trust in health care system - 41.3%, trust in physicians - 69.9%, implementation of right to health care - 48.9%, concern about health care - 96.5% and patient impact in health care decisions - 19.1%. Nearly half of respondents (47.4%) prefer informative general practitioner-patient interaction model, which is realized in most cases (58.8%). Partnership (shared decision-making) as interaction model is expected by 37.2% of polled respondents and realized in every sixth case in primary care. CONCLUSIONS: Health as value is the most preferred among Lithuanian citizens. Younger and more educated people trusted less in health care system, but are more motivated to play an active role in health care decision-making. The informative model of doctor-patient is dominant, while partnership is not so exposed as being expected by patients.

[Patient confidence in health care]. / Pacientu pasitikejimas sveikatos prieziura.

The aim of the study was to evaluate patient confidence in organization of health care and health care policy. The study material was gathered using self-administrated anonymous questionnaire in November-December, 2001. The patients were recruited from therapeutic departments of Kaunas 2nd hospital and Alytus S. Kudirka hospital. The data was analyzed using Microsoft Excel and SPSS program data package. Chi-square test was used to compare observed results with expected results. The hypothesis was statistically significant at the p<0.05. More patients in Alytus hospital (31%) than in Kaunas hospital (22%) predicated as being non-confident in health care policy. Statistical significant difference between patients of two hospitals was obtained comparing opinion about health care reform. Alytus S. Kudirka hospital patients were more optimistic about health care reform than patients in Kaunas hospital. Thirty percent of patients in Alytus hospital and 19% in Kaunas hospital were confident that reform has improved their treatment (p<0.05). More patients in Kaunas hospital (22%) than in Alytus hospital (9%) confirmed that health care reform aggravated their treatment. The majority of Alytus hospital patients (62%) and 40% of Kaunas hospital patients were satisfied with health care services. More than half respondents were not confident in health care system but they trusted physicians. Gender and education level had impact on patient confidence in health care. The most part of the respondents were satisfied with health care in hospital. More patients in Alytus hospital compared with Kaunas hospital patients confirmed that they did not trust health care policy, however were more satisfied with health care reform and services in hospital.