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2.
Pediatrics ; 144(4)2019 10.
Artículo en Inglés | MEDLINE | ID: mdl-31484675

RESUMEN

Doctors are required to notify Child Protective Services (CPS) if parents do not provide appropriate medical care for their children. But criteria for reporting medical neglect are vague. Which treatments properly fall within the realm of shared decision-making in which parents can decide whether to accept doctors' recommendations? Which treatments are so clearly in the child's interest that it would be neglectful to refuse them? When to report medical neglect concerns to CPS may be controversial. It would seem inhumane to allow a child to suffer because of parental refusal to administer proper analgesia. In this ethics rounds, we present a case of an adolescent with chronic pain who is terminally ill. Her parents were not adherent to recommended analgesia regimens. Her palliative care team had to decide whether to report the case to CPS.


Asunto(s)
Analgésicos Opioides/uso terapéutico , Dolor en Cáncer/tratamiento farmacológico , Maltrato a los Niños , Cuidados Paliativos/ética , Padres , Adolescente , Servicios de Protección Infantil , Femenino , Hospitales para Enfermos Terminales , Humanos , Cumplimiento de la Medicación , Autonomía Personal , Autoadministración/ética , Enfermo Terminal
4.
Ann Palliat Med ; 8(3): 231-239, 2019 07.
Artículo en Inglés | MEDLINE | ID: mdl-31370662

RESUMEN

BACKGROUND: As patients with advanced cancer approach end of life, ethical issues may arise. We describe ethical issues encountered by radiation oncologists in this setting. METHODS: A prospective, survey-based study assessed 162 consecutive consults for palliative radiation therapy (PRT) over 4 months at 3 hospitals. Consulting radiation clinicians completed a survey assessing palliative care issues encountered, based on national guidelines. Ethical issues included 5 subthemes (conflict between clinicians, caregiver-clinician conflict, internal conflict, feeling unable to do what was best for the patient, and violation of personal morals), an option for unclassified issues, and open-ended responses. Multivariate analyses (MVA) assessed potential patient-related predictors of ethical issues: gender, performance status (PS), PRT indication, physical symptoms, and presence of psychosocial, goals of care, care coordination, cultural, or spiritual issues. RESULTS: Of 162 surveys, 140 were completed (response rate =86%). Overall, 14 (10%) surveys identified ethical issues relevant to care; 11 of 14 (78%) identified more than 1 ethical issue. Half (7; 50%) involved conflict between clinicians and clinician-caregiver conflict; 6 (43%) involved clinician distress or internal conflict; and 2 (14%) felt impeded from doing what they felt was best for the patient. Open-ended responses revealed differences in opinion between medical specialties (n=6, 43%), and conflict related to coordination of care among clinicians (n=3, 21%). On UVA, ethical issues were associated with PRT referrals for bleeding, dyspnea, or dysphagia due to visceral metastases (30%) versus CNS indications such as brain metastases or cord compression (7%) or for bony metastases (4%) P<0.001. On MVA, ethical issues were associated with PRT for visceral metastases (OR 13.0; 95% CI, 2.3-74.6; P<0.001) and presence of spiritual issues (OR 4.0; 95% CI, 1.1-14.5; P=0.04). CONCLUSIONS: At least 1 in 10 referrals for PRT involve ethical issues. Further studies are warranted to assess the ability of radiation oncologists to manage ethical issues.


Asunto(s)
Neoplasias Encefálicas/radioterapia , Cuidados Paliativos/ética , Cuidados Paliativos/métodos , Oncólogos de Radiación/ética , Adulto , Anciano , Anciano de 80 o más Años , Características Culturales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Principios Morales , Metástasis de la Neoplasia , Planificación de Atención al Paciente , Rendimiento Físico Funcional , Estudios Prospectivos , Derivación y Consulta , Factores Sexuales , Factores Socioeconómicos , Espiritualidad
5.
Surg Clin North Am ; 99(5): 941-953, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31446919

RESUMEN

Obstetricians and general surgeons frequently navigate the challenges of providing surgical care that is mindful of the unique circumstances of pregnancy. Ensuring pregnant patients have high-quality surgical care is an ethical imperative. Providers should maintain a high index of suspicion for surgical disease to ensure that surgical diagnoses are not missed or inadequately treated. A variety of imaging modalities are used in pregnancy. Surgical management includes laparoscopic and open approaches. Perioperative fetal monitoring should be the subject of multidisciplinary discussion. Symptomatic control in pregnancy should have the same goals as for nonpregnant patients. Enhanced recovery after surgery pathways frequently are appropriate.


Asunto(s)
Discusiones Bioéticas , Complicaciones del Embarazo/cirugía , Femenino , Humanos , Cuidados Paliativos/ética , Cuidados Posoperatorios , Embarazo , Complicaciones del Embarazo/diagnóstico por imagen , Complicaciones del Embarazo/terapia , Servicios de Salud Reproductiva/ética , Justicia Social/ética
6.
Surg Clin North Am ; 99(5): 955-965, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31446920

RESUMEN

Surgeons are often asked to perform tracheostomies and percutaneous endoscopic gastrostomies for a wide variety of patients. As consultants, surgeons are tasked with honoring the relationship between the referring provider and the patient while also assessing whether the consult is appropriate given the patient's prognosis and goals of care. This article discusses the most common conditions for which these procedures are requested and reviews the evidence supporting either the placement or avoidance of these tubes in each condition. It provides a framework for surgeons to use when discussing these procedures in the context of goals of care.


Asunto(s)
Endoscopía Gastrointestinal , Nutrición Enteral , Neoplasias de Cabeza y Cuello/cirugía , Enfermedades del Sistema Nervioso/cirugía , Traqueostomía , Heridas y Traumatismos/cirugía , Enfermedad Crítica/terapia , Endoscopía Gastrointestinal/efectos adversos , Endoscopía Gastrointestinal/mortalidad , Humanos , Cuidados Paliativos/ética , Traqueostomía/efectos adversos , Traqueostomía/mortalidad
7.
Prim Care ; 46(3): 387-398, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31375188

RESUMEN

In caring for dying patients, family medicine practitioners intentionally adopt care plans that affect the manner and timing of death. These decisions are morally weighty. This article provides guidance regarding the ethical and legal appropriateness of practitioner decisions near the end of life. Topics include surrogate decision making, advance care planning, medical nutrition and hydration, double effect, futile care, physician-assisted death, voluntarily stopping eating and drinking, palliative sedation to unconsciousness, and cultural humility.


Asunto(s)
Toma de Decisiones , Cuidado Terminal/ética , Cuidado Terminal/legislación & jurisprudencia , Planificación Anticipada de Atención/ética , Planificación Anticipada de Atención/legislación & jurisprudencia , Analgésicos Opioides/administración & dosificación , Humanos , Hipnóticos y Sedantes/administración & dosificación , Terapia Nutricional/ética , Cuidados Paliativos/ética , Cuidados Paliativos/legislación & jurisprudencia , Planificación de Atención al Paciente/ética , Planificación de Atención al Paciente/legislación & jurisprudencia , Prioridad del Paciente , Atención Primaria de Salud/ética , Atención Primaria de Salud/legislación & jurisprudencia , Pronóstico , Suicidio Asistido/ética , Suicidio Asistido/legislación & jurisprudencia , Privación de Tratamiento/ética , Privación de Tratamiento/legislación & jurisprudencia
8.
Georgian Med News ; (289): 168-173, 2019 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-31215901

RESUMEN

The aim of the study is to analyze individual legal problems of the implementation of the human right to palliative care. To achieve this goal, statistical data on the number of palliative patients, their access to medical services were analyzed. The absence of reasons for limiting the patient's right to receive palliative care, as such a right is a fundamental human right, is substantiated. An analysis of the understanding of the legal construction of "palliative care" in the scientific literature, national and international legal documents was carried out. It was revealed that the terms "hospice care", "end-of-life-care", "respite care" are components of a precise definition - "palliative care". Two groups of subjects that ensure the human right to this type of medical care are identified, their powers are indicated. In the course of the research it was established that palliative patients, more often than other patients, need medical care, including children. This category of patients faces the following problems: incomplete providing of high-quality free medical palliative care; insufficient number of palliative and hospice departments for such patients; palliative care does not meet international standards (logistical support for palliative departments, there are no specialists of a multidisciplinary team); there is no special training for medical personnel working with incurable patients; painkillers (non-narcotic and narcotic) drugs for relieving pain syndrome of such patients are not provided in full volume; there is no cooperation of state authorities in the field of palliative care with public and charitable organizations; palliative patients do not have access to free legal services (pensions, inheritance).


Asunto(s)
Cuidados Paliativos al Final de la Vida , Derechos Humanos , Cuidados Paliativos , Adulto , Niño , Personal de Salud , Cuidados Paliativos al Final de la Vida/ética , Cuidados Paliativos al Final de la Vida/legislación & jurisprudencia , Humanos , Cuidados Paliativos/ética , Cuidados Paliativos/legislación & jurisprudencia , Ucrania
10.
Bioethics ; 33(4): 421-430, 2019 05.
Artículo en Inglés | MEDLINE | ID: mdl-31115084

RESUMEN

The article explores the underlying reasons for patients' self-perception of being a burden (SPB) in family settings, including its impact on relationships when wishes to die (WTD) are expressed. In a prospective, interview-based study of WTD in patients with advanced cancer and non-cancer disease (organ failure, degenerative neurological disease, and frailty) SPB was an important emerging theme. In a sub-analysis we examined (a) the facets of SPB, (b) correlations between SPB and WTD, and (c) SPB as a relational phenomenon. We analyzed 248 interviews with 62 patients, their family caregivers, and professionals using grounded theory and interpretive phenomenological analysis. SPB appeared as important empathic concern in care situations. Patients expressed many sorts of concerns for others, but also perceived an altered self-understanding that did not meet mutual expectations within relationships. In SPB associated with WTD three constellations were found: (a) WTD to unburden others; (b) patients decided against hastening death to prevent being a further burden to others (in these cases, the SPB counteracted the wish to die); and (c) both wishes for and against dying were sustained by SPB. These patients often felt paralyzed and suffered deeply. Family caregivers felt emotionally touched by SPB and tried to unburden patients by caring and compassion. We concluded that the impact of SPB on a WTD and the various meanings the facets of SPB have in balancing relationships need to be worked out individually. An early palliative and narrative approach is warranted.


Asunto(s)
Actitud Frente a la Muerte , Emociones , Relaciones Familiares/psicología , Motivación , Cuidados Paliativos , Estrés Psicológico , Cuidado Terminal , Discusiones Bioéticas , Cuidadores , Muerte , Empatía , Familia , Teoría Fundamentada , Humanos , Cuidados Paliativos/ética , Cuidados Paliativos/psicología , Estudios Prospectivos , Autoimagen , Encuestas y Cuestionarios , Cuidado Terminal/ética , Cuidado Terminal/psicología , Enfermo Terminal/psicología
12.
BMC Res Notes ; 12(1): 217, 2019 Apr 08.
Artículo en Inglés | MEDLINE | ID: mdl-30961674

RESUMEN

OBJECTIVE: In Indonesia, palliative care has not been uniformly implemented at all levels of healthcare facilities. Healthcare personnel play an important role in providing that care. This study aimed to explore the current conditions and expectations regarding palliative care from the perspective of healthcare personnel. RESULTS: A qualitative study was conducted with 12 physicians and five nurses from December 2017 to June 2018. In-depth interviews of these professionals were conducted. The responses were subjected to inductive thematic analysis, generating five themes and 24 subthemes. The themes were (1) family and environment, including barriers and contributions to palliative care; (2) numbers and competence of healthcare providers; (3) accessibility of palliative care; (4) case management of patient's and family's problems by healthcare personnel; and (5) barriers or enabling factors from the healthcare system. Patients, family members, and healthcare personnel contribute to case management. Attention must be paid to improving access and the healthcare system for thorough implementation of palliative care.


Asunto(s)
Actitud del Personal de Salud , Enfermeras y Enfermeros/psicología , Cuidados Paliativos/psicología , Relaciones Médico-Paciente/ética , Médicos/psicología , Cuidado Terminal/organización & administración , Adulto , Competencia Clínica , Femenino , Accesibilidad a los Servicios de Salud/ética , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Humanos , Indonesia , Masculino , Persona de Mediana Edad , Cuidados Paliativos/ética , Investigación Cualitativa , Enfermo Terminal/psicología
13.
Cuad. bioét ; 30(98): 23-34, ene.-abr. 2019.
Artículo en Español | IBECS | ID: ibc-180692

RESUMEN

Este articulo analiza el tema amplio de la eutanasia, pero bajo un punto de vista muy concreto, el de sus implicaciones sociales. Se defiende aquí que la eutanasia no es exclusivamente una decisión individual, sino que tiene, sobre todo, una importante repercusión social. Si se aceptara y legalizara la eutanasia, la naturaleza misma de la medicina y la propia identidad del médico sufrirían una profunda transformación. La relación médico-paciente basada en la confianza quedaría rota. También si se refrendara la eutanasia se fomentaría a que el ser humano no fuese valorado por su ser, sino por su capacidad de producir. Ahora bien, las personas vulnerables, frágiles y débiles (dependientes, ancianos, enfermos…) mantienen intacta su dignidad, porque ésta se tiene por el simple hecho de nacer como seres humanos. Todas las vidas humanas merecen la pena vivirse, por muy enfermos y deteriorados que estén sus cuerpos. Admitir lo contrario es entrar en una espiral donde la dignidad del ser humano se convertiría en objeto de ponderación respecto de otro valor, que, en un hipotético conflicto, podría ser pospuesto por otro. Sin embargo, los Cuidados Paliativos tienen en cuenta la dimensión social del fin de la vida del ser humano. Atienden en su totalidad al ser humano enfermo. De ahí que sean la opción más acorde con la dignidad del ser humano al final de su vida


This article analyzes the issue of euthanasia, but under a concrete point of view, that of its social implications. It is defended here that euthanasia is not exclusively an individual decision, but has, above all, an important social repercussion. If euthanasia were accepted and legalized, the very nature of the medicine and the physician´s own identity would undergo a profound transformation. The doctor-patient relationship based on trust would be broken. Also, if euthanasia were endorsed, it would be encouraged that the human being was not valued for his / her being, but for his capacity to produce. Now, vulnerable, fragile and weak people (dependent, old, sick ...) keep their dignity intact, because we have this because of the simple fact of being born as human beings. All human lives are worth living, however sick and deteriorated their bodies are. To admit the opposite is to enter a spiral where the dignity of the human being would become an object of weighting with respect to another value, which, in a hypothetical conflict could be postponed by another. However, Palliative Care takes into account the social dimension of the end of life of the human being. They take care of the sick human being in its entirety. That is why they are the option most in line with the dignity of the human being at the end of his life


Asunto(s)
Humanos , Eutanasia/ética , Eutanasia/legislación & jurisprudencia , Cuidados Paliativos/ética , Condiciones Sociales , Problemas Sociales , Personeidad
14.
Am J Hosp Palliat Care ; 36(7): 577-582, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-30803255

RESUMEN

OBJECTIVE: This article sought to explore ethical issues associated with prioritization decisions in palliative care. METHODS: As part of a broader series of studies of triage in palliative care, this qualitative substudy was conducted via semi-structured focus groups and individual interviews. Transcripts were subjected to thematic analysis. SETTING/PARTICIPANTS: Twenty health professionals working across disciplines (primary, specialist; medicine, nursing, and allied health), service types (inpatient, hospital liaison, and community), and locations (metropolitan and rural) in Victoria, Australia. RESULTS: Four themes emerged from the data: (1) Clinicians understood the tension between maintaining service quality with the delivery of a compromised service that sought to respond to demand. (2) They were aware of the influences of relationships and responsibilities upon patient waiting list prioritization, and (3) reported a hierarchy of suffering with certain types of clinical problems viewed as more urgent than others, for example, pain being more urgent than existential distress. (4) Clinicians noted a lack of transparency around waiting lists as they currently exist. CONCLUSIONS: This study revealed key ethical decision-making issues associated with prioritizing access to palliative care services. Making explicit the processes and influences upon decision-making provides greater transparency of health-care utilization at the end of life.


Asunto(s)
Actitud del Personal de Salud , Personal de Salud/psicología , Prioridades en Salud/ética , Enfermería de Cuidados Paliativos al Final de la Vida/ética , Cuidados Paliativos/ética , Cuidados Paliativos/psicología , Adulto , Australia , Toma de Decisiones , Grupos Focales , Humanos , Masculino , Persona de Mediana Edad , Investigación Cualitativa
15.
Am J Med Sci ; 357(2): 143-150, 2019 02.
Artículo en Inglés | MEDLINE | ID: mdl-30665495

RESUMEN

Implantable cardioverter-defibrillators (ICDs) monitor for and terminate malignant arrhythmias. Given their potential as a life-saving therapy, an increasing number of people receive an ICD every year, and a growing number are currently living with ICDs. However, cardiopulmonary arrest serves as the final common pathway of natural death, and the appropriate management of an ICD near the end-of-life is crucial to ensure that a patient's death is not marked by further suffering due to ICD shocks. The tenets of palliative care at the end-of-life include addressing any medical intervention that may preclude dying with dignity; thus, management of ICDs during this phase is necessary. Internists are at the forefront of discussions about end-of-life care, and are likely to find discussions about ICD care at the end-of-life particularly challenging. The present review addresses issues pertaining to ICDs near the end of a patient's life and their potential impact on dying patients and their families. A multidisciplinary, patient-centered approach can ensure that patients receive the maximum benefit from ICDs, without any unintended pain or suffering.


Asunto(s)
Arritmias Cardíacas/terapia , Desfibriladores Implantables/psicología , Cuidados Paliativos , Cuidado Terminal , Humanos , Cuidados Paliativos/ética , Cuidado Terminal/ética
16.
BMJ Support Palliat Care ; 9(3): 245-254, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-30636204

RESUMEN

OBJECTIVES: Palliative care providers may be exposed to numerous detrimental psychological and existential challenges. Ethical issues in the healthcare arena are subject to continual debate, being fuelled with ongoing medical, technological and legal advancements. This work aims to systematically review studies addressing the moral distress experienced by healthcare professionals who provide adult palliative care. METHODS: A literature search was performed on PubMed, Scopus, Web of Science and PsycINFO databases, searching for the terms 'moral distress' AND 'palliative care'. The review process has followed the international PRISMA statement guidelines. RESULTS: The initial search identified 248 papers and 10 of them were considered eligible. Four main areas were identified: (1) personal factors, (2) patients and caregivers, (3) colleagues and superiors and (4) environment and organisation. Managing emotions of self and others, witnessing sufferance and disability, caring for highly demanding patients and caregivers, as well as poor communication were identified as distressing. Moreover, the relationship with colleagues and superiors, and organisational constraints often led to actions which contravened personal values invoking moral distress. The authors also summarised some supportive and preventive recommendations including self-empowerment, communication improvement, management of emotions and specific educational programmes for palliative care providers. A holistic model of moral distress in adult palliative care (integrating emotional, cognitive, behavioural and organisational factors) was also proposed. CONCLUSIONS: Cognisance of risk and protective factors associated with the moral distress phenomenon may help reframe palliative healthcare systems, enabling effective and tailored actions that safeguard the well-being of providers, and consequently enhance patient care.


Asunto(s)
Cuidadores/psicología , Personal de Salud/psicología , Principios Morales , Estrés Laboral/psicología , Cuidados Paliativos/psicología , Adulto , Comunicación , Prestación de Atención de Salud , Emociones , Empatía , Femenino , Personal de Salud/ética , Humanos , Masculino , Cuidados Paliativos/ética
17.
Rev Bras Anestesiol ; 69(1): 72-77, 2019.
Artículo en Portugués | MEDLINE | ID: mdl-29776669

RESUMEN

BACKGROUND AND OBJECTIVE: Palliative sedation is a medical procedure that has been used for more than 25 years to relieve refractory symptoms not responsive to any previous treatment in patients with no possibility of cure and near the end of life. Many uncertainties persist on the theme regarding definition, indications, decision making, most appropriate place to perform the procedure, most used drugs, need for monitoring, fluids and nutritional support, and possible ethical dilemmas. The objective of this review was to seek a probable consensus among the authors regarding these topics not yet fully defined. METHOD: An exploratory search was made in secondary sources, from 1990 to 2016, regarding palliative sedation and its clinical and bioethical implications. CONCLUSIONS: Palliative sedation is an alternative to alleviate end-of-life patient suffering due to refractory symptoms, particularly dyspnea and delirium, after all other treatment options have been exhausted. Decision making involves prior explanations, discussions and agreement of the team, patient, and/or family members. It can be performed in general hospital units, hospices and even at home. Midazolam is the most indicated drug, and neuroleptics may also be required in the presence of delirium. These patients' monitoring is limited to comfort observation, relief of symptoms, and presence of adverse effects. There is no consensus on whether or not to suspend fluid and nutritional support, and the decision must be made with family members. From the bioethical standpoint, the great majority of authors are based on intention and proportionality to distinguish between palliative sedation, euthanasia, or assisted suicide.


Asunto(s)
Sedación Profunda/ética , Cuidados Paliativos/ética , Cuidado Terminal/ética , Toma de Decisiones Clínicas , Humanos , Cuidados Paliativos/métodos , Cuidado Terminal/métodos
18.
BMJ Support Palliat Care ; 9(2): 219-224, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-26823291

RESUMEN

BACKGROUND: Social media (SM) have altered the way we live and, for many, the way we die. The information available on even the rarest conditions is vast. Free from restrictions of mobility, time and distance, SM provides a space for people to share experiences of illness, death and dying, and potentially benefit from the emotional and practical support of others n similar positions. The communications that take place in these spaces also create large amounts of 'data' which, for any research centre, cannot be ignored. However, for a palliative care research centre the use of this 'data' comes with specific ethical dilemmas. METHODS: This paper details the process that we, as a research, went through in constructing a set of ethical guidelines by which to work. This involved conducting two consensus days; one with researchers from within the centre, and one with the inclusion of external researchers with a specific interest in SM. RESULTS: The primary themes that emerged from the consensus meetings includes; SM as a public or private space; the status of open and closed groups; the use of historical data; recruiting participants and obtaining informed consent and problems of anonymity associated with dissemination. CONCLUSIONS: These are the themes that this paper will focus on prior to setting out the guidelines that we subsequently constructed.


Asunto(s)
Investigación Biomédica/ética , Investigación Biomédica/normas , Cuidados Paliativos/ética , Cuidados Paliativos/normas , Proyectos de Investigación , Medios de Comunicación Sociales/ética , Medios de Comunicación Sociales/normas , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Guías como Asunto , Humanos , Masculino , Persona de Mediana Edad
19.
Bioethics ; 33(1): 195-200, 2019 01.
Artículo en Inglés | MEDLINE | ID: mdl-30226280

RESUMEN

In the end-of-life context, alleviation of the suffering of a distressed patient is usually seen as a, if not the, central goal for the medical personnel treating her. Yet it has also been argued that suffering should be seen as a part of good dying. More precisely, it has been maintained that alleviating a dying patient's suffering can make her unable to take care of practical end-of-life matters, deprive her of an opportunity to ask questions about and find meaning in and for her existence, and detach her from reality. In this article, I argue that the aims referred to either do not support suffering or are better served by alleviating it. When the aims would be equally well served by enduring suffering and relieving it, the latter appears to be the preferable option, given that the distress a patient experiences has no positive intrinsic value. Indeed, as the suffering can be very distressing, it may not be worth bearing even if that was the best way to achieve the aims: the distress can sometimes be bad enough to outbalance the worth of achieving the goals. Having considered an objection to the effect that a patient can have a self-regarding moral duty to endure the distress she faces at the end of life, I conclude that the burden of proof is on the side of those who maintain that the suffering experienced at the end of life ought to be endured as a part of dying well.


Asunto(s)
Actitud Frente a la Muerte , Metas , Vida , Obligaciones Morales , Cuidados Paliativos , Estrés Psicológico/terapia , Cuidado Terminal , Muerte , Ética Clínica , Humanos , Cuidados Paliativos/ética , Valores Sociales , Estrés Psicológico/psicología , Cuidado Terminal/ética
20.
Am J Hosp Palliat Care ; 36(4): 308-315, 2019 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-30463415

RESUMEN

BACKGROUND:: The Institute of Medicine identifies that quality palliative/end-of-life (EOL) care should be provided to patients with serious, life-limiting illnesses and their families by competently prepared health professionals. PURPOSE:: This study assessed perceived concerns of health professionals pertaining to the delivery of palliative/EOL care in the hospital setting. The specific aim was to determine thematic concerns in the delivery of palliative/EOL care which emerged from respondents' impressions of a memorable palliative/EOL patient experience. METHODS:: Interdisciplinary health professionals at a large academic health system in the Midwest were surveyed to reflect upon a memorable palliative/EOL life care patient situation (positive or negative). A Thematic Analysis approach was used to code qualitative responses to 4 open-ended questions and then extract themes and subthemes from the coded data. RESULTS:: Concerns identified by participants (N = 425) emerged around 7 themes including communication (97%), decision-making/care planning (75%), education needs (60%), EOL care (48%), ethics (24%), satisfaction with care (9%), and spiritual/cultural sensitivity (6%). CONCLUSION:: Challenges exist in the delivery of quality palliative/EOL care in the hospital setting which may be addressed through educational initiatives that focus on recognition of cultural influences on care preferences, improving communication between patients/families and providers, education about the differences between palliative and EOL care, and increased competency of health providers in having EOL/goals-of-care discussions. Health professionals must recognize the benefit of collaborative palliative care in order to meet patient and family needs holistically and comprehensively.


Asunto(s)
Personal de Salud/psicología , Cuidados Paliativos/organización & administración , Cuidados Paliativos/psicología , Cuidado Terminal/organización & administración , Cuidado Terminal/psicología , Centros Médicos Académicos/organización & administración , Adulto , Anciano , Actitud del Personal de Salud , Competencia Clínica , Comunicación , Competencia Cultural , Toma de Decisiones , Ética Clínica , Femenino , Educación en Salud/organización & administración , Personal de Salud/educación , Personal de Salud/ética , Humanos , Masculino , Persona de Mediana Edad , Cuidados Paliativos/ética , Satisfacción del Paciente , Percepción , Investigación Cualitativa , Calidad de la Atención de Salud , Cuidado Terminal/ética
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