The Communication of Bad News in Palliative Care: The View of Professionals in Spain.

BACKGROUND: Communication is one of the central axes around which end-of-life care revolves in the context of palliative care. Communication of bad news is reported as one of the most difficult and stressful tasks by palliative care professionals. Therefore, the aim of this study is to identify aspects related to the communication of bad news in palliative care in Spain. METHODS: Descriptive cross-sectional study. An ad hoc questionnaire was designed and sent by e-mail to all palliative care teams in Spain. RESULTS: Overall, 206 professionals (102 nurses, 88 physicians and 16 psychologists) completed the questionnaire. A total of 60.2% considered their communication of bad news skills to be good or very good. This was related to older age, experience in both the profession and palliative care, and to having received specific postgraduate training (P < .001). Around 42.2% perform communication of bad news with the patient first, which is associated with lower skill (P = .013). About 78.15% of the professionals do not use any specific protocol. CONCLUSION: This study suggests that patients access palliative care with little information about their diagnosis and prognosis. The barriers identified in the communication of bad news are the lack of specific education and training in protocol management, the difficult balance between hope and honesty, the young age of the patient, and the family.

Cardiac System during the Aging Process.

The aging process is accompanied by a continuous decline of the cardiac system, disrupting the homeostatic regulation of cells, organs, and systems. Aging increases the prevalence of cardiovascular diseases, thus heart failure and mortality. Understanding the cardiac aging process is of pivotal importance once it allows us to design strategies to prevent age-related cardiac events and increasing the quality of live in the elderly. In this review we provide an overview of the cardiac aging process focus on the following topics: cardiac structural and functional modifications; cellular mechanisms of cardiac dysfunction in the aging; genetics and epigenetics in the development of cardiac diseases; and aging heart and response to the exercise.

Effects of different musical stimuli in vital signs and facial expressions in patients with cerebral damage: a pilot study.

BACKGROUND: Along history, music has been used in a variety of ways for therapeutic purposes and has long been recognized for its physiological and psychological effects. Music listening can be an effective nursing intervention, to enhance relaxation, provide distraction, and reduce pain. OBJECTIVES: The aims of this study were to identify changes produced by different musical stimuli in blood pressure (BP), heart rate (HR), respiratory rate (RR), and oxygen saturations (SpO2) and to verify the influence of music listening on patients' facial expressions with severe cerebral damage. METHOD: A quasiexperimental study was performed in 26 patients with severe cerebral damage, divided into control and case groups. Patients belonging to the case group were exposed to musical stimuli, radio, classical relaxing music (CRM), and relaxing music with nature sounds (RMNS). Patients were evaluated by measuring vital signs before and after exposure to each musical stimulus, as were the patients within the control group. Patients in the control group were exempt from any musical stimulus. Facial expressions were observed in each patient within the case group during the intervention. RESULTS: The results show that radio produced a slight increase in systolic BP, HR, RR, and SpO2. The CRM induced a decrease of RR and an increase of SpO2 and also produced alterations of the facial expression. When RMNS was played, a decrease was displayed in BP, HR, and RR and an increase was displayed in SpO2. Alterations in facial expression were displayed in each patient. CONCLUSIONS: The results of the study suggest that the application of musical stimuli such as CRM and RMNS can be used to provide a state of relaxation in patients with severe cerebral damage.