[Advance care planning in nursing homes: scoping review]. / Planificación anticipada de cuidados en residencias de mayores: revisión narrativa.

Advance care planning is a deliberative process that aims to help patients define goals and preferences for future care and treatment at a times when they have limited decision-making capacity. This study aims to analyze models of advance care planning in elderly individuals living in nursing homes. We reviewed papers published in Cochrane, PubMed and Embase. A total of 26 studies were selected, including a total of 44,131 people over 65 years of age. We analyzed the types of intervention (interviews, videos, workshops, documentation, etc.) and their results derived from the application. We conclude that no study implements a standardized intervention model. These interventions include decision-making (transfers to hospital, resucitation orders) and the adequacy of therapeutic effort (antibiotherapy, nutrition, serotherapy, etc.). Other outcomes are implementation barriers (time and training).

Cuidados al paciente y su familia al final de la vida: la anticipación compasiva / Care for the patient and his family at the end of life: compassionate advance care planning

El final de la vida va acompañado de sufrimiento y penalidades que pueden ser aliviados en las unidades de Cuidados Paliativos (CP) con una atención compasiva. El objetivo de este trabajo consiste en describir el concepto de "anticipación compasiva" como una forma de cuidar al paciente y a su familia al final de la vida desde la perspectiva tanto de los profesionales, profesores y estudiantes de las ciencias de la salud, como de las personas con enfermedad avanzada y sus familiares. Se ha empleado para ello una metodología cualitativa. Los datos se recogieron a través de entrevistas en profundidad y de grupos focales, siendo analizados y codificados usando la técnica de la teoría fundamentada. Se obtuvo la aprobación de un Comité de Ética. La muestra intencionada fue de 29 participantes: pacientes y familiares de pacientes con enfermedad avanzada, profesionales asistenciales de CP y expertos en bioética, profesores universitarios y estudiantes de Ciencias de la Salud. Los datos se recogieron en un Hospital de CP en Madrid, España. Los participantes valoran positivamente la anticipación compasiva de los profesionales que supone estudiar y reflexionar sobre las posibles complicaciones que pueden derivarse de la situación de enfermedad avanzada que padece el enfermo y dialogar con él acerca de las posibles actuaciones al respecto. El artículo concluye que la compasión es una virtud que implica adelantarse a las necesidades de los pacientes para que el enfermo pueda tomar decisiones compartidas acertadas. Es lo que se denomina anticipación compasiva. Son necesarios ulteriores estudios que profundicen en las características de la anticipación compasiva y cómo desarrollarla de forma óptima en los pacientes al final de la vida

End of life is frequently accompanied by suffering and hardships that can be alleviated in the Palliative Care (PC) units by applying compassionate advance care. It is the aim of this paper to describe the concept of "compassionate advance care" as a way of caring for the patient and his family at the end of life from the perspective of both professionals, teachers and students of the health sciences, and persons with advanced disease and their families. A qualitative methodology was used. Data were collected through in-depth interviews and focus groups, and analysed and coded using the theory of Grounded Theory. Approval of an Ethics Committee was obtained. The intentional sample consisted of 29 participants, who were patients and relatives of patients with advanced disease, PC professionals and experts in bioethics, university professors and Health Sciences students. Data were collected in a PC Hospital in Madrid, Spain. The participants positively valued the compassionate advance care provided by professionals: analysing and reflecting on possible complications that may arise from the advanced disease situation suffered by the patient and establishing a dialogue with him about possible actions in this regard. The paper concludes that compassion is a virtue that implies anticipating the needs of patients, thus allowing the patient to make the right shared decisions. This is what the term Compassionate Advance Care Planning entails. Further studies are needed to delve into the characteristics of compassionate Advance Care Planning and how to optimally implement it in patients at the end of life. 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

[Care for the Patient and his Family at the end of Life: Compassionate Advance Care Planning]. / Cuidados al Paciente y su Familia al Final de la Vida: La Anticipación Compasiva.

End of life is frequently accompanied by suffering and hardships that can be alleviated in the Palliative Care (PC) units by applying compassionate advance care. It is the aim of this paper to describe the concept of "compassionate advance care" as a way of caring for the patient and his family at the end of life from the perspective of both professionals, teachers and students of the health sciences, and persons with advanced disease and their families. A qualitative methodology was used. Data were collected through in-depth interviews and focus groups, and analysed and coded using the theory of Grounded Theory. Approval of an Ethics Committee was obtained. The intentional sample consisted of 29 participants, who were patients and relatives of patients with advanced disease, PC professionals and experts in bioethics, university professors and Health Sciences students. Data were collected in a PC Hospital in Madrid, Spain. The participants positively valued the compassionate advance care provided by professionals: analysing and reflecting on possible complications that may arise from the advanced disease situation suffered by the patient and establishing a dialogue with him about possible actions in this regard. The paper concludes that compassion is a virtue that implies anticipating the needs of patients, thus allowing the patient to make the right shared decisions. This is what the term Compassionate Advance Care Planning entails. Further studies are needed to delve into the characteristics of compassionate Advance Care Planning and how to optimally implement it in patients at the end of life. 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.

[Palliative care support teams and the commitment of primary care teams to terminally ill patients in their homes]. / Equipos de soporte de cuidados paliativos y dedicación de los equipos de atención primaria a pacientes en situación terminal en sus domicilios.

OBJECTIVE: To find out if the activity of palliative care support teams (PCST) does not negatively influences the performance of the primary care "care of terminally ill patients" service. PARTICIPANTS: Terminally ill patients cared for at home. DESIGN: Multicentre observational study. MAIN MEASUREMENTS: The observed variable is the increase in the number of registered patients in primary care, and the number of patients covered between the years 2002 and 2003 and the 4 intervention variables are: total visits, joint visits, assessments, and teaching sessions. RESULTS: The number of patients covered in 2002 was 41.19%, increasing to 45.44% in 2003. The activity rate of the PCST for each 100 000 inhabitants was 526 home visits in 2003, 86.15 joint visits, 313.68 professional assessments, and 23.14 teaching sessions. The joint visits and the teaching sessions were strongly associated with an improvement in the coverage of primary care (Pearson correlation of 0.784 and 0.759, respectively). The total visits were moderately associated (0.525) and the assessments were weakly associated (0.245). CONCLUSIONS: Joint visits and teaching sessions of a PCST are associated to an increase in the activity of primary care teams. Assessments and total visits did not have a negative influence.

Primer nivel asistencial en cuidados paliativos: evolución del contenido de la cartera de servicios de atención primaria y criterios de derivación al nivel de soporte / Primary palliative care: development of the contents of the primary care services portfolioand criteria for referral according to complexity

Los cuidados paliativos son un derecho de la persona, reconocido internacionalmente, que ha de prestarse en 3 niveles de atención: primario (básico), secundario (consulta de equipos especializados) y terciario (atención a pacientes muy complejos que precisan hospitalización). Es preciso definir las funciones que cada uno de estos 3 niveles debe desempeñar, la capacitación necesaria y los criterios de derivación de casos desde la atención primaria a los equipos de cuidados paliativos. Con el objetivo de concretar el contenido del servicio de cuidados paliativos en el primer nivel y determinar el dintel de complejidad que asegure la correcta derivación, se realizó un cuádruple abordaje: revisión sistemática de la bibliografía, revisión de un documento borrador de cartera de servicios, elaboración de un documento de propuesta y validación por un grupo nominal de profesionales de atención primaria. Se revisó más de 1.200 artículos y se elaboró y validó el documento propuesta, que contenía 12 prestaciones de la atención primaria y 4 criterios de derivación a los equipos específicos de cuidados paliativos, todo ello según los objetivos marcados inicialmente. Se concluyó que la atención primaria es responsable de los cuidados paliativos en el domicilio y debe garantizarlos cuando la complejidad no es elevada. Para ello, sus profesionales precisan una adecuada formación que permita el manejo de síntomas físicos y emocionales, basándose en una evaluación sistemática con escalas validadas, y una mejora en la coordinación, de forma que se derive a los pacientes en función de su complejidad y de la propia capacidad del profesional de atención primaria para resolverla. Finalmente, se detectó la necesidad de mejorar los sistemas de evaluación de resultados obtenidos por los servicios de salud en la atención a los pacientes en fase terminal (AU)

Palliative care is an internationally recognized right that should be provided in three levels of healthcare: primary (basic), secondary (specialized teams) and tertiary (care of highly complex patients requiring hospitalization). The functions that each of these three levels should perform, the required resources, and the criteria for referring patients from primary care to palliative care teams should be defined. To define the contents of primary palliative care provesion and the threshold of complexity required to ensure appropriate referral, a four-step approach was used: systematic review of the literature, review of a draft of the services portfolio, drafting of a proposal, and validation of the proposal by a nominal group composed of primary care health professionals. In accordance with the objectives initially established, more than 1,200 articles were reviewed and a proposal was drafted and validated. This proposal contained 12 primary care services and four criteria for referring patients to specific palliative care teams. It was concluded that primary care is responsible for palliative care in the home and should guarantee to provide this care in patients with low complexity. To do this, primary care staff require adequate training that would allow them to manage physical and emotional symptoms, based on systematic evaluation with validated scales. Primary care staff also require improved coordination, so that patients can be referred according to their degree of complexity and the ability of the primary care health professional to provide the necessary care. Finally, the need to improve systems for evaluating the results obtained by the health services in the care of terminally-ill patients was detected (AU)

Equipos de soporte de cuidados paliativos y dedicación de los equipos de atención primaria a pacientes en situación terminal en sus domicilios / Palliative care support teams and the commitment of primary care teams to terminally ill patients in their homes

Objetivo. Comprobar si la actividad de los equipos de soporte de cuidados paliativos (ECP) influye negativamente en el cumplimiento del servicio de «atención a pacientes terminales» en atención primaria. Participantes. Pacientes en situación terminal atendidos en el domicilio. Diseño. Estudio observacional, multicéntrico. Mediciones principales. La variable observada es el aumento en el número de pacientes registrados en atención primaria, y la cobertura de cartera entre los años 2002 y 2003 y las 4 variables de intervención son: visitas totales, visitas conjuntas, asesorías y sesiones docentes. Resultados. La cobertura de cartera en el año 2002 fue del 41,19%, aumentando al 45,44% en 2003. La tasa de actividad de los ECP por cada 100.000 habitantes en 2003 fue de 526 visitas a domicilio; 86,15 visitas conjuntas; 313,68 asesorías a profesionales y 23,14 sesiones docentes. Las visitas conjuntas y las sesiones docentes se asociaron fuertemente con una mejora de cartera de atención primaria (correlación de Pearson de 0,784 y 0,759, respectivamente). Las visitas totales tuvieron una asociación moderada (0,525) y las asesorías, una asociación débil (0,245). Conclusiones. Las visitas conjuntas y las sesiones docentes de un ECP se asocian con un aumento de la actividad de los equipos de atención primaria. Asesorías y visitas totales no influyen negativamente

Objective. To find out if the activity of palliative care support teams (PCST) does not negatively influences the performance of the primary care "care of terminally ill patients" service. Participants. Terminally ill patients cared for at home. Design. Multicentre observational study. Main measurements. The observed variable is the increase in the number of registered patients in primary care, and the number of patients covered between the years 2002 and 2003 and the 4 intervention variables are: total visits, joint visits, assessments, and teaching sessions. Results. The number of patients covered in 2002 was 41.19%, increasing to 45.44% in 2003. The activity rate of the PCST for each 100 000 inhabitants was 526 home visits in 2003, 86.15 joint visits, 313.68 professional assessments, and 23.14 teaching sessions. The joint visits and the teaching sessions were strongly associated with an improvement in the coverage of primary care (Pearson correlation of 0.784 and 0.759, respectively). The total visits were moderately associated (0.525) and the assessments were weakly associated (0.245). Conclusions. Joint visits and teaching sessions of a PCST are associated to an increase in the activity of primary care teams. Assessments and total visits did not have a negative influence