Description and Analysis of Research on Death and Dying during the COVID-19 Pandemic, Published in Nursing Journals Indexed in SCOPUS.

AIM: To offer an overall picture of the research published regarding the different aspects of death and dying during the COVID-19 pandemic in journals covering the field of nursing in the Scopus database. DESIGN: bibliometric analysis. METHODS: The metadata obtained were exported from Scopus for subsequent analysis through Bibliometrix. Using the VOSviewer co-word analysis function, the conceptual and thematic structure of the publications was identified. RESULTS: A total of 119 papers were retrieved, with the participation of 527 authors. The publications were found in 71 journals covering the nursing area. The main lines of research revolved around the keywords "palliative care" and "end-of-life care" in regard to the ethical, psychological, and organizational challenges faced by the health professionals who cared for these patients. CONCLUSION: The results obtained offer a range of data and images that characterize the scientific production published on this topic, coming to the conclusion that, due to the multifaceted and multidisciplinary approach to the experience of death, care, and accompaniment in the dying process, bibliometric maps improve the comprehensive understanding of the semantic and conceptual structure of this field of research. This study was retrospectively registered with the OSF Registries on the 14 March 2024.

'I am afraid the news is not good' - Breaking bad news in the time of COVID: Experiences from a field hospital.

BACKGROUND:  The COVID-19 Pandemic had profound effects on healthcare systems around the world. In South Africa, field hospitals, such as the Mitchell's Plain Field Hospital, managed many COVID patients and deaths, largely without family presence. Communicating with families, preparing them for death and breaking bad news was a challenge for all staff. AIM:  This study explores the experiences of healthcare professionals working in a COVID-19 field hospital, specifically around having to break the news of death remotely. SETTING:  A150-bed Mitchells Plain Field Hospital (MPFH) in Cape Town. METHODS:  A qualitative exploratory design was utilised using a semi-structured interview guide. RESULTS:  Four themes were identified: teamwork, breaking the news of death, communication and lessons learnt. The thread linking the themes was the importance of teamwork, the unpredictability of disease progression in breaking bad news and barriers to effective communication. Key lessons learnt included effective management and leadership. Many families had no access to digital technology and linguo-cultural barriers existed. CONCLUSION:  We found that in the Mitchell's Plain Field Hospital, communication challenges were exacerbated by the unpredictability of the illness and the impact of restrictions on families visiting in preparing them for bad news. We identified a need for training using different modalities, the importance of a multidisciplinary team approach and for palliative care guidelines to inform practice.Contribution: Breaking the news of death to the family is never easy for healthcare workers. This article unpacks some of the experiences in dealing with an extraordinary number of deaths by a newly formed team in the COVID era.

[Living Networks in Health during the covid-19 pandemic: Evaluation of the multiprofessional training course "Nós da Linha de Frente" in Manaus, Amazonas, Brazil]. / Redes vivas en salud en la pandemia de covid-19: evaluación del curso de formación multiprofesional "Nós da Linha de Frente" en Manaus, Amazonas, Brasil.

This article presents the evaluation of the therapeutic intervention course in situations of traumatic loss and grief, offered online by the Universidade do Estado do Amazonas, between April and August 2021, for volunteer professionals. A semi-structured questionnaire with open and closed questions was administered. The analysis of the 55 responses from volunteer professionals and 14 responses from individuals who received the intervention was based on the Kirkpatrick evaluation model. The results demonstrate the theoretical and practical success of the course, with a positive assessment at the reaction, learning, behavior, and results levels, emphasizing collective work and the motivation of the course speakers. The main acquired knowledge pertained to topics related to death and grief care. The behaviors resulting from the course fall within the affective-social and technical-professional domains. Regarding impact, there was a predominance of satisfaction among the individuals who received the intervention, as well as identification of changes brought about by the training.

Este artículo presenta la evaluación del curso de intervención terapéutica en situaciones de pérdida traumática y duelo, ofrecido en línea por la Universidade do Estado do Amazonas, entre abril y agosto de 2021, para profesionales voluntarios. Se aplicó un cuestionario semiestructurado con preguntas abiertas y cerradas. El análisis de las 55 respuestas de profesionales voluntarios y 14 respuestas de personas atendidas se basó en el modelo de evaluación Kirkpatrick. Los resultados muestran el acierto teórico y práctico del curso, con una evaluación positiva en los niveles de reacción, aprendizaje, comportamiento y resultados, en la que se destacó el trabajo colectivo y la motivación de los disertantes del curso. Los principales contenidos aprehendidos fueron temas relacionados con el cuidado de la muerte y el duelo. Las conductas derivadas del curso se encuadran en los campos afectivo-social y técnico-profesional. En cuanto al impacto, hubo un predominio de la satisfacción de las personas atendidas, así como identificación de cambios provocados por la formación.

Attitudes and experiences related to the deaths of COVID-19 patients among nursing staff: A qualitative evidence synthesis.

AIM: To identify and synthesize the experiences and attitudes of nursing staff regarding the deaths of COVID-19 patients. REVIEW METHODS: A qualitative evidence synthesis was carried out, using Noblit and Hare's meta-ethnographic approach. The review protocol was listed in PROSPERO (CRD42022330928). Studies published from January 2020 to January 2022 that met the criteria were searched in PubMed, Web of Science, Scopus, CINAHL, CUIDEN and PsycInfo. A total of 12 articles were included. RESULTS: Thirty-three metaphors emerged, which were grouped into three main themes: Determining factors of care, Feelings about death and Strategies for coping with death. Nurses reported the high emotional toll, the absence of family and the lack of staff, protocol and training as determining factors. Furthermore, staff had doubts about the quality of care that COVID-19 patients received. As coping strategies, nurses developed avoidance behaviours towards COVID-19 patients, selective memories, resilience, and/or leaving the profession. CONCLUSIONS: The difficulty in providing adequate nursing care and the high number of deaths has increased anxiety and stress among nurses. These factors, alongside their lived experiences of seeing patients suffering, many dying alone without family members, have had psychological repercussions on nursing staff. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: The results demonstrate a high emotional toll and doubts surrounding their caregiving role caused by the lack of professional training needed to face a pandemic. This research shows what has been learned for future pandemics and highlights basic components that could provide a foundation for coping interventions for healthcare professionals. IMPACT: WHAT PROBLEM DID THE STUDY ADDRESS?: The challenges posed by COVID-19 patient deaths for nursing staff around the world and also by the pandemic circumstances in which those deaths occurred. WHAT WERE THE MAIN FINDINGS?: The high number of deceased patients who were isolated from family members, communication with family members and doubts surrounding care given during the pandemic have created feelings of fear, stress and anxiety, as well as obsessive thoughts that have changed nursing staff's perception of death due to COVID-19. WHERE AND ON WHOM WILL THE RESEARCH HAVE AN IMPACT?: Results will be useful for preparing for future pandemics, and for policymakers and health staff in supporting healthcare professionals by creating programmes to help them cope with the emotional toll they have felt after dealing with death in such unprecedented circumstances. REPORTING METHOD: The authors have adhered to the PRISMA guidelines and the eMERGe Reporting Guidance. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Cultural adaptation and validation of the Quality of Dying in Long-term Care (QoD-LTC and QoD-LTC-C) scales by caregivers in nursing homes.

BACKGROUND: There is a lack of tools that can evaluate quality of dying in nursing homes from the perspective of deceased patients' caregivers. The aim of this study was to adapt and validate the caregivers' versions of the Quality of Dying in Long-Term Care (QoD-LTC) and Quality of Dying in Long-Term Care Complete (QoD-LTC-C) scales in the Spanish context. METHODS: This was a cultural adaptation and validation study. The scales were translated from English to Spanish and vice versa, and 13 experts in end-of-life care participated in a two-round Delphi panel. Caregivers of 69 deceased residents from seven nursing homes in southern Spain completed both scales. Reliability, feasibility, and concurrent validity with global quality of dying perception and symptom burden (Edmonton Symptom Assessment Scale), were evaluated. RESULTS: Spanish caregivers' version of the QoD-LTC scale showed good internal consistency for the total scale (α = 0.74) and each of its three factors, and good inter-rater reliability (ICC = 0.50) and test-retest reliability (ICC = 0.81). The Spanish QoD-LTC-C scale for caregivers showed good internal consistency for the total scale (α = 0.81) and for its component factors, and good test-retest reliability (ICC = 0.89) and inter-rater reliability (ICC = 0.66). Both scales correlated with family caregivers' global perception of deceased residents' quality of dying (r = 0.39; r = 0.32), but not with the ESAS score. CONCLUSIONS: Both scales presented an adequate factorial structure, internal consistency, and reliability to assess caregivers' perception of the quality of dying in Spanish nursing homes.

Factors That Influence Attitudes toward Advance Directives among Female Cancer Patients.

Purpose: This study aimed to identify attitudes toward advance directives (ADs) among female cancer patients and factors related to ADs. Methods: The study was conducted at a university hospital in Seoul from September 19, 2020, to January 20, 2021. The participants were 153 patients diagnosed with gynecological cancer or breast cancer. Data were collected using questionnaires and included general characteristics, disease- and AD-related characteristics, knowledge and attitudes about ADs, and attitudes about dignified death. Data were analyzed using the t-test, analysis of variance, and multiple regression analysis. Results: Only 2% of the participants completed ADs. The mean score for attitudes toward ADs was 3.30, indicating a positive knowledge and attitude toward dignified death. The factors related to attitudes toward ADs were attitudes toward dignified death (ß=0.25, P=0.001), experience discussing life-sustaining treatment (ß=0.17, P=0.037), preferred time to have a consultation about ADs (ß=0.19, P=0.046), intention to write ADs (ß= 0.15, P=0.038), and Eastern Cooperative Oncology Group Performance Status (ß=-0.37, P<0.001). The explanatory power of these variables for attitudes toward ADs was 38.5%. Conclusion: Overall, patients preferred to have a consultation about ADs when they were still active, mentally healthy, and able to make decisions. Education about ADs should be provided to patients on the first day of hospitalization for chemotherapy or while awaiting treatment in an outpatient setting so patients can write ADs and discuss them with family and friends.

Factors associated with death literacy among Swedish adults: A cross-sectional exploratory study.

OBJECTIVES: Death literacy is a recent conceptualization representing both individual and community competence, for example, a set of knowledge and skills for engaging in end-of-life-related situations. Little is yet known about which factors are associated with death literacy. A cross-sectional survey using the Swedish version of the Death Literacy Index, the DLI-S, was therefore conducted to explore associations between death literacy and sociodemographic, health, and experience variables. METHODS: A quota sample of 503 adults (mean age 49.95 ± 17.92), recruited from an online Swedish survey panel, completed a survey comprising the DLI-S and background questions. RESULTS: A hierarchical regression model with 3 blocks explained 40.5% of the variance in death literacy, F(22, 477) = 14.75. The sociodemographic factors age, gender, education, widowhood, and religious/spiritual belief accounted for 13.7% of the variance. Adding professional care factors contributed to an additional 15.8% of variance, with working in health care being significantly associated with death literacy. Including experiential factors explained another 11.0% of the variance, of which experiences of caring for and supporting dying and grieving people, both in a work, volunteer, or personal context, were positively associated with death literacy. SIGNIFICANCE OF RESULTS: This study contributes a tentative explanatory model of the influence of different factors on death literacy, outlining both direct and indirect associations. Our findings also support the hypothesized experiential basis for death literacy development in the Swedish context. The moderate degree of overall variance explained suggests there may be additional factors to consider to better understand the death literacy construct and how its development may be supported.

Anxiety and fear of death in Health Professionals in Hospital Emergency services in Aragón.

OBJECTIVES: To describe the levels of anxiety in the face of death in professionals from hospital emergency services in Aragon. To analyse its association with sociodemographic, perception and work-related variables. METHODOLOGY: Observational, descriptive and cross-sectional study. The population and context of the study were health professionals in the hospital emergency services of Aragon. A non-probabilistic sampling selection was applied (n = 230 participants). The "Collet-Lester-Fear-of-Death-Scale" instrument was introduced to measure anxiety about death. The data was collected with a self-applied telematic questionnaire. Descriptive and inferential statistics were performed to analyse the association between the study variables. RESULTS: Mean values obtained for anxiety in the face of death were 94.58 ±â€¯21.66 with a CI of 95%: (91.76-97.39) (range of scale: 28-140 points). A significant association was identified with the professional category variables (physicians, medical residents, nurses, and auxiliary nurses) (p: 0,006), gender (p: 0.001), level of training in emotional self-management (p: 0.03), self-perceived level of mental health (p: 0.07) and perception of lack of support from palliative care/mental health professionals (p: 0.006). This association was not obtained with the variables age (Sig: 0.558), total professional experience (p: 0.762) and in emergencies (p: 0.191). CONCLUSION: The levels of anxiety in the face of death in the emergency hospital services are lower than those presented in other hospital units. Variables such as professional category, degree of training in emotional self-management and self-perceived level of mental health are related to levels of anxiety in the face of death and their study requires further work.

Percepción de preparación de los internos y egresados de Medicina para enfrentar la muerte de un paciente

Historically, death has been socially accepted, but for the last decades it has been hidden in hospitals, transforming physicians into "death specialists". Thus, medical graduates should feel prepared to assume this responsibility accompanying the patient and their family through the process. With this in consideration, the present work explores students' and graduates' perceptions of preparation to face a patient's death (SPEM) in a Chilean Medical school and identifies SPEM-associated characteristics. An observational study was performed using a digital form sent by email to interns and 2018 and 2019 graduates of the Facultad de Medicina CAS-UDD, in which they were asked about their SPEM and possible SPEM-related variables. The results showed that 63% and 31% of interns and graduates reported feeling inadequately prepared or unprepared to address a patient's death, respectively. During the first two years of their profession, 71% of graduates faced a patient's death. There was a significant correlation between the SPEM and death-facing training. Considering these results and the previous evidence of the positive impact that classes and courses have on SPEM, it is suggested that an obligatory course should be added to improve SPEM in medical students.

Overrepresentation of In-Home, Natural Deaths Among Individuals Treated for Mental Illnesses in New York State.

OBJECTIVE: The authors compared rates of in-home, natural death among individuals receiving treatment for mental illnesses with those in the general population. METHODS: Two data sets were used to determine the prevalence of in-home, natural deaths in the general population and among those receiving treatment for mental illnesses in New York State, outside New York City, for the period 2016-2018. RESULTS: Overall, 37% of natural deaths among individuals receiving mental health treatment occurred in the home, compared with 26% in the general population. Earlier death was also apparent; for example, 26.4% of in-home deaths among those receiving mental health treatment were among those ages 45-54 years, compared with 5.5% in the general population. In-home, natural deaths were also higher among non-Hispanic Black and Hispanic subpopulations. CONCLUSIONS: These findings suggest a need for programmatic and policy advances to reduce disparities in general health care for those living with mental illnesses. Additional analyses are warranted.

Jovens diante da morte: experiências de sobreviventes de acidentes de trânsito e tentativas de homicídios / Young people facing death: experiences of survivors of traffic accidents and attempted homicides / Jóvenes frente a la muerte: experiencias de sobrevivientes de accidentes de tránsito y tentativas de homicidio

INTRODUÇÃO: Ainda hoje, a morte é um tema tabu, fortemente associado ao envelhecimento. Contudo, é preocupante o número de jovens que se envolvem em situações inesperadas, como os acidentes de trânsito e as tentativas de homicídio, levando-os a se depararem com sua finitude. OBJETIVO: compreender e analisar a experiência de jovens sobreviventes de acidentes de trânsito e tentativas de homicídios. MÉTODO: Foram realizadas entrevistas narrativas com oito jovens, com idade entre 19 e 29 anos, que residem no estado de Mato Grosso do Sul e que se sobreviveram a acidentes de trânsito ou tentativas de homicídio. As entrevistas foram orientadas por um roteiro semiestruturado e foram analisadas na perspectiva da Análise de Conteúdo. RESULTADOS: O discurso dos jovens entrevistados aponta para as implicações existenciais das mudanças impostas pelas intercorrências, sobretudo a partir dos impactos que elas causaram, alterando tanto suas rotinas como também a forma como pensavam e viviam. Além disso, essa experiência também trouxe implicações na percepção da imagem corporal, além de mudanças em outros âmbitos da vida dos entrevistados, como o trabalho, os estudos, bem como as relações familiares e de amizade, que também foram afetadas. CONCLUSÃO: Faz-se necessária uma maior compreensão dessas experiências, com o intuito de contribuir com elaboração de estratégias em saúde para ajudar esses jovens a lidarem com as consequências das ocorrências que, muitas vezes, são graves e permanentes.

INTRODUCTION: Even today, death is a taboo topic, strongly associated with aging. However, the number of young people who become involved in unexpected situations, such as traffic accidents and attempted murders, is worrying, leading them to face their finitude. OBJECTIVE: To understand and analyze the experience of young survivors of traffic accidents and attempted homicides. METHOD: Open interviews were carried out with eight young people, aged between 19 and 29 years old, who live in the state of Mato Grosso do Sul and who survived traffic accidents or attempted homicides. The interviews were guided by a semi-structured script and were analyzed from the perspective of Content Analysis. RESULTS: The speech of the young people interviewed points to the existential implications of the changes imposed by the intercurrences, especially from the impacts they caused, changing both their routines and the way they thought and lived. In addition, this experience also had implications for the perception of body image, in addition to changes in other areas of the interviewees' lives, such as work, studies, as well as family and friendship relationships that were also affected. CONCLUSION: A better understanding of these experiences is needed, in order to contribute to the development of health strategies that help these young people to deal with the consequences of events that are often serious and permanent.

INTRODUCCIÓN: Hoy en día, la muerte es un tema tabú, fuertemente asociado al envejecimiento. Sin embargo, es preocupante la cantidad de jóvenes que se ven involucrados en situaciones inesperadas, como accidentes de tránsito e intentos de homicidio, que los llevan a enfrentar su finitud. OBJETIVO: Comprender y analizar la experiencia de jóvenes sobrevivientes de accidentes de tránsito y tentativas de homicidio. MÉTODO: Se realizaron entrevistas abiertas con ocho jóvenes, con edades entre 19 y 29 años, que viven en el estado de Mato Grosso do Sul y que han sobrevivido a accidentes de tráfico o intentos de homicidio. Las entrevistas fueron guiadas por un guión semiestructurado y fueron analizadas desde la perspectiva del Análisis de Contenido. RESULTADOS: El discurso de los jóvenes entrevistados apunta a las implicaciones existenciales de los cambios impuestos por las intercurrencias, especialmente a partir de los impactos que provocaron, modificando tanto sus rutinas como su forma de pensar y vivir. Además, esta experiencia también tuvo implicaciones en la percepción de la imagen corporal, además de cambios en otras áreas de la vida de los entrevistados, como el trabajo, los estudios, así como las relaciones familiares y de amistad que también se vieron afectadas. CONCLUSION: Se necesita una mejor comprensión de estas experiencias, para contribuir al desarrollo de estrategias de salud que ayuden a estos jóvenes a enfrentar las consecuencias de eventos que muchas veces son graves y permanentes.

Natural Death Versus Known Date-Of-Death: A Qualitative Study of Views on Voluntary Assisted Dying in an Online Course About Death.

The study aimed to describe views on Voluntary Assisted Dying (VAD), gleaned through qualitative analysis of participant responses to a set activity, run during the 2018 'Dying2Learn' Massive Open Online Course (MOOC). Data from 508 participants, most of whom identified as health professionals, were analysed using thematic content analysis, and themes generated. A large proportion of participants discussed their personal views related to VAD, specifically around choice, control, dignity, palliative care and dying at home, medical intervention, societal factors, the impact on those left behind, laws and regulations, dying 'naturally', advance care directives, and being in pain. In this study, participants had many different views on the act itself, often divisive, but also with common concepts such as respecting the choices and decisions of others.

The Effect of Attitude to Death on Self-Management in Patients With Type 2 Diabetes Mellitus During the COVID-19 Pandemic.

This study was conducted to examine the effect of attitude to death on self-management in patients with Type 2 Diabetes Mellitus during the COVID-19 pandemic. This study was carried out in a descriptive and correlational type with the participation of n = 103 type 2 diabetes mellitus patients registered in the Internal Medicine Unit at a University Hospital. Personal Information Form, Death Attitude Profile-Revised (DAP-R), Diabetes Self-Management Questionnaire and Fear of COVID-19 Scale were used in data collection. According to the results of the study, it was determined that diabetes patients' fear of COVID-19 increased their fear of death and self-management. Similarly, neuropathy and nephropathy developed in these patients. In addition, it was determined that the diabetic patients who worked 6-7 days a week outside the home had higher levels of fear. It was found that those with high fear were more attentive to social distancing, wearing masks and hand sanitizer use. Staying at home is also not always possible for patients with chronic diseases, and people struggle with COVID-19 by working in crowded workspaces. It is necessary to recognize the struggle of patients with chronic diseases and provide social, economic and psychological support.

[Care complexity and place of death in palliative home care]. / Complejidad asistencial y lugar de muerte en atención domiciliaria paliativa.

OBJECTIVE: To examine the associations between the dimensions of the HexCom care complexity model and the place of death. METHOD: Multicenter longitudinal observational study in patients with advanced illness cared for by home care support teams in Catalonia. Age, gender, type of illness, main caregiver, external support, place of death and the sub-areas of care complexity provided by HexCom were registered. A multivariate Cox regression analysis was performed. RESULTS: Participation of 1527 patients (72% oncology), cared for a median of 35 days. 45% died at home. The probability of dying at home was greater when a greater functional impairment was detected in the initial assessment (hazard ratio [HR]: 7.67; 95% confidence interval [95%CI]: 4.93-11.92), when the patient was male (HR: 1.19; 95%CI: 1.02-1.39), was over 80 years old (HR: 1.41; 95%CI: 1.20-1.66) and when care complexity was detected in relation to being in a situation of last days (HR: 2.24; 95%CI: 1.69-2.97). It was more likely not to die at home in the case of cancer (HR: 0.76; 95%CI: 0.64-0.89), or if poor external support to the family group was detected in the first evaluation (HR: 0.79; 95%CI: 0.67-0.93), or that the patient did not feel at peace with others (HR: 0.56; 95%CI: 0.40-0.79), or lack of agreement on the planning of the place of death (HR: 0.57; 95%CI: 0.48-0.68). CONCLUSIONS: The assessment of the complexity of care through the HexCom-Clin model can help to improve advance planning of decisions by incorporating among its dimensions the feeling of peace with others, the external support to the family nucleus and the degree of agreement on the place of death.

Complejidad asistencial y lugar de muerte en atención domiciliaria paliativa / Care complexity and place of death in palliative home care

Objetivo: Examinar las asociaciones entre las dimensiones del modelo de complejidad asistencial HexCom y la ubicación de la muerte. Método: Estudio observacional longitudinal multicéntrico en pacientes con enfermedad avanzada tratados por los equipos de soporte a la atención domiciliaria en Cataluña. Se recogieron edad, sexo, estado funcional y cognitivo, tipo de enfermedad, cuidador/a principal, trabajador/a familiar, lugar de la muerte y complejidad tras la primera visita. Se realizó un análisis de regresión de Cox multivariante. Resultados: Participación de 1527 pacientes (72% oncológicos), atendidos una mediana de 35 días. El 45% fallecieron en su domicilio. La probabilidad de morir en casa era mayor cuando se detectaba un mayor deterioro funcional (hazard ratio [HR]: 7,67; intervalo de confianza del 95% [IC95%]: 4,93-11,92), cuando el sujeto era varón (HR: 1,19; IC95%: 1,02-1,39), cuando la edad era >80 años (HR: 1,41; IC95%: 1,20-1,66) y cuando se detectaba complejidad en relación a la situación de últimos días (HR: 2,24; IC95%: 1,69-2,97). Era más probable no morir en casa si se padecía cáncer (HR: 0,76; IC95%: 0,64-0,89), si se detectaba un pobre apoyo externo al grupo familiar (HR: 0,79; IC95%: 0,67-0,93), si el/la paciente no se sentía en paz con los demás (HR: 0,54; IC95%: 0,39-0,75) o si había falta de acuerdo en la planificación del lugar de la muerte (HR: 0,57; IC95%: 0,48-0,68). Conclusiones: La valoración de la complejidad asistencial a través del modelo HexCom-Clin puede contribuir a una mejor planificación anticipada de decisiones al incorporar entre sus dimensiones el sentirse en paz con los demás, el soporte externo al núcleo familiar y el grado de acuerdo sobre el lugar de muerte. (AU)

Objective: To examine the associations between the dimensions of the HexCom care complexity model and the place of death. Method: Multicenter longitudinal observational study in patients with advanced illness cared for by home care support teams in Catalonia. Age, gender, type of illness, main caregiver, external support, place of death and the sub-areas of care complexity provided by HexCom were registered. A multivariate Cox regression analysis was performed. Results: Participation of 1527 patients (72% oncology), cared for a median of 35 days. 45% died at home. The probability of dying at home was greater when a greater functional impairment was detected in the initial assessment (hazard ratio [HR]: 7.67; 95% confidence interval [95%CI]: 4.93-11.92), when the patient was male (HR: 1.19; 95%CI: 1.02-1.39), was over 80 years old (HR: 1.41; 95%CI: 1.20-1.66) and when care complexity was detected in relation to being in a situation of last days (HR: 2.24; 95%CI: 1.69-2.97). It was more likely not to die at home in the case of cancer (HR: 0.76; 95%CI: 0.64-0.89), or if poor external support to the family group was detected in the first evaluation (HR: 0.79; 95%CI: 0.67-0.93), or that the patient did not feel at peace with others (HR: 0.56; 95%CI: 0.40-0.79), or lack of agreement on the planning of the place of death (HR: 0.57; 95%CI: 0.48-0.68). Conclusions: The assessment of the complexity of care through the HexCom-Clin model can help to improve advance planning of decisions by incorporating among its dimensions the feeling of peace with others, the external support to the family nucleus and the degree of agreement on the place of death. (AU)

Formação para enfrentar a morte na perspectiva de futuros médicos / Training to cope with death from the perspective of future physicians / Formación para afrontar la muerte en la perspectiva de los futuros médicos

Resumo Ocasionalmente, a morte é considerada falha ou insucesso da medicina e a inabilidade em enfrentá-la pode gerar medo e frustração, interferindo nas decisões clínicas. Este estudo avaliou a percepção de estudantes de medicina quanto ao enfrentamento da morte, analisando seu preparo para lidar com essas situações e comparando seus perfis sociodemográfico, religioso e acadêmico. Realizou-se estudo transversal, quantitativo e qualitativo, com 294 estudantes de medicina da Bahia. Demonstrou-se que o estudante de medicina considera a morte um processo natural, mas não se sente totalmente preparado para lidar com a terminalidade da vida durante a prática clínica, possivelmente em razão das escassas discussões acadêmicas e da oferta insuficiente de conteúdo teórico-prático durante a formação. Homens com formação prévia e que tiveram contato pessoal e acadêmico com a morte foram associados à maior percepção de preparo para lidar com a terminalidade da vida, sem interferência de ciclo acadêmico e religião.

Abstract Occasionally, death is considered a medical failure and the inability to cope with it can generate fear and frustration, interfering with clinical decisions. This study assessed how medical students perceived coping with death, analyzing their preparedness to tackle these situations and comparing their sociodemographic, religious and academic profiles. This cross-sectional, quantitative and qualitative study was conducted with 294 medical students from Bahia. Results showed that medical students consider death to be a natural process, but do not feel fully prepared to address end of life during clinical practice, possibly due to the scarcity of academic discussions and the insufficient theoretical and practical content during training. Men with previous training and who had personal and academic contact with death were associated with a greater perceived preparedness to cope with death, without interference from academic level and religion.

Resumen En ocasiones, se percibe la muerte como un fracaso de la medicina, y la incapacidad de afrontarla puede generar miedo y frustración, interfiriendo en las decisiones clínicas. Este estudio evaluó la percepción de los estudiantes de medicina sobre el enfrentamiento a la muerte, analizando su preparación para lidiar con esta situación y comparando sus perfiles sociodemográficos, religiosos y académicos. En este estudio transversal, cuantitativo y cualitativo participaron 294 estudiantes de medicina de Bahía (Brasil). Los estudiantes de medicina perciben la muerte como algo natural, pero no se sienten totalmente preparados para afrontar el final de la vida durante la práctica clínica, posiblemente debido a escasas discusiones académicas y a insuficientes contenidos en la formación teórico-práctica. Los hombres con formación previa y que tuvieron contacto personal y académico con la muerte tuvieron una mayor percepción de preparación para afrontar el final de la vida, sin interferencia académica y de la religión.

Limitação terapêutica para crianças: revisão sistemática sobre final de vida / Therapeutic limitation for children: a systematic review on end-of-life / Limitación terapéutica para niños: una revisión sistemática sobre el final de la vida

Resumo Esta revisão sistemática visa identificar dificuldades enfrentadas por profissionais no manejo clínico de crianças em final de vida. Para tanto, realizou-se busca de artigos científicos nas bases de dados SciELO e LILACS por meio dos descritores "limitação de suporte terapêutico", "terminalidade" e "medidas de conforto", combinados com o descritor "crianças". Do total de 102 trabalhos completos encontrados, nove contemplaram os critérios de inclusão para a amostra do estudo. Os resultados apontam dificuldades em relação à tomada de decisões e à limitação terapêutica de pacientes infantis. Conclui-se que, quando se sentem melhor preparados para trabalhar com questões referentes ao processo de morte e morrer, os profissionais podem prestar um cuidado mais humanizado a pacientes e familiares.

Abstract This systematic review sought to identify difficulties faced by professionals in the clinical management of end-of-life child patients. Bibliographic search was conducted on the SciELO and LILACS databases using the descriptors "therapeutic limitation," "hospice care" and "comfort measures," combined with the descriptor "child." Of the 102 complete studies identified, nine met the established inclusion criteria. The results point to difficulties regarding decision making and therapeutic limitation for infant patients. In conclusion, when professionals feel better prepared to address issues related to the process of death and dying, they can provide more humanized care to patients and families.

Resumen Esta revisión sistemática tiene por objetivo identificar las dificultades que enfrentan los profesionales en el manejo clínico de los niños al final de la vida. Para ello, se realizó una búsqueda de artículos científicos en las bases de datos SciELO y LILACS utilizando las palabras clave "limitación del apoyo terapéutico", "final de la vida" y "medidas de confort", combinadas con "niños". Del total de 102 artículos completos encontrados, nueve cumplieron con los criterios de inclusión para la muestra del estudio. Los resultados apuntan a dificultades con relación a la toma de decisiones y a limitaciones terapéuticas de los pacientes pediátricos. Se concluye que los profesionales cuando se sienten más preparados para lidiar con cuestiones relacionadas con el proceso de muerte y morir pueden brindar una asistencia más humanizada a los pacientes y familias.

Aspectos existenciais e bioéticos nos cuidados paliativos oncológicos / Existential and bioethical aspects of palliative care in cancer / Aspectos existenciales y bioéticos en cuidados paliativos oncológicos

Resumo O adoecimento grave lança o sujeito à facticidade da morte, que faz parte da experiência do viver. Realizaram-se 12 entrevistas com adultos em cuidados paliativos oncológicos, as quais foram analisadas sob a perspectiva fenomenológica, com descrição dos eixos de significado produzidos nas narrativas. Verificaram-se três dimensões do modo como as pessoas (re)organizam seus projetos de ser a partir do adoecimento e da finitude: espiritualidade/religiosidade; ser em família; relação com a morte. O significado atribuído às trajetórias existenciais e à relação estabelecida com projeto de ser são fundamentais para o paciente aderir ao tratamento e enfrentamento da morte. Além disso, ressignificar vida, doença e morte oferece alívio ao sofrimento e auxilia o paciente a dar sentido ao tempo que ainda lhe resta. Tais questões são importantes para refletir sobre a dimensão bioética nos cuidados paliativos e auxiliam no planejamento desta modalidade de atenção.

Abstract Severe illness places individuals in direct confrontation with death, an element of the experience of living. A total of 12 interviews were conducted with adults undergoing palliative care in cancer, and investigated by phenomenological analysis, describing the axes of meaning produced in the narratives. Analysis of the ways individuals (re)organize their life projects based on illness and finitude identified three dimensions: spirituality/religiosity; life in the family; relationship with death. The meaning patients attribute to existential trajectories and the relationship established with their life project are essential for treatment adherence and coping with death. Resignifying life, illness and death can relieve suffering and help patients give meaning to the time left. Such questions help us reflect on the bioethical dimension of palliative care and enable planning in this modality of care.

Resumen La enfermedad grave lleva al sujeto a la factibilidad de la muerte, una experiencia del vivir. Se realizaron 12 entrevistas con adultos en cuidados paliativos oncológicos; y para el análisis se aplicó la perspectiva fenomenológica, con una descripción de los ejes de sentido producidos en los relatos. Se encontraron tres dimensiones de cómo las personas (re)organizan sus proyectos de ser a partir de la enfermedad y la finitud: Espiritualidad/religiosidad; ser en familia; relación con la muerte. El sentido de las trayectorias existenciales y la relación con el proyecto de ser son fundamentales para la adherencia al tratamiento y el enfrentamiento de la muerte. Resignificar la vida, la enfermedad y la muerte alivia el sufrimiento del paciente y le ayuda a dar sentido al tiempo que aún le queda. Estos interrogantes permiten reflexionar sobre la dimensión bioética en los cuidados paliativos y auxilian en la planificación de ese tipo de asistencia.