Stability over time in the preferences of older persons for life-sustaining treatment.

OBJECTIVE: To measure the stability of life-sustaining treatment preferences amongst older people and analyse the factors that influence stability. DESIGN: Longitudinal cohort study. SETTING: Primary care centres, Granada (Spain). Eighty-five persons age 65 years or older. Participants filled out a questionnaire with six contexts of illness (LSPQ-e). They had to decide whether or not to receive treatment. Participants completed the questionnaire at baseline and 18 months later. RESULTS: 86 percent of the patients did not change preferences. Sex, age, marital status, hospitalisation, and self-perception of health and pain did not affect preferences. Morbidity and the death of a relative did. CONCLUSION: Stability of preferences of older persons in relation to end-of-life decisions seems to be more probable than instability. Some factors, such as the death of a relative or the increase in morbidity, can change preferences. These findings have implications for advance directives (ADs) and advance care planning.

Advance directives and proxies' predictions about patients' treatment preferences.

The accuracy of proxies when they interpret advance directives or apply substituted decision-making criteria has been called into question. It therefore became important to know if the Andalusian Advance Directive Form (AADF) can help to increase the accuracy of proxies' predictions. The aim of this research was to compare the effect of the AADF on the accuracy of proxies' predictions about patients' preferences with that gained from informative and deliberative sessions about end-of-life decision making. A total of 171 pairs of patients and their proxies were randomized to three groups. The control group's answers to the Life Sustaining Preferences Questionnaire (LSPQ) were compared with their proxies' answers to the same questionnaire. In one intervention group, the patients had already completed the AADF and given it to their proxies, who used it to guide their own answers to the LSPQ. In the second intervention (discussion) group, both patients and proxies attended two educative sessions guided by trained nurses and later filled in the LSPQ. Comparisons of accuracy and other variables showed a strong association with the discussion group. The findings show that promoting communication between patients and their proxies improves the accuracy of proxies' predictions much more than isolated use of the AADF form.

Opinión de los pacientes sobre la legibilidad de los folletos de Educación para la Salud / Opinion of the patients about legible health education leaflets

Antecedentes: los Servicios de salud normalmente proporcionan a los pacientes folletos u otros documentos relacionados con tratamientos. Este material no está escrito con mucha legibilidad y los pacientes tienen dificultad en entenderlos. Objetivos: determinar la opinión de los lectores en relación a los requisitos que deberían ser encontrados en este material para asegurar la legibilidad. Metodología: metodología cualitativa de entrevistas semiestructuradas. 24 participantes fueron entrevistados con preguntas abiertas. Los participantes tenían un bajo nivel académico. Resultados: ocho categorías fueron identificadas en los folletos que debían encontrarse para aumentar la legibilidad: escribir como se habla, interés por el tema, estilo directo, ordenar las ideas, mensajes afirmativos, imágenes, amplios márgenes, letra grande y clara. Conclusiones: los profesionales sanitarios y los escritores de folletos educativos deberían involucrar a los pacientes en el proceso de diseño del material educativo (AU)

Introduction: Healthcare Service usually provides patients with leaflets relating to treatment. Often, this material is written not very legible and patients have difficulty understanding it. Aims: This study aims to determine the opinion of readers in relation to the requisites that should be met by this material in order to ensure legibility. Design: Qualitative method of semi-structured interviews. Method: Twelve interviews were conducted. Open-ended questions were asked in each interview. Participants had a low academic level, poor reading habits, but they usually were capable of read. Finding: Eight categories were identified that describe the opinion of the participants in relation to the requisites that the leaflets must meet in order to improve legibility: Writing like speaking, interest in the subject, direct style, order of the ideas, affirmative messages, images and clear fonts. Conclusions: Health professionals and writers of educational leaflets should involve patients in the process of designing educational material (AU)

Revisión de la literatura sobre el uso del testamento vital por la población mayor / Review of literature about the use of living bill by elderly population

El Testamento Vital (TV) recoge las preferencias detratamiento de una persona para cuando sea incapazde tomar decisiones por sí misma. Nuestro país estádando los primeros pasos para su implantación. Paraque el TV sea accesible y útil para las personas mayores,conviene conocer cómo se ha desarrollado en otrospaíses. En EE.UU., el TV ha pasado de una concepciónformal y burocrática a otra integral, denominadade Planificación Anticipada de Decisiones Sanitarias.La población mayor española tiene una opinión favorablesobre el TV si se incluye en una estrategia de comunicacióncon la familia y los profesionales. Teneren cuenta los hallazgos de la literatura facilitará eldesarrollo de un modelo organizativo efectivo que normaliceen España el uso del testamento vital por partede los mayores(AU)

The Living Will (LW) gathers the treatment preferencesof a person. Spain is starting the LW’ implantation.In order to the TV will be accessible and usefulfor the older people, we have to know how it has beendeveloped in other countries. In United States, TV hashappened through different stages: from a formal andbureaucratic conception to an integral concept, denominatedAdvance Care Planning. Spanish oldadults have a favourable opinion about TV, but it isnecessary to include it in a strategy of communicationand dialogue with its family and its professionals caregivers.Review literature findings will facilitate the developmentof an effective organizational model thatstandardizes in Spain the use of the TV by the oldadults(AU)

Exploración del fenómeno de la planificación anticipada de decisiones al final de la vida. Visión de los profesionales que cuidan a personas mayores / Exploration of the phenomenon of advanced care decisions. The perspective of professionals caring for the elderly

Objetivo. Explorar las perspectivas de los profesionales que atienden a personas mayores en el ámbito sanitario y social en cuanto a la toma de decisiones sanitarias al final de la vida. Método. Estudio cualitativo mediante la realización de 4 grupos focales (un grupo de profesionales no sanitarios y 3 grupos del ámbito de atención especializada y primaria), buscando heterogeneidad grupal, homogeneidad intragrupal y saturación estructural. Para el análisis de los datos se procedió a su reducción, disposición-presentación y obtención de conclusiones, produciéndose en todos los pasos una contraverificación entre investigadores. En los textos se identificaron las unidades de significado, se construyeron las metacategorías y se identificaron temas principales e integraron en "constructos teóricos". Resultados. Los participantes opinan que la toma de decisiones al final de la vida se hace compleja debido a: la concepción de la muerte como tabú que imposibilita un diálogo abierto; los factores que influyen en los diferentes actores; el escaso conocimiento del derecho legislado de la autonomía; la existencia del fuerte paternalismo de profesionales sociosanitarios y familiares sobre el anciano; la escasa preparación de los profesionales en el proceso de final de la vida, y la falta de políticas institucionales que den lugar y cabida a estos cuidados emergentes. Conclusiones. Los resultados obtenidos nos aproximan al escenario actual de la toma de decisiones al final de la vida y nos obligan a desarrollar estrategias para planificar anticipadamente dichas decisiones desde una perspectiva sociosanitaria, a fin de conseguir que las instrucciones previas no sólo se centren en la implementación de un simple documento legal

Objective. To explore the perspectives of health professionals and other professionals working with the elderly on decision making at the end of life. Method. A qualitative study was performed through 4 focal groups: one group of non-health professionals, and 3 groups of health professionals in primary and specialized care. Heterogeneity among groups, intragroup homogeneity and structural saturation were sought. Data analysis consisted of data reduction, data presentation and conclusions drawn from the data, with counter-verification among researchers at each step. Units of meaning were identified in the texts and meta-categories were constructed. The principal issues were identified and integrated in theoretical constructs. Results. The participants believed that decision making at the end of life becomes difficult due to the conception of death as a taboo, which hampers open dialogue, the items influencing the different agents, the lack of knowledge of legislation on autonomy, the existence of strongly paternalistic attitudes among medical and allied professionals and relatives to the elderly, insufficient training on end of life issues among professionals, and the lack of institutional policies that promote this emerging area of healthcare. Conclusions. The results obtained provide an approximation to the current scenario on decision making at the end of life. It is essential to develop strategies for the advance planning of such decisions from a social and health perspective and for living wills to reflect more than just the implementation of a legal document