Bad news for the patient and the family? The worst part of being a health care professional.

In Spain, there is a general tendency to conceal the prognosis from a terminally ill patient. We conducted grounded-theory-based, phenomenological, qualitative research on this using a final sample of 42 in-depth interviews with doctors and nurses from different fields. We found that most health professionals believe that although patients don't ask questions, they know what is happening to them. Many professionals feel bad when communicating bad news. In hospitals, doctors take responsibility for doing so. The attitudes of professionals are influenced by their sense of responsibility and commitment to the principle of patient autonomy, as well as to the level of their agreement with the cultural context. The tacit agreement of silence makes communication impossible: the patient does not ask questions, the health professional does not want to be interrogated, and family members don't talk about the disease and want health professionals to follow their example. This situation is detrimental to patients and their families and leads to suffering, low levels of satisfaction, and feelings of guilt and helplessness. Health care professionals must acquire the means and the skills for communicating bad news.

Efectos de un programa de formacion en cuidados paliativos sobre el afrontamiento de la muerte / The effects of a training program on coping with death in palliative care

Objetivos: Evaluar el efecto de un programa de formación en cuidados paliativos dirigido a estudiantes de ciencias de la salud, usando la escala de Bugen de afrontamiento de la muerte. Método: Estudio cuasi-experimental. Se desarrolló un programa de formación dirigido a futuros profesionales de la salud (enfermería, medicina, psicología, terapia ocupacional y fisioterapia)que participaron voluntariamente y cuyo único criterio de selección es que no hubiesen tenido formación previa en cuidados paliativos. La duración del curso fue de 45 horas, distribuidas en15 semanas, desde octubre de 2008 a febrero de 2009. Iniciaron el programa 90 participantes, de los cuales tres abandonaron la formación, finalizando 87. Al inicio y al final del mismo se administró la «escala de Bugen de afrontamiento de la muerte» a los 87 participantes para determinar su grado de afrontamiento de la muerte en cada uno de los momentos. Resultados: De los 87 participantes un 74% son mujeres y el resto hombres. La edad media es de 21,35 años. La mayoría de los participantes son de enfermería (64%), seguidos de terapia ocupacional (23,6%), psicología (5,6%), por último medicina y fisioterapia (2,2%). Se encontraron diferencias significativas respecto al afrontamiento de la muerte tras el programa formativo(p = 0,000). Antes del mismo la media era de 121,46 ± 19,7 y tras el curso la media fue de (..) (AU)

Objective: To evaluate a training program in palliative care for Health Science students using Bugen’s Coping with Death Scale. Method: Quasi-experimental research. A training program was designed for future health professionals (nursing, medicine, psychology, occupational therapy and physiotherapy). Students’ participation was voluntary. The sole selection criterion was not having previous training in palliative care. The course duration was 45 hours over 15 weeks from October 2008 to February2009. A total of 90 participants started the program, and 87 completed it (three stopped attending). Bugen’s Coping with Death Scale was filled in by all participants both at the beginning and at the end of the program in order to establish their coping skills before and after the program. Results: Of the 87 participants, 74% were female, with the rest being male. The mean age was21.35 years. Most participants were nurses (64%), followed by occupational therapy (23.6%),psychology (5.6%), and finally medicine and physiotherapy (2.2%). A clear difference could be observed in coping skills before and after the program (p=.000). Before the training program the average score was 121.46 ± 19.7, while after the course it was 158.16 ± 20.6. The Scale’s minimum score is 30, the maximum being 210. Values below 105 (percentile 50) indicate inadequate (..) (AU)

Enfermería, familia y paciente terminal / Nurses, the family and a terminal patient

Se presentan datos referidos a un estudio realizado con una muestra de 350 profesionales de enfermería de la red hospitalaria de Granada, subdivididos en dos grupos: grupo de riesgo (GR) y grupo de no riesgo (NR). Se analizan los resultados obtenidos relativos a la presencia de estrés en situaciones de agonía y muerte, y el lugar de la familia como objeto de intervención profesional en ambos grupos (AU)