María Arantzamendi

Does palliative care education matter to medical students? The experience of attending an undergraduate course in palliative care

Background Palliative care (PC) education has become a priority in many European countries where PC is quickly developing. There remains, however, a lack of information on acceptability and medical students’ experiences in PC education. This kind of information is important because it could encourage universities to adapt their curricula appropriately to the demographic and societal necessity. Objective To explore medical students’ reactions to an optional PC course using their reflective written comments. Methods 316 medical students at the University of Navarra, over a period of 4 years, wrote evaluative comments regarding their experience and what they perceived as the courses contribution to their education. With these comments, a qualitative thematic analysis was carried out. Results With a response ratio of 90%, five main themes were identified: (1) The course helped medical students to become and act as doctors, (2) The benefits of having a holistic view of the patient and taking the family into account, (3) PC opens up a new a field of knowledge, (4) The course makes students think and reflect on their personal development and encourages them to deepen humanistic aspects of their practice, (5) The practical aspect is essential in PC learning. In addition, significantly, students used vigorous and positive expressions when writing about their experiences. Discussion The subject of PC turns out to be very important to students, who almost unanimously evaluated their experience positively and highlighted the benefits of attending a PC course. Students especially reported being surprised by the humane and holistic features of the course, and they found that what they learned in the course is applicable to all patients and prepares them to work better as doctors. Participants recommend the course for all undergraduate students as a core component of the curricula.

‘Dignity therapy’, a promising intervention in palliative care: A comprehensive systematic literature review

Background: Dignity therapy is psychotherapy to relieve psychological and existential distress in patients at the end of life. Little is known about its effect. Aim: To analyse the outcomes of dignity therapy in patients with advanced life-threatening diseases. Design: Systematic review was conducted. Three authors extracted data of the articles and evaluated quality using Critical Appraisal Skills Programme. Data were synthesized, considering study objectives. Data sources: PubMed, CINAHL, Cochrane Library and PsycINFO. The years searched were 2002 (year of dignity therapy development) to January 2016. ‘Dignity therapy’ was used as search term. Studies with patients with advanced life-threatening diseases were included. Results: Of 121 studies, 28 were included. Quality of studies is high. Results were grouped into effectiveness, satisfaction, suitability and feasibility, and adaptability to different diseases and cultures. Two of five randomized control trials applied dignity therapy to patients with high levels of baseline psychological distress. One showed statistically significant decrease on patients’ anxiety and depression scores over time. The other showed statistical decrease on anxiety scores pre–post dignity therapy, not on depression. Nonrandomized studies suggested statistically significant improvements in existential and psychosocial measurements. Patients, relatives and professionals perceived it improved end-of-life experience. Conclusion: Evidence suggests that dignity therapy is beneficial. One randomized controlled trial with patients with high levels of psychological distress shows DT efficacy in anxiety and depression scores. Other design studies report beneficial outcomes in terms of end-of-life experience. Further research should understand how dignity therapy functions to establish a means for measuring its impact and assessing whether high level of distress patients can benefit most from this therapy.

Spanish Version of the Patient Dignity Inventory: Translation and Validation in Patients With Advanced Cancer

CONTEXT The Patient Dignity Inventory (PDI) is an instrument to measure sources of distress related to dignity at the end of life. OBJECTIVES To obtain a Spanish version of the PDI and measure psychometric aspects in patients with advanced cancer. METHODS A back-translation method was used to obtain the Spanish version. Inpatients and outpatients with advanced cancer were included. Patients completed the Spanish versions of the PDI (PDI-s), Edmonton Symptom Assessment System (ESAS), Hospital Anxiety and Depression Scale (HADS), and Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being (FACIT-Sp-12) instruments. The psychometric properties evaluated were internal consistency; concurrent validity between PDI-s/ESAS, PDI-s/HADS, and PDI-s/FACIT-Sp-12; discriminant validity, test-retest reliability, and factor analysis. The usefulness of the instrument also was tested. RESULTS A Spanish version of the PDI was obtained. One hundred twenty-four patients completed the study. Cronbachs alpha coefficient for the PDI-s was 0.89. The PDI-s significantly correlated with the ESAS (rs = 0.669; P < 0.001), HADS (rs = 0.788; P < 0.001), and FACIT-Sp-12 (rs = -0.442; P = 0.008). The instrument distinguished outpatients from inpatients and between patients with differing Karnofsky Performance Status scores (rs = -0.328; P < 0.001). The test-retest method indicated excellent reproducibility (intraclass correlation coefficient = 0.931). Factor analysis showed three factors accounting for 79.4% of the variance. Factors were labeled psychological and existential distress, physical symptoms and dependency, and social support. Patients had no difficulties in understanding or completing the questionnaire (mean time to complete: 7.2 minutes). CONCLUSION The Spanish version of the PDI showed adequate psychometric properties when tested with advanced cancer patients. This research provides a three-factor alternative in Spanish to the PDI.

Promoting patient-centred palliative care: a scoping review of the patient dignity question.

Purpose of reviewIn recent years, there has been a growing interest in promoting dignity in care, and specific interventions have been developed to include it at the end of life. The patient dignity question (PDQ) is a recent, novel and simple intervention that healthcare professionals can implement; however, little information is known about its impact. This scoping review aims to examine and map out the PDQ literature. Recent findingsStudies suggest that patients, families and professionals have a positive view of the PDQ in that it helps to get to know patients and provide them with the best care possible. The PDQ seems to promote an environment of care focused on the person and the prevalence of more human aspects in clinical encounters between professionals and patients. This is especially so in situations in which human aspects of the healthcare relationship at baseline received lower marks. Healthcare professionals thought that performing the PDQ to determine what is important to the patient is a feasible and effective exercise. SummaryThe published literature suggests that PDQ is a beneficial intervention for approaching and getting to know a patient as a person. More studies are needed that measure pre–post-PDQ changes and that demonstrate their impact on patient care.

Essential elements of the relationship between the nurse and the person with advanced and terminal cancer: A meta-ethnography

OBJECTIVE The purpose of this study was to understand how the nurse-patient relationship is interpreted by nurses and patients with advanced and terminal cancer (ATC) and which aspects of this relationship are perceived to be the most valuable for patients. METHODS A literature search was conducted using the Cumulative Index to Nursing and Allied Health (CINAHL), PubMed, and PsycINFO databases and was supported by reviewing reference lists. Nine articles were selected, and the quality of them was assessed using the Critical Appraisal Skills Program. A synthesis was performed following the seven-stage meta-ethnography described by Noblit and Hare. RESULTS Four primary themes were derived from the synthesis: (a) being with and being for the person with ATC, (b) time is required for establishing the relationship, (c) the influence of the primary actors in the relationship: the nurse and the person with ATC, and (d) the effects of the relationship on both the nurse and the person with ATC. Finally, an explanatory model of the relationship between the nurse and the patient with ATC was developed, which shows that the relationship is an interpersonal process with several key elements including familiarity with one another, reciprocity, respect, and confidence. The nurses and patients with ATC perceive that their relationship is important and beneficial. The patients demand a helping and caring relationship focused on them as persons, not only as patients. CONCLUSIONS Patients with ATC and nurses consider their relationship to be important and beneficial. An approach to caring focused on patients as persons should be fostered among health care professionals and students.

van Manen's phenomenology of practice: How can it contribute to nursing?

Phenomenology of practice is a useful, rigorous way of deeply understanding human phenomena. Therefore, it allows research to be conducted into nursings most sensitive and decisive aspects. While it is a widely used research approach and methodology in nursing, it is seldom addressed and made use of in its practical and applied value. This article aimed to approach the global outlook of van Manens hermeneutic-phenomenological method to better understand its theoretical background and to address and support the contribution this method can make to nursing, if rigorously applied. For a professional discipline like nursing, van Manens approach is especially interesting because, in addition to contributing to the body of knowledge of nursing, it provides a special kind of knowledge that allows nurses to act in a more reflective manner, and with tact and skill, in certain situations and relationships that arise in their daily practice. A more in-depth understanding of this research methodology may help nurse-researchers make good use of it and also harness knowledge derived from this type of research. This comes as a result of assuming that phenomenological texts, the final product of the research, have tremendous educational potential for people who read them carefully.

Gratitude between patients and their families and health professionals: A scoping review

AIM To synthesize existing evidence regarding gratitude in health care relationships, with a specific focus on expressions of gratitude from patients and their families to health professionals, including their meaning and impact. BACKGROUND Studying expressions of gratitude by patients and their families within the scope of health care is an innovative way of identifying the most valuable elements of care. EVALUATION A scoping review of three data bases was conducted using the terms gratitude and health professionals (1984-2016). Data were extracted, analysed thematically and synthesized. KEY ISSUES A total of 32 publications were identified, around half being opinions or reflections. Thematic analysis resulted in the identification of three themes: the characteristics of expressions of gratitude, the focus of expressions of gratitude and the effect of gratitude on health professionals. CONCLUSIONS Expressions of gratitude by patients and their families may have an important personal and professional effect on health professionals that is long lasting. A systematic study of its effect is needed. IMPLICATIONS FOR NURSING MANAGEMENT Gratitude from patients and their families may contribute to motivation and retention among health professionals. Gratitude can be nurtured and is associated with a healthy work environment.

Palliative care consultants’ ethical concerns with advanced cancer patients participating in phase 1 clinical trials. A case study

Patients with advanced cancer often continue to choose aggressive interventions and/or treatments up until the final stages of life. This clinical approach may compromise the preservation of a patient’s quality of life, and secondarily, contributes to higher healthcare costs. Therefore, the ethics of enrolling terminal cancer patients in clinical trials which are testing new, aggressive chemotherapy agents requires careful discussion between the Oncology and the Palliative Care team. We present the case of a patient with stomach cancer admitted to a clinical trial at a very advanced stage of her disease. A number of clinical and ethical difficulties encountered by the PC team are discussed as well as possible solutions.

The Patient Dignity Inventory: just another evaluation tool? Experiences with advanced cancer patients.

OBJECTIVE The Patient Dignity Inventory (PDI) evaluates sources of distress related to the feeling of loss of dignity and was designed for patients at the end of life. The aim of the present work was to generate a better understanding of the experiences of healthcare staff when using the PDI. METHOD An exploratory qualitative study is presented about the experience of 4 professionals who applied the PDI to 124 advanced-cancer patients. Our study consisted of an analysis of their experiences, taken from information generated in a focus group. A thematic analysis was performed on the information generated at that meeting by two researchers working independently. RESULTS The initial experiences with the PDI on the part of the professionals led them to systematically administer the questionnaire as part of an interview instead of having patients fill it out themselves in written form. What started out as an evaluation very often led to a profound conversation on the meaning of life, dignity, and other sensitive, key issues related to the process of the illness. SIGNIFICANCE OF RESULTS The PDI has intrinsic therapeutic value and is useful in clinical practice, and it is also a way of examining issues related to dignity and the meaning of life within the context of advanced-stage illness. There is a need for studies that examine patient experiences through a PDI-based interview.