Sofia C. Zambrano

Palliative sedation in Latin America: survey on practices and attitudes

IntroductionPalliative sedation (PS) is the subject of ethical and legal debates worldwide. Statistics of its utilization are available in developed countries; however, in Latin America, these data are scarcely known. The purpose of this research was to determine the practices and attitudes of palliativists in Latin America towards PS.Materials and methodsData was collected during the Latin American Congress on Palliative Care in Isla Margarita, Venezuela. A total of 89 professionals participated in this survey.ResultsIt was found that the use of PS was positively associated with being a physician and being members of a palliative care (PC) group. On the other hand, it was found that being a psychologist and identifying barriers toward PS limited its utilization.DiscussionThe findings of this study support the need to establish clinical guidelines for its utilization and to educate other specialists on end-of-life care approaches, and the need to develop PC programs in acute care hospitals in Latin America.

Furry and feathered family members--a critical review of their role in palliative care.

This article presents a comprehensive critical review of the peer-reviewed literature on palliative care and companion animals (CAs), reporting on the evidence and knowledge base regarding CAs and their role for people at end of life. PubMed, PsycINFO, Medline, Scopus, and Google Scholar were searched for studies pertaining to CAs, end of life, and hospice palliative care. Six studies dealt specifically with empirical research. The remaining literature addressed the topic peripherally or anecdotally. The evidence for efficacy and the knowledge base about the role of CAs at end of life in hospice and palliative care is weak. Further efforts are required to study the conditions under which CAs may be beneficial for patient care, including acceptability to staff, family, and other patients, and with consideration of welfare for the animals involved.

On the Journey with the Dying: How General Practitioners Experience the Death of Their Patients

A grounded theory study was undertaken to understand how general practitioners (GPs) experience the death of their patients. Eleven GPs participated in semi-structured interviews. The participants explained their experience of a patients death using the “death journey” metaphor. This journey, the Journey with the Dying, could be described from 5 different moments in the participants’ encounters with people who are dying: private acknowledgement, communication of prognosis, continuity of care, the moment of death, and looking after the family. Emotional responses for each of the stages, and coping strategies in general, were outlined. GPs’ narratives about professional identity, learning about dying and death, and death beliefs were also important in the Journey with the Dying. The experience of death described by the GPs in this study was different from that reported by medical doctors in other care settings. The 5 phases of the Journey with the Dying identified here show the different adjustments and appraisals that GPs undertake to comprehend and to be able to work in the presence of death.

Junior doctors' views of how their undergraduate clinical electives in palliative care influenced their current practice of medicine.

Purpose To explore how junior doctors (doctors in postgraduate training) retrospectively perceived the influence of their undergraduate palliative care attachments (clinical electives) on their current medical practice. Method From 2008 to 2013, 100 students participated in palliative care attachments at the University of Adelaide School of Medicine. In 2013, the authors invited 14 of these, now junior doctors, to be in this study. Participants took part in one-on-one, semistructured interviews. Interview data were analyzed for themes. Results Nine junior doctors participated. They were sent a summary of the findings to check whether the themes captured each participant’s experiences. Eight replied and agreed. Two main themes were identified: (1) from apprehension to gaining a sense of control, and (2) gaining perspective on the practice of medicine. Participants perceived that the learning experiences from the attachments provided them with a sense of confidence and control over their interactions with dying patients and families. This positive influence not only was present when caring for patients at the end of life but also influenced the participants’ identity as medical practitioners. Conclusions Findings suggest that junior doctors trained earlier in palliative care have enhanced competencies of professionalism, patient-centered medicine, psychosocial and spiritual aspects of palliative care, communication, teamwork, and self-awareness. Learning a palliative approach can help them make a difference in treating dying patients, but also in general patient care. Therefore, physicians trained in palliative care may be better prepared to contribute to a health care system that is person-centered, ethically conscientious, and personally fulfilling.

Not appropriate dinner table conversation? Talking to children about meat production.

Although Australians on average consume large quantities of meat, their attitudes to farm animal welfare are poorly understood. We know little about how farm animal production is discussed in Australian households or how children learn about the origins of meat. This study consisted of an online survey completed by 225 primary carers throughout Australia recruited through social media. Findings include that conversations about the origin of meat were generally stimulated by meal preparation within the home rather than visits to agricultural shows or similar activities. Parents preferred to initiate conversations with children about meat production before they were 5 years of age. Urban parents were more likely than rural parents to reveal that they were conflicted about eating meat and would be more empathetic to children who chose to stop eating meat. Rural parents were more likely than urban parents to feel that children should eat what they are given and that talking about meat is not a major issue. Both groups felt that it was important that children should know where their food comes from. The findings of this study suggest that parental attitudes to meat production and consumption influence conversations about meat origins with children.

How do surgeons experience and cope with the death and dying of their patients? A qualitative study in the context of life-limiting illnesses

BackgroundThe present qualitative study explores surgeons’ experiences and coping mechanisms with the death of their patients in the context of life-limiting illnesses.MethodsNine Australian surgeons participated in in-depth interviews. Thematic analysis of the interview transcriptions allowed for identification of themes and subthemes. Methodological trustworthiness and rigor were preserved at all stages of the research process.ResultsThe essence of surgical practice, comprising participants’ descriptions of their identity as surgeons, influenced their experiences and coping mechanisms when dealing with death and dying. The following subthemes were identified: distancing from patients, wanting to fix problems, doing in terms of operating on a patient, prominence of the surgeon’s personal ability, and high personal responsibility for patient outcomes. Giving hope and having a mixed surgical practice were some of the coping mechanisms described by participants.DiscussionDeath and dying are a part of surgical practice, and surgeons face challenges as they care for dying patients. Although participants stated that they felt less affected by dealing with patients dying of life-limiting illnesses than by unexpected deaths, their descriptions of their encounters, reactions, and behaviors, as well as their use of language, suggest that these deaths have a lasting impact. Potential areas for improvement of surgical practice and approaches to teaching about death and dying in surgery are addressed. Furthermore, the results of this study suggest the need to expand research in this area.

The influence of information leaflets on morphine consumption in postoperative patients using patient-controlled analgesia.

ABSTRACT Negative preconceived beliefs about the benefits of morphine use are frequently seen in hospitalized patients and may be associated with reports of severe pain, poor patient satisfaction, impaired rehabilitation, and possibly more chronic postsurgical pain. In some patients, providing information through instructive leaflets may modify negative beliefs that limit proper medication use. The purpose of this study was to determine whether the morphine-related information provided through leaflets during the postoperative period led to increased use of morphine and lower pain scores in patients using patient-controlled analgesia. One hundred patients scheduled for surgery were randomly assigned to the experimental (n = 53) or control group (n = 38). Patients included in the former group received detailed information on morphine; those in the latter group received only general information on postoperative acute pain. The results indicated that during the immediate postoperative period, morphine use was directly associated with pain intensity and satisfaction with pain management and inversely related with side effects. These results show that pain intensity is the most relevant issue in the decision to use morphine. Information leaflets did not change morphine consumption.

The impact of early palliative care on the quality of care during the last days of life: what does the evidence say?

Purpose of reviewThe aim of this review is to critically appraise the existing evidence on ‘early palliative care’ (EPC), discuss its relationship with advance care planning, and to reflect on the impact of EPC on the quality of care provided during the last days of life. Recent findingsThere are indicators that EPC may help to avoid aggressive treatment, shorten hospital stay, improve overall quality of life, and to see more frequently dying and death at the preferred place of care. SummaryThe evidence from randomized controlled trials supports the integration of palliative care early in the disease trajectory. However, in terms of outcomes and quality indicators for care in the last days of life, evidence is still lacking. Predominantly, when it comes to the outcomes which may be more difficult to assess, such as spiritual aspects, or the social network, for which more comprehensive information is needed. These outcomes should not be neglected in palliative care studies, particularly when they can provide meaningful information about patient and family adjustment, and focus on psychosocial aspects rather than physical symptom control.

Characteristics of the Last Hospital Stay in Terminal Patients at an Acute Care Hospital in Colombia

In Colombia, most palliative care is provided in acute care hospitals. In those settings, a palliative care approach could be limited because of a disease-oriented approach instead of patient-centered care. Purpose: To know the framework of a typical Colombian university hospital that provides palliative care services. Material and Methods: In a retrospective manner, the medical records of deceased patients during 2006 were revisited. Results: Most patients were not treated by palliative care specialists, so curative-oriented treatment were common among these patients. Conclusion: In acute hospitals, palliative care teams should paricipate in the care of patients at the start of treatment.

Attending patient funerals: Practices and attitudes of Australian medical practitioners

ABSTRACT The appropriateness of attending a patient’s funeral is a medical dilemma. This article focuses on 437 doctors who participated in an online survey. Seventy-one percent of general practitioners, 67% of oncologists, 67% of psychiatrists, 63% of palliative medicine specialists, 52% of surgeons, and 22% of intensive care specialists had attended patient funerals. Significant differences in demographics and between specialties were identified in terms of barriers and benefits associated with attendance. Although attendance is a personal decision, there is a need for open discussions in medical education and professional development concerning death and the role of doctors after a patient dies.