Espiritualidad en atención paliativa: Evidencias sobre la intervención con counselling

ResumenLas necesidades espirituales, cuando son elaboradas de forma efectiva, ayudarán a la persona al final de la vida a encontrar significado, mantener la esperanza y aceptar la muerte. El counselling es una de las terapias más utilizadas para mejorar estas necesidades. El objetivo del presente trabajo es ofrecer evidencia sobre la eficacia de esta terapia para la mejora de la espiritualidad de los pacientes atendidos en diversos dispositivos de salud. Para conseguirlo, se llevó a cabo una intervención de tres semanas en 131 pacientes de atención domiciliaria y hospitalizados. Tenían una edad media de 70.61 años (DT = 11.17). El 51.1% eran hombres. Se evaluó la espiritualidad de los pacie…

Deliberación moral y asesoramiento

Espiritualidad en atención paliativa: evidencias sobre la intervención con counselling

Las necesidades espirituales, cuando son elaboradas de forma efectiva, ayudarán a la persona al final de la vida a encontrar significado, mantener la esperanza y aceptar la muerte. El counselling es una de las terapias más utilizadas para mejorar estas necesidades. El objetivo del presente trabajo es ofrecer evidencia sobre la eficacia de esta terapia para la mejora de la espiritualidad de los pacientes atendidos en diversos dispositivos de salud. Para conseguirlo, se llevó a cabo una intervención de tres semanas en 131 pacientes de atención domiciliaria y hospitalizados. Tenían una edad media de 70.61 años (DT = 11.17). El 51.1% eran hombres. Se evaluó la espiritualidad de los pacientes an…

Assessment of the Perception of Symptoms and Anxiety in Terminally Ill Patients in Spain

A new measure of home care patients' dignity at the end of life: The Palliative Patients' Dignity Scale (PPDS).

ABSTRACTObjective:This study aimed to develop a new and brief instrument to be employed in dignity measurement, one based on the perceptions of patients, relatives, and professionals about dignity.Method:Surveys of patients receiving palliative care, family caregivers, and palliative care professionals were first carried out (sample 1). In the second step, palliative care patients were surveyed with a pilot questionnaire (sample 2). Finally, a survey design was used to assess patients admitted into a home care unit (sample 3). Sample 1 included 78 subjects, including patients, family caregivers, and professionals. Some 20 additional palliative patients participated in sample 2. Finally, 70 …

Intervenciones psicológicas en espiritualidad en cuidados paliativos: una revisión sistemática

Resumen Contexto La espiritualidad puede entenderse como una condicion fundamental del sentido de la persona. Se incluye dentro de los objetivos fundamentales de trabajo de los cuidados paliativos, considerandose que la calidad de vida del paciente no puede favorecerse en su conjunto si no se aborda la dimension espiritual. Objetivo El objetivo de esta revision sistematica es sintetizar la evidencia cientifica mas reciente en espiritualidad en pacientes paliativos con enfermedad avanzada, atendiendo sobre todo a que tipo de intervencion que contemple la dimension espiritual se ha llevado a cabo con ellos. Se recogen datos sobre el tipo de estudio y resultados estadisticos encontrados en cua…

Demoralization Scale in Spanish-Speaking Palliative Care Patients.

Abstract Context Among the approaches to the demoralization syndrome, the one proposed by Kissane et al. is prevalent in the literature. These authors developed the Demoralization Scale (DS) to assess emotional distress, conceived as demoralization. Objectives To present the Spanish adaptation of the Demoralization Scale in palliative care patients, with a new and more comprehensive approach to its factorial structure. Methods A cross-sectional study was carried out in 226 Spanish palliative care patients in three different settings: hospital, home care unit, and continued care unit. Outcome measures included the DS and the Hospital Anxiety and Depression Scale. Analyses comprised confirmat…

Grief support provided to caregivers of palliative care patients in Spain

Grief support for relatives of patients in palliative care is recognized as a fundamental practice within palliative medicine. The aim of this research was to determine the nature and extent of grief support programs offered to relatives of patients in palliative care in Spain. A postal survey was carried out among members of the Spanish Society of Palliative Care. The members' names were obtained through the Society's 2000 Directory, which lists 160 different teams, of which 50% answered a questionnaire made up of 34 questions, some open-ended and others multiple choice. Results show that 88.6% of the services include grief support, that mainly emotional and one-to-one care is provided (9…

Responding to the Spiritual Needs of Palliative Care Patients: A Randomized Controlled Trial to Test the Effectiveness of the Kibo Therapeutic Interview

Context The WHO recognizes the need to attend to patients' spiritual needs as being fundamental to comprehensive and high-quality end-of-life care. Spiritual needs must be attended since the resolution of biological and psychosocial issues is insufficient to reduce patients' suffering. Associations have been found between spiritual needs and other variables of importance for patients in palliative care. Despite the consensus that exists regarding the importance of assessing and attending to spiritual needs, professionals encounter many difficulties in attempting to do so. Objectives Our study aims to demonstrate the benefits that the KIBO therapeutic interview in palliative care patients ca…

Development and Validation of a New Tool for the Assessment and Spiritual Care of Palliative Care Patients

Context. Spiritual assessment tools and interventions based on holistic approaches are needed to promote healing. Such tools must be adapted to the wide cultural backgrounds of contemporary Western society. Objectives. To develop and validate a new brief measure, simultaneously featuring clinical applicability and adequate psychometric properties. The tool uses six initial questions to establish a climate of trust with patients before they complete an eight-item, five-point Likert scale. The questionnaire is based on a model of spirituality generated by the Spanish Society of Palliative Care (SECPAL) Task Force on Spiritual Care (Grupo de Espiritualidad de la SECPAL), which aims to recogniz…

Predictores de duelo complicado

Pilar.Barreto@uv.es; Patricia.Yi@uv.es OBJETIVO: Estudiar el proceso de evolución en sus primeras etapas tras la pérdida y determinar cuáles son los factores de riesgo y protección previos a la muerte que permiten predecir el surgimiento de posibles complicaciones en los familiares/cuidadores de pacientes oncológicos. MÉTODO: Se evaluaron 236 dolientes cuyos familiares eran pacientes oncológicos atendidos en servicios de cuidados paliativos de Valencia y Madrid y se realizó un seguimiento en 2 momentos temporales: 2 y 6 meses tras la muerte, evaluándose la presencia/ausencia de complicaciones en el proceso de duelo mediante dos criterios diagnósticos (DSM e ICG). RESULTADOS: Se encontró una…

Frail elderly with and without cognitive impairment at the end of life: Their emotional state and the wellbeing of their family caregivers.

Abstract Purpose of the study (1) To identify the main predictors of the emotional state of the frail elderly at the end-of-life and that of their primary family caregivers, taking into consideration the presence/absence of significant cognitive impairment in the patient and (2) to analyse the relationship between the emotional state of the patient and that of their primary family caregiver. Methods Our study is cross-sectional. 85 frail elderly patients at the end-of-life and their primary family caregivers participated. Information on the following aspects was collected: (1) From the patients: Socio-demographics, Functional independence, and Cognitive and Emotional state; (2) From the car…

The Short Demoralization Scale (SDS): A new tool to appraise demoralization in palliative care patients.

ABSTRACTObjective:The Demoralization Scale (DS) is the most widely used measure for assessing demoralization. Following the recent clamor for brief assessment tools, and taking into account that demoralization has proved to be a symptom that needs to be controlled and treated in the palliative care setting, a shorter scale is needed. The aim of the present research is to introduce and evaluate the Short Demoralization Scale (SDS).Method:We employed a cross-sectional design that included a survey of 226 Spanish palliative care patients from the Hospital General Universitario de Valencia. We employed the SDS, the DS, and the Hospital Anxiety and Depression Scale (HADS).Results:The confirmator…

Screening of complicated grief

Objetivo: Conocer en profundidad el fenómeno del duelo complicado o patológico, y recabar aquellos indicadores de detección y evaluación que nos permitan su pronta identificación en la práctica clínica. Método: Tras una amplia revisión de la literatura científica aparecida en los últimos años, y a la luz de nuestra experiencia profesional, se realizó una recopilación de los indicadores más significativos. Resultados: Presentamos los principales criterios diagnósticos e instrumentos de medida utilizados en la actualidad, que permiten a los profesionales del ámbito de la salud valorar con precisión posibles complicaciones en el proceso de duelo. Conclusiones: Contamos con importantes indicado…

Spirituality in patients with advanced illness: The role of symptom control, resilience and social network.

In this study, we analyzed the relationships among clinical, emotional, social, and spiritual dimensions of patients with advanced illness. It was a cross-sectional study, with a sample of 108 patients in an advanced illness situation attended by palliative care teams. Statistically significant correlations were found between some dimensions of spirituality and poor symptomatic control, resiliency, and social support. In the structural model, three variables predicted spirituality: having physical symptoms as the main source of discomfort, resiliency, and social support. This work highlights the relevance of the relationships among spirituality and other aspects of the patient at the end o…

Síndrome de desmoralización como alternativa diagnóstica al estado de ánimo deprimido en pacientes paliativos

The emotional state of palliative patients is one of the main aims in their professional attention. Several authors have approach this matter using depression definitions as defined for the general population. There are also many expert professional opinions and research data pointing to the need for adequate research at the patient’s end of life situation. Perhaps one of the most interesting ideas is that one initia­lly expressed by Frank and developed by Kis­sanne et al., suggesting differentiation between depression and demoralization. Following this line of thought, demoralization would more accurately reflect the situation observed in these patients, allows a better differential diagno…

Effect of a short-term psychological intervention on the anxiety and depression of amyotrophic lateral sclerosis patients

This study evaluated the effectiveness of a psychological intervention in amyotrophic lateral sclerosis patients, consisting of four semi-structured sessions of cognitive behavioural therapy combined with counselling techniques. An intervention group and a control group were established. The Hospital Anxiety and Depression Scale was used to assess levels of anxiety and depression. In total, fifty-four patients took part. Prior to the intervention, the intervention group displayed rates of 63.3 and 36.7 per cent for anxiety and depression, respectively, falling to 16.7 and 10.0 per cent afterwards. The psychological intervention demonstrated potential for the reduction of levels of anxiety …

Bienestar emocional y espiritualidad al final de la vida

Resumen Objetivo La atencion al conjunto de las necesidades fisicas, sociales, psicologicas y espirituales de los pacientes es un elemento clave para la disminucion del sufrimiento en el marco de los cuidados paliativos. Material y metodos Desde el modelo antropologico planteado por el Grupo de Espiritualidad de la SECPAL y mediante un nuevo cuestionario desarrollado para evaluar la espiritualidad en 3 niveles: intrapersonal (sentido), interpersonal (armonia) y transpersonal (pertenencia), se han estudiado los recursos y las necesidades espirituales, asi como las relaciones entre espiritualidad y funcionamiento emocional, atendiendo a aspectos como ansiedad, depresion y resiliencia. Esta in…

Estudio comparativo de la eficacia del counselling y de la terapia de la dignidad en pacientes paliativos

Resumen Objetivo Existen multiples trabajos que contemplan el conjunto de las necesidades de los pacientes al final de la vida, contando con propuestas de modelos integrales para una intervencion terapeutica paliativa. La metodologia mas comun que aborda estas necesidades es la intervencion de counselling, aunque recientemente tambien ha crecido el uso internacional de la «terapia de la dignidad». Este estudio tiene como objetivo identificar y cuantificar diferencias en terminos de distres emocional, calidad de vida y preservacion de la dignidad tras el tratamiento con estos 2 tipos de intervenciones. Metodo Diseno cuasi-experimental en la Unidad de Hospitalizacion a Domicilio (UHD) del Hos…

A way to screen for suffering in palliative care

We report a new tool for screening the suffering of terminally ill patients in a palliative care service. We systematically asked 371 terminal oncological and AIDS patients on 665 different occasions, “How long did yesterday seem to you?”; we then asked them to assess their current condition. The simple answer about subjective length of time correlated well with subjective suffering in approximately half the patients. Thus it may be a good starting point for future assessment and more extensive explorations.

Comparing counseling and dignity therapies in home care patients: A pilot study

AbstractObjective:Several studies have successfully tested psychosocial interventions in palliative care patients. Counseling is the technique most often employed. Dignity therapy (DT) has recently emerged as a tool that can be utilized to address patients' needs at the end of life. The aims of our study were to examine the effects of DT and counseling and to offer useful information that could be put into practice to better meet patients' needs.Method:We developed a pilot randomized controlled trial at the Home Care Unit of the General University Hospital of Valencia (Spain). Some 70 patients were assigned to two therapy groups. The measurement instruments employed included the Patient Dig…