Knowledge among Primary Care Health Professionals about the-rapeutic resources at the end of life

Authors

DOI: https://doi.org/10.6018/edumed.600401
Keywords: Livin Will, therapeutic effort limitation, palliative sedation, euthanasia, primary Care, Knowledge

Supporting Agencies

  • No funding was received

Abstract

Regulation on Living Wills, Therapeutic Effort Limitation, Palliative Sedation) and Euthanasia have undergone deep changes in the last years. Primary Care professionals should give information and apply those options, but previous research shows their knowledge may be inadequate. Our goal is to describe Primary Care professionals knowledge on options of last resort. An autoadministered questionaire was delivered to Family Practices, Family Nurses, Pediatricians and students or interns of any of the forementioned in six Primary Care Health Centers in the region of Madrid, consisting on 40 true/false questions. Percentage of correct answers, those under 75% of correct answers and age and profession differences were analysed. We got 54 valid answers with no data missing. Median percentage of correct answers was 81,5%, with no significative differences among topics, and some while considering age or profession. Eleven questions got less than a 50% and four between 50-75% correct answers. Differences were observed in three questions when age was considered and in four when profession was. Our sample may not be representative, but questions with less than 50% correct answers remain consistent with previous research. Mistaking therapeutic effort limitation and palliative sedation, morphine usage in sedation or euthanasia or what the advice and requirements for those resources are, have been found the least known. Further training of Primary Care professionals on their legal obligations, when to use and how to apply end of life options should be performed.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

References

Simón-Lorda P, Tamayo-Velázquez MI, González Rubio MJ, Ruiz Díaz P, Moreno González J, del Carmen Rodríguez González M. Conocimientos y actitudes del personal de enfermería acerca de las voluntades anticipadas en 2 áreas sanitarias de Andalucía. Enferm Clin. 2008;18(1):11–7. Available from: https://linkinghub.elsevier.com/retrieve/pii/S1130862108706880

Boletín Oficial del Estado. Ley 3/2005, de 23 de mayo, por la que se regula el ejercicio del derecho a formular instrucciones previas en el ámbito sanitario y se crea el registro correspondiente. [citado el 4 de julio de 2023]. Available from: https://www.boe.es/buscar/pdf/2005/BOE-A-2005-18452-consolidado.pdf

Champer Blasco A, Caritg Monfort F, Marquet Palomer R. Conocimientos y actitudes de los profesionales de los equipos de atención primaria sobre el documento de voluntades anticipadas. Aten Primaria. 2010;42(9):463–9. https://www.elsevier.es/es-revista-atencion-primaria-27-articulo-conocimientos-actitudes-profesionales-equipos-atencion-S0212656710001885

Ávila E, Bermejo JC, Sastre P, Villacieros M, Prieto R. Knowledge and preferences on end-of-life resources in a sample of professionals of the Community of Madrid. Semergen. 2019;45(5):303–10. https://doi.org/10.1016/j.semerg.2018.08.005

Contreras-Fernández E, Barón-López FJ, Méndez-Martínez C, Canca-Sánchez JC, Cabezón Rodríguez I, Rivas-Ruiz F. Validation of the knowledge and attitudes of health professionals in the Living Will Declaration process. Aten Primaria. 2017;49(4):233–9. https://doi.org/10.1016/j.aprim.2016.06.004

Boletín Oficial del Estado. Ley 4/2017, de 9 de marzo, de Derechos y Garantías de las Personas en el Proceso de Morir. BOE 149/2017, Disposición 7178. https://www.boe.es/buscar/doc.php?id=BOE-A-2017-7178

Organización Médica Colegial de España. Sedación Paliativa, Alimentación e Hidratación al Final de la Vida. Documento de consenso. [citado el 31 de enero de 2024]. Available from: https://www.cgcom.es/media/290/download.

Ciancio AL, Mirza RM, Ciancio AA, Klinger CA. The Use of Palliative Sedation to Treat Existential Suffering: A Scoping Review on Practices, Ethical Considerations, and Guidelines. J Palliat Care. 2020;35(1):13–20. https://doi.org/10.1177/0825859719827585

Sarah Z, Margareta S, Matthias B, Georg B, Alan PM. Continuous deep sedation until death in patients admitted to palliative care specialists and internists: A focus group study on conceptual understanding and administration in German-speaking Switzerland. Swiss Med Wkly. 2018;148(33–34). https://doi.org/10.4414/smw.2018.14657

Hamano J, Morita T, Ikenaga M, Abo H, Kizawa Y, Tunetou S. A Nationwide Survey About Palliative Sedation Involving Japanese Palliative Care Specialists: Intentions and Key Factors Used to Determine Sedation as Proportionally Appropriate. J Pain Symptom Manage. 2018;55(3):785–91. https://doi.org/10.1016/j.jpainsymman.2017.10.006

Donker GA, Slotman FG, Spreeuwenberg P, Francke AL. Palliative sedation in Dutch general practice from 2005 to 2011: a dynamic cohort study of trends and reasons. Br J Gen Pract. 2013;63(615):e669–75. https://doi.org/10.3399/bjgp13x673676

Boletín Oficial del Estado. Ley Orgánica 3/2021, de 24 de marzo, de regulación de la eutanasia. Diposición 4628 del BOE núm. 72 de 2021. https://www.boe.es/diario_boe/txt.php?id=BOE-A-2021-4628

Cejudo-López Á, Gil-García E, Porcel-Gálvez AM. Los profesionales sanitarios ante el pacto de silencio. Aspectos éticos y legales. Med Paliativa. 2020; 1:1. DOI:10.20986/medpal.2020.1110/2019

Simón-Lorda P, Isabel Tamayo-Velázquez M, Vázquez-Vicente A, Durán-Hoyos A, Pena-González J, Jiménez-Zurita P. Conocimientos y actitudes de los médicos en dos áreas sanitarias sobre las voluntades vitales anticipadas. Aten Primaria. 2008;40(2):61–6. https://doi.org/10.1157%2F13116148

Chambaere K, Bilsen J, Cohen J, Onwuteaka-Philipsen BD, Mortier F, Deliens L. Physician-assisted deaths under the euthanasia law in Belgium: A population-based survey. C Can Med Assoc J. 2010;182(9):895–901. https://doi.org/10.1503/cmaj.091876

Aguilar-Sánchez JM, Cabañero-Martínez MJ, Puerta Fernández F, Ladios-Martín M, Fernández-de-Maya J, Cabrero-García J. Knowledge and attitudes of health professionals towards advance directives. Gac Sanit. 2018;32(4):339–45. https://doi.org/10.1016/j.gaceta.2017.08.006

Contreras-Fernández E, Barón-López FJ, Méndez-Martínez C, Canca-Sánchez JC, Cabezón Rodríguez I, Rivas-Ruiz F. Validación del cuestionario de conocimientos y actitudes de los profesionales sanitarios en el proceso de declaración de voluntades vitales anticipadas. Atenc Primaria. 2017;49(4):233–9. http://dx.doi.org/10.1016/j.aprim.2016.06.004

Gruenewald DA, Vandekieft G. Options of Last Resort: Palliative Sedation, Physician Aid in Dying, and Voluntary Cessation of Eating and Drinking. Vol. 104, Medical Clinics of North America. 2020. p. 539–60. https://doi.org/10.1016/j.mcna.2020.01.002

Pousset G, Bilsen J, Cohen J, Mortier F, Deliens L. Continuous deep sedation at the end of life of children in Flanders, Belgium. J Pain Symptom Manage. 2011 Feb;41(2):449–55. https://doi.org/10.1016/j.jpainsymman.2010.04.025

Abdul-Razzak A, Lemieux L, Snyman M, Perez G, Sinnarajah A. Description of Continuous Palliative Sedation Practices in a Large Health Region and Comparison with Clinical Practice Guidelines. J Palliat Med. 2019 Sep 1;22(9):1052–64. https://doi.org/10.1089/jpm.2018.0372

Anquinet L, Rietjens JAC, Seale C, Seymour J, Deliens L, Van Der Heide A. The practice of continuous deep sedation until death in Flanders (Belgium), the Netherlands, and the U.K.: A comparative study. J Pain Symptom Manage. 2012 Jul;44(1):33–43. https://doi.org/10.1016/j.jpainsymman.2011.07.007

Alonso Babarro A, Fernández Bueno J. Sedación paliativa. FMC Form Medica Contin en Aten Primaria [Internet]. 2008;15(10):678–87. Available from: https://ingesa.sanidad.gob.es/bibliotecaPublicaciones/publicaciones/internet/docs/Guia_sedacion_paliativa.pdf

Brouwer M, Maeckelberghe E, De Weerd W, Verhagen E. Quality of Living and Dying: Pediatric Palliative Care and End-of-Life Decisions in the Netherlands. Cambridge Q Healthc Ethics. 2018 Jul 30;27(3):376–84. https://doi.org/10.1016/j.jpainsymman.2011.07.007

Chambaere K, Bilsen J, Cohen J, Raman E, Deliens L. Differences in Performance of Euthanasia and Continuous Deep Sedation by French- and Dutch-Speaking Physicians in Brussels, Belgium. Vol. 39, Journal of Pain and Symptom Management. 2010; 39(2):e5-7. https://doi.org/10.1016/j.jpainsymman.2009.10.001

Rurup ML, Borgsteede SD, van der Heide A, van der Maas PJ, Onwuteaka-Philipsen BD. Trends in the Use of Opioids at the End of Life and the Expected Effects on Hastening Death. J Pain Symptom Manage. 2009 Feb;37(2):144–55. https://doi.org/10.1016/j.jpainsymman.2008.02.010

Sanjuán JL. Manual de las buenas prácticas en eutanasia. Adm Doc y Arch [Internet]. 2011;429–72. Available from: https://www.sanidad.gob.es/eutanasia/docs/Manual_BBPP_eutanasia.pdf

Published
12-02-2024
How to Cite
Hernández Manzano, C. M., Angulo Ardoy, M., & Viloria Jiménez, A. (2024). Knowledge among Primary Care Health Professionals about the-rapeutic resources at the end of life. Spanish Journal of Medical Education, 5(2). https://doi.org/10.6018/edumed.600401