End-of-life expectations and experiences among nursing home patients and their relatives—A synthesis of qualitative studies

Objective

Synthesize research about patients’ and relatives’ expectations and experiences on how doctors can improve end-of-life care in nursing homes.

Methods

We systematically searched qualitative studies in English in seven databases (Medline, Embase, PsycINFO, CINAHL, Ageline, Cochrane Systematic Reviews and Cochrane Trials). We included 14 publications in the analysis with meta-ethnography.

Results

Patients and families emphasized the importance of health personnel anticipating illness trajectories and recognizing the information and palliation needed. Family members who became proxy decision-makers reported uncertainty and distress when guidance from health personnel was lacking. They worried about staff shortage and emphasized doctor availability. Relatives and health personnel seldom recognized patients’ ability to consent, and patients’ preferences were not always recognized.

Conclusion

Nursing home patients and their relatives wanted doctors more involved in end-of-life care. They expected doctors to acknowledge their preferences and provide guidance and symptom relief.

Practice implications

High-quality end-of-life care in nursing homes relies on organization, funding and skilled staff, including available doctors who are able to recognize illness trajectories and perform individualized Advance Care Planning.     

Resident physicians’ attitudes and confidence in communicating with patients: A pilot study at a Japanese university hospital

Objective

This study aimed to explore the relationships among physicians’ confidence in conducting medical interviews, their attitudes toward the patient–physician relationship, and undergraduate training in communication skills among resident physicians in Japan.

Methods

Participants were 63 first-year resident physicians at a university hospital in Tokyo. The Physician Confidence in the Medical Interview scale (PCMI) was constructed based on the framework of the Calgary–Cambridge Guide. Additionally, participants’ attitudes toward the patient–physician relationship (Patient–Practitioner Orientation Scale; PPOS), undergraduate experience of communication skills training, and demographic characteristics were assessed through a self-reported questionnaire.

Results

The internal consistency of the PCMI and PPOS scales were adequate. As expected from the undergraduate curriculum for medical interviews in Japan, residents had relatively higher confidence in their communication skills with respect to gathering information and building the relationship, whereas less confident about sharing information and planning treatment. The PCMI was associated with a more patient-centered attitude as measured by the PPOS.

Conclusion

These scales could be useful tools to measure physicians’ confidence and attitudes in communicating with patients and to explore their changes through medical education.

Practice implications

Residency programs should consider including systematic training and assessment in communication skills related to sharing information and planning treatment.     

Le déni de la complexité en douleur chronique : la part psychique maltraitée

Patients with chronic pain often want to obtain a diagnosis and treatments from a practitioner that supports them in their conviction of organicity in order to protect themselves against difficult and painful concerns. Therefore, it is pertinent to evoke a real collusion between the request and the numerous reductive derivatives of modern medicine, often clearly choosing denial of the complexity of variable dependants (psychological, social and environmental) when providing care services. The epistemological obstacles marking the limits of the knowledge and medical abilities redouble here the gap of the patients of another gap, making a shift of an organic conviction versus a “somato-psychic” one even more difficult. A linguistic masking through somatic diagnoses, semantic and conceptual shifts with regard to the definition of pain versus a “disease”, allowing a purely somatic access, are just as much modalities of a “failure” of subjectivity… Has an exposure of patients at risk of their conditions becoming chronic to be classified as poor treatment or as a form of iatrogenitics? Does a choice of denial of some in order to protect themselves against all ethical suffering justify the risk-taking of patients as well as a significant social cost that we also have to take into account?     

Parental influence on children's oral health-related behavior

Objective. The aim of this study was to determine whether there are differences between oral health-related knowledge, attitudes, beliefs and behaviors of children and their parents, and to identify the family-related factors associated with children's poor or good oral health-related behavior. Material and Methods. The data were gathered by means of questionnaires from 11–12-year-old schoolchildren and their parents who replied without having knowledge of the answers of the others. Differences between subgroups of children were analyzed by cross-tabulation, and the factors related to children's good or poor oral health-related behavior by logistic regression analyses. Results. Parents of children who reported good oral health-related behavior had better knowledge and more favorable behaviors than those of other parents. Predictors for a child's poor oral health-related behavior were the child's poor knowledge, male gender, the parent's frequent consumption of sweets, and the parent's infrequent use of xylitol gum. When a less strict threshold for the child's poor oral health-related behavior was used, more predictors entered the model: the parent's unfavorable use of fluoride toothpaste; among girls, the parent's lack of knowledge; and among children whose mother's occupation level was high, the parent's infrequent use of xylitol gum. The parents of children whose oral health behavior was favorable were more likely to have a high level occupation and favorable oral health-related behaviors. Conclusions. Oral health-related knowledge of children and their parents seems to be associated with children's oral health-related behavior. Parents’ behaviors, but not attitudes, were associated with children's oral health behavior.     

Knowledge levels and attitudes of health care professionals toward patients with hepatitis C infection

AIM: To study knowledge levels and attitudes of health care providers toward patients with hepatitis C virus infection in Guilan, a northern province of Iran.METHODS: This cross-sectional study was performed on 239 health care professionals from the Razi Hospital, including doctors, nurses, and operating room technicians. The questionnaires consisted of questions on demographic characteristics, knowledge levels, and attitudes toward hepatitis C patients. The questionnaire was tested in a pilot study and validated by Cronbach’s alpha coefficient. Data were analyzed using SPSS16 software.RESULTS: The mean ± SD knowledge score was 17.43 ± 2.65 (from a total of 22). 51.9% of the participants achieved scores higher than the mean. There was a significant relationship between knowledge score and age (P = 0.001), gender (P = 0.0001), occupational history (P = 0.0001), and educational history (P = 0.027). There was also a significant relationship between attitude level and age (P = 0.002), gender (P = 0.0001), occupational history (P = 0.0001), and educational history (P = 0.035). Physicians were significantly more knowledgeable and showed more positive attitudes. There was a positive correlation between knowledge and attitude scores (P = 0.02).CONCLUSION: Discriminatory attitudes are common among health care providers toward hepatitis C patients. It is therefore necessary to improve their knowledge level and attitude toward this disease.     

Differential cognitive performances between schizophrenic responders and non-responders to antipsychotics: Correlation with course of the illness,psychopathology, attitude to the treatment and antipsychotics doses

Multiple lines of evidence demonstrate that schizophrenia patients may perform worse than normal controls in several cognitive tasks. However, little is known on putative differences in cognitive functioning between schizophrenia patients responding to antipsychotics and those resistant to the treatment. In this cross-sectional study, 63 subjects (41 schizophrenia and schizoaffective patients and 22 age and sex-matched controls) were enrolled. Patients were divided in resistant (TRS, n=19) and non-resistant to pharmacological treatment (non-TRS, n=22) according to the American Psychiatric Association (APA) criteria for treatment resistance. The Brief Assessment of Cognition in Schizophrenia (BACS) was administered to patients and controls. The following rating scales were administered to schizophrenia patients: the Positive and Negative Syndrome Scale (PANSS), the Drug Attitude Inventory (DAI) and the Subjective Well-being under Neuroleptics (SWN). Statistically significant differences among non-TRS patients, TRS ones, and controls were detected at the BACS. TRS patients performed significantly worse than non-TRS ones on Verbal Memory task, exhibited higher PANSS total and subscales scores and were prescribed higher antipsychotic doses. Poorer performances at the BACS significantly correlated with more severe negative symptoms in TRS but not in non-TRS patients. These results may suggest that TRS patients suffer from a form of the disease with prominent cognitive impairment possibly related to negative symptoms.     

我国高中低流行地区居民艾滋病知识及态度调查分析

目的 了解我国不同艾滋病疫情地区居民艾滋病知识的知晓情况、艾滋病态度以及艾滋病知识来源,为制定城镇居民艾滋病防治策略提供参考依据。方法 在艾滋病流行的高、中、低地区采用随机抽样,以问卷形式在每个地区调查150～200名居民。结果 调查人群的艾滋病整体知晓率为84.77%,低流行地区艾滋病知晓率为91.61%,高流行地区艾滋病知晓率为78.74%,中流行地区艾滋病知晓率为86.03%,3个地区艾滋病知晓率之间差异有统计学意义（χ²=11.33,P=0.003）;超过20.00%的居民在假设与艾滋病感染者/病人同桌吃饭、从他们那里购买蔬菜、艾滋病儿童与未感染者儿童在一起上学时,都表示出排斥心理;艾滋病知识获取来源主要是电视（89.06%）、免费宣传资讯（64.84%）和报刊（63.48%）。结论 艾滋病流行的高、中、低地区居民的艾滋病知识知晓率整体水平较高,但高流行地区居民的艾滋病知识知晓率仍相对较低,应加强对局部地区居民艾滋病知识的教育。     

Perceptions and attitudes toward the menopause among middle aged women from Guayaquil, Ecuador

BACKGROUND: Studies reporting the perspective of Latin American women, Ecuador, included, regarding the menopausal phenomena are scarce or lacking. OBJECTIVES: Obtain information regarding the perception and attitudes toward the menopause among middle aged women of Guayaquil, Ecuador. METHODS: Women aged 40 or more, nursing staff members of two major associated teaching hospitals of the Universidad Católica de Santiago de Guayaquil, Ecuador, were surveyed with a structured questionnaire containing items intended to assess women's perception and attitudes toward the menopause. Secondarily level of information related to the menopause was explored. RESULTS: During the study period, 349 women were surveyed of which mean age was 48+/-6.8 years. A 41.3% were postmenopausal, 55% premenopausal and 3.7% had a history of hysterectomy with conserved ovaries. Women more frequently perceived the menopause as a positive event as they agreed that it is a normal (93.7%) and important event (73.6%), that it gives more confidence and maturity (78.8%), that they may fully enjoy sexual relations (74.8%), that there is a relief as the risk of becoming pregnant is null (65.3%) and that life becomes easier and calmer (60.7%). A relatively high rate demonstrated a preoccupying attitude toward the menopause as 79.4% responded to be concerned about it indicating that seeking medical attention was important, moreover, 77.9% responded that health during this phase be taken care of and life styles changed. Less than 50% of surveyed women considered having enough information regarding the menopause whereas a high rate indicated wanting to receive educational sessions related to the menopause. Married and lower educated women were not concerned about the menopause in a higher rate than their counterparts. CONCLUSIONS: Despite the fact that women perceived the menopause as a positive event, displaying a concerned attitude toward it, their related knowledge was low.     

合肥市社区医务人员食源性疾病认知及临床诊断能力调查

目的 调查合肥市社区医务人员食源性疾病知信行及其临床诊断能力并分析相关因素,为疾病预防控制机构和街道社区卫生服务中心内部的培训工作提供理论依据。方法 采用整群随机抽样的方法抽取41家街道社区卫生服务中心,选取929名医务人员进行问卷调查,采用单因素分析和多因素logistic回归模型分析医务人员基本特征对食源性疾病认知及其临床诊断能力的影响。结果 社区医务人员知识、态度、行为和临床情景模拟诊断的得分分别是（8.38±2.92）、（7.18±1.64）、（9.51±3.41）、（5.49±2.54）分。多因素分析表明科室是食源性疾病知识及行为的影响因素（P< 0.05）,是否参加培训是态度及行为的影响因素（P< 0.05）。结论 合肥市社区医务人员对食源性疾病的认知和诊断水平有待加强,培训应区别不同科室有针对性开展。