Attitudes toward euthanasia and physician-assisted suicide among Italian primary care physicians

The public debate about euthanasia and assisted suicide is less pronounced in Italy than in other countries, and data about this topic are lacking. The aim of this study was to investigate primary care physicians' experience in requests for and opinions about euthanasia and/or assisted suicide for terminally ill patients and the relationship between attitudes and professional variables. Three-hundred thirty-six general practitioners completed the Euthanasia Questionnaire to assess attitudes toward euthanasia and/or assisted suicide and the Maslach Burnout Inventory to examine burnout symptoms. The rate of requests for euthanasia or assisted suicide was low (11% and 4.5%, respectively). Only a minority of the physicians endorsed euthanasia and/or assisted suicide. Agreement with the practice of euthanasia/assisted suicide was correlated with non-Catholic religious affiliation, inexperience in treating terminally ill patients, and the burnout dimension of depersonalization. The fact that professional as well as individual factors (e.g., inexperience, non-Catholic affiliation, burnout) were associated with favorable attitudes toward euthanasia and/or assisted suicide underscores the need to examine the problem as a complex phenomenon involving the dyadic patient-doctor relationship.     

Assessing an adult patient's suicide risk. What primary care physicians need to know

There is no pathognomonic sign or symptom that predicts suicide. However, suicide threats, hopelessness, and other risk factors may signal a patient's intent for self-harm. Through careful history taking and examination, the physician can assess the patient's risk profile for suicide and construct an appropriate treatment plan, which may include hospitalization, drug therapy, and/or referral to a psychiatrist.     

Self-harm and suicide: care, interventions and policy

This article aims to raise awareness about self-harming behaviours and suicide. It explores their complex nature, social context, why they have become a central issue in public health and the challenges they present. The assessment of patients who self-harm is discussed, together with psychological and social policy interventions that may be used.     

Impact of suicide on health professionals in psychiatric care mental healthcare professionals' perceptions of suicide during ongoing psychiatric care and its impacts on their continued care work

People who attempt suicide as well as those who actually take their own life often have communicated their suicidal thoughts and feelings to healthcare professionals in some form. Suicidality is one of the most challenging caring situations and the impacts of suicide care affect both the professional and personal lives of healthcare professionals. This study investigates how mental health professionals perceive suicide while providing psychiatric care and how this perception impacts their continued care work. This qualitative exploratory study includes 19 mental health professionals in psychiatry who had provided care for patients who had taken their own life. Analysis followed the principle of phenomenography. The findings reveal that these healthcare professionals experienced an internal conflict that affected them both personally and professionally. In response to these conflicts, the healthcare professionals developed strategies that involved a safety zone and increased vigilance. Those who were able to commute and balance a safe spot and learning to be more vigilant seem to have developed as a result of patient's suicide. These findings have the potential to help establish a post‐suicide caring process where healthcare professionals learn to make better suicide assessments, become more open to talking about death with patients, and develop a humbler approach to understanding a patient's suicide.     

Schizophrenia in primary care

Schizophrenia affects 1 percent of the general population in the United States. Unfortunately, this common illness is often poorly understood and feared by many health care professionals. Whether nurse practitioners who work in primary care are aware of it or not, they inevitably come into daily or weekly contact with schizophrenics. This article is designed to increase nurse practitioners' understanding of this brain disease and help them realize that they already possess skills that are ideally suited to working with this population. Presented here are current definitions and facts about schizophrenia, as well as practical ideas for history taking, physical exam and the development of a realistic management plan.     

Urolithiasis in primary care

Urolithiasis is a common, multifactorial, medically manageable disease. Primary care physicians can play a prominent role in metabolic evaluation and medical treatment of patients with urolithiasis. Patients should be referred for urologic evaluation in the presence of intractable urinary tract infection, progressive renal damage, urinary obstruction, refractory pain, or presence of stones of uncertain etiology. Expectant management of symptomatic ureteral stones can be undertaken by a primary care physician in conjunction with urologic support. Interventional treatment of urinary stones has improved markedly with the availability of extracorporeal shock-wave lithotripsy, and percutaneous stone removal. In patients with certain types of urinary stones, medical treatment can greatly reduce the incidence of subsequent stone-forming episodes.     

Resuscitation in primary care

The Resuscitation Council (UK) in its publication Cardiopulmonary Resuscitation--Guidance for Clinical Practice and Training in Primary Care (2001) has made recommendations for the provision of resuscitation and training in the primary care setting. This article aims to provide an overview of these recommendations.     

Providing Complementary and Alternative Medicine in primary care: the primary care workers' perspective

BACKGROUND: The use of Complementary and Alternative Medicine (CAM) in primary care is growing, but still not widespread. Little is known about how CAM can/should be integrated into mainstream care. OBJECTIVES: To assess primary care health professionals' perceptions of need and of some ways to integrate CAM in primary care. METHOD: Questionnaire survey of primary health care workers in Northwest London. General Practitioners (GPs) were targeted in a postal survey, other members of the primary care team, such as district and practice nurses, were targeted via colleagues. The questionnaire assessed health care professionals' perspective on complementary medicine, referrals, ways to integrate complementary medicine into primary care and interest in research on CAM. RESULTS: Responses were obtained from 149 GPs (40% response rate after one reminder) and 24 nurses and 32 other primary care team members. One hundred and seventy-one (83%) respondents had previously referred (or influenced referral) for CAM treatments, the main reasons cited were: patients request (68%), conventional treatments failed (58%) and evidence (36%) (more than one reason could be given). Acupuncture and homoeopathy were the therapies for which patients were most frequently referred, followed by manual therapies. There was a significant interest in more training/information on CAM (66%). Only 12 respondents (6%) were against any integration of CAM in mainstream primary care. Most respondents felt that CAM therapies should be provided by doctors (66%) or other health professionals trained in CAM (82%). Twenty-six percent of respondents agreed with provision of CAM by non-state-registered practitioners. It was felt that the integration of CAM could lead to cost savings (70%), particularly in conditions involving pain, but also cost increases (55%) particularly in 'poorly defined conditions'. Fifty-six percent of respondents would consider participating in studies investigating CAM. The greatest interest was in acupuncture (41% of those who expressed an interest in research), homoeopathy (30%) and therapeutic massage/aromatherapy (26%). CONCLUSIONS: There is considerable interest in CAM among primary care professionals, and many are already referring or suggesting referral. Such referrals are driven mainly by patient demand and by dissatisfaction with the results of conventional medicine. Most of our respondents were in favour of integrating at least some types of CAM in mainstream primary care. There is an urgent need to further educate/inform primary care health professionals about CAM.     

Intermediate care in a primary care trust

Improving the quality of care for older people has been a key aim of the NHS for many years and is an important part of the NHS Plan (DoH 2000). The National Service Framework for Older People, published in 2001, made it clear that intermediate care processes are central to the provision of quality care to this sector of the population (DoH 2001). This article describes a service model of intermediate care in one primary care trust, outlining the processes and challenges encountered in establishing this multidisciplinary cross-agency initiative.     

Exercise and pregnancy in primary care

An increasing number of women exercise throughout pregnancy. New evidence illustrates that moderate intensity exercise in healthy pregnant women, with certain considerations, does not increase adverse pregnancy risks. Exercise during pregnancy may actually decrease pregnancy-associated discomforts and improve maternal fitness and well-being. By following the American College of Obstetricians and Gynecologists recommendations, clinicians can confidently prescribe exercise to women during preconception, pregnancy, and the postpartum period.