Aspectos bioéticos de la adecuación del esfuerzo terapéutico en el final de la vidaun estudio empírico en profesionales sanitarios de las Islas Baleares

Abstract

Introduction: New ethical dilemmas have emerged from the new technologies and current advanced life support care that allow different vital functions to be artificially sustained, forcing the health professional to rethink the limits of therapeutic effort. This explosion made it evident that new technological advances, used inappropriately, may not save lives, but transform death into a miserable, undignified and prolonged process. The actions of not initiating, withdrawing or maintaining therapeutic measures are complex for healthcare professionals and their actions must be based on prudent, informed reflection, discussed and shared by the team. Objectives: To analyse the attitudes of healthcare professionals in the Balearic Islands in relation to basic end-of-life care and the adequacy of therapeutic effort. Methodology: A descriptive, quantitative, cross-sectional study was carried out on nurses and doctors from different care services in the Balearic Islands involved in the care of terminally ill patients in order to observe whether their experiences, beliefs and values influence their clinical actions. It was carried out by means of a questionnaire grouped into 4 themes: basic care at the end of life and the adequacy of therapeutic effort, care of the terminally ill patient, the Bugen scale for coping with death and the scale of attitudes towards palliative care. Results: The study was conducted from March to May 2022. A total sample of 456 healthcare professionals who signed an informed consent form was obtained. The care most considered basic were: pain relief medication, body hygiene and mouth care. Less than half considered they had the knowledge and skills to care for patients and their families in the dying process. Believing healthcare professionals were less likely than non-believing healthcare professionals to remove a nasogastric tube to nourish a terminally ill patient (p=0,009), more likely to consider physical, psychological and spiritual aspects of pain management (p=0,025), more likely to report advance directives (p=0,011) and more likely to consult with them (p=0,02). Male health professionals considered postural changes (p=0.038), bladder catheterisation (p<0.001), nasogastric catheterisation (p=0.001), serum therapy (p<0.001) and wound care (p<0.001) as basic end-of-life care to a greater extent. Serum therapy (p=0.041) and enteral nutrition (p=0.037) were more often indicated by female professionals as disproportionate measures in a terminally ill patient. Hospital (HA) and primary care (PC) health professionals had similar considerations about the care considered basic at the end of life and the appropriateness of the therapeutic effort. Higher percentages of HA professionals indicated treating the patient's symptoms correctly, taking cultural aspects into account and offering access to spiritual guidance. They reported having more resources to provide palliative care (p=0.007) and less distress in various palliative situations (p<0.001). Statistically significant differences were found in nurses and physicians when rating most basic end-of-life care. Nurses stated that VA is not known or consulted and pain is not effectively assessed and treated. Physicians reported better coping with death (p=0.012). Healthcare professionals with less work experience indicated less ability to care for patients in the dying process and had poorer coping with death. Those with more experience had more positive attitudes towards palliative care. Conclusions: The appropriateness of the therapeutic effort is justified by bioethics and based on the principle of non-maleficence. In order to promote proper care for the terminally ill patient and palliative care, it is necessary to promote knowledge of ethics, communication skills and deliberative processes. One of the greatest challenges that healthcare professionals will have to face will be end-of-life accompaniment and the provision of quality palliative care, which is why training in ethics, communication of bad news and deliberative processes will facilitate decision-making and ensure quality care.