Necessidades dos familiares de doentes terminais em cuidados paliativos: Revisão crítica da literatura

Terminal illness and death are critical events that interfere in the family system. The knowledge about illness and death’s impact on the family is, still, scarce. Therefore, a critical review of literature was conducted with the general goal of determining the impact of terminal illness on the family and which are the family’s support needs. The findings suggest that terminal illness is one of the most difficult experiences for the family system and an inadequate or non-existent approach to the family’s problems can put that system in risk. Therefore, palliative care aims at the integration of the family in the care plan. However, the empirical production about this topic is insufficient, which compromises the development of new efficient family approaches that are sensitive to family needs. By this way, it is important to have more research that aims to determine the family needs of terminally ill patients and develop new family intervention strategies.A doença terminal e a morte são acontecimentos críticos que interferem no sistema familiar. Considerando a escassez de literatura sobre o assunto, procedeu-se a uma revisão crítica da literatura, com o objetivo geral de determinar o impacto que a doença terminal tem na família e quais as suas necessidades de suporte. Concluiu-se que a doença terminal constitui uma das experiências mais difíceis para o sistema familiar e que uma abordagem formal inadequada dos problemas emergentes o pode colocar em risco. Por isto, os cuidados paliativos visam a integração da família no plano de cuidados. Todavia, verificou-se que a produção empírica neste âmbito é insuficiente, comprometendo o desenvolvimento de modalidades de intervenção eficazes e sensíveis às necessidades que emergem na família. Urge desenvolver mais estudos que visem determinar as necessidades das famílias do doente terminal e desenvolver estratégias de intervenção dirigidas a essas mesmas famílias

Cuidados paliativos oncológicos em contexto de internamento e domiciliário: Necessidades, morbilidade psicológica e luto antecipatório nos familiares do doente terminal e impacto na qualidade de vida familiar

Terminal cancer has a profound impact on family and its’ elements. Therefore, palliative care foresees a family support. However, there are not many studies that aim to determine the family needs within palliative care. The present study aims to determine family needs, psychological morbidity and anticipatory grief of terminal patients’ relatives, distinguishing two care contexts (hospice and home care), and examine the influence of unmet needs, anticipatory grief, psychological morbidity and care setting on the perceived family quality of life. For such, an exploratory study was conducted with a sample of 40 terminal cancer patients’ relatives in palliative care. It was found that psychosocial needs are lesser satisfied in home-based palliative care. Regardless the context of care, patients’ relatives report clinically significant levels of psychological morbidity and anticipatory grief with impact on family perceived quality of life. Unmet needs, psychological morbidity and anticipatory grief seem to influence on the perceived family quality of life. This study demonstrates the importance of attending patients’ relatives in palliative care, in a holistic and multidisciplinary approach.A doença oncológica na fase terminal tem um importante impacto na família e seus elementos. Por este motivo, os cuidados paliativos pressupõem o suporte à família. No entanto, são escassos os estudos que visam determinar as necessidades das famílias em cuidados paliativos. O presente estudo teve como objetivos determinar quais as necessidades dos familiares dos doentes terminais, a presença de morbilidade psicológica e experiência de luto antecipatório, distinguindo dois contextos de prestação de cuidados (internamento e domicílio), e examinar a influência de uma satisfação inadequada das necessidades, luto antecipatório e contexto de prestação de cuidados na perceção de qualidade de vida familiar. Para tal, procedeu-se a um estudo exploratório junto de uma amostra de 40 familiares de doentes oncológicos terminais em cuidados paliativos. Verificou-se que as necessidades de suporte psicossocial são menos satisfeitas em contexto de cuidados domiciliários. Independentemente do contexto de prestação de cuidados, os familiares apresentam níveis clinicamente significativos de morbilidade psicológica e luto antecipatório com impacto na perceção da qualidade de vida familiar. A satisfação inadequada das necessidades, a presença de morbilidade psicológica e a experiência de luto antecipatório influenciam a perceção de qualidade de vida familiar. Este estudo vem demonstrar a importância de atender às necessidades dos familiares em cuidados paliativos, numa perspetiva holística e multidisciplinar

Territorial risk management in the adaptation to climate change

A atual emergência climática exige não só a implementação de ações de mitigação, bem como o reforço urgente de estratégias de adaptação nos territórios particularmente vulneráveis às consequências das mudanças dos padrões climáticos. Considerando o seu caráter sistémico, advoga-se que os modelos de gestão de riscos podem contribuir significativamente no sucesso dos processos de adaptação. Assim, e tendo por base os modelos de gestão do risco, salientam-se os objetivos fundamentais para a consolidação das ações de adaptação às alterações climáticas. Com base nestes, sugere-se um modelo territorial de gestão do risco baseado em dez questões principais, no contexto das alterações climáticas, para o território Português, que consiste em quatro espaços-risco com características específicas para planeamento, aplicação e monitorização das ações de adaptação.The current climate emergency requires not only the implementation of mitigation actions, but also the urgent strengthening of the adaptation strategies in territories that are particularly vulnerable to the consequences of the changes in climate patterns. Considering their systemic character, it is argued that risk management models can significantly contribute to the success of the adaptation processes to climate change. Therefore, and based on risk management models, the fundamental objectives for the consolidation of adaptation actions towards climate change are stressed. Based on ten key-questions, a territorial risk management model is suggested, for the Portuguese territory, which consists of four risk spaces with specific characteristics for planning, implementing and monitoring actions to adapt to climate change

Environment Actors Confronting a Post Climate-Related Disaster Scenario: A Feasibility Study of an Action-Based Intervention Aiming to Promote Climate Action

(1) A climate change awareness-action gap still prevails in our society, with individuals showing significant social inertia regarding environmental issues. The communication on climate change is pointed out as one of the causes of the social inertia; (2) Following an action-oriented transformation research, the main goal of this study was to ascertain the feasibility of an action-based communication intervention, based on the participants' exposure to a post climate-related disaster scenario. The feasibility of the action-based communication intervention was assessed in a focus group meeting, whose content was qualitatively analysed; (3) The results of this study demonstrate that action-based communication interventions are feasible to trigger an attitude transformation, catalysed by the experiential processing of climate change and by the affect arousal; (4) This study comes to contribute to a transformation of the climate change communication praxis, by highlighting the urgency to shift the for a new paradigm of communicating climate change, in which the affect and the experiential processing should account for conveying environment-related information in order to promote society's climate action

Social engagement in coastal adaptation processes: Development and validation of the CoastADAPT scale

Introduction: Engaging citizens and communities is considered a central element and a good practice in coastal management. However, individuals still demonstrate a general disengagement with coastal risks. To understand the factors that underlie the citizens’ engagement in coastal risks processes and to implement evidence-based strategies aimed at enhancing public participation in coastal management, is pivotal to the success of coastal adaptation. Goals: Therefore, this study sought to develop and validate an assessment tool aiming at measuring individuals’ engagement in coastal adaptation processes and their underlying factors. Methods: A cross-sectional and 2-phase research was implemented to analyze the psychometric properties of the CoastADAPT scale. The Phase 1 study (N = 491) determined the CoastADAPT scale’s factorial structure, through Exploratory Factor Analysis; its reliability, through internal consistency and test-retest reliability; and construct validity, through convergent and divergent validity. The Phase 2 study (N = 207) confirmed the CoastADAPT scale’s factorial structure, through Confirmatory Factor Analysis. Results: Analyses indicated that the CoastADAPT scale showed good psychometric properties and a 3-factor structure consisting of the following domains: Experiential Processing (Affective component), Risk Awareness (Cognitive component) and Environmental Justice (Social value orientation component). Conclusions: The CoastADAPT scale is a reliable and valid measure of citizens’ engagement in coastal risk adaptation processes. It may be a useful tool to facilitate the development of strategies to overcome individuals’ disengagement with coastal management and to provide a deeper understanding of the predictors of individuals’ engagement in coastal risk processes

Psychological morbidity in family caregivers of people living with terminal cancer: Prevalence and predictors

Objective. The issues surrounding a patient's terminal phase of cancer and the imminent death of the individual represent a major family crisis affecting all its members. The goal of this study was to assess the prevalence of psychological morbidity in family caregivers of persons with terminal cancer in terms of psychological distress, depression, anxiety, somatization, and complicated anticipatory grief, and to determine which factors may influence these responses. Method. One hundred and twelve family caregivers of individuals with terminal cancer completed an assessment protocol comprising the Brief Symptom Inventory (depression, anxiety, somatization, and a computed score for global distress), the Marwit-Meuser Caregiver Grief Inventory - Short Form (anticipatory grief), the Family Inventory of Needs (importance and satisfaction of needs), and the Systemic Clinical Outcome Routine Evaluation -15 (family functioning). Prevalence of psychological morbidity was determined through descriptive and frequency statistics. Predictors of psychological morbidity were ascertained through structural equation modelling methods. Result. Regarding the prevalence of psychological morbidity in family caregivers, 66.1% reported high levels of distress, 68.8% showed high risk of depression, 72.3% showed high risk of anxiety, 50.9% reported high levels of somatization, and 25.9% showed high risk of complicated anticipatory grief. It was found that the predictors of age, gender, relationship to the family member with terminal cancer, the caregiving role played (i.e., primary vs. nonprimary), the satisfaction of needs by healthcare professionals, and family functioning play an important role in terms of one’s risk of developing psychological morbidity. Significance of results. This study revealed an alarming prevalence of psychological morbidity in family caregivers of individuals living with terminal cancer, making it crucial to move forward from a patient-centered approach to a family-centrad approach to reduce the risk of family maladjustment when facing the imminent death of a family member and to prevent postdeath unadjusted responses

The European Media Portrayal of Climate Change: Implications for the Social Mobilization towards Climate Action

Beyond other social actors, such as policymakers and scholars, common citizens are also expected to actively engage with climate change, by adopting sustainable actions and supporting environmental policies. However, and despite the actual growing of environment-related social movements, a kind of inertia still prevails in the social climate of our society. The media should play a key role in promoting, among common individuals, the adoption of new and more sustainable practices. However, it is argued that the media seems to be failing to effectively address the climate crisis. As such, this study aims to identify the main weaknesses of climate change media communication to further discuss possible opportunities of communication improvements. For that, 1609 news articles published between 2017 and 2018 in five European countries were analyzed in-depth, through quantitative content analysis. The news’ general characteristics, specifically reported themes, and the specificities of actors’ discourses were taken into account for the analysis. It was verified that the European media tends to report climate change by using distant (e.g., future-focused) and outcome (e.g., threatening messages) framings, based on non-resilient, scientific, and political narratives, whilst overlooking the role of civil society on adapting to climate change. These results demonstrate that instead of promoting society’s climate action, the media may be contributing to a widespread social apathy about the climate and the disengagement of individuals regarding environment-related matters. Evidence-based forms of improving the media’s communication on climate change will be further discussed