Francisca Rego | Faculdade de Medicina da Universidade do Porto (original) (raw)
Papers by Francisca Rego
Palliative and Supportive Care
ObjectiveDignity therapy (DT) is a kind of psychotherapy that identifies the main concerns of end... more ObjectiveDignity therapy (DT) is a kind of psychotherapy that identifies the main concerns of end-of-life patients that affect their perception of dignity and helps them to find a new meaning in life. Most prior studies on DT analyze outcomes for palliative care patients. The aim of this systematic review is to explore the outcomes of DT in palliative care patients’ family members.MethodIn June 2020, a bibliographic search was performed using the terms “Dignity Therapy” and “Palliative Care” in the following databases: Cochrane library, TRIP database, PUBMED, Scopus, and Web of Knowledge. Of the 294 articles found, 8 met the selection criteria and were considered in the present study. No articles were excluded based on their publication date.ResultsFamily members generally believe that DT helps them to better prepare the patient's end-of-life and overcome the bereavement phase. The legacy document was considered a source of comfort, and most would recommend DT to other people in...
Background. Advance care planning (ACP) and goals of care discussions involve the exploration of ... more Background. Advance care planning (ACP) and goals of care discussions involve the exploration of what is most important to a person to prepare for health-care decision-making. Despite their well-established benefits, they are still not frequently performed in clinical oncology practice. The awareness of physicians’ barriers enables the development of tailored interventions to improve professional practice. Considering the scarcity of studies about the difficulties of medical residents in discussing goals of care, this study aims to determine, from the perspective of medical residents, the barriers to the discussion goals of care and ACP with patients with cancer. Methods. A previously published survey (Decide-Oncology) to assess barriers to goals of care discussion among health care providers was adapted to Portuguese language and distributed to Brazilian medical residents from three hospitals in Brazil in a cross-sectional pilot study. Residents were asked to rank the importance of...
Annals of Palliative Medicine
The literature about the factors associated with cancer treatment refusal, especially by the olde... more The literature about the factors associated with cancer treatment refusal, especially by the older patients is scarce. Therefore, this study aimed to identify predictive factors associated with treatment refusal by older patients with cancer. A systematic review was conducted using three databases, Medline, Web of Science, and Scopus with the key concepts, "refusal treatment" and "cancer" and "decision making" and "elderly" or "aged". The search took place in July 2020 and it included articles published in the last 5 years. Of the 211 articles found, 22 were included in the review. Most studies have focused on head and neck and breast cancer treatment decisions and used a quantitative design. The majority of studies evaluated refusal of surgery interventions. Important factors associated with refusal cancer treatment include gender, marital status, race, having government insurance, advanced cancer, poor performance status (cancer stage III or IV) and Charlson Comorbidity Index ≥2. Thus, there are socio-demographic and clinical variables associated with treatment refusal. More studies with the elderly are needed. Understanding these factors may be useful to recognize situations where active education and support can help elderly patients accept optimal care.
Annals of Palliative Medicine
Moral agency is a prerequisite for a full autonomous decision, meaning that the agents have the i... more Moral agency is a prerequisite for a full autonomous decision, meaning that the agents have the intrinsic capacity to understand their actions and to be accountable for the consequences of these actions. Palliative care patients have the moral right to build their capacity to decide, so that they are truly empowered to make choices. However, moral and spiritual distress are common at the end-of-life, which may arise if there is a threat to the individual's integrity and disruption of one's belief system, consequently leading to the deterioration of the patient's moral agency. The aim of this paper is to determine if spirituality may be an important tool for the empowerment of palliative care patients and if moral agency can be enhanced by a diligent spiritual advocate. Spiritual awareness, self-knowledge, and specific training are key elements for the spiritual advocate to address patients' spiritual needs and distress in a neutral and non-directive way, to promote autonomy, well-being, and quality of life. Thus, patients' dignity and right for self-determination are respected, thereby supporting empowerment, reducing suffering, respecting patients' individuality, and engaging moral agency. Palliative care patients should be able to fully exercise their autonomy. This strategy might be very appealing for adequate advance care planning, whatever the choices of the patient, as well as to prevent distress, hopelessness, and the lack of meaning that many terminal patients experience.
Health and Quality of Life Outcomes
Background: Forgiveness is linked with well-being, and social and health research has focused on ... more Background: Forgiveness is linked with well-being, and social and health research has focused on the role and aspects of forgiveness that has been recently suggested as a phenomenon of public health importance. The Heartland Forgiveness Scale (HFS) was developed gathering three subscales to assess the forgiveness of others, forgiveness of self, and forgiveness of situation. The present study aimed to adapt the HFS into European Portuguese, and investigate its reliability and validity. Methods: Translation and cross-cultural adaptation were conducted using a multistep forward-back translation process. Internal consistency was assessed by Cronbach's alpha. Confirmatory factor analysis was conducted to verify that the factor structure is the same as in the original HFS. The short version of the Ruminative Response Scale (RRS) and the Satisfaction with Life Scale (SWLS) were used to examine convergent validity. Results: A sample of 222 university students, selected through convenience sampling, was used to access the validity of the European Portuguese version of the HFS (EPHFS). Cronbach's alpha for the European Portuguese HFS subscales were 0.777, 0.814 and 0.816 for Self, Others and Situation, respectively, indicating acceptable reliability. The 3-factor model of the original HFS was replicated in confirmatory factor analysis. As expected by evidence in the literature, positive and statistically significant correlations were found between SWLS and HFS and subscales. RRS showed negative and statistically significant correlations with HFS and subscales. Conclusions: The European Portuguese version of the HFS presented acceptable internal consistency, construct validity and confirmed the three-factor structure of the original HFS.
Neuropsychiatry
Objective: To study the relationship between the psychological and spiritual dimensions in adult ... more Objective: To study the relationship between the psychological and spiritual dimensions in adult palliative care. Methods: The data sources used were Medline, Web of Knowledge and Scopus, using the following key concepts: "palliative care" and "psychology" and "spirituality". The search took place 5th December 2017, at 10:20 am, and no articles were excluded based on publication date. Out of a total of 1038 articles found, 65 met the pre-selected criteria and were included in the descriptive qualitative synthesis. Results: Some lack of definitional consensus of spirituality is still evident. Nevertheless, spiritual wellbeing was considered an important component of quality of life, closely related to physical and psychological distress symptoms, therefore highlighting the importance of psychological and psychiatric care in enhancing the wellbeing of palliative care patients. Conclusion: Understanding the interface of the psychological and spiritual dimensions of adult palliative care patients may contribute to a more efficient therapeutic practice. Therefore, training healthcare professionals to improve spiritual support and appropriately addressing these issues should be of great importance in palliative care settings, thus promoting an appropriate response to the patients' needs and dying process.
Death studies, Jan 6, 2018
This study aimed to understand, through the bias of everyday life, the phenomenon of maternal mou... more This study aimed to understand, through the bias of everyday life, the phenomenon of maternal mourning. It is a qualitative pilot study on three bereaved mothers. Semi-structured interviews were used for data collection and content analysis was performed using typical categories of daily life. It was possible to observe significant changes in the mothers' daily lives after their children's deaths; however, they created strategies that minimized such impacts. Losing a child leads to reconstructing one's own history and identity. It is believed that daily life is an important bias, and thus its study could help us understand this phenomenon.
Journal of Palliative Care & Medicine, 2016
BMC Palliative Care
Background Decision-making in palliative care can be complex due to the uncertain prognosis and g... more Background Decision-making in palliative care can be complex due to the uncertain prognosis and general fear surrounding decisions. Decision-making in palliative care may be influenced by spiritual and cultural beliefs or values. Determinants of the decision-making process are not completely understood, and spirituality is essential for coping with illness. Thus, this study aims to explore the influence of spirituality on the perception of healthcare decision-making in palliative care outpatients. Methods A cross-sectional study was developed. A battery of tests was administered to 95 palliative outpatients, namely: sociodemographic questionnaire (SQ), Decisional Conflict Scale (DCS), Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being scale (FACIT-Sp), and a semi-structured interview (SSI) to study one’s perception of spirituality and autonomy in decision-making. Statistical analyses involved descriptive statistics for SQ and SSI. The Mann-Whitney test was used to...
Palliative and Supportive Care
ObjectiveDignity therapy (DT) is a kind of psychotherapy that identifies the main concerns of end... more ObjectiveDignity therapy (DT) is a kind of psychotherapy that identifies the main concerns of end-of-life patients that affect their perception of dignity and helps them to find a new meaning in life. Most prior studies on DT analyze outcomes for palliative care patients. The aim of this systematic review is to explore the outcomes of DT in palliative care patients’ family members.MethodIn June 2020, a bibliographic search was performed using the terms “Dignity Therapy” and “Palliative Care” in the following databases: Cochrane library, TRIP database, PUBMED, Scopus, and Web of Knowledge. Of the 294 articles found, 8 met the selection criteria and were considered in the present study. No articles were excluded based on their publication date.ResultsFamily members generally believe that DT helps them to better prepare the patient's end-of-life and overcome the bereavement phase. The legacy document was considered a source of comfort, and most would recommend DT to other people in...
Background. Advance care planning (ACP) and goals of care discussions involve the exploration of ... more Background. Advance care planning (ACP) and goals of care discussions involve the exploration of what is most important to a person to prepare for health-care decision-making. Despite their well-established benefits, they are still not frequently performed in clinical oncology practice. The awareness of physicians’ barriers enables the development of tailored interventions to improve professional practice. Considering the scarcity of studies about the difficulties of medical residents in discussing goals of care, this study aims to determine, from the perspective of medical residents, the barriers to the discussion goals of care and ACP with patients with cancer. Methods. A previously published survey (Decide-Oncology) to assess barriers to goals of care discussion among health care providers was adapted to Portuguese language and distributed to Brazilian medical residents from three hospitals in Brazil in a cross-sectional pilot study. Residents were asked to rank the importance of...
Annals of Palliative Medicine
The literature about the factors associated with cancer treatment refusal, especially by the olde... more The literature about the factors associated with cancer treatment refusal, especially by the older patients is scarce. Therefore, this study aimed to identify predictive factors associated with treatment refusal by older patients with cancer. A systematic review was conducted using three databases, Medline, Web of Science, and Scopus with the key concepts, "refusal treatment" and "cancer" and "decision making" and "elderly" or "aged". The search took place in July 2020 and it included articles published in the last 5 years. Of the 211 articles found, 22 were included in the review. Most studies have focused on head and neck and breast cancer treatment decisions and used a quantitative design. The majority of studies evaluated refusal of surgery interventions. Important factors associated with refusal cancer treatment include gender, marital status, race, having government insurance, advanced cancer, poor performance status (cancer stage III or IV) and Charlson Comorbidity Index ≥2. Thus, there are socio-demographic and clinical variables associated with treatment refusal. More studies with the elderly are needed. Understanding these factors may be useful to recognize situations where active education and support can help elderly patients accept optimal care.
Annals of Palliative Medicine
Moral agency is a prerequisite for a full autonomous decision, meaning that the agents have the i... more Moral agency is a prerequisite for a full autonomous decision, meaning that the agents have the intrinsic capacity to understand their actions and to be accountable for the consequences of these actions. Palliative care patients have the moral right to build their capacity to decide, so that they are truly empowered to make choices. However, moral and spiritual distress are common at the end-of-life, which may arise if there is a threat to the individual's integrity and disruption of one's belief system, consequently leading to the deterioration of the patient's moral agency. The aim of this paper is to determine if spirituality may be an important tool for the empowerment of palliative care patients and if moral agency can be enhanced by a diligent spiritual advocate. Spiritual awareness, self-knowledge, and specific training are key elements for the spiritual advocate to address patients' spiritual needs and distress in a neutral and non-directive way, to promote autonomy, well-being, and quality of life. Thus, patients' dignity and right for self-determination are respected, thereby supporting empowerment, reducing suffering, respecting patients' individuality, and engaging moral agency. Palliative care patients should be able to fully exercise their autonomy. This strategy might be very appealing for adequate advance care planning, whatever the choices of the patient, as well as to prevent distress, hopelessness, and the lack of meaning that many terminal patients experience.
Health and Quality of Life Outcomes
Background: Forgiveness is linked with well-being, and social and health research has focused on ... more Background: Forgiveness is linked with well-being, and social and health research has focused on the role and aspects of forgiveness that has been recently suggested as a phenomenon of public health importance. The Heartland Forgiveness Scale (HFS) was developed gathering three subscales to assess the forgiveness of others, forgiveness of self, and forgiveness of situation. The present study aimed to adapt the HFS into European Portuguese, and investigate its reliability and validity. Methods: Translation and cross-cultural adaptation were conducted using a multistep forward-back translation process. Internal consistency was assessed by Cronbach's alpha. Confirmatory factor analysis was conducted to verify that the factor structure is the same as in the original HFS. The short version of the Ruminative Response Scale (RRS) and the Satisfaction with Life Scale (SWLS) were used to examine convergent validity. Results: A sample of 222 university students, selected through convenience sampling, was used to access the validity of the European Portuguese version of the HFS (EPHFS). Cronbach's alpha for the European Portuguese HFS subscales were 0.777, 0.814 and 0.816 for Self, Others and Situation, respectively, indicating acceptable reliability. The 3-factor model of the original HFS was replicated in confirmatory factor analysis. As expected by evidence in the literature, positive and statistically significant correlations were found between SWLS and HFS and subscales. RRS showed negative and statistically significant correlations with HFS and subscales. Conclusions: The European Portuguese version of the HFS presented acceptable internal consistency, construct validity and confirmed the three-factor structure of the original HFS.
Neuropsychiatry
Objective: To study the relationship between the psychological and spiritual dimensions in adult ... more Objective: To study the relationship between the psychological and spiritual dimensions in adult palliative care. Methods: The data sources used were Medline, Web of Knowledge and Scopus, using the following key concepts: "palliative care" and "psychology" and "spirituality". The search took place 5th December 2017, at 10:20 am, and no articles were excluded based on publication date. Out of a total of 1038 articles found, 65 met the pre-selected criteria and were included in the descriptive qualitative synthesis. Results: Some lack of definitional consensus of spirituality is still evident. Nevertheless, spiritual wellbeing was considered an important component of quality of life, closely related to physical and psychological distress symptoms, therefore highlighting the importance of psychological and psychiatric care in enhancing the wellbeing of palliative care patients. Conclusion: Understanding the interface of the psychological and spiritual dimensions of adult palliative care patients may contribute to a more efficient therapeutic practice. Therefore, training healthcare professionals to improve spiritual support and appropriately addressing these issues should be of great importance in palliative care settings, thus promoting an appropriate response to the patients' needs and dying process.
Death studies, Jan 6, 2018
This study aimed to understand, through the bias of everyday life, the phenomenon of maternal mou... more This study aimed to understand, through the bias of everyday life, the phenomenon of maternal mourning. It is a qualitative pilot study on three bereaved mothers. Semi-structured interviews were used for data collection and content analysis was performed using typical categories of daily life. It was possible to observe significant changes in the mothers' daily lives after their children's deaths; however, they created strategies that minimized such impacts. Losing a child leads to reconstructing one's own history and identity. It is believed that daily life is an important bias, and thus its study could help us understand this phenomenon.
Journal of Palliative Care & Medicine, 2016
BMC Palliative Care
Background Decision-making in palliative care can be complex due to the uncertain prognosis and g... more Background Decision-making in palliative care can be complex due to the uncertain prognosis and general fear surrounding decisions. Decision-making in palliative care may be influenced by spiritual and cultural beliefs or values. Determinants of the decision-making process are not completely understood, and spirituality is essential for coping with illness. Thus, this study aims to explore the influence of spirituality on the perception of healthcare decision-making in palliative care outpatients. Methods A cross-sectional study was developed. A battery of tests was administered to 95 palliative outpatients, namely: sociodemographic questionnaire (SQ), Decisional Conflict Scale (DCS), Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being scale (FACIT-Sp), and a semi-structured interview (SSI) to study one’s perception of spirituality and autonomy in decision-making. Statistical analyses involved descriptive statistics for SQ and SSI. The Mann-Whitney test was used to...