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Objectives: The aim of this study was to translate, culturally adapt, and psychometrically evaluate the Brazilian version of the "End-of-Life Professional Caregiver Survey" (BR-EPCS). Method: This is an observational cross-sectional study. The sample was composed of 285 Brazilian healthcare professionals who work or worked in the palliative care area. A minimum number of 280 participants were established, following the recommendation of 10 subjects for each instrument item. The European Organisation for Research and Treatment of Cancer — Quality of Life Group Translation Procedure protocol was used for the translation and the cultural adaptation. For the precise/reliable evaluation of factors measured by the BR-EPCS, Cronbach's alpha (α) and composite reliability coefficients were used. The factorial analyses were made by means of the exploratory structural equation modeling methods and confirmatory factor analysis. We have conducted a multiple linear regression analysis to evaluate the sociodemographic variables' capabilities in the result prediction measured by BR-EPCS factors. Results: The factorial analysis showed the relevance of two factors: Factor 1 — "Given care effectiveness" (18 items; Cronbach's α = 0.94; Composite Reliability = 0.95) and Factor 2 — "Mourning and ethical and cultural values" (10 items; Cronbach's α = 0.89; Composite Reliability = 0.88). Multiple linear regression analyses revealed that the working time, sex, palliative care training, and its own advance directives are predictors of the constructs assessed by the BR-EPCS. Significance of results: The BR-EPCS is a reliable, valid, and culturally appropriate tool to identify the educational needs of healthcare professionals who work with palliative care. This instrument can be used for educational and research reasons. [ABSTRACT FROM AUTHOR]

Objective: Many cancer centers struggle to implement standardized distress screening despite the American College of Surgeons' Commission on Cancer 2012 mandate for a distress screening program standard of care by 2015. This paper presents outcomes for the first cohort of participants (n = 36) of a Screening for Psychosocial Distress Program (SPDP), a 2-year training program designed to assist clinicians in implementing routine distress screening as mandated by the American College of Surgeons Commission on Cancer. Specifically, participants' success with distress screening implementation, institutional barriers and facilitators to implementation, and the role of the SPDP are described.Method: This research followed a longitudinal pre- and posttest mixed methods design. An investigator-developed questionnaire collected qualitative (distress screening goals, institutional barriers and facilitators, facilitators associated with participation in the SPDP) and quantitative (level of goal achievement) data at 6, 12, and 24 months of participation in the SPDP. Conventional content analysis was applied to qualitative data. Mixed methods data analysis in Dedoose evaluated (1) types and number of distress screening goals, barriers, and facilitators, and (2) goal achievement at 6, 12, and 24 months of participation.ResultNinety-five percent of distress screening implementation goals were completed after 2 years of participation. Most common institutional barriers to distress screening implementation were "lack of staff," "competing demands," and "staff turn-over." Most common institutional facilitators were "buy-in," "institutional support," and "recognition of participants' expertise." The number of reported facilitators associated with SPDP participation was higher than the number associated with any institutional factor, and increased over time of participation.Significance of resultsParticipating in training programs to implement distress screening may facilitate successful achievement of the Commission on Cancer's distress screening standard, and benefits seem to increase with time of participation. Training programs are needed to promote facilitators and overcome barriers to distress screening. [ABSTRACT FROM AUTHOR]

Aim: To develop and validate learning domains, competencies, and evaluation tool for graduate‐level experiential nursing global health programs. Background: Standard competencies have not been synthesized and delineated nor have evaluation tools been developed for global health programs at the graduate level. Design: A combination of a documentary literature review and expert consensus panel to validate results was used as a design for this study. Methods: The NLM and CINAHL databases were searched for articles published between 2007 – 2017 relevant to graduate‐level global health nursing programs. Data were extracted and coded, from which themes regarding learning domains, competencies and evaluation items were derived. We then used a three‐step expert panel to refine and form a statistical representation (>0.78 agreement on importance, relevance and clarity) of the learning domains, competencies, and evaluation items. Results: Relevant articles (N = 26) were included for the documentary review, 18 concerning learning domains of global health immersion programs and eight concerning interdisciplinary global health competencies specific to nursing. These learning relationships were then formatted into a table subdivided between learning categories for expert panel consensus. After expert panel review, a compendium of learning domains, competencies, and evaluation items resulted. Conclusion: Global health clinical learning practicums are essential for graduate‐level preparation of nurses. Learning domains, competencies, and evaluation tools need to be adopted and empirically tested by international and national nursing associations. The results of this study need further testing to aid these associations. [ABSTRACT FROM AUTHOR]

This article explores the ethical issues that arise when patients' and families' religious beliefs collide with clinicians' views of appropriate end-of-life decisions. The article begins with a case study drawn from clinical experience that focuses on the need for a surrogate decision maker for a deeply religious patient in the intensive care unit with life-limiting cancer. The patient's adult children, also religious, against the health care team's clinical advice, want all life-extending measures taken as they await a divine miracle. The conflict between the family and the health care team points to (1) the ethical issues of patients' and families' status of vulnerability and the health care team's necessary moral response to this status; (2) the moral obligation of the health care team to show their trustworthiness to the family by showing the family the team's competence, honesty, and reliability; and (3) the moral obligations of the health care team to provide the patient and family spiritual support. [ABSTRACT FROM AUTHOR]