Rui Nunes’s research while affiliated with University of Porto and other places

Due to social pressure and individual desire to have children, infertility is often accompanied by suffering and decreased quality of life. Among possible coping mechanisms, religion has been suggested to help improve quality of life. The objective of this study was to verify, in a cohort of Brazilian women undergoing infertility treatment, if there is a relationship between religiosity and quality of life. The sample consisted of 104 volunteer Brazilian women who sought infertility treatment. A FertiQoL and a Religiosity questionnaire were administered. Descriptive statistics were computed, and groups were compared using a Chi-square test. Most of the participants in the study stated that religiosity was associated with well-being, and 90% of them concluded that religiosity was an important process during infertility treatment. The study found that religiosity leads to improved adaptive coping capacity. Although it is difficult to demonstrate causality, results strongly suggest that religiosity plays an important role in adjusting the psychological aspects of infertile women.

Background The main goal of palliative care (PC) is to achieve the best possible quality of life for patients and families. Physical, emotional, social, and spiritual dimensions are intertwined and can contribute to the quality of life (QoL). The relief of physical symptoms, such as pain, with pharmacological approaches is very important. The non-pharmacological aspects are also essential, as part of the holistic care. We aimed to investigate the QoL, loneliness, forgiveness, gratitude and spiritual well-being in patients under PC, and to examine the correlation between QoL and these non-pharmacological aspects. Methods A cross-sectional study was conducted between April 2019 and May 2022 with a convenience sample of PC patients, hospitalized and outpatients in Porto, Portugal. Besides demographic and disease characteristics, the EORTC Quality of Life Questionnaire Core 15 for Palliative Care (QLQ-C15-PAL), Heartland Forgiveness Scale (HFS), Gratitude Questionnaire 6 (GQ-6), revised UCLA Loneliness Scale, and the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being (FACIT-Sp-12) were collected. The Spearman correlation coefficient assessed the correlation between quantitative variables. Univariate analysis and multiple regression analysis were performed. Results A total of 75 patients in PC, from 2 inpatient and 2 outpatient settings, were included. The median age was 73 years (range: 45–91 years); 57% were male; 58.7% were married, and 92% were Catholic. The majority (89%) had cancer. The multiple regression analysis revealed that regarding the prediction of overall QoL, meaning (p = 0.016), and emotional functioning (p = 0.001) were significant predictors of overall QoL. For the prediction of pain, peace (p = 0.013), fatigue (p = 0.023) and insomnia (p = 0.009) were predictors of pain. With regards to the prediction of emotional functioning, peace (p < 0.001), faith (p = 0.002), self-forgiveness (p = 0.029), forgiveness of situations (p = 0.032), and fatigue (p < 0.001) were significant predictors of emotional functioning. Conclusion PC patients may consider as relevant for QoL some factors that are not included in the majority of QoL questionnaires. The most commonly used QoL instruments do not include existential questions, but these factors may be important domains in QoL at end of life, particularly issues of meaning and peace.

Background The finitude of life presents various bioethical challenges, especially when palliative care is the therapeutic option. The hospital environment for palliative care has ethical peculiarities that need to be better understood, since the literature presents research that is commonly carried out at home. Objectives This study aims to investigate the fundamental bioethical perspectives for hospital palliative care and to compare these perspectives with those existing in home care. Methods A systematic review of the literature was conducted between March and April 2024. This included observational studies that addressed bioethical perspectives in hospital palliative care. No restrictions were placed on the date of publication or language of the article. This review excluded editorials, intervention studies and articles developed in a home environment. Results Seven databases and other sources were searched, and 3976 articles were found. Eight studies were selected for qualitative synthesis. A paired review was conducted at all stages. The results indicated that respect for cultural beliefs and values, effective communication and empathy were the most significant bioethical perspectives for hospital palliative care, among the nine other ethical aspects present in the studies. The comparison with bioethical perspectives in the home environment highlighted differences such as privacy and autonomy in the patient’s home. Conclusions The conclusion allows us to understand that aspects of caring for the person and understanding the illness should be the focus of bioethics in hospital palliative care.

Introduction: Cancer patients in palliative care frequently experience psychological distress, encompassing cognitive, behavioral, and emotional dimensions. This distress can significantly affect their capacity to accept the inevitability of death. Commonly, such distress manifests as sadness, depression, anxiety, and fear, which may culminate in an existential crisis. Objectives: The purpose of this study was to analyze the psychometric properties of the Edmonton Symptom Assessment System (ESAS) and the Palliative Outcome Scale (POS) among hospitalized cancer patients receiving palliative care in a Portuguese palliative care unit. Methods: Data were collected from psychological screening instruments (ESAS and POS) used in oncology patients admitted to an oncology palliative service. The study period spanned from January 2021 to March 2021. Results: The study included a convenience sample of 60 patients diagnosed with advanced cancer who were sequentially admitted to a palliative care unit. The most frequently reported primary oncological diagnoses were gastrointestinal (41.7%) and head/neck (20%) tumors. The majority of the patients were male (n = 37; 61.7%), with a median age of 72 years (range: 43–94 years). Key findings from the analysis indicated the following associations: anxiety and self-reported symptoms (higher levels of patient anxiety related to illness or treatment were strongly correlated with increased self-reported anxiety (p < 0.01)); emotional sharing and perceived meaning of life (patients who shared their feelings less frequently with family and friends were significantly less likely to find meaning in life (p < 0.01) and were more likely to report a poorer self-perception (p < 0.05)); understanding the importance of life and self-perception (a diminished understanding of the importance of life was associated with worsened self-perception (p < 0.01)); anxiety and depressive symptoms (greater anxiety related to the disease or its treatment correlated with an increased severity of depressive symptoms (p < 0.01)). Discussion and conclusion: There are numerous validated instruments available for measuring emotional distress. Among these, the ESAS and POS complement each other as practical and easy-to-use tools for evaluating emotional distress in patients admitted to palliative care settings. Findings revealed that anxiety and concerns related to the disease and its treatment, as measured by the POS, served as predictors of the risk for self-reported anxiety and depression identified by the ESAS. Furthermore, the items within the POS that evaluate the emotional component demonstrated strong internal correlation, supporting their combined use for a comprehensive assessment of this dimension.

Infertile couples face barriers in access to specialized medical care, leading to a movement that seeks equality in access to infertility treatments. Identifying the ethical issues involved and understanding how discussions about justice occur in the provision of medical infertility treatment is important. A literature review was conducted using the Web of Science, PubMed, and Google Scholar databases. In general, articles showed that most countries do not meet ethical requirements of distributive justice. Articles pointed to barriers to access and resistance that exists in accepting infertility as a health problem. They also demonstrated the suffering caused by infertility and the urgency of putting ethical concepts into practice so that solutions may be adopted. In conclusion, an ethical debate that achieves provision of well-being for all can improve health and the feeling of justice on the part of health professionals and policy makers.

Resumo Casais inférteis enfrentam barreiras no acesso a cuidados médicos especializados, levando a um movimento que busca a igualdade no acesso a tratamentos de infertilidade. Identificar as questões éticas envolvidas e entender como ocorrem as discussões sobre justiça na prestação de tratamento médico de infertilidade é importante. Uma revisão da literatura foi realizada usando as bases de dados Web of Science, PubMed e Google Scholar. Em geral, os artigos mostraram que a maioria dos países não atende aos requisitos éticos de justiça distributiva. Os artigos apontaram barreiras para o acesso e resistência que existem na aceitação da infertilidade como um problema de saúde. Demonstraram, ainda, o sofrimento causado pela infertilidade e a urgência de colocar em prática conceitos éticos para que soluções possam ser adotadas. Um debate ético que alcance a provisão de bem-estar para todos pode melhorar a saúde e o sentimento de justiça por parte dos profissionais de saúde e formuladores de políticas.

Resumen Las parejas infértiles se enfrentan a obstáculos para acceder a cuidados médicos especializados, lo que ha dado lugar a un movimiento que busca la igualdad de acceso a los tratamientos de la infertilidad. Es importante identificar las cuestiones éticas implicadas y comprender cómo se producen los debates sobre la justicia en la prestación de tratamientos médicos de la infertilidad. Se realizó una revisión bibliográfica utilizando las bases de datos Web of Science, PubMed y Google Scholar. En general, los artículos mostraron que la mayoría de los países no cumplen los requisitos éticos de la justicia distributiva. Los artículos señalaban las barreras de acceso y la resistencia a aceptar la infertilidad como un problema de salud. También demostraron el sufrimiento causado por la infertilidad y la urgencia de poner en práctica conceptos éticos para poder adoptar soluciones. Un debate ético que consiga proporcionar bienestar a todos puede mejorar la salud y el sentido de la justicia por parte de los profesionales sanitarios y los formuladores de políticas.

Introduction: Uncontrolled symptoms are widely recognized as one of the main challenges in oncology palliative care patients. The central aim of palliative care is to improve the patient's quality of life. In recent years, there has been a growing use of patient-reported outcome measures in palliative care, particularly to evaluate symptoms, quality of care, and well-being. Aim: To evaluate the sociodemographic and clinical profile, symptom distress, and perceived quality of life in oncology palliative care patients admitted to a specialized palliative care unit in Portugal. Methods: This study was cross-sectional, descriptive, and correlational, carried out in the inpatient setting of the palliative care unit at a tertiary oncology hospital (at admission). The evaluated protocol included a sociodemographic and clinical questionnaire, as well as two measurement instruments: the Edmonton Symptom Assessment Scale (ESAS) and the Palliative Care Outcome Scale (POS), both filled out by the patients. Data analysis was conducted using IBM SPSS ® Statistics version 25.0, with a significance level set at 5% (p < 0.05). Results: The majority of participants in this sample were male (61.7%), with a mean age of around 72 years. More than half of the patients admitted (n = 34; 56.7%) were being monitored in outpatient care. Digestive and head and neck cancers were the most commonly found in the sample (41.7% and 20%, respectively). A significant correlation was found between high symptom intensity and poorer quality of life and care (p < 0.01). This association was particularly pronounced for symptoms such as pain, weakness, depression, anxiety, and anorexia. Conclusions: This study revealed a positive correlation between overall symptom severity and a perceived deterioration in quality of life, well-being, and quality of care. Future studies should consider utilizing alternative assessment tools for evaluating symptoms and quality of care. Additionally, including non-cancer palliative patients in similar studies may provide further valuable insights.

Some philosophical and metaethical theories have tried to provide a fundamental background for bioethics but miss the fundamental question about what medicine is, its nature and its end. We argue that the philosophy of medicine, through the development that Edmund Pellegrino and David Thomasma gave to this field of study, allied with Aristotle’s practical and teleological ethics, can provide an ontological background for bioethics beyond the tradition of principles and deontology, with particular emphasis on the uniqueness of the doctor-patient encounter. Some difficulties and criticisms of this ontological model are also examined.

Objective: The prevalence and mortality of chronic liver disease has risen significantly. In end-stage liver disease (ESLD), the survival of patients is approximately 2 years. Despite the poor prognosis and high symptom burden, integration of palliative care in ESLD is reduced, and the majority of patients continue to die in inpatient care. We aim to assess predictors and outcomes of home palliative care, as well as factors associated with death at home in patients with ESLD. Methods: Retrospective cohort study of patients with ESLD, followed by a palliative care team between 2017 and 2022. Information regarding patient demographics, ESLD etiology, decompensations, and interventions was collected. Two-sided tests were used to identify factors associated with home palliative care. Results: We analyzed 75 patients: 44% had home palliative care and 33% died at home. ESLD patients with home palliative care were older (72.52 vs 64.45; p = 0.002), had a longer palliative care intervention time (149.97 ± 196.23 vs 43.69 ± 100.60 days; p = 0.007), higher rates of ascites or hepatic encephalopathy (χ2 = 11.024; p = 0.029), and hepatocarcinoma (90.9% vs 64.3%; p = 0.007). Patients with home palliative care had a reduction in-hospital admissions (2.61 vs 1.06; p = 0.000) and a greater probability of death at home (66.7% vs 33.3%; p = 0.000). Patients who died at home (33.3%) were older (72.20 vs 64.40; p = 0.000) and had longer palliative care intervention time (178.80 ± 211.78 vs 46.28 ± 99.67 days; p = 0.006). Conclusion: Home palliative care in ESLD differs based on demographics and disease complications, with a positive impact of homecare translated into a reduction in hospital admissions and an increased probability of death at home.