title: [Facilitators and barriers regarding end of life care at nursing homes: A focus group study].
abstract: OBJECTIVE
  To identify the facilitators and barriers experienced by professional related to end of life care in nursing homes.
  
  
  METHODS
  Descriptive qualitative research with phenomenological orientation, through content analysis.
  
  
  METHODS
  Nursing Homes at Primary Care District in Granada (Spain).
  
  
  METHODS
  Fifteen clinical professionals with, at least 6 months of experience in nursing homes, without specific background in palliative care.
  
  
  METHODS
  Three focus groups were undertaken with professionals of different disciplines and nursing homes. Interviews were recorded and transcribed literally. An open and axial coding was performed to identify relevant categories.
  
  
  RESULTS
  Professionals identified difficulties in the communication with families related to relatives' feelings of guilt, difficulty in understanding the deterioration of their relative, and addressing too late the issue of death. Regarding decision making, professionals recognized that they do not encourage participation of patients. Advance directives are valued as a necessary tool, but they do not contemplate implementing them systematically. Other difficulties that professionals highlighted are lack of coordination with other professionals, related to misunderstanding of patients' needs, as well as lack of training, and lack of material and human resources. Facilitators include relationships with primary care teams.
  
  
  CONCLUSIONS
  It is necessary to improve communication among nursing homes professionals, families, patients and other health workers.
authors.affiliation: Centro de Salud Cúllar Vega, Distrito de Atención Primaria Granada-Metropolitano, Servicio Andaluz de Salud, Junta de Andalucía, Cúllar Vega, Granada, Andalucía, España. Electronic address: mremedios.sanchez.sspa@juntadeandalucia.es.
authors.forename: María Remedios
authors.initials: MR
authors.lastname: Sánchez-García
authors.affiliation: Servicio Andaluz de Salud, Junta de Andalucía, Granada, Andalucía, España.
authors.forename: Marina
authors.initials: M
authors.lastname: Moreno-Rodríguez
authors.affiliation: Departamento de Enfermería, Universidad de Granada, Granada, Andalucía, España.
authors.forename: César
authors.initials: C
authors.lastname: Hueso-Montoro
authors.affiliation: Fundación Progreso y Salud, Junta de Andalucía, Granada, Andalucía, España.
authors.forename: Concepción
authors.initials: C
authors.lastname: Campos-Calderón
authors.affiliation: Distrito de Atención Primaria Granada-Metropolitano, Servicio Andaluz de Salud, Junta de Andalucía, Granada, Andalucía, España.
authors.forename: Ana
authors.initials: A
authors.lastname: Varella-Safont
authors.affiliation: Departamento de Enfermería, Universidad de Granada, Granada, Andalucía, España.
authors.forename: Rafael
authors.initials: R
authors.lastname: Montoya-Juárez
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D005260:Female; D017144:Focus Groups; D006707:Homes for the Aged; D006801:Humans; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes; D057566:Self Report; D013727:Terminal Care; D055815:Young Adult
keywords: Barriers; Cuidados paliativos; Dificultades; Facilitators; Factores favorables; Homes for the aged; Investigación cualitativa; Palliative care; Profesionales; Professionals; Qualitative research; Residencias de ancianos