RESUMO
Advance care planning is a deliberative process that aims to help patients define goals and preferences for future care and treatment at a times when they have limited decision-making capacity. This study aims to analyze models of advance care planning in elderly individuals living in nursing homes. We reviewed papers published in Cochrane, PubMed and Embase. A total of 26 studies were selected, including a total of 44,131 people over 65 years of age. We analyzed the types of intervention (interviews, videos, workshops, documentation, etc.) and their results derived from the application. We conclude that no study implements a standardized intervention model. These interventions include decision-making (transfers to hospital, resucitation orders) and the adequacy of therapeutic effort (antibiotherapy, nutrition, serotherapy, etc.). Other outcomes are implementation barriers (time and training).
RESUMO
El final de la vida va acompañado de sufrimiento y penalidades que pueden ser aliviados en las unidades de Cuidados Paliativos (CP) con una atención compasiva. El objetivo de este trabajo consiste en describir el concepto de "anticipación compasiva" como una forma de cuidar al paciente y a su familia al final de la vida desde la perspectiva tanto de los profesionales, profesores y estudiantes de las ciencias de la salud, como de las personas con enfermedad avanzada y sus familiares. Se ha empleado para ello una metodología cualitativa. Los datos se recogieron a través de entrevistas en profundidad y de grupos focales, siendo analizados y codificados usando la técnica de la teoría fundamentada. Se obtuvo la aprobación de un Comité de Ética. La muestra intencionada fue de 29 participantes: pacientes y familiares de pacientes con enfermedad avanzada, profesionales asistenciales de CP y expertos en bioética, profesores universitarios y estudiantes de Ciencias de la Salud. Los datos se recogieron en un Hospital de CP en Madrid, España. Los participantes valoran positivamente la anticipación compasiva de los profesionales que supone estudiar y reflexionar sobre las posibles complicaciones que pueden derivarse de la situación de enfermedad avanzada que padece el enfermo y dialogar con él acerca de las posibles actuaciones al respecto. El artículo concluye que la compasión es una virtud que implica adelantarse a las necesidades de los pacientes para que el enfermo pueda tomar decisiones compartidas acertadas. Es lo que se denomina anticipación compasiva. Son necesarios ulteriores estudios que profundicen en las características de la anticipación compasiva y cómo desarrollarla de forma óptima en los pacientes al final de la vida
End of life is frequently accompanied by suffering and hardships that can be alleviated in the Palliative Care (PC) units by applying compassionate advance care. It is the aim of this paper to describe the concept of "compassionate advance care" as a way of caring for the patient and his family at the end of life from the perspective of both professionals, teachers and students of the health sciences, and persons with advanced disease and their families. A qualitative methodology was used. Data were collected through in-depth interviews and focus groups, and analysed and coded using the theory of Grounded Theory. Approval of an Ethics Committee was obtained. The intentional sample consisted of 29 participants, who were patients and relatives of patients with advanced disease, PC professionals and experts in bioethics, university professors and Health Sciences students. Data were collected in a PC Hospital in Madrid, Spain. The participants positively valued the compassionate advance care provided by professionals: analysing and reflecting on possible complications that may arise from the advanced disease situation suffered by the patient and establishing a dialogue with him about possible actions in this regard. The paper concludes that compassion is a virtue that implies anticipating the needs of patients, thus allowing the patient to make the right shared decisions. This is what the term Compassionate Advance Care Planning entails. Further studies are needed to delve into the characteristics of compassionate Advance Care Planning and how to optimally implement it in patients at the end of life. To admit the opposite is to enter a spiral where the dignity of the human being would become an object of weighting with respect to another value, which, in a hypothetical conflict could be postponed by another. However, Palliative Care takes into account the social dimension of the end of life of the human being. They take care of the sick human being in its entirety. That is why they are the option most in line with the dignity of the human being at the end of his life
Assuntos
Humanos , Cuidados Paliativos na Terminalidade da Vida/ética , Conforto do Paciente/ética , Empatia/ética , Pesquisa QualitativaRESUMO
End of life is frequently accompanied by suffering and hardships that can be alleviated in the Palliative Care (PC) units by applying compassionate advance care. It is the aim of this paper to describe the concept of "compassionate advance care" as a way of caring for the patient and his family at the end of life from the perspective of both professionals, teachers and students of the health sciences, and persons with advanced disease and their families. A qualitative methodology was used. Data were collected through in-depth interviews and focus groups, and analysed and coded using the theory of Grounded Theory. Approval of an Ethics Committee was obtained. The intentional sample consisted of 29 participants, who were patients and relatives of patients with advanced disease, PC professionals and experts in bioethics, university professors and Health Sciences students. Data were collected in a PC Hospital in Madrid, Spain. The participants positively valued the compassionate advance care provided by professionals: analysing and reflecting on possible complications that may arise from the advanced disease situation suffered by the patient and establishing a dialogue with him about possible actions in this regard. The paper concludes that compassion is a virtue that implies anticipating the needs of patients, thus allowing the patient to make the right shared decisions. This is what the term Compassionate Advance Care Planning entails. Further studies are needed to delve into the characteristics of compassionate Advance Care Planning and how to optimally implement it in patients at the end of life. To admit the opposite is to enter a spiral where the dignity of the human being would become an object of weighting with respect to another value, which, in a hypothetical conflict could be postponed by another. However, Palliative Care takes into account the social dimension of the end of life of the human being. They take care of the sick human being in its entirety. That is why they are the option most in line with the dignity of the human being at the end of his life.
Assuntos
Planejamento Antecipado de Cuidados , Empatia , Família , Assistência Terminal , Humanos , Assistência Terminal/normasRESUMO
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