RESUMO
INTRODUCTION: Globally, there is a growing number of population with noncommunicable and aging diseases that are eligible for palliative care. OBJECTIVE: To analyze when palliative care should be integrated in people with non-oncological chronic diseases and the implications of its implementation. METHODOLOGY: Review of scientific literature in the Web of Science, PubMed and CINAHL databases, using the descriptors palliative care, chronic diseases, and benefits. RESULTS: 28 scientific articles were selected, identifying four categories: palliative care for all; early integration of palliative care; strategies for implementation; benefits of palliative care integration. CONCLUSIONS: Palliative care is a strategy of care for all people with complex chronic pathologies, which should be integrated early, in an active, multidimensional and safe way, under the wing of a trained and coordinated health team at different levels of care.
Assuntos
Cuidados Paliativos , Humanos , Doença Crônica/terapia , Prestação Integrada de Cuidados de Saúde/organização & administraçãoRESUMO
No disponible.
Assuntos
Neoplasias , Cuidados Paliativos , Humanos , National Cancer Institute (U.S.) , Estados UnidosRESUMO
Training in Palliative Care (PC) at the undergraduate level has proven to be an effective strategy to expand access to this type of services. In Chile, the increase in magnitude of serious health-related suffering and the recently approved Law that guarantees universal access to Palliative Care, requires the extension of PC undergraduate training in medical and nursing schools. Therefore, this study assessed and described the characteristics of current PC training in the Schools of Medicine and Nursing of Chile through an online survey of their directors. Nursing schools report higher frequency of mandatory training hours and access to clinical training, while Medicine schools report higher frequency of elective internships. However, gaps persist in the number of teaching hours and the teaching methods used, which may be due to the scarcity of qualified professionals in PC, limited access to clinical fields and disciplinary differences. Strengthening and expanding PC training at the undergraduate level with practical and interdisciplinary methodologies are fundamental steps so that future medical and nursing professionals can provide adequate care and relief of serious health-related suffering to an aging population until the end of their life.
Assuntos
Educação de Graduação em Medicina , Cuidados Paliativos , Idoso , Chile , Currículo , Humanos , Faculdades de MedicinaRESUMO
AIM: Asses training, perception of readiness and training needs in palliative care (PC) theoretical and practical of primary care nurses in Spain, through descriptive cross-sectional study. DESIGN: Descriptive cross-sectional study. SETTING: Primary care nurses in Spain with online access. PARTICIPANTS: Primary care nurses in Spain, January and February 2021. 344 responses, 339 met the inclusion criteria. MAIN NEASUREMENTS: Sociodemographic variables, PC training, training needs were analyzed. Through Google Forms online questionnaire and INCUE Instrument. Descriptive analyses were performed and the results were compared using the exact symmetry test and the Mann-Whitney test. RESULTS: 82,6% women, with an average age of 45.5years. 86.1% of the nurses had training in PC, been basic in the 45.4%. Only 40.5% feel quite or very prepared to take care for palliative patients. Nurses demanded more training in psycho-emotional and grief and coping with losses. 83.76% passed the theoretical block compared to 43.36% of the practical, detecting higher training needs in the last (P<.001). The passed rates varied depending on the educational level. CONCLUSIONS: Nursing training in PC in primary care continues to be deficient, especially in practical application. Targeted training is necessary to have an impact on the care of people with palliative needs and their families.
Assuntos
Cuidados Paliativos , Atenção Primária à Saúde , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Paliativos/métodos , Espanha , Inquéritos e QuestionáriosRESUMO
No disponible.
Assuntos
Educação de Graduação em Medicina , Medicina , Currículo , Humanos , Cuidados Paliativos , EstudantesRESUMO
The Chilean House of Representatives is discussing the bill on "Dignified death and palliative care", which regulates the so-called medical assistance in dying or euthanasia. This paper will critically analyze the different aspects of the bill, particularly concerning four main dimensions, namely, the patient's condition at the time of requesting euthanasia; the doctor-patient relationship and respect for the autonomy of both parties; the idea of medicine involved in it; and the possible therapeutic alternatives to euthanasia. This critical analysis raises the need to discuss in more depth a project that has to do with such important decisions about our lives and that implies a radical change in the way of thinking and practicing medicine.
Assuntos
Eutanásia , Cuidados Paliativos , Chile , Humanos , Relações Médico-PacienteRESUMO
OBJECTIVES: To determine whether there is a link between the place of death and the type of health-care provider: Primary Healthcare Team (PHT), Home Palliative Care Support Team (HPCST), or both. To identify other variables that may affect the place of death. DESIGN OF STUDY: Descriptive, observational, retrospective study. SETTING: Three primary care center, Dirección Asistencial Sureste, Comunidad de Madrid (Madrid, Spain). PARTICIPANTS: Patients over the age of 18 with an A.99.01 episode (patient palliative care supports) according to coding CIAP2, active in their electronic medical record (AP-Madrid) from January 2016 until December 2018 (n=499). Two hundred and twenty four (224) patients did not meet the inclusion criteria. MAIN MEASUREMENTS AND RESULTS: Two hundred and seventy five (275) patients were included. Their average age was 78. Eighty point four (80.4%) (n=221) patients had oncologic disease. Sixty seven point six (67.6%) (n=186) lived in an urban setting. There were significant differences (P<0.0001) between the place of death and the type of health-care provider team. Death occurred at home for: 23.1% (n=6) patients in follow-up by PHTs, 14.5% (n=10) patients in follow-up by HPCSTs, and 29.4% (n=53) patients in joint follow-up; 20.8% (n=46) were oncologic patients and 42.6% (n=23) were non-oncologic patients; 26.5% (n=63) had a main caregiver and 16.2% (n=6) didn't. Death occurred at home for 34.8% (n=31) of rural setting patients and for 20.4% (n=38) of urban setting patients (P<0.007). CONCLUSIONS: Results support a higher percentage of deaths at home with joint follow-up.
Assuntos
Serviços de Assistência Domiciliar , Cuidados Paliativos , Adulto , Idoso , Cuidadores , Humanos , Pessoa de Meia-Idade , Atenção Primária à Saúde , Estudos Retrospectivos , EspanhaRESUMO
In Chile, there are four bills to legalize euthanasia, an act which public surveys report as supported by most of the population. At the legislative, healthcare and social level, there is an active debate about euthanasia, the rights of terminally ill patients and the context of Palliative Care (PC) in the country. Chilean literature on euthanasia focuses mainly on the ethical analysis of the act itself but does not address the moral legitimacy of the legalization of this practice. This distinction is relevant since the probity of a particular action does not determine the moral legitimacy of its implementation at a public policy level. One aspect of this dimension is the potential negative impact of the legalization of physician-assisted death (PAD) on the development of PC services. This issue is particularly relevant in Chile, where PC provision is currently suboptimal and mostly restricted to cancer patients. This paper analyses available evidence on the potential impairment of PC development after PAD legalization. Although the analysis of evidence has some limitations, this concern is not supported by the available evidence. However, any project about PAD legalization must contemplate a factual commitment with the development of minimum PC provision, according to international recommendations.
Assuntos
Cuidados Paliativos , Suicídio Assistido , Chile , Humanos , Cuidados Paliativos/organização & administração , Suicídio Assistido/legislação & jurisprudênciaRESUMO
OBJECTIVE: Evaluate the process and the economic impact of an integrated palliative care program. DESIGN: Comparative cross-sectional study. LOCATION: Integrated Healthcare Organizations of Alto Deba and Goierri Alto-Urola, Basque Country. PARTICIPANTS: Patients dead due to oncologic and non-oncologic causes in 2012 (control group) and 2015 (intervention group) liable to need palliative care according to McNamara criteria. INTERVENTIONS: Identification as palliative patients in primary care, use of common clinical pathways in primary and secondary care and arrange training courses for health professionals. MAIN MEASURES: Change in the resource use profile of patients in their last 3 months. Propensity score by genetic matching method was used to avoid non-randomization bias. The groups were compared by univariate analysis and the relationships between variables were analysed by logistic regressions and generalized linear models. RESULTS: One thousand and twenty-three patients were identified in 2012 and 1,142 patients in 2015. In 2015 doubled the probability of being identify as palliative patient in deaths due to oncologic (19-33%) and non-oncologic causes (7-16%). Prescriptions of opiates rise (25-68%) and deaths in hospital remained stable. Contacts per patient with primary care and home hospitalization increased, while contacts with hospital admissions decreased. Cost per patient rise 26%. CONCLUSIONS: The integrated palliative care model increased the identification of the target population. Relationships between variables showed that the identification had a positive impact on prescription of opiates, death outside the hospital and extension to non-oncologic diseases. Although the identification decreased admissions in hospital, costs per patient had a slight increase due to home hospitalizations.
Assuntos
Prestação Integrada de Cuidados de Saúde/organização & administração , Cuidados Paliativos/organização & administração , Seleção de Pacientes , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Prestação Integrada de Cuidados de Saúde/métodos , Feminino , Custos de Cuidados de Saúde/estatística & dados numéricos , Humanos , Modelos Lineares , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Avaliação das Necessidades , Avaliação de Processos e Resultados em Cuidados de Saúde , Cuidados Paliativos/métodos , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/organização & administração , EspanhaRESUMO
BACKGROUND: In 2013 the Chilean regulatory sanitary agency issued a warning concerning dose adjustment and use restriction to avoid severe adverse effects of metoclopramide such tardive dyskinesia. AIM: To study dyskinesia type adverse effects in a population using metoclopramide. MATERIAL AND METHODS: A cross sectional observational study was conducted among patients pertaining to palliative care and diabetes mellitus programs and consuming 10 mg/day or more of metoclopramide. Patients were interrogated looking for extrapiramidal signs and symptoms using a questionnaire validated by two neurologists. RESULTS: In 40% of diabetic patients with gastroparesia and 35% of palliative care patients, extrapyramidal adverse reactions to metoclopramide were suspected. Palliative Care patients suffered the largest number of adverse events. The period of use and individual doses of the drug were largely above Chilean regulatory agency recommendations in all cases. CONCLUSIONS: A significant number of patients using metoclopramide could experience extrapyramidal adverse reactions.
Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico , Antagonistas dos Receptores de Dopamina D2/efeitos adversos , Metoclopramida/efeitos adversos , Dor/tratamento farmacológico , Chile , Estudos Transversais , Antagonistas dos Receptores de Dopamina D2/administração & dosagem , Feminino , Humanos , Masculino , Metoclopramida/administração & dosagem , Cuidados Paliativos , Farmacovigilância , Inquéritos e QuestionáriosRESUMO
Objective To analyze the complexity of nursing care with use of the Perroca scale in a Palliative Care Unit. Method Retrospective descriptive study of quantitative analysis. Results Between 2008 and 2016, the total of 2,486 patients were hospitalized, and their median length of hospital stay was 12 days. Of these patients, 1,568 had at least one Perroca scale evaluation. Nine hundred and ten patients (58%) were classified as minimal or intermediate care. Of these, 602 (66%) were discharged. As semi-intensive and intensive care were classified 658 (42%) patients, of whom 64% died and only 36% were discharged. Conclusion The Perroca scale is a tool to identify patients with greater need for care and the possible prognosis for hospitalized patients.
Assuntos
Hospitalização/estatística & dados numéricos , Unidades de Terapia Intensiva/estatística & dados numéricos , Cuidados de Enfermagem/organização & administração , Cuidados Paliativos/organização & administração , Idoso , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Cuidados de Enfermagem/estatística & dados numéricos , Cuidados Paliativos/estatística & dados numéricos , Alta do Paciente/estatística & dados numéricos , Prognóstico , Estudos RetrospectivosRESUMO
Objective To understand the experience of spirituality in the daily routine of a palliative care interdisciplinary team. Method A qualitative study was conducted with an oncological palliative care team in southern Brazil. The data was collected through phenomenological interviews in 2014, and interpreted using a hermeneutic phenomenological approach. Results Six professionals participated in the study. Spiritually-related activities, such as prayer and providing comprehensive care, were useful therapeutic resources for offering comfort, survival with dignity and humanization of death, in addition to helping the team and patients understand the end-of-life process and search for meaning in the suffering caused by illness. Conclusion Spirituality on the part of professionals with patients imparted meaning to their palliative care work and facilitated the formation of bonds between teams, patients, and family members.
Assuntos
Neoplasias/psicologia , Cuidados Paliativos/métodos , Equipe de Assistência ao Paciente/organização & administração , Espiritualidade , Brasil , Família/psicologia , Humanos , Neoplasias/terapia , Cuidados Paliativos/psicologia , Pesquisa Qualitativa , Religião , Assistência Terminal/métodos , Assistência Terminal/psicologiaRESUMO
Objective To evaluate the effect of a games-based intervention on palliative care nursing students' scores on the Collett-Lester Fear of Death Scale. The challenge was to innovate and integrate grief-related theory and experiences into the classroom. Method Quasi-experimental study. Before and after the games-based intervention, 101 and 111 students completed the questionnaires, respectively. The intervention was performed in the context of a palliative care class taught during the first semester of the third year of the nursing programme. Results The students obtained moderate mean scores on the variable fear of death (between 14 and 19) at both time points (pre- and post-intervention). Both men and women indicated a heightened sense of fear post-intervention and a decrease in self-perceived emotional preparedness, which support the value of the games for exposing the student to situations that closely approximated reality. Conclusion The use of games as a didactic tool in the classroom context helped the students recognize the fear generated by proximity to death in the patient and family and in the student him- or herself.
Assuntos
Jogos Experimentais , Enfermagem de Cuidados Paliativos na Terminalidade da Vida/educação , Cuidados Paliativos/métodos , Estudantes de Enfermagem/psicologia , Adolescente , Adulto , Atitude Frente a Morte , Educação em Enfermagem/métodos , Avaliação Educacional , Medo/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Adulto JovemRESUMO
OBJECTIVE: To identify the profile of studies published on palliative care in oncology and to analyze their levels of evidence. METHOD: A scoping review. Inclusion criteria published in the last 5 years, in English, Portuguese or Spanish. Exclusion criteria incomplete articles, paid for, or those without results. RESULTS: The search resulted in 42,650 publications, where 341 remained after four selection steps. The largest number of publications was in 2015, with 32.55% of the total; 83% were classified as Recommendation Grade B, and 52% with Level of Evidence 2B. Uniprofessional production was more frequent with 67.74% of the publications; physicians were the authors in 93.26%, and nurses in 25.22% of the total articles. CONCLUSION: There are several articles on the subject, however they have low scientific evidence. Most of the production is uniprofessional, and nurses are the main authors of multiprofessional publications. A brief overview of the scientific publication on palliative care in oncology was performed, from which we can recommend integration among professionals for producing multiprofessional studies with better quality of scientific evidence to direct and improve healthcare.
Assuntos
Oncologia/estatística & dados numéricos , Cuidados Paliativos/estatística & dados numéricos , Editoração/estatística & dados numéricos , Autoria , Humanos , Idioma , Enfermeiras e Enfermeiros/estatística & dados numéricos , Fatores de TempoRESUMO
AIM: To know the experience of case-manager nurses with regard to transferring palliative-care patients from the hospital to their homes. DESIGN: Qualitative phenomenological study carried out in 2014-2015. SETTING: Poniente and Almería health districts, which referral hospitals are Poniente Hospital and Torrecárdenas Hospital, respectively. PARTICIPANTS: A purposive sample comprised of 12 case-manager nurses was recruited from the aforementioned setting. METHOD: Theoretical data saturation was achieved after performing 7 in-depth individual interviews and 1 focus group. Data analysis was performed following Colaizzi's method. RESULTS: Three themes emerged: (1) 'Case-management nursing as a quality, patient-centred service' (2) 'Failures of the information systems', with the subthemes "patients" insufficient and inadequate previous information" and "ineffective between-levels communication channels for advanced nursing"; (3) 'Deficiencies in discharge planning', with the subthemes "deficient management of resources on admission", "uncertainty about discharge" and "insufficient human resources to coordinate the transfer". CONCLUSIONS: Case-manager nurses consider themselves a good-quality service. However, they think there are issues with coordination, information and discharge planning of palliative patients from hospital. It would be useful to review the communication pathways of both care and discharge reports, so that resources needed by palliative patients are effectively managed at the point of being transferred home.
Assuntos
Serviços de Assistência Domiciliar , Hospitais , Cuidados Paliativos , Transferência de Pacientes , Atenção Primária à Saúde , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa QualitativaRESUMO
OBJECTIVE: To identify and understand the view of students regarding palliative care in paediatric oncology during a graduate programme. METHODS: Exploratory research with a qualitative approach conducted in a school of nursing in Rio de Janeiro. Data were collected from September to November 2014, through semi-structured interviews with 20 students enrolled in the last period of a graduate programme. The data were subjected to thematic analysis. RESULTS: The results produced two thematic units: the (un)preparedness of nursing students regarding palliative care in paediatric oncology and how the subject of palliative care in paediatric oncology is approached in the graduate programme. The students mentioned difficulties in providing this care and their lack of exposure to the topic during their graduate studies. They stated strategies to prepare for the provision of care, and talked about how the subject should be addressed in their curricular programme. CONCLUSION: It is necessary to expand discussions on palliative care in paediatric oncology during the nurses' graduate programme.
Assuntos
Educação de Pós-Graduação em Enfermagem , Enfermagem Oncológica/educação , Cuidados Paliativos , Enfermagem Pediátrica/educação , Estudantes de Enfermagem/psicologia , Adulto , Brasil , Currículo , Emoções , Feminino , Humanos , Entrevistas como Assunto , Masculino , Cuidados Paliativos/psicologia , Pesquisa Qualitativa , Adulto JovemRESUMO
Dementia is an important public health problem due to the complex challenges it poses during the progression of the disease and especially during its end-of-life stage. The aim of this article is to consider the issues that arise from the use of commonly administered therapies in patients with severe dementia. Scenarios where excessive or futile therapeutic interventions might occur are discussed. The article concludes that it is advisable to analyze the clinical criteria and ethical considerations related to the administration of those treatments in order to develop and disseminate better practice guidelines for health professionals.
Assuntos
Demência/terapia , Cuidados Paliativos , Doença de Alzheimer/psicologia , Doença de Alzheimer/terapia , Demência/psicologia , Nutrição Enteral , Humanos , Fatores de Risco , Índice de Gravidade de Doença , Assistência TerminalRESUMO
INTRODUCTION: Despite advances in the treatment of cancer in paediatric patients, 15% of children die from the illness progression in Chile, and pain is the most significant symptom in advanced stages. Although the World Health Organization guidelines demonstrate that opioids are fundamental in pain management, there is still resistance to their use. The main objective of this article was to describe the experience in the use of opioids for pain management in paediatric patients with advanced cancer in palliative care (PC). PATIENTS AND METHOD: Retrospective study of patients admitted into the PC Program at the Hospital Roberto del Río between 2002 and 2013. Analysis was carried out on demographic data; oncological diagnosis; pain intensity on admission and discharge, according to validated scales; use of non-steroidal anti-inflammatory drugs; weak opioids; strong opioids; adjuvants drugs; the presence of secondary effects resulting from the use of morphine, and the need for palliative sedation. RESULTS: Of the 99 medical records analysed, the median age was 8 years, 64.6% were male, and there was a similar distribution in three oncological diagnosis groups. Upon admission, 43.4% presented intense to severe pain, and upon discharge there were four patients, but with a maximum VAS score of 7 in only one case. Of the 66 patients taking strong opioids, 89% required less than 0.5mg/kg/hr. Constipation was the most frequently observed secondary effect. CONCLUSIONS: Two thirds of the patients studied required strong opioids, with which adequate pain management was achieved, with no serious complications observed. The use of opioids in this group of patients, following a protocol, is considered effective and safe.
Assuntos
Analgésicos Opioides/uso terapêutico , Neoplasias/patologia , Dor/tratamento farmacológico , Cuidados Paliativos/métodos , Adolescente , Analgésicos Opioides/efeitos adversos , Criança , Pré-Escolar , Chile , Constipação Intestinal/induzido quimicamente , Constipação Intestinal/epidemiologia , Feminino , Humanos , Masculino , Morfina/efeitos adversos , Morfina/uso terapêutico , Dor/etiologia , Medição da Dor , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Objective To know the experience of health workers who are coping with having a relative in palliative care for cancer. Methodology A qualitative study conducted with four family members of cancer patients in palliative care. Data were collected by means of semi-structured interviews from November to December, 2014, at the home of the participants. The data were analysed using the operative proposal of Minayo. Results Two themes emerged, Health worker and family member coping with a cancer diagnosis and Health worker and family member coping with the proximity of death. Conclusions Being a family member and a health professional at the same time demanded greater involvement in care and caused distress since these workers witnessed the suffering of a family member with a terminal disease. However, their professional knowledge supported decision-making during the care process.
Assuntos
Adaptação Psicológica , Relações Familiares , Pessoal de Saúde/psicologia , Neoplasias/psicologia , Cuidados Paliativos/psicologia , Adulto , Atitude Frente a Morte , Tomada de Decisões , Odontólogos/psicologia , Família , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Enfermeiras e Enfermeiros/psicologia , Assistentes de Enfermagem/psicologia , Conforto do Paciente , Estresse Psicológico , Adulto JovemRESUMO
BACKGROUND: Adequate provision of palliative care by nursing in intensive care units is essential to facilitate a "good death" to critically ill patients. OBJECTIVE: To determine the perceptions, experiences and knowledge of intensive care nurses in caring for terminal patients. METHODOLOGY: A literature review was conducted on the bases of Pubmed, Cinahl and PsicINFO data using as search terms: cuidados paliativos, UCI, percepciones, experiencias, conocimientos y enfermería and their alternatives in English (palliative care, ICU, perceptions, experiences, knowledge and nursing), and combined with AND and OR Boolean. Also, 3 journals in intensive care were reviewed. RESULTS: Twenty seven articles for review were selected, most of them qualitative studies (n=16). After analysis of the literature it has been identified that even though nurses perceive the need to respect the dignity of the patient, to provide care aimed to comfort and to encourage the inclusion of the family in patient care, there is a lack of knowledge of the end of life care in intensive care units' nurses. CONCLUSION: This review reveals that to achieve quality care at the end of life, is necessary to encourage the training of nurses in palliative care and foster their emotional support, to conduct an effective multidisciplinary work and the inclusion of nurses in decision making.