A importância da equipe multiprofissional no acompanhamento e seguimento do paciente paliativo
Palavras-chave:
Cuidados paliativos; Equipes multidisciplinares; Qualidade de vida.Resumo
Os cuidados paliativos, segundo a OMS, melhoram a qualidade de vida de pacientes e suas famílias diante de doenças fatais, focando na prevenção e alívio do sofrimento através da identificação precoce e tratamento abrangente de dor e outros problemas físicos, psicossociais e espirituais. Estes cuidados são oferecidos por equipes multidisciplinares que estabelecem metas de cuidado e apoiam o planejamento antecipado, visando atender às necessidades variadas dos pacientes e garantir uma comunicação eficaz e execução coordenada dos cuidados. Portanto, esta revisão tem como objetivo analisar os cuidados paliativos, destacando a abordagem multidisciplinar. Além disso, pretende-se explorar como diferentes modelos de equipe podem aprimorar a qualidade de vida dos pacientes por meio de intervenções domiciliares, ambulatoriais e hospitalares. Esta pesquisa consiste em uma revisão bibliográfica que adota uma abordagem qualitativa exploratória e descritiva, foi realizada em junho de 2024, a pesquisa utilizou as bases SciELO e PubMed com os termos de busca "Palliative care" AND “Multidisciplinary team”. Foram incluídos artigos originais, gratuitos, em português, sem limite de tempo, desde que relevantes para o tema. Trabalhos incompletos, repetidos ou não alinhados foram excluídos. Os Cuidados Paliativos são divididos em três modalidades principais de assistência: domiciliar, ambulatorial e hospitalar, todas visando oferecer suporte especializado a pacientes com doenças graves, independentemente da idade. Cada abordagem busca melhorar a qualidade de vida, reduzir sintomas e proporcionar conforto, com evidências destacando benefícios como menor necessidade de hospitalização e maior satisfação dos pacientes e cuidadores. Apesar dos avanços, desafios persistem, como desigualdades na disponibilidade de serviços e a necessidade de mais pesquisa para expandir o uso dos cuidados paliativos em diferentes condições de saúde.
Referências
ALMAGRO, P. et al. Multimorbidity gender patterns in hospitalized elderly patients. PLoS One, v. 15, n. 1, p. e0227252, 2020.
BARROS, A. de J. P. de; LEHFELD, N. A, de S. Projeto de pesquisa: propostas metodológicas. In: Projeto de pesquisa: propostas metodológicas. p. 127, 1990.
BERGLUND, K. et al. A social worker-led primary palliative care model for hospitalized patients admitted to the hospital medicine service. Palliative Medicine Reports, v. 1, n. 1, p. 234-241, 2020.
BRUMLEY, R. et al. Increased satisfaction with care and lower costs: results of a randomized trial of in‐home palliative care. Journal of the American Geriatrics Society, v. 55, n. 7, p. 993-1000, 2007.
CAPC. National Palliative Care Registry. A project of CAPC and NPCRC. 2009-2015. How we work: trends and insights in hospital palliative care. Disponível em: https://registry.capc.org/wp-content/uploads/2017/02/How-We-Work-Trends-and-Insights-in-Hospital-Palliative-Care-2009-2015.pdf. Acesso em: 27 jun. 2024.
DUMANOVSKY, T.; ROGERS, M. Trends in hospital palliative care from the National Palliative Care Registry™(S723). Journal of Pain and Symptom Management, v. 53, n. 2, p. 422, 2017.
FERNANDEZ, N. et al. Varying conceptions of competence: an analysis of how health sciences educators define competence. Medical education, v. 46, n. 4, p. 357-365, 2012.
FINN, L.; MALHOTRA, S. The development of pathways in palliative medicine: definition, models, cost and quality impact. In: Healthcare. MDPI, p. 22, 2019.
GADE, G. et al. Impact of an inpatient palliative care team: a randomized controlled trial. Journal of palliative medicine, v. 11, n. 2, p. 180-190, 2008.
GIL, A. C. Como elaborar projetos de pesquisa. Editora Atlas SA, 2002.
GOMES, B. et al. Effectiveness and cost‐effectiveness of home palliative care services for adults with advanced illness and their caregivers. Cochrane Database of Systematic Reviews, n. 6, 2013.
HANSON, L. C. et al. Clinical and economic impact of palliative care consultation. Journal of pain and symptom management, v. 35, n. 4, p. 340-346, 2008.
HUGHES, S. L. et al. Effectiveness of team-managed home-based primary care: a randomized multicenter trial. Jama, v. 284, n. 22, p. 2877-2885, 2000.
HUI, D. et al. Improving patient and caregiver outcomes in oncology: Team‐based, timely, and targeted palliative care. CA: a cancer journal for clinicians, v. 68, n. 5, p. 356-376, 2018.
JONES, A. et al. Demographic shifts, case mix, activity, and outcome for elderly patients admitted to adult general ICUs in England, Wales, and Northern Ireland. Critical care medicine, v. 48, n. 4, p. 466-474, 2020.
KAASA, S. et al. Integration of oncology and palliative care: a Lancet Oncology Commission. The lancet oncology, v. 19, n. 11, p. e588-e653, 2018.
KAMAL, A. H. et al. Community-based palliative care: the natural evolution for palliative care delivery in the US. Journal of pain and symptom management, v. 46, n. 2, p. 254-264, 2013.
KANE, R. et al. A randomised controlled trial of hospice care. The Lancet, v. 323, n. 8382, p. 890-894, 1984.
KAO, C. et al. Effects of the hospital-based palliative care team on the care for cancer patients: an evaluation study. International journal of nursing studies, v. 51, n. 2, p. 226-235, 2014.
KHANDELWAL, N. et al. How often is end-of-life care in the United States inconsistent with patients' goals of care?. Journal of palliative medicine, v. 20, n. 12, p. 1400-1404, 2017.
KHATEEB, R. et al. Interprofessional rounds improve timing of appropriate palliative care consultation on a hospitalist service. American Journal of Medical Quality, v. 33, n. 6, p. 569-575, 2018.
LAVILLE, C.; DIONNE, J. A construção do saber: manual de metodologia da pesquisa em ciências humanas. Porto Alegre: Artmed; Belo Horizonte: Editora UFMG, 1999.
LEFKOWITS, C. et al. Improvement in symptom burden within one day after palliative care consultation in a cohort of gynecologic oncology inpatients. Gynecologic oncology, v. 136, n. 3, p. 424-428, 2015.
MAKAROUN, L. K. et al. Late transitions and bereaved family member perceptions of quality of end‐of‐life care. Journal of the American Geriatrics Society, v. 66, n. 9, p. 1730-1736, 2018.
MARU, S. et al. Cost-effectiveness of home versus clinic-based management of chronic heart failure: Extended follow-up of a pragmatic, multicentre randomized trial cohort—The WHICH? study (Which Heart Failure Intervention Is Most Cost-Effective & Consumer Friendly in Reducing Hospital Care). International journal of cardiology, v. 201, p. 368-375, 2015.
MOLASSIOTIS, A. et al. Effectiveness of a home care nursing program in the symptom management of patients with colorectal and breast cancer receiving oral chemotherapy: a randomized, controlled trial. Journal of Clinical Oncology, v. 27, n. 36, p. 6191-6198, 2009.
MUIR, J. C. et al. Integrating palliative care into the outpatient, private practice oncology setting. Journal of pain and symptom management, v. 40, n. 1, p. 126-135, 2010.
National Advisory Committee on Palliative Care. Report of the National Advisory Committee on Palliative Care [Internet]. Irlanda; 2001. Disponível em: http://hdl.handle.net/10147/42522. Acesso em: 27 jun. 2024.
National Coalition for Hospice and Palliative Care. Clinical practice guidelines for quality palliative care. 4th edition. Clinical Practice Guidelines for Quality Palliative Care, 2018.
PUELLE, M. et al. Interprofessional intervention to improve geriatric consultation timing on an acute medical service. Journal of the American Geriatrics Society, v. 66, n. 12, p. 2372-2376, 2018.
RABOW, M. W. et al. New frontiers in outpatient palliative care for patients with cancer. Cancer Control, v. 22, n. 4, p. 465-474, 2015.
RABOW, M. W. et al. The comprehensive care team: a controlled trial of outpatient palliative medicine consultation. Archives of internal medicine, v. 164, n. 1, p. 83-91, 2004.
Radbruch, L.; Lima, L.de ; Knaul, F.; Wenk, R.; Ali, Z.; Bhatnaghar, S. et al. Redefining palliative care—a new consensus-based definition. Journal of Pain and Symptom Management, v. 60, n. 4, p. 754-764, 2020.
RADBRUCH, L.. White paper on standards and norms for hospice and palliative care in Europe: part 1. European journal of palliative care, v. 16, n. 6, p. 278, 2009.
RYAN, K. et al. Palliative care competence framework 2014. Health Service Executive (HSE), 2014.
SANTACRUZ, J. G; GIL, L. F. M. Cuidados paliativos: conceptos básicos. Revista de Nutrición clínica y metabolismo, v. 4, n. 2, p. 14-18, 2021.
SARAIYA, B. et al. End‐of‐life planning and its relevance for patients' and oncologists' decisions in choosing cancer therapy. Cancer: Interdisciplinary International Journal of the American Cancer Society, v. 113, n. S12, p. 3540-3547, 2008.
SHEPPERD, S. et al. Is comprehensive geriatric assessment admission avoidance hospital at home an alternative to hospital admission for older persons? A randomized trial. Annals of internal medicine, v. 174, n. 7, p. 889-898, 2021.
SHIBATA, T. et al. Multidisciplinary team-based palliative care for heart failure and food intake at the end of life. Nutrients, v. 13, n. 7, p. 2387, 2021.
SIDEBOTTOM, A. C. et al. Inpatient palliative care for patients with acute heart failure: outcomes from a randomized trial. Journal of palliative medicine, v. 18, n. 2, p. 134-142, 2015.
TABERNA, M. et al. The multidisciplinary team (MDT) approach and quality of care. Frontiers in oncology, v. 10, p. 85, 2020.
TEMEL, J. S. et al. Early palliative care for patients with metastatic non–small-cell lung cancer. New England Journal of Medicine, v. 363, n. 8, p. 733-742, 2010.
TEMEL, J. S. et al. Effects of early integrated palliative care in patients with lung and GI cancer: a randomized clinical trial. Journal of Clinical Oncology, v. 35, n. 8, p. 834-841, 2017.
TENO, J. M. et al. Site of death, place of care, and health care transitions among US Medicare beneficiaries, 2000-2015. Jama, v. 320, n. 3, p. 264-271, 2018.
THELEN, M.; BREARLEY, S. G.; WALSHE, C. A grounded theory of interdependence between specialist and generalist palliative care teams across healthcare settings. Palliative Medicine, v. 37, n. 10, p. 1474-1483, 2023.
VISSERS, K. C. P. et al. Palliative medicine update: a multidisciplinary approach. Pain Practice, v. 13, n. 7, p. 576-588, 2013.
WALLERSTEDT, B. et al. What is palliative care? Perceptions of healthcare professionals. Scandinavian journal of caring sciences, v. 33, n. 1, p. 77-84, 2019.
WEISSMAN, D. E.; MEIER, D. E. Identifying patients in need of a palliative care assessment in the hospital setting a consensus report from the Center to Advance Palliative Care. Journal of palliative medicine, v. 14, n. 1, p. 17-23, 2011.
WHO. World Health Organization. Definition of Palliative Care. 2007. Disponível em: http://www.who.int/cancer/palliative/definition/en/. Acesso em: 27 jun. 2024.
WHO. World Health Organization. WHO definition of palliative care. Geneva: WHO, 2002. Disponível em: http://www.who.int/cancer/palliative/definition/en/. Acesso em: 27 jun. 2024.
WINKLER, P. et al. Cost-effectiveness of care for people with psychosis in the community and psychiatric hospitals in the Czech Republic: an economic analysis. The Lancet Psychiatry, v. 5, n. 12, p. 1023-1031, 2018.
ZHANG, B.; NILSSON, M. E.; PRIGERSON, H. G. Factors important to patients' quality of life at the end of life. Archives of internal medicine, v. 172, n. 15, p. 1133-1142, 2012.
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