Perfil e indicadores da assistência de um serviço de atenção domiciliar em cuidados paliativos de um Hospital de Câncer
Palavras-chave:
Cuidados Paliativos. Institutos de Câncer. Visita Domiciliar. Pessoal Técnico de Saúde. Indicadores Básicos de saúde. Sinais e Sintomas.
Resumo
O objetivo deste trabalho é descrever o perfil de um serviço de atendimento domiciliar em cuidados paliativos e os resultados obtidos após o primeiro ano de funcionamento. Foi realizado um estudo transversal, observacional retrospectivo e foram analisados os dados referentes aos atendimentos realizados pelo Serviço de Atendimento Domiciliar em Cuidados Paliativos (SAD/CP) no primeiro ano de funcionamento. Observou-se que, de 72 pacientes elegíveis, 56,9% eram mulheres e a idade média foi de 67,74 anos. O Karnofsky Performance Status médio foi de 48,16 e o Índice de Prognóstico Paliativo médio foi de 3,23. A maioria dos pacientes faleceu na Unidade de Cuidados Paliativos (51,4%). Concluiu-se, assim, que os pacientes que morreram em casa receberam mais visitas da equipe de atendimento domiciliar e se deslocaram menos vezes para a urgência e emergência. Fadiga, dor e anorexia foram os sintomas mais frequentes. Ansiedade, depressão e sensação de bem-estar reduzido foram os sintomas mais intensos.
Referências
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24. Bruera E, Kuehn N, Miller MJ, Selmser P, Macmillan K. The Edmonton Symptom Assessment System (ESAS): a simple method for the assessment of palliative care patients. Journal of palliative care. 1991;7(2):6-9.
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26. Timmermann C. 'Just give me the best quality of life questionnaire': the Karnofsky scale and the history of quality of life measurements in cancer trials. Chronic Illn. 2013;9(3):179-90.
27. Morita T, Tsunoda J, Inoue S, Chihara S. The Palliative Prognostic Index: a scoring system for survival prediction of terminally ill cancer patients. Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer. 1999;7(3):128-33.
28. Morita T, Tsunoda J, Inoue S, Chihara S. Improved accuracy of physicians' survival prediction for terminally ill cancer patients using the Palliative Prognostic Index. Palliative medicine. 2001;15(5):419-24.
29. Brasil. Melhor em Casa - Caderno de Atenção Domiciliar. In: Saúde SdAà, editor. Brasília: Editora do Ministério da Saúde; 2013.
30. Fripp JC FL, Silva SM. Caracterização de um programa de internação domiciliar e cuidados paliativos no Município de Pelotas, Estado do Rio Grande do Sul, Brasil: uma contribuição à atenção integral aos usuários com câncer no Sistema Único de Saúde, SUS. Epidemiol Serv Saúde. 2012;21(1):69-78.
31. Abedini NC, Hechtman RK, Singh AD, Khateeb R, Mann J, Townsend W, et al. Interventions to reduce aggressive care at end of life among patients with cancer: a systematic review. Lancet Oncol. 2019;20(11):e627-e36.
32. Earle CC, Park ER, Lai B, Weeks JC, Ayanian JZ, Block S. Identifying potential indicators of the quality of end-of-life cancer care from administrative data. J Clin Oncol. 2003;21(6):1133-8.
33. Unit EI. The 2015 Quality of Death Index - Ranking Palliative Care Around the World. 2015.
34. WHO. Global Atlas of Palliative Care. London: Worldwide Palliative Care Alliance; 2014.
35. WHO. Availability of Internationally Controlled Drugs - Ensuring Adequate Access for Medical Purposes. Viena: INCB; 2015.
36. Donabedian A. Evaluating the quality of medical care. 1966. Milbank Q. 2005;83(4):691-729.
37. Silva KLS, R.; Leite, J.C.A.; Seixas, C.T.; Gonçalves, A.M. Home Care in the Brazilian National Health. Rev Saúde Pública. 2005;39(3):1-6.
38. Costa V. The Determinants of Place of Death: An Evidence-Based Analysis. Ont Health Technol Assess Ser. 2014;14(16):1-78.
39. Hui D, Kim SH, Roquemore J, Dev R, Chisholm G, Bruera E. Impact of timing and setting of palliative care referral on quality of end-of-life care in cancer patients. Cancer. 2014;120(11):1743-9.
2. Brasil. Portaria GM 963. In: Saúde Md, editor. Brasilia: Diário Oficial da União - Official Union Diary; 2013. p. 30-2.
3. Fischer S, Min SJ, Cervantes L, Kutner J. Where do you want to spend your last days of life? Low concordance between preferred and actual site of death among hospitalized adults. Journal of hospital medicine. 2013;8(4):178-83.
4. Aoun SM, Skett K. A longitudinal study of end-of-life preferences of terminally-ill people who live alone. Health & social care in the community. 2013;21(5):530-5.
5. Ishikawa Y, Fukui S, Saito T, Fujita J, Watanabe M, Yoshiuchi K. Family preference for place of death mediates the relationship between patient preference and actual place of death: a nationwide retrospective cross-sectional study. PloS one. 2013;8(3):e56848.
6. Beccaro M, Costantini M, Giorgi Rossi P, Miccinesi G, Grimaldi M, Bruzzi P, et al. Actual and preferred place of death of cancer patients. Results from the Italian survey of the dying of cancer (ISDOC). Journal of epidemiology and community health. 2006;60(5):412-6.
7. Holdsworth L, Fisher S. A retrospective analysis of preferred and actual place of death for hospice patients. International journal of palliative nursing. 2010;16(9):424, 6, 8 passim.
8. De Roo ML, Miccinesi G, Onwuteaka-Philipsen BD, Van Den Noortgate N, Van den Block L, Bonacchi A, et al. Actual and preferred place of death of home-dwelling patients in four European countries: making sense of quality indicators. PloS one. 2014;9(4):e93762.
9. Higginson IJ, Sarmento VP, Calanzani N, Benalia H, Gomes B. Dying at home--is it better: a narrative appraisal of the state of the science. Palliative medicine. 2013;27(10):918-24.
10. Gomes B, Higginson IJ. Factors influencing death at home in terminally ill patients with cancer: systematic review. BMJ. 2006;332(7540):515-21.
11. Payne S, Brearley S, Milligan C, Seamark D, Thomas C, Wang X, et al. The perspectives of bereaved family carers on dying at home: the study protocol of 'unpacking the home: family carers' reflections on dying at home. BMC palliative care. 2012;11:23.
12. Delalibera M, Presa J, Barbosa A, Leal I. [Burden of caregiving and its repercussions on caregivers of end-of-life patients: a systematic review of the literature]. Cien Saude Colet. 2015;20(9):2731-47.
13. Marcucci FC, Cabrera MA. Death in hospital and at home: population and health policy influences in Londrina, State of Parana, Brazil (1996-2010). Cien Saude Colet. 2015;20(3):833-40.
14. Telarolli Junior R, Loffredo Lde C. [Mortality of the elderly in a municipality of southeastern Brazil from 2006 to 2011]. Cien Saude Colet. 2014;19(3):975-84.
15. Murakami N, Tanabe K, Morita T, Kadoya S, Shimada M, Ishiguro K, et al. Going back to home to die: does it make a difference to patient survival? BMC palliative care. 2015;14:7.
16. Brasil. Portaria GM 825 - Atenção Domiciliar. In: Ministro Gd, editor. Brasília: DOU; 2013.
17. Pinto HA. Melhor em Casa - Caderno de Atenção Domiciliar. In: Básica DdA, editor. Brasília: Ministério da Saúde; 2013. p. 207.
18. Brasil. Manual de Monitoramento e Avaliação - Programa Melhor em Casa. In: Básica DdA, editor. Brasília: Ministério da Saúde; 2014.
19. van Riet Paap J, Vernooij-Dassen M, Droes RM, Radbruch L, Vissers K, Engels Y, et al. Consensus on quality indicators to assess the organisation of palliative cancer and dementia care applicable across national healthcare systems and selected by international experts. BMC health services research. 2014;14:396.
20. Pasman HR, Brandt HE, Deliens L, Francke AL. Quality indicators for palliative care: a systematic review. Journal of pain and symptom management. 2009;38(1):145-56.
21. Pastrana T, Radbruch L, Nauck F, Hover G, Fegg M, Pestinger M, et al. Outcome indicators in palliative care--how to assess quality and success. Focus group and nominal group technique in Germany. Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer. 2010;18(7):859-68.
22. Dy SM, Kiley KB, Ast K, Lupu D, Norton SA, McMillan SC, et al. Measuring what matters: top-ranked quality indicators for hospice and palliative care from the american academy of hospice and palliative medicine and hospice and palliative nurses association. Journal of pain and symptom management. 2015;49(4):773-81.
23. Kamal AH, Gradison M, Maguire JM, Taylor D, Abernethy AP. Quality measures for palliative care in patients with cancer: a systematic review. Journal of oncology practice / American Society of Clinical Oncology. 2014;10(4):281-7.
24. Bruera E, Kuehn N, Miller MJ, Selmser P, Macmillan K. The Edmonton Symptom Assessment System (ESAS): a simple method for the assessment of palliative care patients. Journal of palliative care. 1991;7(2):6-9.
25. Monteiro Dda R, Almeida Mde A, Kruse MH. [Translation and cross-cultural adaptation of the Edmonton Symptom Assessment System for use in Palliative Care]. Revista gaucha de enfermagem / EENFUFRGS. 2013;34(2):163-71.
26. Timmermann C. 'Just give me the best quality of life questionnaire': the Karnofsky scale and the history of quality of life measurements in cancer trials. Chronic Illn. 2013;9(3):179-90.
27. Morita T, Tsunoda J, Inoue S, Chihara S. The Palliative Prognostic Index: a scoring system for survival prediction of terminally ill cancer patients. Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer. 1999;7(3):128-33.
28. Morita T, Tsunoda J, Inoue S, Chihara S. Improved accuracy of physicians' survival prediction for terminally ill cancer patients using the Palliative Prognostic Index. Palliative medicine. 2001;15(5):419-24.
29. Brasil. Melhor em Casa - Caderno de Atenção Domiciliar. In: Saúde SdAà, editor. Brasília: Editora do Ministério da Saúde; 2013.
30. Fripp JC FL, Silva SM. Caracterização de um programa de internação domiciliar e cuidados paliativos no Município de Pelotas, Estado do Rio Grande do Sul, Brasil: uma contribuição à atenção integral aos usuários com câncer no Sistema Único de Saúde, SUS. Epidemiol Serv Saúde. 2012;21(1):69-78.
31. Abedini NC, Hechtman RK, Singh AD, Khateeb R, Mann J, Townsend W, et al. Interventions to reduce aggressive care at end of life among patients with cancer: a systematic review. Lancet Oncol. 2019;20(11):e627-e36.
32. Earle CC, Park ER, Lai B, Weeks JC, Ayanian JZ, Block S. Identifying potential indicators of the quality of end-of-life cancer care from administrative data. J Clin Oncol. 2003;21(6):1133-8.
33. Unit EI. The 2015 Quality of Death Index - Ranking Palliative Care Around the World. 2015.
34. WHO. Global Atlas of Palliative Care. London: Worldwide Palliative Care Alliance; 2014.
35. WHO. Availability of Internationally Controlled Drugs - Ensuring Adequate Access for Medical Purposes. Viena: INCB; 2015.
36. Donabedian A. Evaluating the quality of medical care. 1966. Milbank Q. 2005;83(4):691-729.
37. Silva KLS, R.; Leite, J.C.A.; Seixas, C.T.; Gonçalves, A.M. Home Care in the Brazilian National Health. Rev Saúde Pública. 2005;39(3):1-6.
38. Costa V. The Determinants of Place of Death: An Evidence-Based Analysis. Ont Health Technol Assess Ser. 2014;14(16):1-78.
39. Hui D, Kim SH, Roquemore J, Dev R, Chisholm G, Bruera E. Impact of timing and setting of palliative care referral on quality of end-of-life care in cancer patients. Cancer. 2014;120(11):1743-9.
Publicado
2020-07-08
Como Citar
1.
Rodrigues L, Pacheco L, Chubaci E, Zabeu G, Souza G, de Freitas Colombino I, Frasseto S, de Souza A. Perfil e indicadores da assistência de um serviço de atenção domiciliar em cuidados paliativos de um Hospital de Câncer. Revista de Saúde Pública do Paraná [Internet]. 8jul.2020 [citado 22dez.2024];3(1). Available from: http://revista.escoladesaude.pr.gov.br/index.php/rspp/article/view/320
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