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- Cuidados paliativos domiciliários: uma prioridade nacional - revisão integrativaPublication . Coelho, Patrícia; Capelas, Manuel Luís; Pinho-Reis, Cintia; Sá, LuísIntrodução: O aumento da longevidade com consequente aumento da fragilidade e vulnerabilidade com a prevalência de doenças crónicas, limitadoras da vida, e a mudança do perfil social, criaram novas preocupações no que respeita ao planeamento e apoio no fim de vida. Para tal, é necessário capacitar os profissionais e criar equipas comunitárias especializadas, em cuidados paliativos.Objetivo: Demonstrar a necessidade de ampliar uma cobertura de cuidados paliativos domiciliários para atender às necessidades e preferências dos doentes.Métodos: Revisão integrativa da literatura nas bases de dados ISI Web of Knowledge, EBSCO, PubMed e B-on com os descritores “Palliative Care”, “Home Care”, ”End-of-life”, “Preferences”, “Adults”. Como critérios de inclusão incluíram-se todos os artigos de língua inglesa; existentes em texto integral; com resumo e referências disponíveis e analisados por especialistas entre 2006 e 2016. Resultados: A evidência demonstra que dos 22 artigos, a maioria dos doentes prefere permanecer, ser cuidado e morrer em casa (50,3%) mas em termos de cobertura de cuidados paliativos domiciliários, existe uma assimetria nacional quanto à disponibilidade e equidade destas equipas. Atualmente existem 18 equipas comunitárias, públicas, com um índice de cobertura de 17.5%, com maior incidência em Beja e Bragança, sendo o rácio nacional de 0.2 equipas por 100 mil habitantes e apenas uma equipa tem disponibilidade de 24h, enquanto as diretrizes emanadas pela European Association for Palliative Care preconiza a necessidade de 1 equipa de cuidados paliativos domiciliários por 100 mil habitantes- 24h/d. Conclusões: O desenvolvimento de equipas de cuidados paliativos domiciliários é uma prioridade para providenciar cuidados em fim de vida eficazes respeitando as preferências da população, permitindo que as pessoas com doença avançada e incurável permaneçam e morram em casa, com a melhor qualidade de vida possível e acompanhados, por equipas especializadas, bem como pelas suas famílias.
- Palliative care at home: a literature reviewPublication . Coelho, Sílvia Patrícia; Costa, Tânia; Barbosa, Manuel Maria; Capelas, Manuel Luís; Mello, Ramon Andrade de; Sá, LuísIntroduction: Palliative care promotes a holistic care, promoting a centered care to the patient and, thus contributing to the comfort and quality of life by addressing the problems associated with life-threatening diseases, preventing and relieving suffering. Aims: Identify the evidence produced about home palliative care. Materials and methods: A integrative review on the data- bases of ISI Web of Knowledge, CINHAL, MEDLINE and PubMed, B-on with the descriptors “palliative care”, “home care”, “nursing care”. Articles in the English language, existing in full text, with abstract and references available and analyzed by experts were included. Results: A total of 69 articles were found and analyzed. The majority of the articles found are: original studies, literature reviews, editorials and commentaries. The most discussed topics were: home palliative care, family sup- port, home care, symptom control and promoting quality of life. There is predominance in the last decade especially in 2009-2012 and the predominant language was English. The research reveals the increasing number of patients with progressive and incurable diseases and 68,2% of patients prefer die at home. It becomes essential to develop a network of care extended to cover the home assistance. Conclusion: We observed that palliative care should improve social and innovative health policies, centered on the needs and preferences of patients, associating scientific knowledge, skills and attitudes in order to develop the excellence of care. According to the evidence found the development of a specialized care, implementing effective interventions which provide a dignified death, and supporting the family throughout the process including the stage of grief, contributes for an individualized approach focused on the problems of patients and families, in symptom control and maximizing comfort.
- Palliative care in lung cancer: from the challenges to the home carePublication . Coelho, Sílvia Patrícia; Pinho-Reis, Cíntia; Capelas, Manuel Luís; Mello, Ramon Andrade de; Crispim, Douglas Henrique; Sá, LuísBackground: Lung cancer is currently one of the mostcommon malignant neoplasms worldwide. Distress symptomsrelated to the primary disease or in combination with diseaseprogression have challenges faced by the patients, family, andthe health care team. Aims: Demonstrate the benefits of an integrated palliativecare approach for lung cancer patients at the time ofdiagnosis and also the benefits of care these patients athome. Methods: Integrative review on the ISI Web of Knowledge,PubMed, CINAHL and Academic Search Complete. Thekeywords were “Lung Cancer”, “Palliative Care”, “Approaches”and “Therapies”. The inclusion criteria were articles in theEnglish published until 2015 with full-text and referencesavailable and peer-reviewed. The research anddocumentation were carried out in accordance with thePrisma 2009 Referencia guidelines. Results: 164 articles were found, of which 33 were selectedto full analysis. Most of the lung cancer patients suffer frommultiple distressing symptoms with high levels of intensityand are simultaneously influenced by disease progressionand the undertaken therapies. Palliative interventions havean integrative philosophy that has been demonstrate to be aneffective relief of the patients suffer. Moreover, palliativedevelops interventions that control the symptoms related tothe disease and integrates the different dimensions of peopleand their problems in the evaluation of their health status andtherapeutic intervention to respond favorably to the patientsand family’s needs because many cancer patients prefer aconservative or supportive treatment. Conclusion/discussion: The provision of specialized palliativecare at home allows the respect of the patients’ preferencesand providing humane care throughout the course of thedisease, particularly at the end-of-life.
- Palliative Home Care, for a holistic approach to the patient and familyPublication . Coelho, Sílvia Patrícia; Costa, Tânia; Barbosa, Manuel Maria; Capelas, Manuel Luís; Mello, Ramon Andrade de; Sá, Luís
- Challenges in lung cancer approaches: from the clinical issues to the novel therapiesPublication . Coelho, Silvia Patrícia; Capelas, Manuel Luís; Alves, Sandra Marlene; Sá, Luís; Mello, Ramón Andrade deBackground: Lung cancer is currently one of the most common malignant neoplasms worldwide. Distress symptoms related to the primary disease or in combination with disease progression have challenges faced by the patients, family, and their multidisciplinary team. The aim of this study was to demonstrate the benefits of an integrated palliative care approach for lung cancer patients at the time of diagnosis and to analyze the main symptoms and its treatment. Methods: We performed an integrative review of the databases ISI Web of Knowledge, PubMed, CINAHL and Academic Search Complete using the keywords “lung cancer”, “palliative care”, “approaches” and “therapies”. The research and documentation were carried in accordance with the guideline PRISMA 2009. Results: Among 164 articles found in the searched databases, only 33 were selected due to their suitability and relevance to the subject with respect to the inclusion criteria defined. The evidence showed that early inclusion of palliative or supportive care could originate a satisfactory resolution of most of the symptoms and promote quality of life for the patients and their families. Conclusion: Early palliative care led to significant improvements in the patient’s quality of life and mood. The focus on care was the management of symptoms and the well-being of the patients be in a hospital or in a home setting.
- Elderly that care other elderly: this group needs palliative care?Publication . Costa, Tânia; Coelho, Sílvia Patrícia; Capelas, Manuel Luís; Sá, LuísIntroduction: The chronic situations associated to changes in family contributed to increasing numbers of older people who cares for another elder. In this sense, it would be relevant to know the characteristics of these caregivers to measure the need of palliative care. Aim: To identify the profile of elderly caregiver who cares another elderly at home. Materials and methods: Cross-sectional study with elderly caregivers who care for an elderly at home. Data were collected by questionnaire that includes Barthel Scale, Lawton and Brody Scale, Index of complexity of pharmacotherapy, Geriatric Depression Scale and Mini Mental State Examination. Data were analyzed with SPSS version 22 for Windows. Results: Participated 30 elderly caregivers with 74±6.9years. The most are female, married and with low education. All are independent in daily living activities while in instrumental activities 10 have partial dependency and 3 severe. They refer, on average, 3 diseases and taking 6 drugs/day. Twelve have depression and 3 have cognitive deficit. The difficulties are physical requirement, absence of support and reduced reporting to manage critical events. The strategy adopted is question the social worker but when occurs the intensification of symptoms most caregivers use the emergency. As for community resources, they highlight the home support service. Conclusion: Characteristics of caregiver difficults the effective exercise of the role and promoting health problems. It is important expand the research but also develop tools of evaluation/monitoring and intervention centered on long-term care and palliative care philosophy.
- Palliative sedation in terminal cancer patients with refractory uncontrolled symptomsPublication . Correia, Joana Lacerda; Coelho, Patrícia; Capelas, Manuel Luís; Alves, Paulo; Sá, Luís; Mello, Ramón Andrade de