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Abstract(s)
Introdução: Cuidados paliativos (CP) podem melhorar a qualidade de vida e morte de
doentes com Doença Pulmonar Obstrutiva Crónica (DPOC). A comunicação precoce
sobre a trajetória da doença e a provável necessidade de CP é crucial para assegurar
cuidados de fim de vida de qualidade.
Objetivos: Quantificar práticas relativas a CP, Planeamento Avançado de Cuidados (PAC)
e tomada de decisões médicas partilhadas em doentes com DPOC. Descrever perceções
e atitudes de pneumologistas em relação a esses processos e identificar as suas
necessidades de treino em CP.
Métodos: Amostragem por conveniência em 9/18 Hospitais/Centros Hospitalares
portugueses participantes (H/CH) e acidental para doentes e pneumologistas. Os dados
foram anonimizados na origem. Analisados dados provenientes dos processos clínicos
de 178 doentes com DPOC que reuniam critérios de fim de vida e frequentavam
Consultas Externas de Pneumologia (CEP) de H/CH participantes. Respostas a um
questionário respondidas por 28 especialistas em pneumologia e 9 residentes da
especialidade e dados de 8/9 questionários caracterizantes dos H/CH participantes.
Resultados: Durante o período do estudo, 6/178 (3,4%) dos doentes selecionados
estavam a ser acompanhados por equipas de CP (ECP). 3/178 (1,7%) tinham tido
discussões sobre sedação paliativa, 10/176 (5,7%) tinham decisões de não reanimar
(DNR) e 1/176 (0,6%) de ressuscitação potencial. 11/177 (6,2%) tinham decisões sobre
ventilação mecânica (VM), das quais 9 (5,1%) tinham ventilação não invasiva (VNI) como
teto de tratamento. 2 (1,1%) doentes recusavam receber qualquer forma de VM.
Constatou-se ausência de registos, (0/177) relativos a discussões sobre preferência do
local de morte. A autoavaliação dos pneumologistas revelou baixos/moderados níveis
de competência no uso do PAC. Barreiras identificadas incluíram a falta de treino (33/36;
92%), prioridade crítica destacada por este estudo.
Conclusões: Estes resultados sugerem necessidade urgente de melhorias nas atitudes e
nas práticas clínicas dos pneumologistas em relação às necessidades paliativas de
doentes com DPOC. Parametrização das práticas e alocação de recursos no País devem
ser promovidos a fim de prover cuidados de fim de vida de qualidade a doentes com
DPOC.
Introduction: Palliative care (PC) can improve quality of life and death among patients with Chronic Obstructive Pulmonary Disease (COPD). Early communication about the disease trajectory and the likely need for PC is crucial to ensure quality end-of-life care. Aims: To quantify current practices concerning PC, Advance Care Planning (ACP) and shared medical decision-making in COPD patients. To describe pulmonologists’ perceptions and attitudes to these processes and identify their training needs in PC. Methods: Convenience sampling in 9/18 participating Portuguese Hospitals/Hospital Centers (H/HCs) and accidental sampling among patients and pulmonologists. All data were anonymized at the source. Data from the clinical records of 178 COPD patients who met end-of-life criteria and were attending the Outpatient Pulmonology Clinics (OPC) of the participating H/HCs were analyzed, as well as responses to a written questionnaire obtained from 28 accredited pulmonologists and 9 pulmonology residents, and 8/9 questionnaires returned characterizing the H/HCs. Results: During the designated study interval, 6/178 (3.4%) of the selected patients were being followed up by PC teams. 3/178 (1.7%) had had discussions about palliative sedation, 10/176 (5.7%) had do-not-resuscitate (DNR) decisions, and 1/176 (0.6%) on potential resuscitation. 11/177 (6.2%) had recorded decisions on mechanical ventilation (MV), of which 9 (5.1%) had non-invasive ventilation (NIV) as the ceiling of treatment. 2 (1.1%) patients refused to receive any MV. No records, (0/177) contained references to discussion about preferred place for dying. Self-assessment by pulmonologists revealed only low/moderate levels of competence using ACPs. The identified barriers included lack of training (33/36; 92%) and this was highlighted as a critical priority. Conclusions: These findings suggest the urgent need to develop improvements in attitudes and practice among pulmonologists towards the palliative needs of COPD patients. National practice parameters and resource allocation should be promoted in order to provide quality end-of-life care for COPD patients.
Introduction: Palliative care (PC) can improve quality of life and death among patients with Chronic Obstructive Pulmonary Disease (COPD). Early communication about the disease trajectory and the likely need for PC is crucial to ensure quality end-of-life care. Aims: To quantify current practices concerning PC, Advance Care Planning (ACP) and shared medical decision-making in COPD patients. To describe pulmonologists’ perceptions and attitudes to these processes and identify their training needs in PC. Methods: Convenience sampling in 9/18 participating Portuguese Hospitals/Hospital Centers (H/HCs) and accidental sampling among patients and pulmonologists. All data were anonymized at the source. Data from the clinical records of 178 COPD patients who met end-of-life criteria and were attending the Outpatient Pulmonology Clinics (OPC) of the participating H/HCs were analyzed, as well as responses to a written questionnaire obtained from 28 accredited pulmonologists and 9 pulmonology residents, and 8/9 questionnaires returned characterizing the H/HCs. Results: During the designated study interval, 6/178 (3.4%) of the selected patients were being followed up by PC teams. 3/178 (1.7%) had had discussions about palliative sedation, 10/176 (5.7%) had do-not-resuscitate (DNR) decisions, and 1/176 (0.6%) on potential resuscitation. 11/177 (6.2%) had recorded decisions on mechanical ventilation (MV), of which 9 (5.1%) had non-invasive ventilation (NIV) as the ceiling of treatment. 2 (1.1%) patients refused to receive any MV. No records, (0/177) contained references to discussion about preferred place for dying. Self-assessment by pulmonologists revealed only low/moderate levels of competence using ACPs. The identified barriers included lack of training (33/36; 92%) and this was highlighted as a critical priority. Conclusions: These findings suggest the urgent need to develop improvements in attitudes and practice among pulmonologists towards the palliative needs of COPD patients. National practice parameters and resource allocation should be promoted in order to provide quality end-of-life care for COPD patients.
Description
Keywords
Doença pulmonar obstrutiva crónica Cuidados paliativos Planeamento avançado de cuidados Fim de vida Chronic obstructive pulmonary disease Palliative care Advance care planning End-of-life