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Introdução: O Plano Avançado de Cuidados é reconhecido como ferramenta de
promoção da autonomia do doente com demência. A presença de diretivas avançadas
de cuidados está associada a cuidados de conforto no fim de vida, como menos
transferências e menor número de tratamentos agressivos. Os doentes na comunidade
estão em maior risco quando comparados com os institucionalizados. Como, quando e
quem deve tomar a iniciativa de implementar permanece indefinido. Pretende-se
avaliar se a iniciação de Plano Avançado de Cuidados no doente com demência em
Cuidados Primários está associada a melhoria na qualidade de vida e a conforto no fim
de vida.
Metodologia: Ensaio clínico randomizado por clusters através da identificação de
médicos de família em cuidados de saúde primários. A intervenção será constituída
por programa de treino sobre Plano Avançado de Cuidados e Demência, identificação
dos doentes com demência e realização de consulta com o mesmo propósito. O grupo
controlo manterá a rotina normal. Ambos os grupos serão avaliados 6 meses após e os
resultados serão colhidos de forma cega. Qualidade de vida será avaliada com Escala
Quality of life-AD e a sobrecarga do cuidador com Escala de Sobrecarga de Zarit.
Outros outcomes serão avaliados como sobrevida, intervenções médicas específicas,
gastos em medicação e recurso a hospitalizações/serviço de urgência.
Limitações: Condicionadas ao poder do tamanho amostral, adesão, falta de placebo no
grupo controlo e o tempo de exposição.
Finalidade: Determinar se formação sobre demência e Plano Avançado de Cuidados ao
médico de família aumenta a qualidade de vida no fim de vida no doente com
demência.
Introduction: The Advanced Care Plan is recognized as a tool to promote the autonomy of the patient with dementia. The presence of advanced directives is associated with comfort care at the end of life, such as fewer transfers and fewer aggressive treatments. Patients in the community are at greater risk when compared to institutionalized patients. How, when and who should take the initiative to implement remains undefined. It is intended to assess whether the initiation of an Advanced Care Plan for patients with dementia in Primary Care is associated with improved quality of life and comfort at the end of life. Methodology: Randomized clinical trial by clusters through the identification of family doctors in primary health care. The intervention will consist of training program about dementia and Advanced Care Plan, identification of patients with dementia and consultation with the same purpose. The control group will maintain a normal routine. Both groups will be evaluated 6 months later and the results will be collected blindly. Quality of life will be assessed with Quality of life-AD scale and the caregiver burden with the Zarit-Burden Scale. Other outcomes will be assessed such as survival, specific medical interventions, medication costs and use of hospitalizations / emergency services. Limitations: Conditioned by the power of the sample size, adherence and lack of placebo in the control group, small time exposure. Purpose: To determine whether a training program about dementia and Advanced Care Plan for family doctors increases the quality of life at the end of life for the patient with dementia.
Introduction: The Advanced Care Plan is recognized as a tool to promote the autonomy of the patient with dementia. The presence of advanced directives is associated with comfort care at the end of life, such as fewer transfers and fewer aggressive treatments. Patients in the community are at greater risk when compared to institutionalized patients. How, when and who should take the initiative to implement remains undefined. It is intended to assess whether the initiation of an Advanced Care Plan for patients with dementia in Primary Care is associated with improved quality of life and comfort at the end of life. Methodology: Randomized clinical trial by clusters through the identification of family doctors in primary health care. The intervention will consist of training program about dementia and Advanced Care Plan, identification of patients with dementia and consultation with the same purpose. The control group will maintain a normal routine. Both groups will be evaluated 6 months later and the results will be collected blindly. Quality of life will be assessed with Quality of life-AD scale and the caregiver burden with the Zarit-Burden Scale. Other outcomes will be assessed such as survival, specific medical interventions, medication costs and use of hospitalizations / emergency services. Limitations: Conditioned by the power of the sample size, adherence and lack of placebo in the control group, small time exposure. Purpose: To determine whether a training program about dementia and Advanced Care Plan for family doctors increases the quality of life at the end of life for the patient with dementia.
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Demência Plano avançado de cuidados Cuidados primários Qualidade de vida Dementia Advanced care plan Primary care Quality of life