Sedação paliativa em oncologia sob a ótica de médicos e enfermeiros que atuam em cuidados paliativos

• Ano de defesa: 2013
• Autor(a) principal: Spineli, Vivian Marina Calixto Damasceno [UNIFESP]
• Tipo de documento: Dissertação
• Tipo de acesso: Acesso aberto
• dARK ID: ark:/48912/001300001ngp2
• Idioma: por
• Instituição de defesa: Universidade Federal de São Paulo (UNIFESP)
• Palavras-chave em Português: paliative care; end-of-life care; palliative sedation; cuidados paliativos; sedação paliativa; cuidados de final de vida
• Link de acesso: https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=560425; http://repositorio.unifesp.br/handle/11600/47501

INTRODUCTION. During the end of life process, some biological and psychological manifestations such as pain, dyspnea, nausea, vomiting, fatigue, agitation, mental confusion, anxiety, among others, become uncontrollable and difficult to manage. In this context, palliative sedation arises as a therapeutic resource for the control of these issues, seeking the reduction of suffering at the end of life. OBJECTIVE. To describe the opinion of physicians and nurses working in palliative care about the process of palliative sedation. METHOD. A descriptive, quantitative study, conducted with a snowball-type convenience sample, in the period of January to September of 2011. Thirty-two physicians and 29 nurses working in facilities that formally or informally adopted the practice of palliative care, and who agreed to participate in the study, responded to a questionnaire adapted from the instrument used by Moyano and colleagues. Data were analyzed using descriptive and inferential analysis, using the Pearson's chi-square (x2) or Fisher's exact tests of association, depending on the adherence to the normal curve, considering a level of significance of 5% (p<0.05%). RESULTS. Among the data regarding the sociodemographic aspects, characteristics of the professionals and the profile of patients attended by the participants of this study were: average age of respondents was 34.3 years; 77% were female; mean time of formation was nine years, the mean length of experience in palliative care was 5 years, and 60.7% of the professionals reported having some type of training in palliative care. Oncology was the predominant specialty, while only 3.3% of them reported being specialists in palliative care. The monthly mean of patients assisted by the study participants was 43.3 patients, and among these, 7.3 were referred for palliative sedation. Lung cancer was the type of cancer that more frequently affected the patients attended by professionals of this study. Symptoms indicating the priority for palliative sedation were: dyspnea, (cited by 98.4% of participants), delirium (70.5%) and pain (47.5%), and the type of sedation most commonly used by them was continuous (88.5%). Among the principle drugs used for sedation, the following were mentioned: midazolam (85.2% of professionals) and morphine (54.1%). Regarding the process of palliative sedation and the point of view of physicians and nurses about it, the data showed that for 65% of the respondents, the survival time of patients in the final phase was not a determining factor for the indication of palliative sedation. For 65.6% of these professionals, the patient, family and health care team should be involved in the decision-making process for the indication of sedation, but 42.6% of them considered the opinion of the family as the main barrier for indicating this therapeutic measure. For 90.2% of the professionals, palliative sedation was not a way to cover up or mask symptoms that affected patients and/or family. Dyspnea was the symptom that presented as statistically significant when related to the influence of survival time for the decision to indicate palliative sedation (p = 0.042). Another variable that had a statistically significant association was training in palliative care and the inclusion of family or staff and other professionals, when the patient had no ability to participate in the decision-making process for the indication of palliative sedation (p = 0.017). CONCLUSION. With the intent of controlling refractory symptoms and promoting comfort at end of life, it was observed that palliative sedation, even though it is being adopted therapy in palliative care, remained a challenging practice generating discussions, either on ethical and bioethical issues or for its technical and legal aspects.