Cuidados paliativos en la Atención Primaria de Salud: una revisión integradora de la literature

Silva, Thayná Champe da; Nietsche, Elisabeta Albertina; Cogo, Silvana Bastos

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Revista Brasileira de Enfermagem

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Brasil

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REVIEW • Rev. Bras. Enferm. 75 (1) • 2022 • https://doi.org/10.1590/0034-7167-2020-1335 copiar

Cuidados paliativos en la Atención Primaria de Salud: una revisión integradora de la literature

Autoría SCIMAGO INSTITUTIONS RANKINGS

RESUMEN

Objetivos:

analizar la evidencia científica sobre la implementación y desempeño de los cuidados paliativos en la Atención Primaria de Salud.

Métodos:

revisión integradora de la literatura, de acuerdo con el Preferred Reporting Items for Systematic Reviews and Meta-Analyses, realizada en las bases de datos PubMed, SciVerse Scopus y LILACS, en diciembre de 2020, sin marco temporal.

Resultados:

se analizaron 22 artículos científicos originales, 14 clasificados como nivel de evidencia VI. El objetivo fue conocer las vivencias y roles de los profesionales, pacientes y familiares sobre los cuidados paliativos en Atención Primaria de Salud, artículos centrados en el tema de la gestión y organización de los servicios de salud y en la importancia de las intervenciones educativas sobre el tema.

Consideraciones Finales:

la evidencia encontrada que relaciona los cuidados paliativos en Atención Primaria de Salud apunta a la posibilidad de este cuidado; Los equipos de salud trabajan en estrecha colaboración con la familia y su hogar, pero aún se percibe la necesidad de ampliar este tema.

Descriptores:
Atención Primaria de Salud; Cuidados Paliativos; Enfermería; Estrategia de Salud Familiar; Revisión

ARTICLE	TITLE	JOURNAL/YEAR OF PUBLICATION	OBJECTIVE	METHOD	LEVEL OF EVIDENCE
A1⁽⁸8 Baliza MF, Bousso RS, Spineli VMCD, Silva L, Poles K. Palliative care in the home: perceptions of nurses in the Family Health Strategy. Acta Paul Enferm. 2012;25(2):13-8. https://doi.org/10.1590/S0103-21002012000900003 https://doi.org/10.1590/S0103-2100201200... ⁾	Palliative care in the home: perceptions of nurses in the Family Health Strategy	ActaPaul Enferm. 2012	Understand the perception of FHS nurses in relation to PCs at home.	Descriptive, exploratory, qualitative study	VI
A2⁽⁹9 Van der Plas AG, Francke AL, Vissers KC, Jansen WJ, Deliens L, Onwuteaka-Philipsen BD. Case management in primary palliative care is associated more strongly with organisational than with patient characteristics: results from a cross-sectional prospective study. BMC Palliat Care. 2015;14(31). https://doi.org/10.1186/s12904-015-0029-8 https://doi.org/10.1186/s12904-015-0029-... ⁾	Case management n primary palliative care is associated more strongly with organizational than characteristics: results from a cross-sectional prospective study	BMCPalliat Care. 2015	Describe and investigate characteristics of patients and the organizational environment, related to the number of contacts and times that cases are discussed between patients and professional case managers.	Cross-sectional study	VI
A3⁽¹⁰10 Corrêa SR, Mazuko C, Mitchell G, Pastrana T, Lima L, Murray S. Identificando pacientes para cuidados paliativos na atenção primária no Brasil: experiência do Projeto Estar ao Seu Lado. Rev Bras Med Fam Comunidade [Internet]. 2017 [cited 2021 Apr 28];12(39):1-8. Available from: https://www.rbmfc.org.br/rbmfc/article/view/1507 https://www.rbmfc.org.br/rbmfc/article/v... ⁾	Developing an innovative model of palliative care in the community in Brazil	BMJ Support Palliat Care. 2015	Propose a PC model in the public health service in Brazil, offered through Primary Care to the community.	Descriptive	VI
A4⁽¹¹11 Ghosh A, Dzeng E, Cheng MJ. Interaction of palliative care and primary care. Clin Geriatr Med. 2015;31(2):207-18. https://doi.org/10.1016/j.cger.2015.01.001 https://doi.org/10.1016/j.cger.2015.01.0... ⁾	Interaction of palliative care and primary care	ClinGeriatr Med. 2015	Analyze the primary PC skill set and criteria to consider when patients are eligible for specialized PC.	Experience report	VI
A5⁽¹²12 Offen J. The role of UK district nurses in providing care for adult patients with a terminal diagnosis: a meta-ethnography. Int J Palliat Nurs. 2015;21(3):134-41. https://doi.org/10.12968/ijpn.2015.21.3.134 https://doi.org/10.12968/ijpn.2015.21.3.... ⁾	The role of UK district nurses in providing care for adult patients with a terminal diagnosis: a meta-ethnography	Int J Palliat Nurs. 2015	Explore the role of UK district nurses in providing care to adult patients with a terminal diagnosis.	Meta-ethnographic	V
A6⁽¹³13 Van der Plas AG, Onwuteaka-Philipsen BD, Francke AL, Jansen WJ, Vissers KC, Deliens L. Palliative care case managers in primary care: a descriptive study of referrals in relation to treatment aims. J Palliat Med. 2015;18(4):324-31. https://doi.org/10.1089/jpm.2014.0269 https://doi.org/10.1089/jpm.2014.0269... ⁾	Palliative care case managers in primary care: a descriptive study of referrals in relation to aims	JPalliat Med. 2015	Investigate referral of patients to primary care case managers in relation to three elements.	Cross-sectional study	VI
A7⁽¹⁴14 Murray SA, Firth A, Schneider N, Van den Eynden B, Gomez-Batiste X, Brogaard T, et al. Promoting palliative care in the community: production of the primary palliative care toolkit by the European Association of Palliative Care Taskforce in primary palliative care. Palliat Med. 2015;29(2):101-11. https://doi.org/10.1177/0269216314545006 https://doi.org/10.1177/0269216314545006... ⁾	Promoting palliative care in the community: production of the primary palliative care toolkit by the European Association of Palliative Care Taskforce in primary palliative care	Palliat. Med. 2015	Document barriers and facilitators to PC in the community and produce grants for PC specialists.	Cross-sectional study	V
A8⁽¹⁵15 Faull C, Windridge K, Ockleford E, Hudson M. Anticipatory prescribing in terminal care at home: what challenges do community health professionals encounter? BMJ Support Palliat Care. 2013;3(1):91-7. https://doi.org/10.1136/bmjspcare-2012-000193 https://doi.org/10.1136/bmjspcare-2012-0... ⁾	Anticipatory prescribing in terminal care at home: what challenges do the community health professionals encounter?	BMJSupport Palliat Care. 2013	Explore the challenges faced by primary and community health professionals in Leicestershire and Rutland related to the advance prescription of care for terminally ill patients who wish to remain at home to die.	Qualitative study	VI
A9⁽¹⁶16 Álvarez-Cordovés MM, Mirpuri-Mirpuri PG, Gonzalez-Losada J, Chávez-Díaz B. Cuidados paliativos en atención primaria: a propósito de un caso. Semergen. 2013;39(7):396-9. https://doi.org/10.1016/j.semerg.2012.05.009 https://doi.org/10.1016/j.semerg.2012.05... ⁾	Palliative care in Primary Care: presentation of a case	Semergen. 2013	Present the case study of a patient diagnosed with glioblastoma multiforme.	Case study	VI
A10⁽¹⁷17 Pelayo-Alvarez M, Perez-Hoyos S, Agra-Varela Y. Clinical effectiveness of online training in palliative care of primary care physicians. J Palliat Med. 2013;16(10):1188-96. https://doi.org/10.1089/jpm.2013.0005 https://doi.org/10.1089/jpm.2013.0005... ⁾	Clinical effectiveness of online training in palliative care of primary care physicians	JPalliat Med. 2013	Test the clinical effectiveness of online education in PC for physicians through impacts on symptom control and quality of life.	Randomized clinical trial	II
A11⁽¹⁸18 Beyea A, Fischer J, Schenck A, Hanson LC. Integrating palliative care information and hospice referral in medicaid primary care. J Palliat Med. 2013;16(4):376-82. https://doi.org/10.1089/jpm.2012.0483 https://doi.org/10.1089/jpm.2012.0483... ⁾	Integrating palliative care information and hospice referral in medicaid primary care	JPalliat Med. 2013	Assess an intervention to improve communication about early care planning and facilitate PC referral.	Analytical	VI
A12⁽¹⁹19 Johansen ML, Ervik B. Teamwork in primary palliative care: general practitioners' and specialised oncology nurses' complementary competencies. BMC Health Serv Res. 2018;18(1):159. https://doi.org/10.1186/s12913-018-2955-7 https://doi.org/10.1186/s12913-018-2955-... ⁾	Do rural primary health care nurses feelequipped for palliative care?	AustJPrim Health. 2012	Explore nurses' experiences and determine how they feel personally and professionals equipped to provide palliative services.	Qualitative	VI
A13⁽²⁰20 Warmenhoven F, Van Rijswijk E, Van Hoogstraten E, Van Spaendonck K, Lucassen P, Prins J, et al. How family physicians address diagnosis and management of depression in palliative care patients. Ann Fam Med. 2012;10(4):330-6. https://doi.org/10.1370/afm.1373 https://doi.org/10.1370/afm.1373... ⁾	How family physicians address diagnosis and management of depression in palliative care patients	AnnFam Med. 2012	Explore family doctors' opinions on knowledge, diagnosis and treatment of depression in PC.	Comparative analysis	VI
A14⁽²¹21 Murray SA, Osman H. Primary palliative care: the potential of primary care physicians as providers of palliative care in the community in the Eastern Mediterranean region. East Mediterr Health J. 2012;18(2):178-83. Available from: https://apps.who.int/iris/handle/10665/118464 https://apps.who.int/iris/handle/10665/1... ⁾	Primary palliative care: the potential of primary care physicians as providers of palliative care in the community in the Eastern Mediterranean region	East Mediterr HealthJ. 2012	Assess the urgent need for providing PC in the region.	Descriptive	V
A15⁽²²22 Cameron BL, Salas AS, Moissac D. Participatory knowledge exchange to support palliative care in Chile: lessons learned through global health research. Can J Nurs Res. 2011;43(3):16-37. Available from: https://pubmed.ncbi.nlm.nih.gov/21977724/ https://pubmed.ncbi.nlm.nih.gov/21977724... ⁾	Participatory knowledge exchange to support palliative care in Chile: lessons learned through global health research	CanJNurs Res. 2011	Support the provision of PC in vulnerable contexts through a participatory process of knowledge exchange, through qualitative and participatory methodologies.	Qualitative	VI
A16⁽²³23 Nnadi DC, Singh S. Knowledge of palliative care among medical interns in a tertiary health institution in Northwestern Nigeria. Indian J Palliat Care [Internet]. 2016 [cited 2021 Apr 29];22:343-7. Available from: https://www.jpalliativecare.com/text.asp?2016/22/3/343/185080 https://www.jpalliativecare.com/text.asp... ⁾	Effects of online palliative care training on knowledge, attitude and satisfaction of primary care physicians	BMCFam Pract. 2011	Compare the knowledge and attitude of primary care physicians in relation to PC for patients with advanced cancer as well as job satisfaction.	Educational randomized controlled trial for comparison	II
A17⁽²⁴24 Reigada C, Arantzamendi, Centeno C. Palliative care in its own discourse: a focused ethnography of professional messaging in palliative care. BMC Palliat Care. 2020;88(19). https://doi.org/10.1186/s12904-020-00582-5 https://doi.org/10.1186/s12904-020-00582... ⁾	Palliative and support care at home in primary care	GacSanit. 2011	Estimate the proportion of people who need PC and support at home in primary care and describe their characteristics.	Descriptive study	VI
A18⁽²⁵25 Winger A, Kvarme LG, Løyland B, Kristiansen C, Helseth S, Ravn IH. Family experiences with palliative care for children at home: a systematic literature review. BMC Palliat Care. 2020;19(1):165. https://doi.org/10.1186/s12904-020-00672-4 https://doi.org/10.1186/s12904-020-00672... ⁾	Palliative care for a child: role of a primary care doctor	MalaysFam Physician. 2011	Highlight the important role of primary care physicians in providing care.	Case study	VI
A19⁽²⁶26 Berggren E, Ödlund Olin A, Orrevall Y, Strang P, Johansson SE, Törnkvist L. Early palliative home care: evaluation of an interprofessional educational intervention for district nurses and general practitioners about nutritional care. SAGE Open Med. 2017;5:2050312117726465. https://doi.org/10.1177/2050312117726465 https://doi.org/10.1177/2050312117726465... ⁾	Sharedcareinbasiclevelpalliativehome care: organizational and interpersonal challenges	JPalliat Med. 2010	Analyze the views of health professionals on interprofessional cooperation at the basic level of home PC for patients with terminal cancer.	Descriptive qualitative study	VI
A20⁽²⁷27 Schneider N, Lueckmann SL, Kuehne F, Klindtworth K, Behmann M. Developing targets for public health initiatives to improve palliative care. BMC Public Health. 2010;10:222. https://doi.org/10.1186/s12904-016-0149-9 https://doi.org/10.1186/s12904-016-0149-... ⁾	Developing targets for public health initiatives to improve palliative care	BMCPublicHealth. 2010	Develop the first targets of public health initiatives to improve PC in Germany.	Qualitative study	VI
A21⁽²⁸28 Marques FP, Bulgarelli AF. Os sentidos da atenção domiciliar no cuidado ao idoso na finitude: a perspectiva humana do profissional do SUS. Ciênc Saúde Colet. 2020;25(6):2063-72. https://doi.org/10.1590/1413-81232020256.21782018 https://doi.org/10.1590/1413-81232020256... ⁾	Os sentidos da atenção domiciliar no cuidado ao idoso na finitude: a perspectiva humana do profissional do SUS	Ciênc. saúde coletiva. 2020	Understand the meanings of home care in the scope of primary care actions in elderly care from the perspective of SUS health professionals.	Qualitative theoretical-methodological approach	VI
A22⁽²⁹29 Wassmansdorf Mattos C, D'Agostini Derech R. Cuidados paliativos providos por médicos de família e comunidade na atenção primária à saúde brasileira: um survey nacional. Rev Bras Med Fam Comun [Internet]. 2020[cited 2021 Apr 29];15(42):2094. Available from: https://rbmfc.org.br/rbmfc/article/view/2094 https://rbmfc.org.br/rbmfc/article/view/... ⁾	Cuidados paliativos providos por médicos de família e comunidade na atenção primária à saúde brasileira	Revista Brasileira De Medicina De Família E Comunidade, 2020.	Characterize the practice of PC provided by family and community physicians in Brazilian primary care.	Cross-sectional and descriptive study	V

ARTICLE	CHALLENGES	ARTICLE	CHALLENGES
01	Centering PHC on the logic of care production, oriented to users' problems, needs and quality of life, contemplating not only curative procedures and actions, but human relationships, bonding and welcoming.	02	Provide patient-centered care rather than organizational logic, as implemented by case managers.
03	Develop innovative models for PC at PHC.	04	Plan PC assistance at PHC, considering the discomforts and difficulties in addressing issues that can cause suffering, depression, or destroy hope.
05	Encourage the organization of an information flow between secondary and primary care.	06	Expand the scope of care and PC at PHC, including other CNCDs and not just cancer.
07	Train professionals to identify patients eligible for PC at PHC.	08	Improve communication and the bond of trust between patients and professionals.
09	Also consider terminally ill families in care planning.	10	Assess the expectations of patients and caregivers in relation to care, aiming to improve the quality of life and avoid unnecessary travel to emergency services in the final stage of the disease.
11	Create patient-centred care systems, promote patient autonomy, improve quality of life, and lead to more effective use of health care resources.	12	End barriers to continuing education for professionals, including workload and geographic isolation.
13	Improve the diagnosis and treatment of depression in PC patients by PHC physicians through better communication strategies in the doctor-patient relationship.	14	Implement PC training and support to improve end-of-life care capacity.
15	Ensure more timely, fair and equitable access to PC in the community.	16	Need for continuous training of primary care physicians for PC.
17	Broaden the focus of PC, as most are very focused on providing care in response to specific clinical processes, such as malignant tumors.	18	Implement PC for children due to lack of knowledge and experience in this field.
19	Improve the organization of PC at this level of care (PHC) and the work culture among health professionals.	20	Establish individual goals for each patient according to their framework, aiming at the implementation of PC.
21	The network's ineffectiveness in articulating the demands with its consumption resources point to situations that bring a reflection on the support of this network in relation to its capacity to meet the demands of patients in finitude at home.	22	Difficulties in medical training, limited availability of supplies and human material can hinder a better provision of PC in Brazilian PHC.

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[1] Corresponding author: Thayná Champe da Silva. E-mail: thaynachampe@hotmail.com