Hostname: page-component-cd9895bd7-dzt6s Total loading time: 0 Render date: 2024-12-22T18:35:24.515Z Has data issue: false hasContentIssue false
  • English
  • Français

The process of palliative sedation as viewed by physicians and nurses working in palliative care in Brazil

Published online by Cambridge University Press:  31 October 2014

Vívian Marina Calixto Damasceno Spineli ,
Andrea Yamaguchi Kurashima  and
Maria Gaby Rivero De Gutiérrez
Vívian Marina Calixto Damasceno Spineli*
Affiliation:
Paulista School of Nursing, Federal University of São Paulo, São Paulo, São Paulo, Brazil
Andrea Yamaguchi Kurashima
Affiliation:
Fundação Antônio Prudente, A.C. Camargo Cancer Center, São Paulo, São Paulo, Brazil
Maria Gaby Rivero De Gutiérrez
Affiliation:
Paulista School of Nursing, Federal University of São Paulo, São Paulo, São Paulo, Brazil
*
Address correspondence and reprint requests to: Vívian Marina Calixto Damasceno Spineli, Rua Napoleão de Barros, 754, São Paulo, São Paulo, Brazil. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

Our aim was to describe the process of palliative sedation from the point of view of physicians and nurses working in palliative care in Brazil.

Method:

Ours was a descriptive study conducted between May and December of 2011, with purposeful snowball sampling of 32 physicians and 29 nurses working in facilities in Brazil that have adopted the practice of palliative care.

Results:

The symptoms prioritized for an indication of palliative sedation were dyspnea, delirium, and pain. Some 65.6% of respondents believed that the survival time of a patient in the final phase was not a determining factor for the indication of this measure, and that the patient, family, and healthcare team should participate in the decision-making process. For 42.6% of these professionals, the opinion of the family was the main barrier to an indication of this therapy.

Significance of results:

The opinion of the physicians and nurses who participated in this study converged with the principal national and international guidelines on palliative sedation. However, even though it is a therapy that has been adopted in palliative care, it remains a controversial practice.

Keywords

Palliative careEnd of lifePalliative sedationTerminal sedationDeep sedation
Type
Original Articles
Information
Palliative & Supportive Care , Volume 13 , Issue 5 , October 2015 , pp. 1293 - 1299
Copyright
Copyright © Cambridge University Press 2014 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Arantes, A.C. & Sardenberg, C. (2012). Diretrizes assistenciais: Avaliação e monitorização do paciente em cuidados paliativos estando ou não em estado terminal de doença grave e incurável. Available at http://medsv1.einstein.br/diretrizes_paliativos.asp.Google Scholar
Araújo, D. & Linch, G.F.C. (2011). Cuidados paliativos oncológicos: Tendências da produção científica. Revista de Enfermagem, 1(2), 238–245.Google Scholar
Blondeau, D., Dumont, S., Roy, L., et al. (2009). Attitudes of Quebec doctors toward sedation at the end of life: An exploratory study. Palliative & Supportive Care, 7(3), 331–337.Google Scholar
Boceta Osuna, J., Nabal Vicuña, M., Martínez Peñalver, F., et al. (2013). Sedación paliativa en un Hospital Universitario: Experiencia tras la puesta en marcha de un protocolo específico [Palliative sedation in a university hospital: Experience after introducing a specific protocol]. Revista de Calidad Asistencial, 28(4), 225–233.Google Scholar
Calvo-Espinos, C., Ruiz de Gaona, E., Gonzalez, C., et al. (2014). Palliative sedation for cancer patients included in a home care program: A retrospective study. Palliative & Supportive Care, 24, 1–6.Google Scholar
Camargo, B. & Kurashima, A.Y. (2007). Cuidados paliativos em oncologia pediátrica: O cuidar além do curar. São Paulo: Lemar.Google Scholar
Campbell, M.L. (2011). Nurse to nurse: Cuidados paliativos na enfermagem. Transl. Ritomy, Maiza. New York: McGraw-Hill.Google Scholar
Cherny, N.I., Radbruch, L. & Board of the European Association for Palliative Care (2009). European Association for Palliative Care (EAPC) recommended framework for the use of sedation in palliative care. Palliative Medicine, 23(7), 581–593.Google Scholar
Conselho Federal de Medicina (2010). Resolução CFM—1.931/2010. Código de ética médica. Available at http://www.portalmedico.org.br/novocodigo/.Google Scholar
Conselho Federal de Medicina (2012). Pacientes poderão registrar em prontuário a quais procedimentos querem ser submetidos no fim da vida. Available at http://portal.cfm.org.br/index.php?option=com_content&view=article&id=23197:pacientes-poderao-registrar-em-prontuario-a-quais-procedimentos-querem-ser-submetidos-no-fim-da-vida&catid=3.Google Scholar
Conselho Regional de Medicina do Estado de São Paulo (2008). Cuidado paliativo. Available at http://www.cremesp.org.br/.Google Scholar
Dumont, S., Blondeau, D., Turcotte, V., et al. (2014). The use of palliative sedation: A comparison of attitudes of French-speaking physicians from Quebec and Switzerland. Palliative & Supportive Care, 14, 1–9.Google Scholar
Elsayem, A., Curry, E., Boohene, J. et al. (2009). Use of palliative sedation for intractable symptoms in the palliative care unit of a comprehensive cancer center. Supportive Care in Cancer, 17, 53–59.Google Scholar
Etter, J.F. & Perneger, T.V. (2000). Snowball sampling by mail: Application to a survey of smokers in the general population. International Journal of Epidemiology, 29, 43–44.Google Scholar
Ferreira, S.P. (2006). Experiência do programa de cuidados paliativos do Hospital do Servidor Público Estadual de São Paulo. Revista Prática Hospitalar, 8(47), 55–58.Google Scholar
Girond, J.B.R. & Waterkemper, R. (2006). Sedação, eutanásia e o processo de morrer do paciente com câncer em cuidados paliativos: Compreendendo conceitos e interrelações. Cogitare Enfermagem, 11(3), 258–263.Google Scholar
Gonçalves, F., Cordero, A., Almeida, A., et al. (2012). A survey of the sedation practice of Portuguese palliative care teams. Supportive Care in Cancer, 20(12), 3123–3127.CrossRefGoogle ScholarPubMed
International Association for Hospice and Palliative Care (IAHPC) (2009). Hospices services, donate to hospice, find a local hospice, hospice and palliative events, conferences and meetings. Available at http://hospicecare.com/home/.Google Scholar
Koper, I., van der Heide, A., Janssens, R., et al. (2014). Consultation with specialist palliative care services in palliative sedation: Considerations of Dutch physicians. Supportive Care in Cancer, 22(1), 225–231.Google Scholar
Maltoni, M., Pittureri, C., Scarpi, E. et al. (2009). Palliative sedation therapy does not hasten death: Results from a prospective multicenter study. Annals of Oncology, 20, 1163–1169.Google Scholar
Maltoni, M., Scarpi, E. & Nanni, O. (2013). Palliative sedation in end-of-life care. Current Opinion in Oncology, 25(4), 360–367.CrossRefGoogle ScholarPubMed
Miccinesi, G., Rietjens, J.A., Deliens, L., et al. (2006). Continuous deep sedation: Physicians' experiences in six European countries. Journal of Pain and Symptom Management, 31(2), 122–129.Google Scholar
Ministério da Saúde, Instituto Nacional de Câncer de Brazil (2001). Cuidados paliativos oncológicos: Controle da dor. Available at http://www.inca.gov.br/publicacoes/manual_dor.pdf.Google Scholar
Morita, T., Akechi, T., Sugawara, Y., et al. (2002). Practices and attitudes of Japanese oncologists and palliative care physicians concerning terminal sedation: A nationwide survey. Journal of Clinical Oncology, 20(3), 758–764.Google Scholar
Moritz, R. (2011). Sedação e cuidados paliativos. Available at http://www.amib.org.br/detalhe/noticia/sedacao-e-cuidados-paliativos/.Google Scholar
Moyano, J., Zambrano, S., Ceballos, C., et al. (2008). Palliative sedation in Latin America: Survey on practices and attitudes. Supportive Care in Cancer, 16, 431–435.Google Scholar
Nabal, M., Palomar, C., Juvero, M.T., et al. (2014). Sedación paliativa: Situación actual y áreas de mejora [Palliative sedation: Current situation and areas of improvement]. Revista de Calidad Asistencial, 29(2), 104–111.Google Scholar
Nogueira, F.L. & Sakata, R.K. (2012). Sedação paliativa do paciente terminal. Revista Brasileira de Anestesiologia, 62(4), 580–592.Google Scholar
Santos, D., Valle, A.D., Barlocco, B., et al. (2009). Sedación paliativa: Experiencia en una unidad de cuidados paliativos de Montevideo. Revista Médica del Uruguay, 25(2), 78–83.Google Scholar
Silva, C.H.D. (2008). Quando o tratamento oncológico pode ser fútil? Do ponto de vista do saber-fazer médico. Revista Brasileira de Cancerologia, 54(4), 401–410.Google Scholar
van Deijck, R.H., Krijnsen, P.J., Hasselaar, J.G., et al. (2010). The practice of continuous palliative sedation in elderly patients: A nationwide explorative study among Dutch nursing home physicians. Journal of the American Geriatrics Society, 58(9), 1671–2678.Google Scholar
World Health Organization (WHO) (2011). Palliative care. Available at http://www.euro.who.int/en/home/.Google Scholar