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Abstract(s)
Introdução: Na prática clínica atual, é frequente que os médicos prescrevam alimentação
artificial a indivíduos com demência avançada. Contudo, as recomendações das sociedades
científicas de geriatria e nutrição contraindicam a administração da mesma nesta
população. Com o envelhecimento global e contínuo da população, espera-se um aumento
significativo do número de indivíduos que vivem com demência, num futuro próximo. A
decisão sobre alimentação artificial em indivíduos com demência avançada é eticamente
desafiante. Num contexto em que será cada vez mais frequente que a equipa clínica se
confronte com este processo de tomada de decisão, revela-se pertinente compreender quais
os aspetos que o influenciam.
Objetivo: Analisar a literatura, de modo a perceber quais os aspetos que influenciam a
decisão sobre alimentação artificial em indivíduos com demência avançada.
Métodos: Foi realizada uma revisão sistemática da literatura. Para tal foi efetuada uma
pesquisa bibliográfica abrangente, em 3 bases de dados eletrónicas: PubMed/MEDLINE,
Web of Science e SciELO. Foi respeitada a metodologia PRISMA. Todos os títulos e
abstracts encontrados foram avaliados, de acordo com os critérios de seleção definidos. Os
artigos duplicados foram removidos. Foram selecionados para leitura na íntegra os artigos
considerados adequados. Os estudos que cumpriram os critérios de seleção foram incluídos
na análise qualitativa e foi utilizada a escala de Hawker et al para avaliação da qualidade
dos mesmos. Para tornar o processo de extração de dados coerente e sistematizado, foi
utilizado um formulário de extração de dados. A análise dos estudos incluídos resultou de
uma combinação de análise temática e síntese narrativa.
Resultados: Foram incluídos 17 estudos nesta revisão sistemática, cuja análise permitiu
identificar os seguintes 11 temas interrelacionados: Decisão partilhada; Vontade prévia do
paciente; DAV/PAC sobre alimentação artificial; Opinião do PCS/familiares/cuidadores;
Opinião da equipa clínica; Benefícios, riscos e opções alternativas; Aspetos legais; Aspetos
socioeconómicos; Aspetos religiosos; Aspetos culturais/ambientais; e Qualidade de vida.
Conclusão: A decisão sobre alimentação artificial em demência avançada é efetivamente
influenciada por uma panóplia de aspetos, que se encontram intimamente relacionados.
Esta decisão é eticamente desafiante na medida em que estes aspetos entram
frequentemente em conflito gerando dilemas éticos. O processo de decisão deve ser
compartilhado, sustentado por um processo de deliberação ética, e sempre norteado pelos
princípios basilares da ética médica.
Introduction: In current clinical practice, physicians frequently prescribe artificial feeding to individuals with advanced dementia. However, the recommendations of the scientific societies of geriatrics and nutrition contraindicate the use of artificial feeding in this population. With the global and continuous aging of the world’s population, a significant increase in the number of individuals living with dementia is expected in the near future. The decision about artificial feeding in individuals with advanced dementia is ethically challenging. Thus, in a context in which the clinical team will often face this decision making, it is relevant to understand which aspects influence it. Objective: To analyze the literature, in order to understand which aspects influence the decision about artificial feeding in individuals with advanced dementia. Methods: A systematic review of the literature was performed. To this end, a comprehensive literature search was carried out in 3 electronic databases: PubMed/MEDLINE, Web of Science and SciELO. PRISMA methodology was followed. All titles and abstracts found were evaluated according to the defined selection criteria. Duplicate articles were removed. The articles considered adequate were selected for full reading. Studies that met the selection criteria were included in the qualitative analysis and the Hawker et al scale was used to assess their quality. To make the data extraction process coherent and systematized, a data extraction form was used. The analysis of the included studies resulted from a combination of thematic analysis and narrative synthesis. Results: 17 studies were included in this systematic review, whose analysis allowed the identification of the following 11 interrelated themes: Shared decision; Patient's prior wishes; ADW/ACP on artificial feeding; HCA/relatives/caregivers’s opinion; Clinical team’s opinion; Benefits, risks and alternative options; Legal aspects; Socio-economic aspects; Religious aspects; Cultural/environmental aspects; and Quality of life. Conclusion: The decision about artificial feeding in advanced dementia is influenced by a wide range of aspects, which are closely related. This decision is ethically challenging as these aspects often come into conflict, generating ethical dilemmas. The decision process must be shared, supported by a process of ethical deliberation, and always guided by the fundamental principles of medical ethics.
Introduction: In current clinical practice, physicians frequently prescribe artificial feeding to individuals with advanced dementia. However, the recommendations of the scientific societies of geriatrics and nutrition contraindicate the use of artificial feeding in this population. With the global and continuous aging of the world’s population, a significant increase in the number of individuals living with dementia is expected in the near future. The decision about artificial feeding in individuals with advanced dementia is ethically challenging. Thus, in a context in which the clinical team will often face this decision making, it is relevant to understand which aspects influence it. Objective: To analyze the literature, in order to understand which aspects influence the decision about artificial feeding in individuals with advanced dementia. Methods: A systematic review of the literature was performed. To this end, a comprehensive literature search was carried out in 3 electronic databases: PubMed/MEDLINE, Web of Science and SciELO. PRISMA methodology was followed. All titles and abstracts found were evaluated according to the defined selection criteria. Duplicate articles were removed. The articles considered adequate were selected for full reading. Studies that met the selection criteria were included in the qualitative analysis and the Hawker et al scale was used to assess their quality. To make the data extraction process coherent and systematized, a data extraction form was used. The analysis of the included studies resulted from a combination of thematic analysis and narrative synthesis. Results: 17 studies were included in this systematic review, whose analysis allowed the identification of the following 11 interrelated themes: Shared decision; Patient's prior wishes; ADW/ACP on artificial feeding; HCA/relatives/caregivers’s opinion; Clinical team’s opinion; Benefits, risks and alternative options; Legal aspects; Socio-economic aspects; Religious aspects; Cultural/environmental aspects; and Quality of life. Conclusion: The decision about artificial feeding in advanced dementia is influenced by a wide range of aspects, which are closely related. This decision is ethically challenging as these aspects often come into conflict, generating ethical dilemmas. The decision process must be shared, supported by a process of ethical deliberation, and always guided by the fundamental principles of medical ethics.
Description
Keywords
Alimentação Artificial Aspetos Éticos Demência Avançada Suporte Nutricional Tomada de Decisão Ética