| Name: | Description: | Size: | Format: | |
|---|---|---|---|---|
| 2.81 MB | Adobe PDF |
Advisor(s)
Abstract(s)
Introdução: Um dos aspetos mais desafiantes nos doentes oncológicos diz respeito à
nutrição. A nutrição acarreta um forte simbolismo por parte das pessoas, estando
inteiramente ligada ao bem-estar, a valores culturais, ao prazer e à vida, envolvendo
relações sociais e familiares. Desta forma, a alimentação no final da vida adquire um
novo significado devido às necessidades e barreiras impostas pela situação clínica do
doente e torna os cuidados em fim de vida emocionalmente complexos, principalmente
quando se questiona a necessidade de introdução ou suspensão da alimentação
artificial nos doentes oncológicos. Neste sentido, esta dissertação pretende explorar as
barreiras e os dilemas éticos que influenciam esta decisão.
Objetivo: Investigar as barreiras implicadas na decisão de iniciar ou interromper a
nutrição artificial em doentes oncológicos em fim de vida. Os objetivos subsidiários
deste trabalho são abordar os aspetos éticos relacionados com esta decisão.
Métodos: A pesquisa foi realizada entre setembro e dezembro de 2021 nas seguintes
bases de dados PubMed/MEDLINE, SCOPUS e Science Direct no sentido de encontrar
artigos que respondessem à pergunta investigadora. Todos os títulos e abstracts
encontrados foram sistematicamente avaliados. Aqueles que foram considerados
relevantes foram posteriormente lidos na íntegra para confrontação com os critérios de
inclusão e de exclusão. Para cada um dos estudos foi realizada uma tabela com os dados
relevantes tendo em conta a pergunta investigadora.
Resultados: A leitura e análise dos artigos incluídos permitiu encontrar 12 temas
principais que representam as barreiras na tomada de decisão acerca do início ou
retirada da nutrição artificial em doentes oncológicos: Qualidade de vida; Prolongar a
vida; Conhecimento sobre Nutrição artificial; Natureza simbólica da alimentação;
Autonomia do doente; Perspetiva da família; Perspetiva do doente; Perspetiva dos
Profissionais de saúde; Aceitação da doença e prognóstico; Cultura e contexto social;
Comunicação e educação; Sistema de saúde e experiência dos profissionais.
Discussão: A decisão de iniciar, manter ou suspender a alimentação artificial deve ser
discutida com a equipa técnica multiprofissional, paciente e com os seus familiares de
modo a tomar a decisão mais apropriada. Esta discussão deve ser completa o suficiente
de modo a se abordar todas as explicações clínicas necessárias, outras opções terapêuticas, crenças e desejos do paciente/família, e os possíveis benefícios e riscos da
intervenção.
Conclusão: Ter conhecimento das barreiras e dilemas éticos que surgem nos cuidados
em fim de vida dos doentes oncológicos torna-se indispensável para uma prática clínica
de qualidade. O reconhecimento e a abordagem mais precoce destas barreiras diminuiu
a carga psicológica, ansiedade e o conflito que este tema acarreta para o doente e a sua
família.
Introduction: One of the most challenging aspects in cancer patients concerns nutrition. Nutrition carries a strong symbolism by people, being entirely linked to wellbeing, cultural values, pleasure and life, involving social and family relationships. Thus, nutrition at the end of life acquires a new meaning due to the needs and barriers imposed by the patient's clinical situation and makes end-of-life care emotionally complex, especially when the need to introduce or discontinue artificial feeding in cancer patients is questioned. In this sense, this dissertation aims to explore the barriers and ethical dilemmas that influence this decision. Objective: To investigate the barriers involved in the decision to start or stop artificial nutrition in end-of-life cancer patients. The subsidiary objectives of this study are to address the ethical aspects related to this decision. Methods: The search was conducted between September and December 2021 in PubMed/MEDLINE, SCOPUS and Science Direct databases in order to find articles that answered the research question. All titles and abstracts found were systematically evaluated. Those considered relevant were then read in full to check against the inclusion and exclusion criteria. For each of the studies a table was made with the data relevant to the research question. Results: The reading and analysis of the included articles allowed finding 12 main themes that represent the barriers to decision-making about the initiation or withdrawal of artificial nutrition in cancer patients: Quality of life; Prolonging life; Knowledge about Artificial Nutrition; Symbolic nature of Nutrition; Patient Autonomy; Family Perspective; Patient Perspective; Health Professionals' Perspective; Acceptance of the disease and prognosis; Culture and social context; Communication and education; Health system and professionals' experience. Discussion: The decision to start, maintain or suspend artificial feeding should be discussed with the multiprofessional technical team, the patient and his/her relatives in order to make the most appropriate decision. This discussion should be thorough enough to address all the necessary clinical explanations, other therapeutic options, patient/family beliefs and wishes, and the possible benefits and risks of the intervention. Conclusion: Being aware of the ethical barriers and dilemmas that arise in the end-oflife care of cancer patients becomes indispensable for quality clinical practice. The recognition and earlier approach of these barriers decreased the psychological burden, anxiety and the conflict that this issue entails for the patient and family.
Introduction: One of the most challenging aspects in cancer patients concerns nutrition. Nutrition carries a strong symbolism by people, being entirely linked to wellbeing, cultural values, pleasure and life, involving social and family relationships. Thus, nutrition at the end of life acquires a new meaning due to the needs and barriers imposed by the patient's clinical situation and makes end-of-life care emotionally complex, especially when the need to introduce or discontinue artificial feeding in cancer patients is questioned. In this sense, this dissertation aims to explore the barriers and ethical dilemmas that influence this decision. Objective: To investigate the barriers involved in the decision to start or stop artificial nutrition in end-of-life cancer patients. The subsidiary objectives of this study are to address the ethical aspects related to this decision. Methods: The search was conducted between September and December 2021 in PubMed/MEDLINE, SCOPUS and Science Direct databases in order to find articles that answered the research question. All titles and abstracts found were systematically evaluated. Those considered relevant were then read in full to check against the inclusion and exclusion criteria. For each of the studies a table was made with the data relevant to the research question. Results: The reading and analysis of the included articles allowed finding 12 main themes that represent the barriers to decision-making about the initiation or withdrawal of artificial nutrition in cancer patients: Quality of life; Prolonging life; Knowledge about Artificial Nutrition; Symbolic nature of Nutrition; Patient Autonomy; Family Perspective; Patient Perspective; Health Professionals' Perspective; Acceptance of the disease and prognosis; Culture and social context; Communication and education; Health system and professionals' experience. Discussion: The decision to start, maintain or suspend artificial feeding should be discussed with the multiprofessional technical team, the patient and his/her relatives in order to make the most appropriate decision. This discussion should be thorough enough to address all the necessary clinical explanations, other therapeutic options, patient/family beliefs and wishes, and the possible benefits and risks of the intervention. Conclusion: Being aware of the ethical barriers and dilemmas that arise in the end-oflife care of cancer patients becomes indispensable for quality clinical practice. The recognition and earlier approach of these barriers decreased the psychological burden, anxiety and the conflict that this issue entails for the patient and family.
Description
Keywords
Dilemas Éticos Fim de Vida Nutrição Artificial Oncologia Tomada de Decisão