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A complexidade clínica em medicina paliativa
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Introdução: Na fase avançada das doenças crónicas, a presença de necessidades paliativas distingue o nível de cuidados: básico, intermédio e especializado. Os cuidados especializados devem responder a pessoas com necessidades complexas, sendo indispensável integrar o conceito de complexidade na prática clínica. Todavia, é um conceito que carece de uniformização, definição universal e operacionalização. Foram objetivos deste estudo rever, de forma sistemática, as variáveis que contribuem para identificar o doente complexo e contribuir para a uniformização do conceito de complexidade em medicina paliativa. Métodos: Pesquisa nas bases de dados PubMed, Scopus e Ovid por artigos publicados, tendo sido incluídos estudos referentes à complexidade clínica em medicina paliativa, sem limite de tempo. Os outcomes para a extração dos dados foram a definição de complexidade utilizada, o tamanho da população, a percentagem de doentes complexos, os domínios e/ou sistemas e fatores de complexidade considerados, bem como o nível de complexidade. Resultados: A pesquisa resultou em 15 estudos elegíveis, tendo posteriormente sido acrescentado 1 estudo. Os 16 estudos incluídos foram submetidos a avaliação de qualidade e extração e síntese dos dados. Conclusão: Vários fatores contribuem para a complexidade do doente em fase paliativa, destacando os domínios e/ou sistemas de complexidade, bem como a resposta paliativa em função da complexidade. Assim, o trabalho sensibiliza os profissionais de saúde para o doente complexo, reconhecendo as suas características e quando merece uma intervenção mais complexa, facilitando a comunicação entre os clínicos das diferentes especialidades. Contudo, verificou-se que na literatura não há uniformização de critérios de referenciação, nem existe uma abordagem pragmática aos doentes complexos.
Introduction: In the advanced stage of chronic diseases, the presence of palliative needs distinguishes the level of care: basic, intermediate and specialized. Specialized care must respond to people with complex needs, and it is essential to integrate the concept of complexity into clinical practice. However, it is a concept that lacks standardization, universal definition and operationalization. The objectives of this study were to systematically review the variables that identify the complex patient and contribute to the standardization of the concept of complexity in palliative medicine. Methods: Search in PubMed, Scopus and Ovid databases for articles published, including studies related to clinical complexity in palliative medicine, without time limitations. Outcomes for data extraction were the definition of complexity used, population size, percentage of complex patients, domains and/or systems and factors of complexity considered, as well as the level of complexity. Results: The search resulted in 15 eligible studies, and 1 study was added later. The 16 included studies underwent quality assessment and data extraction and synthesis. Conclusion: Several factors contribute to the complexity of the patient in the palliative phase, highlighting the domains and/or systems of complexity, as well as the palliative response depending on the complexity. Thus, the work sensitizes health professionals to the complex patient, recognizing their characteristics and when they deserve a more complex intervention, facilitating communication between clinicians from different specialties. However, it was found that in the literature there is no standardization of referral criteria nor is there a pragmatic approach to complex patients.
Introduction: In the advanced stage of chronic diseases, the presence of palliative needs distinguishes the level of care: basic, intermediate and specialized. Specialized care must respond to people with complex needs, and it is essential to integrate the concept of complexity into clinical practice. However, it is a concept that lacks standardization, universal definition and operationalization. The objectives of this study were to systematically review the variables that identify the complex patient and contribute to the standardization of the concept of complexity in palliative medicine. Methods: Search in PubMed, Scopus and Ovid databases for articles published, including studies related to clinical complexity in palliative medicine, without time limitations. Outcomes for data extraction were the definition of complexity used, population size, percentage of complex patients, domains and/or systems and factors of complexity considered, as well as the level of complexity. Results: The search resulted in 15 eligible studies, and 1 study was added later. The 16 included studies underwent quality assessment and data extraction and synthesis. Conclusion: Several factors contribute to the complexity of the patient in the palliative phase, highlighting the domains and/or systems of complexity, as well as the palliative response depending on the complexity. Thus, the work sensitizes health professionals to the complex patient, recognizing their characteristics and when they deserve a more complex intervention, facilitating communication between clinicians from different specialties. However, it was found that in the literature there is no standardization of referral criteria nor is there a pragmatic approach to complex patients.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2022
Palavras-chave
Cuidados paliativos Complexidade Necessidades complexas