Cuidados Paliativos na Doença Pulmonar Crônica: uma scoping review

Abstract

RESUMO: Introduction: Chronic lung diseases, such as COPD and interstitial lung diseases, are associated with high morbidity and mortality rates. As a result, patients experience progressive decline in quality of life, suffering, and limitations in daily activities. Therefore, the involvement of Palliative Care is essential for symptom management, advance care planning, and providing psychological, emotional, spiritual, and social support to patients and their caregivers. The primary objective of this study was to understand Palliative Care in this context. Additionally, the study aimed to evaluate the effectiveness of Palliative Care in improving health-related quality of life, respiratory and non-respiratory symptom control, and to identify the impact of Palliative Care on location of death, use of mechanical ventilation, hospital admissions and ICU stays, and advance care planning. Methods: A scoping review was conducted following the guidelines of the Joanna Briggs Institute. The databases used were Medline (PubMed) and Web of Knowledge (ISI). The search terms included "palliative care" AND "lung disease" NOT "neoplasm" NOT "COVID-19". The inclusion criteria consisted of original studies published from 2000 onwards, including randomized and non-randomized controlled trials, prospective and retrospective cohorts, without language restrictions. Eligible participants were ≥18 years old with chronic lung disease (COPD or interstitial lung diseases) who underwent any form of palliative care intervention (home-based, hospital-based, hospice, end-of-life care), followed by measurement of relevant outcomes such as health-related quality of life, respiratory and non-respiratory symptom control, hospital admissions or emergency visits, ICU admissions, use of mechanical ventilation in the terminal event, and location of death. Out of the 48 articles initially identified, 12 met the pre-defined selection criteria and were included in this review. Results: The 12 included articles comprised randomized controlled trials, retrospective and prospective cohorts. The results did not demonstrate improvement in health-related quality of life or respiratory and non-respiratory symptom control in patients undergoing Palliative Care. However, they indicated that Palliative Care was associated with increased advance care planning and more deaths occurring in the preferred location. Conclusions: Further multicenter randomized controlled trials are needed to evaluate the predefined outcomes in this analysis and confirm the effectiveness of Palliative Care. Despite not finding improvements in quality of life and other outcomes, patients can still benefit from Palliative Care due to (1) advance care planning and (2) support provided to caregivers during the bereavement phase.