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      COMPROMETIMENTO DA QUALIDADE DE VIDA DE PACIENTES EM QUIMIOTERAPIA PALIATIVA E CUIDADOS PALIATIVOS: SCOPING REVIEW Translated title: COMPROMETIMIENTO DE LA CALIDAD DE VIDA DE PACIENTES EN QUIMIOTERAPIA PALIATIVA Y CUIDADOS PALIATIVOS: SCOPING REVIEW Translated title: LIFE QUALITY ASSESSMENT OF PATIENTS IN PALLIATIVE CHEMOTHERAPY AND PALLIATIVE CARE: SCOPING REVIEW

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          Abstract

          RESUMO: Objetivo: avaliar os domínios que comprometem a qualidade de vida de pacientes com câncer avançado em tratamento quimioterápico paliativo e cuidado paliativo. Método: Trata-se de uma scoping review realizada de março a maio de 2018, nas bases de dados CINAHL, LILACS, PubMed, Cuiden e na literatura cinzenta (Google Scholar e referências encontradas nos artigos analisados), utilizando os descritores “palliative care”,“quality of life”,“emotionalcare”, “functional care”,“sexual care”, “physical care”,“social care”,“comfort care”,“spiritual care”,“palliative chemotherapy” e “cancer advanced”. Foi realizada avaliação da qualidade metodológica por meio do instrumento STROBE para estudos observacionais e o CONSORT para os ensaios clínicos. Resultados: Os nove artigos encontrados e analisados são internacionais, publicados entre 2012 e 2016, com boa qualidade metodológica. Os domínios identificados foram os físicos, sociais e emocionais; o internamento hospitalar e local de óbito são fatores que também comprometeram a qualidade de vida. Conclusão: os pacientes em quimioterapia paliativa possuem baixa qualidade de vida. Porém, a presença de familiar e o acompanhamento concomitante com o serviço de cuidados paliativos melhoram essa situação. A avaliação dos pacientes, com enfoque nestes domínios, permite à Enfermagem adotar estratégias para melhoraria da qualidade de vida.

          Translated abstract

          RESUMEN: Objetivo: evaluar los dominios que comprometen la calidad de vida de pacientes con cáncer avanzado en tratamiento de quimioterapia paliativa y cuidado paliativo. Métodos: se trata de una scoping review realizada de marzo a mayo de 2018, en las bases de datos CINAHL, LILACS, PubMed, Cuiden y en la literatura gris (Google Scholar y referencias encontradas en los artículos analizados), utilizando los descriptores “palliative care”, “quality of life”, “emotional care”, “functional care”, “sexual care”, “physical care”, “social care”, “comfort care”, “spiritual care”, “palliative chemotherapy” y “cancer advanced”. Fue realizada evaluación de la calidad metodológica por medio del instrumento STROBE para estudios observacionales y el CONSORT para los ensayos clínicos. Resultados: Los nueve artículos encontrados y analizados son internacionales, publicados entre 2012 y 2016, con buena calidad metodológica. Los dominios identificados fueron los físicos, sociales y emocionales, la hospitalización y lugar de fallecimiento son factores que también comprometieron la calidad de vida. Conclusión: los pacientes en quimioterapia paliativa poseen baja calidad de vida. Sin embargo, la presencia de familiar y el acompañamiento concomitante con el servicio de cuidados paliativos mejoran esta situación. La evaluación de los pacientes, con enfoque en estos ámbitos, permite que la Enfermería adopte estrategias para la mejora de la calidad de vida.

          Translated abstract

          ABSTRACT Objective: evaluate the domains that compromise the quality of life of patients with advanced cancer in palliative chemotherapy and palliative care. Method: This is a scoping review conducted from March to May 2018 in the databases CINAHL, LILACS, PubMed, Cuiden and in the gray literature (Google Scholar and references found in the articles analyzed), using the descriptors “palliative care”, “quality of life”, “emotional care”, “functional care”, “sexual care”, “physical care”, “social care”, “comfort care”, “spiritual care”, “palliative chemotherapy” and “advanced cancer”. Methodological quality evaluation was done by using the STROBE instrument for observational studies and CONSORT for clinical trials. Result: The nine articles found and analyzed are international, published between 2012 and 2016, with good methodological quality. The domains identified were physical, social and emotional, hospitalization and place of death are factors that also compromised the quality of life. It is concluded that the patients in palliative chemotherapy have low quality of life. Conclusion: However, the presence of family members and the concomitant companion with the palliative care service improves this situation. The evaluation of the patients, focusing on these domains, allows Nursing to adopt strategies to improve the quality of life.

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          Factors important to patients' quality of life at the end of life.

          When curative treatments are no longer options for patients dying of cancer, the focus of care often turns from prolonging life to promoting quality of life (QOL). Few data exist on what predicts better QOL at the end of life (EOL) for advanced cancer patients. The purpose of this study was to determine the factors that most influence QOL at the EOL, thereby identifying promising targets for interventions to promote QOL at the EOL. Coping With Cancer is a US multisite, prospective, longitudinal cohort study of 396 advanced cancer patients and their informal caregivers who were enrolled from September 1, 2002, through February 28, 2008. Patients were followed up from enrollment to death a median of 4.1 months later. Patient QOL in the last week of life was a primary outcome of Coping With Cancer and the present report. The following set of 9 factors, preceded by a sign indicating the direction of the effect and presented in rank order of importance, explained the most variance in patients' QOL at the EOL: 1 = (-) intensive care unit stays in the final week (explained 4.4% of the variance in QOL at the EOL), 2 = (-) hospital deaths (2.7%), 3 = (-) patient worry at baseline (2.7%), 4 = (+) religious prayer or meditation at baseline (2.5%), 5 = site of cancer care (1.8%), 6 = (-) feeding-tube use in the final week (1.1%), 7 = (+) pastoral care within the hospital or clinic (1.0%), 8 = (-) chemotherapy in the final week (0.8%), and 9 = (+) patient-physician therapeutic alliance at baseline (0.7%). The vast majority of the variance in QOL at the EOL, however, remained unexplained. Advanced cancer patients who avoid hospitalizations and the intensive care unit, who are less worried, who pray or meditate, who are visited by a pastor in the hospital/clinic, and who feel a therapeutic alliance with their physicians have the highest QOL at the EOL.
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            Impact of timing and setting of palliative care referral on quality of end-of-life care in cancer patients

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              The determinants of home and nursing home death: a systematic review and meta-analysis

              Background Most Canadians die in hospital, and yet, many express a preference to die at home. Place of death is the result of the interaction among sociodemographic, illness- and healthcare-related factors. Although home death is sometimes considered a potential indicator of end-of-life/palliative care quality, some determinants of place of death are more modifiable than others. The objective of this systematic review was to evaluate the determinants of home and nursing home death in adult patients diagnosed with an advanced, life-limiting illness. Methods A systematic literature search was performed for studies in English published from January 1, 2004 to September 24, 2013 that evaluated the determinants of home or nursing home death compared to hospital death in adult patients with an advanced, life-limiting condition. The adjusted odds ratios, relative risks, and 95 % confidence intervals of each determinant were extracted from the studies. Meta-analyses were performed if appropriate. The quality of individual studies was assessed using the Newcastle-Ottawa scale and the body of evidence was assessed according to the GRADE Working Group criteria. Results Of the 5,900 citations identified, 26 retrospective cohort studies were eligible. The risk of bias in the studies identified was considered low. Factors associated with an increased likelihood of home versus hospital death included multidisciplinary home palliative care, preference for home death, cancer as opposed to other diagnoses, early referral to palliative care, not living alone, having a caregiver, and the caregiver’s coping skills. Conclusions Knowledge about the determinants of place of death can be used to inform care planning between healthcare providers, patients and family members regarding the feasibility of dying in the preferred location and may help explain the incongruence between preferred and actual place of death. Modifiable factors such as early referral to palliative care, presence of a multidisciplinary home palliative care team were identified, which may be amenable to interventions that improve the likelihood of a patient dying in the preferred location. Place of death may not be a very good indicator of the quality of end-of-life/palliative care since it is determined by multiple factors and is therefore dependent on individual circumstances. Electronic supplementary material The online version of this article (doi:10.1186/s12904-016-0077-8) contains supplementary material, which is available to authorized users.
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                Author and article information

                Journal
                ccs
                Ciência, Cuidado & Saúde
                Ciênc. cuid. saúde
                Universidade Estadual de Maringá (Maringá, PR, Brazil )
                1677-3861
                March 2019
                : 18
                : 1
                : e43078
                Affiliations
                [5] Curitiba Paraná orgnameUniversidade Federal do Paraná Brazil lucianakalinke@ 123456yahoo.com.br
                [3] Curitiba Paraná orgnameUniversidade Federal do Paraná Brazil leoneldss@ 123456gmail.com
                [1] Curitiba Paraná orgnameHospital Erasto Gaertner Brasil brulenhani@ 123456gmail.com
                [2] Curitiba Paraná orgnameUniversidade Federal do Paraná Brazil dabnatomim@ 123456gmail.com
                [4] Curitiba Paraná orgnameUniversidade Federal do Paraná Brazil nogueira_lu@ 123456hotmail.com.
                Article
                S1677-38612019000100301 S1677-3861(19)01800100301
                10.4025/cienccuidsaude.v18i1.43078
                35d9063e-9a94-43da-82ff-9cb25cba8248

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : 30 January 2019
                : 05 June 2018
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 27, Pages: 0
                Product

                SciELO Revista de Enfermagem

                Categories
                Artigos Originais

                Oncology nursing,Calidad de vida,Cuidados paliativos,Tratamiento farmacológico,Neoplasias,Enfermería oncológica,Qualidade de vida,Tratamento farmacológico,Enfermagem oncológica,Quality of life,Palliative care,Drug therapy,Neoplasms

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