Abordajes éticos en cuidados paliativos: Una revisión de las estrategias y desafíos del personal médico

Abrahan Rodrigo Escobar Bautista, Edison Santiago Gabela Acurio

Resumen


Los cuidados paliativos presentan desafíos para el personal médico. Esta revisión exploró las estrategias y retos éticos en este contexto. Se realizó una búsqueda sistemática en bases de datos, seleccionando estudios que abordarán la perspectiva ética del personal médico en cuidados paliativos. Se encontró que las principales estrategias fueron el enfoque centrado en el paciente, la comunicación abierta, la toma de decisiones compartida y el apoyo emocional. Los desafíos incluyeron la falta de formación en ética, dificultades de comunicación, gestión de conflictos y barreras institucionales. Factores como valores personales y contexto cultural influyeron en las decisiones éticas. Se concluyó que se requiere promover la formación en ética, un enfoque multidisciplinario y políticas institucionales para abordar los retos. Futuras investigaciones deben profundizar en intervenciones para apoyar al personal médico en la toma de decisiones éticas en cuidados paliativos.


Palabras clave


Abordajes éticos; Cuidados paliativos; Desafíos; Estrategias; Personal médico.

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Referencias


Azevedo, C., Pessalacia, J. D. R., Mata, L. R. F. da, Zoboli, E. L. C. P., & Pereira, M. da G. (2017). Interface between social support, quality of life and depression in users eligible for palliative care. Revista Da Escola de Enfermagem Da USP, 51, e03245. https://doi.org/10.1590/S1980-220X2016038003245

Beauchamp, T. L., & Childress, J. F. (2001). Principles of Biomedical Ethics. Oxford University Press.

Berlinger, N., Jennings, B., Wolf, S. M., & Center, H. (2013). The Hastings Center Guidelines for Decisions on Life-Sustaining Treatment and Care Near the End of Life: Revised and Expanded Second Edition. OUP USA.

Bernacki, R. E., & Block, S. D. (2014). Communication About Serious Illness Care Goals: A Review and Synthesis of Best Practices. JAMA Internal Medicine, 174(12), 1994–2003. https://doi.org/10.1001/jamainternmed.2014.5271

Bolela, F., Lima, R. de, Souza, A. C. de, Moreira, M. R., Lago, A. J. de O., Simino, G. P. R., & Araújo, J. S. de. (2022). Cancer patients in Palliative Care: Occurrences related to venipuncture and hypodermoclysis. Revista Latino-Americana de Enfermagem, 30, e3623. https://doi.org/10.1590/1518-8345.5825.3624

Bookbinder, M., & McHugh, M. E. (2010). Symptom Management in Palliative Care and End of Life Care. Nursing Clinics, 45(3), 271–327. https://doi.org/10.1016/j.cnur.2010.04.002

Busquet-Duran, X., Manresa-Domínguez, J. M., Llobera-Estrany, J., López-García, A. I., Moreno-Gabriel, E., & Torán-Monserrat, P. (2023). [Care complexity and place of death in palliative home care]. Gaceta sanitaria, 37, 102266. https://doi.org/10.1016/j.gaceta.2022.102266

Cain, C. L., Surbone, A., Elk, R., & Kagawa-Singer, M. (2018). Culture and palliative care: Preferences, communication, meaning, and mutual decision making. Journal of pain and symptom management, 55(5), 1408–1419.

Ceballos-Yáñez, D., Astudillo P, P., & Eugenin-Soto, M. I. (2023). Facilitators and barriers perceptions to early referral to pediatric palliative care perceived. Andes Pediatrica, 94(3), 307–315. https://doi.org/10.32641/andespediatr.v94i3.4382

Chochinov, H. M. (2002). Dignity-Conserving Care—A New Model for Palliative CareHelping the Patient Feel Valued. JAMA, 287(17), 2253–2260. https://doi.org/10.1001/jama.287.17.2253

Chochinov, H. M., & Cann, B. J. (2005). Interventions to Enhance the Spiritual Aspects of Dying. Journal of Palliative Medicine, 8(supplement 1), s-103. https://doi.org/10.1089/jpm.2005.8.s-103

Csikai, E. L., Roth, S., & Moore, C. (2004). Ethical Problems in End-of-Life Care Decision Making Faced by Oncology Social Workers and the Need for Practice Guidelines. Journal of Psychosocial Oncology, 22(1), 1–18. https://doi.org/10.1300/J077v22n01_01

Dalal, S., & Bruera, E. (2011). Assessment and management of pain in the terminally ill. Primary Care, 38(2), 195–223, vii–viii. https://doi.org/10.1016/j.pop.2011.03.004

Daugherty, C. K. (2004). Examining Ethical Dilemmas as Obstacles to Hospice and Palliative Care for Advanced Cancer Patients. Cancer Investigation, 22(1), 123–131. https://doi.org/10.1081/CNV-120027587

de Andrade, F. K., Nunes, R. P. I., Zanetti, M. O. B., Zanetti, A. C. B., dos Santos, M., de Oliveira, A. M., Carson-Stevens, A., Pereira, L. R. L., & Varallo, F. R. (2024). Validated medication deprescribing instruments for patients with palliative care needs: A systematic review. Farmacia Hospitalaria, 48(2), 83–89. https://doi.org/10.1016/j.farma.2023.08.004

de-la-Rica-Escuín, M., García-Barrecheguren, A., & Monche-Palacín, A. M. (2019). Assessment of the needs for palliative care in advanced chronic patients on discharge. Enfermería Clínica (English Edition), 29(1), 18–26. https://doi.org/10.1016/j.enfcle.2018.07.004

Diaz, M. H., Ibañez Ledesma, L. G., Torres Gomez, F., Carretero, M., Pasquinelli, R., Martínez, B. J., & Grande Ratti, M. F. (2023). [Chemotherapy at the end of life is compatible with dignified death and palliative care. Revista de la Facultad de Ciencias Medicas (Cordoba, Argentina), 80(2), 93–98. https://doi.org/10.31053/1853.0605.v80.n2.37489

Ferrell, B., Chung, V., Hughes, M. T., Koczywas, M., Azad, N. S., Ruel, N. H., Knight, L., Cooper, R. S., & Smith, T. J. (2021). A Palliative Care Intervention for Patients on Phase 1 Studies. Journal of Palliative Medicine, 24(6), 846–856. https://doi.org/10.1089/jpm.2020.0597

Froggatt, K. A., Moore, D. C., Van den Block, L., Ling, J., Payne, S. A., Van den Block, L., Arrue, B., Baranska, I., Moore, D. C., Deliens, L., Engels, Y., Finne-Soveri, H., Froggatt, K., Gambassi, G., Honincx, E., Kijowska, V., Koppel, M. ten, Kylanen, M., Mammarella, F., … Vernooij-Dassen, M. (2020). Palliative Care Implementation in Long-Term Care Facilities: European Association for Palliative Care White Paper. Journal of the American Medical Directors Association, 21(8), 1051–1057. https://doi.org/10.1016/j.jamda.2020.01.009

García-Salido, A., Navarro-Mingorance, Á., Martino-Alba, R., & Nieto-Moro, M. (2022). Update on the palliative care approach at the pediatric intensive care unit. Archivos Argentinos de Pediatria, 120(6), e255–e263. https://doi.org/10.5546/aap.2022.eng.e255

Gómez-Batiste, X., Amblàs, J., Costa, X., Lasmarías, C., Santaeugènia, S., Sanchez, P., Bullich, I., & Ela, S. (2019). Development of Palliative Care: Past, Present, and Future. En R. D. MacLeod & L. Van den Block (Eds.), Textbook of Palliative Care (pp. 77–88). Springer International Publishing. https://doi.org/10.1007/978-3-319-77740-5_2

González-Rincón, M., de Herrera-Marchal, P. D., & Martínez-Martín, M. L. (2019). The role of the nurse at the end of the life of a critically ill patient. Enfermería Intensiva (English ed.), 30(2), 78–91.

Justino, E. T., Kasper, M., Santos, K. da S., Quaglio, R. de C., & Fortuna, C. M. (2020). Palliative care in primary health care: Scoping review. Revista Latino-Americana de Enfermagem, 28, e3324. https://doi.org/10.1590/1518-8345.3858.3324

Karnik, S., & Kanekar, A. (2016). Ethical Issues Surrounding End-of-Life Care: A Narrative Review. Healthcare, 4(2), Article 2. https://doi.org/10.3390/healthcare4020024

Kenny, A. (2018). Making Tough Decisions about End-of-Life Care in Dementia. JHU Press.

Knaul, F. M., Farmer, P. E., Krakauer, E. L., Lima, L. D., Bhadelia, A., Kwete, X. J., Arreola-Ornelas, H., Gómez-Dantés, O., Rodriguez, N. M., Alleyne, G. A. O., Connor, S. R., Hunter, D. J., Lohman, D., Radbruch, L., Madrigal, M. del R. S., Atun, R., Foley, K. M., Frenk, J., Jamison, D. T., … Zimmerman, C. (2018). Alleviating the access abyss in palliative care and pain relief—an imperative of universal health coverage: The Lancet Commission report. The Lancet, 391(10128), 1391–1454. https://doi.org/10.1016/S0140-6736(17)32513-8

Macauley, R. C. (2018). Ethics in Palliative Care: A Complete Guide. Oxford University Press.

OMS. (2020). Palliative care. https://www.who.int/news-room/fact-sheets/detail/palliative-care

Ortiz-Gonçalves, B., Albarrán Juan, E., Labajo González, E., Santiago-Sáez, A., & Perea-Pérez, B. (2018). [End-of-life decisions: Results of the expert-validated questionnaire]. Gaceta sanitaria, 32(4), 333–338. https://doi.org/10.1016/j.gaceta.2017.09.011

Portenoy, R. K. (2011). Treatment of cancer pain. The Lancet, 377(9784), 2236–2247. https://doi.org/10.1016/S0140-6736(11)60236-5

Quill, T., & Abernethy, A. (2013). Generalist plus Specialist Palliative Care—Creating a More Sustainable Model. New England Journal of Medicine, 368(13), 1173–1175. https://doi.org/10.1056/NEJMp1215620

Quill, T. E. (2012). Physicians Should “Assist in Suicide” When it is Appropriate. Journal of Law, Medicine & Ethics, 40(1), 57–65. https://doi.org/10.1111/j.1748-720X.2012.00646.x

Quirino Afonso, B., da Costa Ferreira, N., & Gengo e Silva Butcher, R. de C. (2020). Conceptual and operational definitions for the indicators of the nursing outcome classification: Symptom control in patients with heart failure in palliative care. Enfermería Clínica (English Edition), 30(6), 386–397. https://doi.org/10.1016/j.enfcle.2020.01.002

Rubio, O., Estella, A., Cabre, L., Saralegui-Reta, I., Martin, M. C., Zapata, L., Esquerda, M., Ferrer, R., Castellanos, A., Trenado, J., & Amblas, J. (2020). Ethical recommendations for a difficult decision-making in intensive care units due to the exceptional situation of crisis by the COVID-19 pandemic: A rapid review & consensus of experts. Medicina Intensiva (English Edition), 44(7), 439–445. https://doi.org/10.1016/j.medine.2020.06.002

Wittenberg, E., Goldsmith, J., & Neiman, T. (2015). Nurse-Perceived Communication Challenges and Roles on Interprofessional Care Teams. Journal of Hospice & Palliative Nursing, 17(3), 257. https://doi.org/10.1097/NJH.0000000000000160

Zamora, M., van-der Hofstadt Román, C. J., Portilla-Tamarit, I., & Rodríguez-Marín, J. (2019). Satisfaction with hospital care at the end of life. Revista Clinica Espanola, 220(3), 174–178.




DOI: https://doi.org/10.23857/pc.v9i8.7744

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