Necessidades Paliativas em Cuidados de Saúde Primários: Características dos Doentes com Neoplasia e Demência Avançadas

Luís Pires; Inês Rosendo; Carlos Seiça Cardoso

doi:10.20344/amp.20049

Autores

Luís Pires Faculdade de Medicina. Universidade de Coimbra. Coimbra. https://orcid.org/0009-0009-0304-9727
Inês Rosendo Faculdade de Medicina. Universidade de Coimbra. Coimbra; Unidade de Saúde Familiar Coimbra Centro. Coimbra. https://orcid.org/0000-0001-8838-6021
Carlos Seiça Cardoso Faculdade de Medicina. Universidade de Coimbra. Coimbra; Unidade de Saúde Familiar Condeixa. Coimbra. https://orcid.org/0000-0001-9214-6995

DOI:

https://doi.org/10.20344/amp.20049

Palavras-chave:

Cuidados de Saúde Primários, Cuidados Paliativos, Demência, Neoplasia

Resumo

Introdução: O aumento da esperança de vida trouxe maior prevalência de doenças crónicas, merecendo destaque as que atingem estádios avançados e que requerem cuidados paliativos. Pretendeu-se caracterizar os doentes com diagnóstico de neoplasia e/ou demência em estádio avançado, acompanhados em cuidados de saúde primários, e testar a sensibilidade de duas ferramentas para identificação de doentes com necessidades paliativas.
Métodos: Recrutámos três médicos de família voluntários que forneceram dados relativos a 623 doentes com codificação ativa de neoplasia e/ou demência na plataforma MIM@UF. Definimos como ‘doente com necessidades paliativas’ todo o doente com doença em estádio avançado, e fizemos a sua caracterização clínica e sociodemográfica. Assumindo como gold standard a existência de doença em estádio avançado, calculámos e comparámos as sensibilidades de cada uma das ferramentas em estudo: a questão surpresa, a questão ‘acha que este doente tem necessidades paliativas?’ e um instrumento que correspondesse a identificação por pelo menos uma das questões.
Resultados: De entre os dados analisados, existiram 559 (89,7%) codificações ativas de neoplasia e 64 (10,3%) de demência; a prevalência de neoplasia e demência avançadas foi de 1,0% na amostra estudada. O subgrupo de doentes com demência avançada mostrou predomínio do sexo feminino, idade superior e menor acesso a cuidados de saúde. Em ambos os subgrupos houve escassez de dados relativos à escolaridade e rendimento e observámos polifarmacoterapia e multimorbilidade. A sensibilidade da questão surpresa foi de 33,3% para neoplasia e 69,3% para demência; da nova ferramenta de 50,0% para neoplasia e 92,3% para demência; e, quando usadas em conjunto, de 55,6% para neoplasia e 92,3% para demência.
Conclusão: Estes resultados ajudam a caracterizar duas subpopulações de doentes com necessidade de cuidados paliativos e avançam com uma possível ferramenta para sua identificação, a confirmar a sua utilidade numa amostra representativa.

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