Cuidados paliativos, cuidados de fin de vida y COVID-19: revisión de alcance

Palabras clave: Cuidados Paliativos, Cuidados Paliativos al Final de la Vida, Infecciones por Coronavirus, Pandemias

Resumen

  • La planificación avanzada de cuidados orienta al equipo de salud con base en los deseos del paciente. La planificación debe hacerse de manera temprana y rutinaria.
  • Debe fomentarse la comunicación entre pacientes y seres queridos. De ser posible, facilitar el acompañamiento presencial, en especial cuando se acerca el final de la vida.
  • Las herramientas tecnológicas facilitaron la comunicación con pacientes, familiares y entre profesionales de la salud, mientras se minimizaba el riesgo de exposición al virus.
  • Las enfermeras especialistas en cuidado paliativo lideran la coordinación de cuidado psicosocial y están entrenadas en planificación avanzada, consideraciones éticas y manejo de síntomas.

Introducción: La COVID-19 exacerbó el déficit en la prestación de cuidados paliativos y de fin de vida y aumentó la sobrecarga de los servicios de salud, pero se desconoce la extensión de la literatura sobre dicho tema. Objetivo: Describir la evidencia sobre la prestación de cuidados paliativos y de fin de vida en adultos durante la pandemia de COVID-19. Materiales y métodos: Revisión de alcance según el marco metodológico de Arksey y O’Malley. La búsqueda se realizó en inglés y español; en PubMed, Scielo, la Biblioteca Virtual en Salud, y la base de datos de investigación en Coronavirus. Las publicaciones se filtraron por título, resumen y lectura completa. Los resultados se sintetizaron de acuerdo con la técnica “charting”. Resultados: Se incluyeron 51 publicaciones. En total emergieron cinco categorías: 1) caracterización de los cuidados paliativos, 2) planificación avanzada de cuidados, 3) acompañamiento a familiares y seres queridos, 4) telesalud, 5) rol de enfermería en los cuidados paliativos. Discusión:: El coste social de la pandemia se refleja en el aumento en la carga de unidades de cuidados paliativos, mayor porcentaje de mortalidad y la disminución de la edad promedio de fallecimiento. Futuros estudios deben abordar el impacto psicosocial en los seres queridos de los pacientes, así como el impacto a nivel comunitario. Conclusión: Los cuidados paliativos y de fin de vida constituyen una herramienta fundamental para la atención de pacientes con COVID-19. La pandemia potenció el desarrollo de las tecnologías de la información y las comunicaciones para la prestación de cuidados paliativos.

Como citar este artículo: Franco-Rocha Oscar Yesid, Carrillo González Gloria Mabel, Rivera-Romero Nathaly. Cuidados paliativos, cuidados de fin de vida y COVID-19: revisión de alcance. Revista Cuidarte. 2022;13(3):e2601. http://dx.doi.org/10.15649/cuidarte.2601       

Biografía del autor/a

Oscar Yesid Franco-Rocha, University of Texas at Austin

University of Texas at Austin, Austin, TX, USA.

Gloria Mabel Carrillo González, Universidad Nacional de Colombia

Enfermera, Magister en Enfermería, Doctora en Enfermería. Profesora Asociada, Universidad Nacional de Colombia. Bogotá, Colombia. 

Nathaly Rivera-Romero, Universidad Nacional de Colombia

Enfermera, Magister en Psicología y Salud Mental. Profesora Asistente, Universidad Nacional de Colombia. Bogotá, Colombia.

Referencias

Organización Mundial de la Salud. Cuidados paliativos. Centro de Prensa. 2020. https://www3.paho.org/hq/index.php?option=com_content&view=article&id=12587:palliative-care&Itemid=42139&lang=es

Sánchez-Pedraza R, Sierra-Matamoros F, Morales-Mesa OL. Relación entre calidad de vida y provisión de cuidado paliativo en mujeres con cáncer en Colombia: un estudio transversal. Rev Colomb Obstet Ginecol. 2017; 68(1): 25–34.https://doi.org/10.18597/rcog.2979

Higginson IJ, Evans CJ. What is the evidence that palliative care teams improve outcomes for cancer patients and their families? Cancer J. 2010; 16(5): 423–35. https://doi.org/10.1097/PPO.0b013e3181f684e5

Calvache JA, Gil F, de Vries E. ¿Cuántas personas requieren cuidados paliativos para enfermedades oncológicas y no oncológicas en un país de ingresos medios? Análisis de datos de mortalidad. Rev Colomb Anestesiol. 2020. https://doi.org/10.1097/cj9.0000000000000159

Pastrana T, De Lima L, Pons J, Centeno C. Atlas de Cuidados Paliativos de Latinoamérica. Edición cartográfica. Houston: IAHPC Press; 2013. https://cuidadospaliativos.org/uploads/2014/3/Atlas%20Latinoamerica%20-%20edicion%20cartografica.pdf

Organización Panamericana de la Salud. La COVID-19 afectó el funcionamiento de los servicios de salud para enfermedades no transmisibles en las Américas. News:OPS. 2020.https://www.paho.org/es/noticias/17-6-2020-covid-19-afecto-funcionamiento-servicios-salud-para-enfermedades-no

Ministerio de Salud y Protección Social. Los cuidados paliativos para pacientes con COVID-19. Boletín de Prensa No. 391 de 2020. 2020. https://www.minsalud.gov.co/Paginas/Los-cuidados-paliativos-para-pacientes-con-covid-19-.aspx

Organización Panamericana de la Salud. La pandemia por COVID-19 revela la creciente necesidad de servicios de cuidados paliativos. Cuidados Paliativos en América Latina. 2020. https://www.paho.org/es/noticias/14-10-2020-pandemia-por-covid-19-revela-creciente-necesidad-servicios-cuidados-paliativos

Beng TS, Kim CLC, Shee CC, Ching DNL, Liang TJ, Kumar MKN, et al. COVID-19, suffering and palliative care: a review. Am J Hosp Palliat Med. 2021: 1-10. https://doi.org/10.1177/10499091211046233

Fadul N, Elsayem AF, Bruera E. Integration of palliative care into COVID-19 pandemic planning. BMJ Supportive & Palliative Care. 2021; 11(1): 40–4. http://dx.doi.org/10.1136/bmjspcare-2020-002364

Arksey H, O’Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol. 2005; 8(1): 19–32. https://doi.org/10.1080/1364557032000119616

Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009; 6(7): e1000097339. https://doi.org/10.1371/journal.pmed.1000097

Franco Rocha, O. “Palliative care, end-of-life care, and COVID-19: scoping review”. Mendeley Data, V1. 2022.

https://doi.org/10.17632/xmwk5twyzm.1

Ritchie J, Spencer L. Qualitative data analysis for applied policy research. Analysing qualitative data. First Ed. London: Routledge. 1994:173–94. https://www.taylorfrancis.com/chapters/edit/10.4324/9780203413081-14/qualitative-data-analysis-applied-policy-research-jane-ritchie-liz-spencer

Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021; 372: n71.https://doi.org/10.1136/bmj.n71

Chidiac C, Feuer D, Flatley M, Rodgerson A, Grayson K, Preston N. The need for early referral to palliative care especially for Black, Asian and minority ethnic groups in a COVID-19 pandemic: Findings from a service evaluation. Palliat Med. 2020; 34(9): 1241–8. https://doi.org/10.1177/0269216320946688

Chou YC, Yen YF, Feng RC, Wu MP, Lee YL, Chu D, et al. Impact of the COVID-19 pandemic on the utilization of hospice care services: A cohort study in Taiwan. J Pain Symptom Manage. 2020; 60(3): e1–6. https://doi.org/10.1016/j.jpainsymman.2020.07.005

Heath L, Yates S, Carey M, Miller M.Palliative Care During COVID-19: Data and Visits From Loved Ones. Am J Hosp Palliat Med. 2020; 37(11): 988–91. https://doi.org/10.1177/1049909120943577

Hetherington L, Johnston B, Kotronoulas G, Finlay F, Keeley P, McKeown A. COVID-19 and Hospital Palliative Care – A service evaluation exploring the symptoms and outcomes of 186 patients and the impact of the pandemic on specialist Hospital Palliative Care. Palliat Med. 2020; 34(9): 1256–62. https://doi.org/10.1177/0269216320949786

Moriyama D, Scherer JS, Sullivan R, Lowy J, Berger J. The impact of COVID-19 surge on clinical palliative care: A descriptive study from a New York hospital system. J Pain Symptom Manage. 2021; 61(3): e1–5. https://doi.org/10.1016/j.jpainsymman.2020.12.011

Lovell N, Maddocks M, Etkind SN, Taylor K, Carey I, Vora V, et al. Characteristics, symptom management, and outcomes of 101 patients with COVID-19 referred for hospital palliative care. J Pain Symptom Manage. 2020; 60(1): e77–81. https://doi.org/10.1016/j.jpainsymman.2020.04.015

Bone AE, Finucane AM, Leniz J, Higginson IJ, Sleeman KE. Changing patterns of mortality during the COVID-19 pandemic: Population-based modelling to understand palliative care implications. Palliat Med. 2020; 34(9): 1193–201. https://doi.org/10.1177/0269216320944810

Strang P, Bergström J, Martinsson L, Lundström S. Dying from COVID-19: Loneliness, end-of-life discussions, and support for patients and their families in nursing homes and hospitals. A National register study. J Pain Symptom Manage. 2020; 60(4): e2–13. https://doi.org/10.1016/j.jpainsymman.2020.07.020

Ersek M, Smith D, Griffin H, Carpenter JG, Feder SL, Shreve S, et al. End-of-life care in the time of COVID-19: Communication matters more than ever. J Pain Symptom Manage. 2021; 62(2): 213-222.e2.https://doi.org/10.1016/j.jpainsymman.2020.12.024

Reja M, Naik J, Parikh P. COVID-19: Implications for advanced care planning and end-of-life care. West J Emerg Med. 2020; 21(5): 1046–7. https://doi.org/10.5811/westjem.2020.6.48049

Alderman B, Webber K, Davies A. An audit of end-of-life symptom control in patients with corona virus disease 2019 (COVID-19) dying in a hospital in the United Kingdom. Palliat Med. 2020; 34(9): 1249–55. https://doi.org/10.1177/0269216320947312

Eriksen S, Grov EK, Lichtwarck B, Holmefoss I, Bøhn K, Myrstad C, et al. Palliative treatment and care for dying nursing home patients with COVID-19. Tidsskr den Nor laegeforening. 2020; 140(8): 10. https://pubmed.ncbi.nlm.nih.gov/32463205/

Janssen DJA, Ekström M, Currow DC, Johnson MJ, Maddocks M, Simonds AK, et al. COVID-19: guidance on palliative care from a European Respiratory Society international task force. Eur Respir J. 2020; 56(3): 2002583.https://doi.org/10.1183/13993003.02583-2020

Etkind SN, Bchir MB, Bone AE, Lovell N, Cripps R, Harding R, et al.The role and response of palliative care and hospice services in epidemics and pandemics: A rapid review to inform practice during the COVID-19 pandemic. J Pain Symptom Manage. 2020; 60(1): e31–40. https://doi.org/10.1016/j.jpainsymman.2020.03.029

Borasio GD, Gamondi C, Obrist M, Jox R. COVID-19: decision making and palliative care. Swiss Med Wkly. 2020; 150: w20233.https://doi.org/10.4414/smw.2020.20233

Wallace CL, Wladkowski SP, Gibson A, White P. Grief during the COVID-19 pandemic: Considerations for palliative care providers. J Pain Symptom Manage. 2020; 60(1): e70–6. https://doi.org/10.1016/j.jpainsymman.2020.04.012

Lapid MI, Koopmans R, Sampson EL, Van Den Block L, Peisah C. Providing quality end-of-life care to older people in the era of COVID-19: Perspectives from five countries. Int Psychogeriatrics. 2020; 32(11): 1345–52. https://doi.org/10.1017/S1041610220000836

Gilissen J, Pivodic L, Unroe KT, Block L Van den. International COVID-19 palliative care guidance for nursing homes leaves key themes unaddressed. J Pain Symptom Manage. 2020; 60(2): e56–69.https://doi.org/10.1016/j.jpainsymman.2020.04.151

Fausto J, Hirano L, Lam D, Mehta A, Mills B, Owens D, et al. Creating a palliative care inpatient response plan for COVID-19-the UW medicine experience. J Pain Symptom Manage. 2020; 60(1): e21–6. https://doi.org/10.1016/j.jpainsymman.2020.03.025

Rogers JEB, Constantine LA, Thompson JM, Mupamombe CT, Vanin JM, Navia RO. COVID-19 pandemic impacts on U.S. hospice agencies: A National Survey of Hospice Nurses and Physicians. Am J Hosp Palliat Med. 2021; 38(5): 521–7. https://doi.org/10.1177/1049909121989987

Ferguson L, Barham D. Palliative Care Pandemic Pack: A Specialist Palliative Care Service Response to Planning the COVID-19 Pandemic. J Pain Symptom Manage. 2020; 60(1): e18–20. https://pubmed.ncbi.nlm.nih.gov/32247056/

Peate I. COVID-19 and palliative care. Br J Nurs. 2020; 29(8):455. https://doi.org/10.12968/bjon.2020.29.8.455

Roland K, Markus M. COVID-19 pandemic: Palliative care for elderly and frail patients at home and in residential and nursing homes. Swiss Med Wkly. 2020; 150: w20235. https://doi.org/10.4414/smw.2020.20235

Powell VD, Silveira MJ. What should palliative care’s response be to the covid-19 pandemic? J Pain Symptom Manage. 2020; 60(1): e1–3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7156808/

The Lancet. Palliative care and the COVID-19 pandemic. Lancet. 2020; 395(10231): 1168. https://doi.org/10.1016/S0140-6736(20)30822-9

Rosa WE, Gray TF, Chow K, Davidson PM, Dionne-Odom JN, Karanja V, et al. Recommendations To Leverage The Palliative Nursing Role During Covid-19 And Future Public Health Crises. J Hosp Palliat Nurs. 2020; 22(4): 260–9. https://doi.org/10.1097/NJH.000000000000066

Stockdill ML, Barnett MD, Taylor R, Dionne-Odom JN, Bakitas M. Telehealth in palliative care. J Hosp Palliat Nurs. 2021; 25(1): 17–22. https://doi.org/10.1188/21.CJON.17-22

Harasym P, Brisbin S, Afzaal M, Sinnarajah A, Venturato L, Quail P, et al. Barriers and facilitators to optimal supportive end-of-life palliative care in long-term care facilities: A qualitative descriptive study of community-based and specialist palliative care physicians’ experiences, perceptions and perspectives. BMJ Open. 2020; 10(8): e037466. https://doi.org/10.1136/bmjopen-2020-037466

Petriceks AH, Schwartz AW. Goals of care and COVID-19: A GOOD framework for dealing with uncertainty. Palliat Support Care. 2020; 18(4): 379–81. https://doi.org/10.1017/S1478951520000474

Rosa WE, Shook A, Acquaviva KD. LGBTQ+ inclusive palliative care in the context of COVID-19: Pragmatic recommendations for clinicians. J Pain Symptom Manage. 2020; 60(2): e44–7. https://doi.org/10.1016/j.jpainsymman.2020.04.155

Pahuja M, Wojcikewych D. Systems barriers to assessment and treatment of COVID-19 positive patients at the end of life. J Palliat Med. 2021; 24(2): 302–4. https://doi.org/10.1089/jpm.2020.0190

Harden K, Price DM, Mason H, Bigelow A. COVID-19 Shines a Spotlight on the Age-Old Problem of Social Isolation. J Hosp Palliat Nurs. 2020; 22(6): 435–41. https://pubmed.ncbi.nlm.nih.gov/32925489/

Frydman JL, Choi EW, Lindenberger EC. Families of COVID-19 patients say goodbye on video: A structured approach to virtual end-of-life conversations. J Palliat Med. 2020; 23(12): 1564–5. https://doi.org/10.1089/jpm.2020.0415

Rica Escuín M, García-Navarro EB, Salvador IG, Ossa Sendra MJ, Alapont EC. Acompañamiento a los pacientes al final de la vida durante la pandemia por COVID-19. Med Paliativa. 2020; 27(3): 181–91. https://doi.org/10.20986/medpal.2020.1162/2020

Feder S, Smith D, Griffin H, Shreve ST, Kinder D, Kutney-Lee A, et al. “Why couldn’t i go in to see him?” Bereaved families’ perceptions of end-of-life communication during COVID-19. J Am Geriatr Soc. 2021; 69(3): 587–92. https://doi.org/10.1111/jgs.16993

Ofosu-Poku R, Anyane G, Agbeko AE, Dzaka AD, Owusu-Ansah M, Appiah MO, et al. Preparing a young palliative care unit for the COVID-19 pandemic in a teaching hospital in Ghana. Palliat Support Care. 2020; 18(4): 400–2. https://doi.org/10.1017/S1478951520000498

Tan AJ, Yamarik R, Brody AA, Chung FR, Grudzen C, The EMPallA Telephonic Working Group. Development and protocol for a nurse-led telephonic palliative care program. Nurs Outlook. 2021; 69(4): 626–31. https://doi.org/10.1016/j.outlook.2020.12.011

Lally K, Kematick BS, Gorman D, Tulsky J. Rapid conversion of a palliative care outpatient clinic to telehealth. JCO Oncol Pract. 2021; 17(1): e62–7. https://doi.org/10.1200/OP.20.00557

Cheng HWB. Palliative care for cancer patients with severe COVID-19: the challenge of uncertainty. Support Care Cancer. 2021; 29(3): 1153–5. https://doi.org/10.1007/s00520-020-05809-y

Wu YR, Chou TJ, Wang YJ, Tsai JS, Cheng SY, Yao CA, et al. Smartphone-enabled, telehealth-based family conferences in palliative care during the COVID-19 pandemic: Pilot observational study. JMIR mHealth. 2020; 8(10): e22069. https://doi.org/10.2196/22069

Antunes B, Bowers B, Winterburn I, Kelly MP, Brodrick R, Pollock K, et al. Anticipatory prescribing in community end-of-life care in the UK and Ireland during the COVID-19 pandemic: Online survey. BMJ Support Palliat Care. 2020; 10(3): 343–9. https://doi.org/10.1136/bmjspcare-2020-002394

Bowers B, Pollock K, Oldman C, Barclay S. End-of-life care during covid-19: Opportunities and challenges for community nursing. Br J Community Nurs. 2021; 26(1): 44–6. https://doi.org/10.12968/bjcn.2021.26.1.44

Pai RR, Nayak MG, Sangeetha N. Palliative care challenges and strategies for the management amid COVID-19 pandemic in India: Perspectives of palliative care nurses, cancer patients, and caregivers. Indian J Palliat Care. 2020; 26(Suppl 1): S121–5. https://doi.org/10.4103/IJPC.IJPC_182_20

Mercadante S, Adile C, Ferrera P, Giuliana F, Terruso L, Piccione T. Palliative care in the time of COVID-19. J Pain Symptom Manage. 2020; 60(2): e79–80. https://doi.org/10.1016/j.jpainsymman.2020.04.025

Paice JA, Wholihan D, Dahlin C, Rosa WE, Mazanec P, Long CO, et al. Palliative nursing: The core of COVID-19 care. J Hosp Palliat Nurs. 2021; 23(1): 6–8. https://doi.org/10.1097/NJH.0000000000000709

Thomas JL, Leiter RE, Abrahm JL, Shameklis JC, Kiser SB, Gelfand SL, et al. Development of a palliative care toolkit for the COVID-19 pandemic. J Pain Symptom Manage. 2020; 60(2): e22–5. https://doi.org/10.1016/j.jpainsymman.2020.05.021

Roberts B, Wright SM, Christmas C, Robertson M, Wu DS. COVID-19 pandemic response: Development of outpatient palliative care toolkit based on narrative communication. Am J Hosp Palliat Med. 2020; 37(11): 985–7. https://doi.org/10.1177/1049909120944868

Mitchell S, Maynard V, Lyons V, Jones N, Gardiner C. The role and response of primary healthcare services in the delivery of palliative care in epidemics and pandemics: A rapid review to inform practice and service delivery during the COVID-19 pandemic. Palliat Med. 2020; 34(9): 1182–92. https://doi.org/10.1177/0269216320947623

Lal A, Bell G, Curseen K, Kavalieratos D. Teaching telepalliative care: An elective rotation for medical students during the COVID-19 pandemic. J Palliat Med. 2021; 24(3): 318–9. https://doi.org/10.1089/jpm.2020.0643

Fusi-Schmidhauser T, Preston NJ, Keller N, Gamondi C. Conservative management of COVID-19 patients—Emergency palliative care in action. J Pain Symptom Manage. 2020; 60(1): e27–30. https://doi.org/10.1016/j.jpainsymman.2020.03.030

Salifu Y, Atout M, Shivji N, Khalid DS, Bardi JN. COVID-19: time to rethink palliative care strategy in resource-poor settings. Int J Palliat Nurs. 2020; 26(6): 268–71. https://doi.org/10.12968/ijpn.2020.26.6.268

Ministerio de Tecnologías de la Información y las Comunicaciones. Acceso a internet en Colombia se aceleró durante la pandemia. MinTIC en los medios. 2021. https://www.mintic.gov.co/portal/inicio/Sala-de-prensa/MinTIC-en-los-medios/161793:Acceso-a-internet-en-Colombia-se-acelero-durante-la-pandemia

Publicado
2022-10-24
Cómo citar
1.
Franco-Rocha OY, Carrillo González GM, Rivera-Romero N. Cuidados paliativos, cuidados de fin de vida y COVID-19: revisión de alcance . Rev Cuid [Internet]. 24 de octubre de 2022 [citado 5 de diciembre de 2022];13(3). Disponible en: https://revistas.udes.edu.co/cuidarte/article/view/2601
Sección
Artículos de Revisión

Descargas

La descarga de datos todavía no está disponible.