Withholding and Withdrawal of Treatments: Differences in Perceptions between Intensivists, Oncologists, and Prosecutors in Brazil

Ramos, João Gabriel Rosa; Vieira, Roberto D’Oliveira; Tourinho, Fernanda Correia; Ismael, Andre; Ribeiro, Diaulas Costa; Medeiro, Humberto Jacques de; Forte, Daniel Neves

doi:10.1089/jpm.2018.0554

Cited by 5 publications

(3 citation statements)

References 26 publications

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“…25 A recent survey in Brazil found that in the absence of documented patient's consent, oncologists, intensivists, and prosecutors have different views about withholding and withdrawing life-sustaining therapies in terminally ill cancer, and almost half of the physicians are afraid that their decisions regarding limitations of medical treatment could have legal implications. 26 Despite the lack of information about the patient's performance status in our database, this study has demonstrated that 1 in 3 patients with advanced cancer received chemotherapy in the last 14 days of life. This rate was much higher than some other estimates.…”

Section: Discussionmentioning

confidence: 74%

Quality Indicators of End-of-Life Care Among Privately Insured People With Cancer in Brazil

Soares¹,

Gomes²,

Palma³

et al. 2019

Am J Hosp Palliat Care

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Purpose: To examine quality indicators of end-of-life (EOL) care among privately insured people with cancer in Brazil. Methods: We evaluated medical records linked to health insurance databank to study consecutive patients who died of cancer. We collected information about demographics, cancer type, and quality indicators of EOL care including emergency department (ED) visits, intensive care unit (ICU) admissions, chemotherapy use, medical imaging utilization, blood transfusions, home care support, days of inpatient care, and hospital deaths. Results: We included 865 patients in the study. In the last 30 days of life, 62% visited the ED, 33% were admitted to the ICU, 24% received blood transfusions, and 51% underwent medical imaging. Only 1% had home care support in the last 60 days of life, and 29% used chemotherapy in the last 14 days of life. Patients had an average of 8 days of inpatient care and 52% died in the hospital. Patients with advanced cancer who used chemotherapy were more likely to visit the ED (78% vs 59%; P < .001), undergo medical imaging (67% vs 51%; P < .001), and die in the hospital (73% vs 50%; P = .03) than patients who did not use chemotherapy. In the multivariate analysis, chemotherapy use near death and advanced cancer were associated with ED visits and ICU admissions, respectively (odds ratio >1). Conclusion: Our study suggests that privately insured people with cancer receive poor quality EOL care in Brazil. Further research is needed to assess the impact of improvements in palliative care provision in this population.

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Section: Discussionmentioning

confidence: 74%

Quality Indicators of End-of-Life Care Among Privately Insured People With Cancer in Brazil

Soares¹,

Gomes²,

Palma³

et al. 2019

Am J Hosp Palliat Care

View full text Add to dashboard Cite

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“…Most family members would likely prefer the choice to shorten the dying process of the patients by withdrawing the ventilator 18 . In Brazil, however, palliative extubation is seldom performed 3 – 5 : 50.2% of Brazilian intensivists admit fear of litigation, although over 75% claim to have received specific palliative care training 19 . A survey 20 collected responses from 105 ICU physicians in Brazil in 2012 regarding a case vignette of a critically ill patient with post-cardiac arrest encephalopathy and sepsis: none would perform palliative extubation.…”

Section: Discussionmentioning

confidence: 99%

Palliative extubation experience in a community hospital in southern Brazil

Antônio

Antonio

2023

Rev. Assoc. Med. Bras.

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“…Nas UTIs de países europeus, por exemplo, mais de 30% dos pacientes vão a óbito sem a participação da família no processo de tomada de decisão a respeito da EP, enquanto no Brasil, esse número é ainda maior, chegando a dois terços dos casos. Esses números ignoram o fato, corroborado pela literatura, de que na prática de EP é recomendada a presença do enfermo ou de seus familiares no processo de decisão 4 .…”

Section: Introductionunclassified

Extubação paliativa: uma revisão sobre o processo de decisão e suas variáveis / Palliative extubation: a review of decision-making process and it's variables

Paiva¹,

Machado²,

Teixeira³

et al. 2021

Braz. J. Hea. Rev.

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A extubação paliativa (EP) consiste na interrupção da ventilação mecânica invasiva (VMI). Apesar de ser recomendada nos casos em que o sofrimento associado ao tratamento supera seus benefícios, isso nem sempre ocorre na prática. Os motivos para isso são diversos, desde questões sócioculturais até desconhecimento de seus desafios ético-jurídicos pela equipe médica. Esta revisão objetiva contextualizar a tomada de decisão acerca da EP, de modo que, munidos dessas informações, os profissionais de saúde sejam capazes de comunicar essa alternativa de maneira adequada aos pacientes e familiares. Para esta pesquisa bibliográfica utilizou-se a busca na biblioteca virtual PubMed, no período de 2010 a 2020 e, depois de aplicados critérios de exclusão,

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Withholding and Withdrawal of Treatments: Differences in Perceptions between Intensivists, Oncologists, and Prosecutors in Brazil

Cited by 5 publications

References 26 publications

Quality Indicators of End-of-Life Care Among Privately Insured People With Cancer in Brazil

Quality Indicators of End-of-Life Care Among Privately Insured People With Cancer in Brazil

Palliative extubation experience in a community hospital in southern Brazil

Extubação paliativa: uma revisão sobre o processo de decisão e suas variáveis / Palliative extubation: a review of decision-making process and it's variables

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