Palavras-chave
Atenção primária à saúde
Apoio social
Identificação precoce
Como Citar
Resumo
Introdução: A integração de cuidados paliativos (CP) à Atenção Primária à Saúde (APS) constitui estratégia custo-efetiva para ampliar cobertura e equidade, inclusive em contextos de recursos limitados. Objetiva-se sintetizar criticamente a produção científica da última década sobre integração de CP na APS, com ênfase em apoio social, manejo de sintomas, instrumentos de identificação precoce, modelos colaborativos de coordenação e prioridades de implementação no contexto brasileiro. Metodologia: Realizou-se revisão integrativa em cinco etapas, com buscas em PubMed e Google Acadêmico (últimos dez anos), avaliação crítica JBI, extração padronizada e síntese narrativa de estudos sobre cuidados paliativos na APS, conduzida por revisores independentes. Conclusão: A integração efetiva dos cuidados paliativos à APS requer capacitação longitudinal, colaboração interprofissional, identificação precoce padronizada e intervenções comunitárias, sustentadas por critérios institucionais e monitoramento por indicadores internacionais.
Referências
ABATE, Y. et al. Barrier analysis for continuity of palliative care from health facility to household among adult cancer patients in Addis Ababa, Ethiopia. BMC Palliative Care, v. 22, n. 1, p. 57, 12 maio 2023. Disponível em: https://pubmed.ncbi.nlm.nih.gov/37173667/. Acesso em: 17 jun. 2024.
AGUIAR-LEIVA, V. P. et al. Validation of a questionnaire to assess complexity of palliative care needs in primary care in Malaga, Spain: a study protocol. BMJ Open, v. 15, n. 7, e102040, 17 jul. 2025. Disponível em: https://pubmed.ncbi.nlm.nih.gov/40675644/. Acesso em: 17 jun. 2024.
AZEVEDO, C. et al. Interface between social support, quality of life and depression in users eligible for palliative care. Rev Esc Enferm USP, v. 51, e03245, 28 ago. 2017. Disponível em: https://pubmed.ncbi.nlm.nih.gov/28902325. Acesso em: 17 jun. 2024.
BEERNAERT, K. et al. Referral to palliative care in COPD and other chronic diseases: a population-based study. Respiratory Medicine, v. 107, n. 11, p. 1731-1739, 2013. DOI: 10.1016/j.rmed.2013.06.003.
CALSINA-BERNA, A. et al. Prevalence and clinical characteristics of patients with advanced chronic illness and palliative care needs identified with the NECPAL Tool. BMC Palliative Care, v. 21, 2022. DOI: 10.1186/s12904-022-01101-4.
CENTER TO ADVANCE PALLIATIVE CARE. CAPC 2024 Serious Illness Scorecard. 2024. Disponível em: https://scorecard.capc.org/. Acesso em: 28 ago. 2025.
DE BOCK, R. et al. Validation of the Supportive and Palliative Care Indicators Tool in a Geriatric Population. Journal of Palliative Medicine, v. 21, n. 2, p. 220-224, 2018. DOI: 10.1089/jpm.2017.0205.
DE GRAAF, E. et al. Hospice assist at home: does the integration of hospice care in primary healthcare support patients to die in their preferred location - A retrospective cross-sectional evaluation study. Palliative Medicine, v. 30, n. 6, p. 580–586, jun. 2016. Disponível em: https://journals.sagepub.com/doi/abs/10.1177/0269216315626353. Acesso em: 17 jun. 2024.
DE PAULA PAZ, C. R. et al. New demands for primary health care in Brazil: palliative care. Invest Educ Enferm, v. 34, n. 1, p. 46–57, abr. 2016. Disponível em: https://pubmed.ncbi.nlm.nih.gov/28569973/. Acesso em: 17 jun. 2024.
DORESHA, L. M.; WILLIAMS, M.; MASH, R. The role of community health workers in non-communicable diseases in Cape Town, South Africa: descriptive exploratory qualitative study. BMC Primary Care, v. 25, n. 1, p. 176, 21 maio 2024. Disponível em: https://pubmed.ncbi.nlm.nih.gov/38773378/. Acesso em: 17 jun. 2024.
DRILLER, B. et al. Cancer patients spend more time at home and more often die at home with advance care planning conversations in primary health care: a retrospective observational cohort study. BMC Palliative Care, v. 21, n. 1, p. 61, 2 maio 2022. Disponível em: https://bmcpalliatcare.biomedcentral.com/articles/10.1186/s12904-022-00952-1. Acesso em: 17 jun. 2024.
DRILLER, B. et al. Cancer patients have a reduced likelihood of dying in hospital with ACP in primary health care and a summarizing palliative plan: a prospective controlled study. Scandinavian Journal of Primary Health Care, 2024. DOI: 10.1080/02813432.2024.2346131.
ECONOMIST INTELLIGENCE UNIT. The 2015 Quality of Death Index – Country Profiles. 2015. Disponível em: https://assets.ctfassets.net/.../2015_Quality_of_Death_Index_Country_Profiles_Oct_6_FINAL.pdf. Acesso em: 28 ago. 2025.
ELMOKHALLALATI, Y. et al. Identification of patients with potential palliative care needs: a systematic review of screening tools in primary care. Palliative Medicine, v. 34, n. 8, p. 989–1005, set. 2020. DOI: 10.1177/0269216320929552.
FINUCANE, A. M. et al. Electronic care coordination systems for people with advanced progressive illness: a mixed-methods evaluation in Scottish primary care. Br J Gen Pract, v. 70, n. 690, p. e20–e28, 26 dez. 2019. Disponível em: https://pubmed.ncbi.nlm.nih.gov/31848198/. Acesso em: 17 jun. 2024.
GAFER, N. et al. A model for integrating palliative care into Eastern Mediterranean health systems with a primary care approach. BMC Palliative Care, v. 23, n. 1, p. 264, 15 nov. 2024. Disponível em: https://pubmed.ncbi.nlm.nih.gov/39543584/. Acesso em: 17 jun. 2024.
GOMES, B.; HIGGINSON, I. Effectiveness and cost-effectiveness of home palliative care services. Cochrane Database of Systematic Reviews, 2013. DOI: 10.1002/14651858.CD007760.pub2.
HOJJAT-ASSARI, S. et al. Developing an integrated model of community-based palliative care into the primary health care (PHC) for terminally ill cancer patients in Iran. BMC Palliative Care, v. 20, n. 1, p. 100, 28 jun. 2021. Disponível em: https://pubmed.ncbi.nlm.nih.gov/34182980/. Acesso em: 17 jun. 2024.
HOSSEINI, H. et al. The effect of community-based palliative supportive care integrated with primary health care (PHC) on the outcomes of terminally ill cancer patients. BMC Primary Care, v. 26, n. 1, p. 139, 1 maio 2025. Disponível em: https://pubmed.ncbi.nlm.nih.gov/40312691/. Acesso em: 17 jun. 2024.
JONES, R. et al. Challenges experienced by GPs when providing palliative care: a systematic review. BJGP Open, v. 7, n. 2, 2023. DOI: 10.3399/BJGPO.2022.0159.
JU, C. et al. Global, regional, and national trends in opioid analgesic consumption, 2010–2019. The Lancet Public Health, v. 7, n. 3, e225-e235, 2022. DOI: 10.1016/S2468-2667(22)00013-5.
KRAUSE, M. et al. Effectiveness of two types of palliative home care in cancer and non-cancer patients: A retrospective population-based study using claims data. Palliative Medicine, v. 35, n. 6, p. 1158–1169, jun. 2021. Disponível em: https://journals.sagepub.com/doi/abs/10.1177/02692163211013666. Acesso em: 17 jun. 2024.
LEACH, I. et al. Understanding patient views and experiences of the IDENTIfication of PALLiative care needs (IDENTI-PALL): a qualitative interview study. Br J Gen Pract, v. 74, n. 739, p. e88–e95, 25 jan. 2024. Disponível em: https://pubmed.ncbi.nlm.nih.gov/38191566/. Acesso em: 17 jun. 2024.
LENIZ, J. et al. Identification of palliative care needs among people with dementia and its association with acute hospital care and community service use at the end-of-life: A retrospective cohort study using linked primary, community and secondary care data. Palliative Medicine, v. 35, n. 9, p. 1691–1700, out. 2021. Disponível em: https://journals.sagepub.com/doi/abs/10.1177/02692163211019897. Acesso em: 17 jun. 2024.
MAIA, L. O. et al. Opioid use, regulation, and harms in Brazil: an integrative review. Substance Abuse Treatment, Prevention, and Policy, v. 16, 2021. DOI: 10.1186/s13011-020-00352-2.
MALLON, T. et al. Effects of timely case conferencing between general practitioners and specialist palliative care services on symptom burden in patients with advanced chronic disease: results of the cluster-randomised controlled KOPAL trial. BMC Palliative Care, v. 23, n. 1, p. 293, 20 dez. 2024. Disponível em: https://pubmed.ncbi.nlm.nih.gov/39707283/. Acesso em: 17 jun. 2024.
MALLON, T. et al. Evaluating palliative care case conferences in primary care for patients with advanced non-malignant chronic conditions: a cluster-randomised controlled trial (KOPAL). Age and Ageing, v. 53, n. 5, afae100, 1 maio 2024. Disponível em: https://pubmed.ncbi.nlm.nih.gov/38783755/. Acesso em: 17 jun. 2024.
MALLON, T. et al. Evaluating palliative care case conferences in primary care for advanced chronic non-malignant diseases (KOPAL). BMC Palliative Care, v. 23, 2024. DOI: 10.1186/s12904-024-01623-z.
MARCUCCI, F. C. et al. Identification and characteristics of patients with palliative care needs in Brazilian primary care. BMC Palliative Care, v. 15, p. 51, 1 jun. 2016. DOI: 10.1186/s12904-016-0125-4.
MARX, G. et al. General practitioners' perspective on timely interprofessional case conferences on non-cancer patients with palliative care needs: a qualitative study (KOPAL). BMJ Open, v. 15, n. 8, e097181, 25 ago. 2025. Disponível em: https://pubmed.ncbi.nlm.nih.gov/40854848/. Acesso em: 17 jun. 2024.
MITCHELL, G. et al. Case conferences between GPs and specialist teams to plan end-of-life care in heart failure and lung disease: pilot study. BMC Palliative Care, v. 13, 2014. DOI: 10.1186/1472-684X-13-24.
MORGAN, J. et al. Healthcare workers' knowledge of indicators for a palliative care approach. Afr J Prim Health Care Fam Med, v. 16, n. 1, p. e1–e7, 31 jul. 2024. Disponível em: https://pubmed.ncbi.nlm.nih.gov/39099274/. Acesso em: 17 jun. 2024.
MORGAN, J. et al. What is the role of family medicine in providing palliative care in Africa? Afr J Prim Health Care Fam Med, v. 17, n. 1, p. e1–e3, 14 abr. 2025. Disponível em: https://pubmed.ncbi.nlm.nih.gov/40336411/. Acesso em: 17 jun. 2024.
OOSTERVELD-VLUG, M. G. et al. What are essential elements of high-quality palliative care at home? An interview study among patients and relatives faced with advanced cancer. BMC Palliative Care, v. 18, n. 1, p. 96, 6 nov. 2019. Disponível em: https://pubmed.ncbi.nlm.nih.gov/31694715/. Acesso em: 17 jun. 2024.
PARAÍZO-HORVATH, C. M. S. et al. Identification of people for palliative care in primary health care: integrative review. Cien Saude Colet, v. 27, n. 9, p. 3547–3557, set. 2022. Disponível em: https://pubmed.ncbi.nlm.nih.gov/36000643/. Acesso em: 17 jun. 2024.
PEELER, A. et al. Primary palliative care in low- and middle-income countries: A systematic review and thematic synthesis of the evidence for models and outcomes. Palliative Medicine, v. 38, n. 8, p. 776–789, set. 2024. Disponível em: https://journals.sagepub.com/doi/abs/10.1177/02692163241248324. Acesso em: 17 jun. 2024.
PETTUS, K. I.; DE LIMA, L. Palliative Care Advocacy: Why Does It Matter? Journal of Palliative Medicine, v. 23, n. 8, p. 1009–1012, ago. 2020. Disponível em: https://www.liebertpub.com/doi/10.1089/jpm.2019.0696. Acesso em: 17 jun. 2024.
PIVODIC, L. et al. Palliative service use in four European countries: comparing cancer and non-cancer. PLOS ONE, v. 8, n. 12, e84440, 2013. DOI: 10.1371/journal.pone.0084440.
POURGHAZIAN, N.; MAHMOUD, L.; HAMMERICH, A. Strengthening palliative care in the WHO Eastern Mediterranean Region. East Mediterr Health J, v. 27, n. 8, p. 553–554, 31 ago. 2022. Disponível em: https://apps.who.int/iris/handle/10665/363821. Acesso em: 17 jun. 2024.
REINKE, L. F. et al. Symptom Burden and Palliative Care Needs Among High-Risk Veterans With Multimorbidity. J Pain Symptom Manage, v. 57, n. 5, p. 880–889, maio 2019. Disponível em: https://pubmed.ncbi.nlm.nih.gov/30794938/. Acesso em: 17 jun. 2024.
RIBEIRO, D. L.; DE CARVALHO FILHO, M. A. Palliative care in emergency care: invoking Kairos and rethinking health care systems. Cad Saude Publica, v. 38, n. 9, e00127922, 23 set. 2022. Disponível em: https://www.scielo.br/j/csp/a/R6T2Q7X8W9F3K1G4P5VjYw/. Acesso em: 17 jun. 2024.
RODRIGUES, L. F.; SILVA, J. F. M. D.; CABRERA, M. Palliative care: pathway in primary health care in Brazil. Cad Saude Publica, v. 38, n. 9, e00130222, 23 set. 2022. Disponível em: https://pubmed.ncbi.nlm.nih.gov/36169517/. Acesso em: 17 jun. 2024.
SÁNCHEZ-CÁRDENAS, M. A. et al. Accessibility to palliative care services in Colombia: an analysis of geographic disparities. BMC Public Health, v. 24, n. 1, p. 1659, 21 jun. 2024. Disponível em: https://pubmed.ncbi.nlm.nih.gov/38907204/. Acesso em: 17 jun. 2024.
SANTOS, F. R. D. et al. Effects of clown activities on patients eligible for palliative care in primary health care. Rev Bras Enferm, v. 74, n. 5, e20200431, 1 jul. 2020. Disponível em: https://pubmed.ncbi.nlm.nih.gov/34346954/. Acesso em: 17 jun. 2024.
SEIÇA CARDOSO, C. et al. Non-pharmacological interventions in primary care to improve the quality of life of older patients with palliative care needs: a systematic review of randomised controlled trials. BMJ Open, v. 13, n. 12, e073950, 9 dez. 2023. Disponível em: https://pubmed.ncbi.nlm.nih.gov/38070901/. Acesso em: 17 jun. 2024.
SELMAN, L. E. et al. Primary care physicians’ educational needs and learning preferences in end of life care: A focus group study in the UK. BMC Palliative Care, v. 16, n. 1, p. 17, 9 mar. 2017. Disponível em: https://pubmed.ncbi.nlm.nih.gov/28274216/. Acesso em: 17 jun. 2024.
SILVA, T. C. D.; NIETSCHE, E. A.; COGO, S. B. Palliative care in Primary Health Care: an integrative literature review. Revista Brasileira de Enfermagem, v. 75, n. 1, e20201335, 29 set. 2021. Disponível em: https://www.scielo.br/j/reben/a/9W1T3Y5U7I0O2P4Q6R8S/. Acesso em: 17 jun. 2024.
SPINELI, V. M. C. D. et al. Educational needs in palliative care of Primary Health Care nurses. Rev Bras Enferm, v. 75, n. 3, e20210391, 2 fev. 2022. Disponível em: https://pubmed.ncbi.nlm.nih.gov/35137889/. Acesso em: 17 jun. 2024.
TRIPODORO, V. A. et al. Implementing the WHO Indicators for Assessing Palliative Care Development in Three Countries: A Do-It-Yourself Approach. J Pain Symptom Manage, v. 69, n. 1, p. e61–e69, jan. 2025. Disponível em: https://pubmed.ncbi.nlm.nih.gov/39326467/. Acesso em: 17 jun. 2024.
TRONCOSO, J. et al. Adaptation and validation in Chile of the patient identification instrument needing palliative care: NECPAL-CCOMS-ICO 3.1©. Aten Primaria, v. 53, n. 4, p. 101994, abr. 2021. Disponível em: https://pubmed.ncbi.nlm.nih.gov/33740612/. Acesso em: 17 jun. 2024.
TURNER, N. et al. Role and response of primary healthcare services in community end-of-life care during COVID-19: Qualitative study and recommendations for primary palliative care delivery. Palliative Medicine, v. 37, n. 2, p. 235–243, fev. 2023. Disponível em: https://pubmed.ncbi.nlm.nih.gov/36461707/. Acesso em: 17 jun. 2024.
VAN HEERDEN, E. M.; JENKINS, L. S. The role of community health workers in palliative care in a rural subdistrict in South Africa. Afr J Prim Health Care Fam Med, v. 14, n. 1, p. e1–e9, 9 nov. 2022. Disponível em: https://pubmed.ncbi.nlm.nih.gov/36453807/. Acesso em: 17 jun. 2024.
VAN LUMMEL, E. V. T. J. et al. The Surprise Question: predictive accuracy in a systematic review and meta-analysis. Palliative Medicine, 2022. DOI: 10.1177/02692163221105595.
VAN WIJMEN, M. P. S. et al. Identifying patients who could benefit from palliative care by the SPICT in general practice. Family Practice, v. 37, n. 5, p. 641-651, 2020. DOI: 10.1093/fampra/cmaa043.
WEETMAN, K. et al. Communication of palliative care needs in discharge letters from hospice providers to primary care. BMC Palliative Care, v. 21, 2022. DOI: 10.1186/s12904-022-01038-8.
WEETMAN, K. et al. Improving patients’, carers’ and primary care professionals’ experiences of discharge communication from specialist palliative care. BMC Palliative Care, v. 23, 2024. DOI: 10.1186/s12904-024-01451-1.
WHITE, N. et al. How accurate is the ‘Surprise Question’ at identifying patients nearing the end of life? BMC Medicine, v. 15, 2017. DOI: 10.1186/s12916-017-0907-4.
WHPCA; WHO. Global Atlas of Palliative Care, 2nd ed., 2020. Disponível em: https://www.iccp-portal.org/sites/default/files/resources/WHPCA_Global_Atlas_FINAL_DIGITAL.pdf. Acesso em: 28 ago. 2025.
Este trabalho está licenciado sob uma licença Creative Commons Attribution 4.0 International License.
Copyright (c) 2025 Rama Valente Lourenço, Luiza Gabriela Alves Gomes, Joyce Helena Leão Queiroz, Ana Karolina Ferreira Pereira , Beatriz Tavares Monteverde da Costa , Fernanda Myllena Sousa Campos, Pedro Borba Freire , Jefferson Lazarini de Aquino ; Vítor Rocha Leitão
