Sedação paliativa no controle do sofrimento existencial em pessoas com doenças graves: Revisão Integrativa

Abstract

Although quality palliative care is available, some people at the end of life suffer from refractory symptoms for which conventional treatments fail. Palliative sedation is an indicated option in these cases, including for the treatment of refractory existential suffering in people at the end of life. This study aimed to analyze the available evidence in the literature on the use of palliative sedation for controlling existential suffering in individuals with serious illnesses. An integrative review was developed and reported according to the items of the Preferred Reporting Items for Systematic Review and Meta-Analysis. A total of 36 studies published between 2000 and 2023 were included. Data analysis was conducted using specific prompts in ChatGPT 4, identifying themes and subthemes according to patterns and recurring topics. The two main themes identified were: 1) Palliative sedation in controlling Existential suffering: challenges for clinical practice, and 2) Definition and assessment of Existential suffering. The assessment of the methodological quality of the included studies was performed using the Evidence Level and Quality Guide - Johns Hopkins Nursing Evidence-Based Practice. The acceptance of palliative sedation for alleviating refractory physical symptoms is widely established, while its use for existential suffering remains controversial. Ethical concerns, especially regarding the distinction between palliative sedation, euthanasia, and assisted dying, are common among healthcare professionals. The apprehension regarding the use of palliative sedation for existential suffering among these professionals is legitimate, considering the lack of robust evidence indicating the effectiveness of palliative sedation for refractory existential suffering, as well as the absence of clear guidelines to assist them in defining refractory existential suffering, identifying it, and using palliative sedation in such cases. Furthermore, the training and experience in palliative care of healthcare professionals influence decision-making, suggesting that their education and training are essential to ensure the proper practice of palliative sedation.