Eficácia e segurança de práticas integrativas e complementares no suporte a pacientes em cuidados paliativos pediátricos: revisão sistemática e metanálise
Data
2024-10-10
Orientadores
Len, Cláudio Arnaldo 
Tipo
Tese de doutorado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Introdução: As práticas integrativas em saúde (PICS) têm sido cada vez mais incorporadas ao suporte em cuidados paliativos pediátricos (CPP), uma vez que ambos trazem como princípios comuns o conceito de cuidado holístico, abordagem multidimensional e promoção de qualidade de vida. Além disso, o profissional que se dedica ao cuidado de crianças com necessidades paliativas e às práticas integrativas em saúde deve estar comprometido com o conhecimento técnico de sua área de atuação, com a disponibilidade para criar vínculos de confiança, acolhendo demandas em todas as dimensões do cuidado à criança, sempre respeitando os princípios éticos. Entretanto, ainda há uma escassez de evidências científicas e pouco padrão para o treinamento de profissionais de práticas integrativas com crianças em cuidados paliativos. Objetivos: Realizar uma revisão sistemática com metanálise para responder à pergunta de pesquisa relacionada à eficácia e segurança das PICS no tratamento de pacientes em cuidados paliativos pediátricos; identificar o escopo de práticas utilizadas em pacientes pediátricos em cuidados paliativos e os possíveis benefícios ou riscos identificados, especialmente nas indicações para controle de sintomas e promoção de qualidade de vida. Método: Foram realizadas duas revisões sistemáticas com metanálises, utilizando descritores universais associados a descritores específicos de cada uma das práticas nas principais bases de dados (Embase, Cochrane, Medline/PubMed, Scopus, Google Scholar, Lilacs, Scielo), com filtro destinado a menores de 18 anos, ou em algumas bases de dados, adicionando os descritores "child*" OR "pediatrics". A população incluída consistiu em pacientes menores de 18 anos, com indicação de cuidados paliativos, submetidos a práticas integrativas e complementares, em comparação aos que não receberam essas práticas. Os resultados analisados foram controle de sintomas, promoção de bem-estar e qualidade de vida. Não houve restrições de idioma ou ano de publicação. A análise estatística utilizou média e desvio-padrão para variáveis contínuas, e frequência e proporção para variáveis dicotômicas, com intervalo de confiança de 95%. A heterogeneidade foi considerada significativa se I²>50%, e p foi considerado significante quando <0,05. Na condução da metanálise em rede, foi utilizada a abordagem frequentista em linguagem R, no programa R Studio. Resultados: Após a aplicação dos critérios de inclusão, 43 estudos foram selecionados para análise final em cada revisão. Foi possível observar que, nestas pesquisas, os grupos mais estudados foram os de doenças oncológicas, neurológicas e doenças crônicas que ameaçam a vida. Citamos, como desfechos mais avaliados no controle de sintomas: dor, ansiedade, náuseas, vômitos, insônia, espasticidade, fadiga, convulsão e constipação. No que concerne à qualidade de vida, foram estudados o estresse relacionado à doença ou tratamento, estado funcional, bem-estar, estratégias de enfrentamento, humor, suporte social e de saúde mental. Foi possível realizar uma metanálise com dois estudos que utilizaram a medicina ayurvédica no tratamento da espasticidade de crianças com condições neurológicas, e uma metanálise em rede com os desfechos citados anteriormente, aplicando terapias como hipnose, musicoterapia, aromaterapia, fitoterapia e terapias mente-corpo. Conclusões: Apesar de poucos estudos em formato de ensaio clínico randomizado e metodologias bem definidas, alguns resultados chamaram atenção quando analisados estatisticamente. Foi possível evidenciar benefícios com a prática de manipulação corporal da medicina ayurvédica no auxílio do controle de espasticidade em crianças com paralisia cerebral em cuidados paliativos, bem como a aplicação de hipnose, direta e indireta, no controle de sintomas e promoção de qualidade de vida em pacientes oncológicos, com condições neurológicas ou outras doenças crônicas complexas em cuidados paliativos.
Background: Integrative health practices (IHPs) have increasingly been incorporated into pediatric palliative care (PPC) support, as both share a common focus on holistic care, a multidimensional approach, and the promotion of quality of life. Additionally, professionals dedicated to the care of children with palliative needs and integrative health practices must be committed to technical knowledge of their fields and to building trust, addressing the child's needs in all dimensions, always respecting ethical principles. However, there is still a lack of scientific evidence and few standards for training professionals in integrative practices with children in palliative care. Objectives: To carry out a systematic review with meta-analysis to answer the research question related to the efficacy and safety of IHPs in treating pediatric palliative care patients; to identify the scope of practices used in pediatric palliative care and the possible benefits or risks identified, especially regarding symptom control and the promotion of quality of life. Methods: Two systematic reviews with meta-analyses were carried out, using universal descriptors combined with specific descriptors for each practice in major databases (Embase, Cochrane, Medline/PubMed, Scopus, Google Scholar, Lilacs, Scielo), filtered for children under 18, or in some databases, using the additional descriptors "child*" OR "pediatrics." The population consisted of patients under 18 years of age, indicated for palliative care, who underwent integrative and complementary practices, compared to those who did not. The outcomes analyzed included symptom control, well-being and quality of life. No restrictions were placed on language or year of publication. Statistical analysis used mean and standard deviation for continuous variables, and frequency and proportion for dichotomous variables, with a 95% confidence interval. Heterogeneity was considered significant if I²>50%, and p was considered significant when <0.05. The network meta-analysis used the frequentist approach in R language, in the R Studio program. Results: After applying the inclusion criteria, 43 studies were selected for final analysis in each review. It was observed that the most studied groups were those with oncological, neurological, and chronic life-threatening conditions. The most assessed outcomes for symptom control included pain, anxiety, nausea, vomiting, insomnia, spasticity, fatigue, convulsions, and constipation. In terms of quality of life, the studies focused on disease- or treatment-related distress, functional status, well-being, coping strategies, mood, social support, and mental health. A meta-analysis was conducted involving two studies that used Ayurvedic medicine for spasticity in children with neurological conditions, and a network meta-analysis was performed on the effects of hypnosis, music therapy, aromatherapy, herbal medicine, and body-mind therapies on the aforementioned outcomes. Conclusions: Although there were few studies in the form of randomized clinical trials with well-defined methodologies, some statistically significant results emerged. Notably, benefits were observed with Ayurvedic medicine, particularly in body manipulation practices, which helped control spasticity in children with cerebral palsy in palliative care, as well as in the use of direct or indirect hypnosis to control symptoms and promote quality of life in patients in palliative care, including those with oncological, neurological, or other complex chronic conditions.
Background: Integrative health practices (IHPs) have increasingly been incorporated into pediatric palliative care (PPC) support, as both share a common focus on holistic care, a multidimensional approach, and the promotion of quality of life. Additionally, professionals dedicated to the care of children with palliative needs and integrative health practices must be committed to technical knowledge of their fields and to building trust, addressing the child's needs in all dimensions, always respecting ethical principles. However, there is still a lack of scientific evidence and few standards for training professionals in integrative practices with children in palliative care. Objectives: To carry out a systematic review with meta-analysis to answer the research question related to the efficacy and safety of IHPs in treating pediatric palliative care patients; to identify the scope of practices used in pediatric palliative care and the possible benefits or risks identified, especially regarding symptom control and the promotion of quality of life. Methods: Two systematic reviews with meta-analyses were carried out, using universal descriptors combined with specific descriptors for each practice in major databases (Embase, Cochrane, Medline/PubMed, Scopus, Google Scholar, Lilacs, Scielo), filtered for children under 18, or in some databases, using the additional descriptors "child*" OR "pediatrics." The population consisted of patients under 18 years of age, indicated for palliative care, who underwent integrative and complementary practices, compared to those who did not. The outcomes analyzed included symptom control, well-being and quality of life. No restrictions were placed on language or year of publication. Statistical analysis used mean and standard deviation for continuous variables, and frequency and proportion for dichotomous variables, with a 95% confidence interval. Heterogeneity was considered significant if I²>50%, and p was considered significant when <0.05. The network meta-analysis used the frequentist approach in R language, in the R Studio program. Results: After applying the inclusion criteria, 43 studies were selected for final analysis in each review. It was observed that the most studied groups were those with oncological, neurological, and chronic life-threatening conditions. The most assessed outcomes for symptom control included pain, anxiety, nausea, vomiting, insomnia, spasticity, fatigue, convulsions, and constipation. In terms of quality of life, the studies focused on disease- or treatment-related distress, functional status, well-being, coping strategies, mood, social support, and mental health. A meta-analysis was conducted involving two studies that used Ayurvedic medicine for spasticity in children with neurological conditions, and a network meta-analysis was performed on the effects of hypnosis, music therapy, aromatherapy, herbal medicine, and body-mind therapies on the aforementioned outcomes. Conclusions: Although there were few studies in the form of randomized clinical trials with well-defined methodologies, some statistically significant results emerged. Notably, benefits were observed with Ayurvedic medicine, particularly in body manipulation practices, which helped control spasticity in children with cerebral palsy in palliative care, as well as in the use of direct or indirect hypnosis to control symptoms and promote quality of life in patients in palliative care, including those with oncological, neurological, or other complex chronic conditions.
Descrição
Citação
ROCHA, Aline Maria de Oliveira. Eficácia e segurança de práticas integrativas e complementares no suporte a pacientes em cuidados paliativos pediátricos: revisão sistemática e metanálise. 2024. 223 f. Tese (Doutorado em Pediatria e Ciências Aplicadas a Pediatra) - Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, 2024.