Cuidados Paliativos Domiciliarios y Hospitalarios: Principales diferencias de costos e impacto psicosocial de los pacientes y sus familiares
Resumen
Los cuidados paliativos tienen como objetivo mejorar la calidad de vida de los pacientes con enfermedades terminales y sus familias, pueden administrarse en entornos hospitalarios o domiciliarios. La elección entre estos dos modelos de atención tiene implicaciones muy relevantes en factores como los costos, comodidad para el paciente y apoyo a los familiares. Esta revisión bibliográfica tiene como objetivo analizar las diferencias entre los cuidados paliativos domiciliarios y hospitalarios, enfocándose en aspectos cruciales como la calidad de vida de los pacientes, los costos asociados y la perspectiva de los familiares durante el curso de la enfermedad al final de la vida. Se compararán ambos escenarios para ofrecer una visión comprensiva de las ventajas y desventajas de cada modalidad de atención. Los cuidados domiciliarios permiten que el paciente permanezca rodeado de un entorno familiar, lo podría contribuir con el bienestar emocional y psicológico. Sin embargo, los cuidados hospitalarios proporcionan un acceso inmediato a recursos médicos avanzados y personal especializado, siendo bastante útil en situaciones de emergencia o complicaciones inesperadas.
Descargas
Citas
Hui D, Bruera E. Models of palliative care delivery for patients with cancer. J Clin Oncol. 2020;38(9):852-65.
Balducci L. Geriatric oncology, spirituality, and palliative care. J Pain Symptom Manag. 2019;57(1):171-5.
Kamal AH, Bausewein C, Casarett DJ, Currow DC, Dudgeon DJ, Higginson IJ. Standards, guidelines, and quality measures for successful specialty palliative care integration into oncology: current approaches and future directions. J Clin Oncol. 2020;38(9):987-94.
Rogal S, Hansen L, Patel A, Ufere N, Verma M, Woodrell C, et al Practice Guidance: palliative care and symptom-based management in decompensated cirrhosis. Hepatology. 2022;76(3):819-53.
Baqeas M, Davis J, Copnell B. Compassion fatigue and compassion satisfaction among palliative care health providers: a scoping review. BMC Palliat Care. 2021;20(1):88.
Abedini N, Hechtman R, Singh A, Khateeb R, Mann J, Townsend W, et al. Interventions to reduce aggressive care at end of life among patients with cancer: a systematic review. Lancet Oncol. 2019;20(11).
Lustbader D, Friedman T, Stewart T. Health Insurance 101: Oportunities for Palliative Care (FR471). J Pain Symptom Manage. 2020;59(2):481.
Moore S, Portz J, Santodomingo M, Elsbernd K, McHale M, Massone J. Using telehealth for hospice reauthorization visits: results of a quality improvement analysis. J Pain Symptom Manage. 2020;60:e22–7.
Luta X, Ottino B, Hall P, Bowden J, Wee B, Droney J, et al. Evidence on the economic value of end-of-life and palliative care interventions: a narrative review of reviews. BMC Palliat Care. 2021;20(1):89.
Pastrana T, Wüller J, Weyers S, Bruera E. Insights from a community-based palliative care course: a qualitative study. BMC Palliat Care. 2021;20:1-7.
Funderskov K, Boe D, Jess M, Munk L, Olsen Zwisler A, Dieperink K. Telemedicine in specialised palliative care: healthcare professionals’ and their perspectives on video consultations—A qualitative study. J Clin Nurs. 2019;28:3966–76.
Veigh C, Reid J, Carvalho P. Healthcare professionals’ views of palliative care for American war veterans with non-malignant respiratory disease living in a rural area: a qualitative study. BMC Palliat Care. 2019;18:22.
Lai L, Sato R, He S, Ouchi K, Leiter R, deLima T, et al. Usage patterns of a webbased palliative care content platform (PalliCOVID) during the COVID-19 pandemic. J Pain Symptom Manage. 2020;60: e20–7.
Morin L, Wastesson JW, Laroche ML, Fastbom J, Johnell K. How many older adults receive drugs of questionable clinical benefit near the end of life? A cohort study. Palliat Med. 2019;33(8):1080-90.
Schill K, Caxaj S. Cultural safety strategies for rural Indigenous palliative care: a scoping review. BMC Palliat Care. 2019;18:1-13.
Ryan S, Wong J, Chow R, Zimmermann C. Evolving definitions of palliative care: Upstream migration or confusion? Curr Treat Options Oncol. 2020;21(3):20.
Marin H, Mayo P, Thai V, Dersch-Mills D, Ling S, Folkman F, et al. The impact of palliative care consults on deprescribing in palliative cancer patients. Support Care Cancer. 2020;28:4107-13.
Thompson J. Deprescribing in palliative care. Clin Med (Lond). 2019;19(4):311-4.
Hong S, Lee J, Chun E, Kim K, Kim J, Kim S, et al. Polypharmacy, inappropriate medication use, and drug interactions in older Korean patients with cancer receiving first-line palliative chemotherapy. Oncologist. 2020;25(3).
Green E, Shaw SE, Harris T. 'They shouldn't be coming to the ED, should they?' A qualitative study of why patients with palliative care needs present to the emergency department. BMJ Support Palliat Care. 2019;9(4):e29-e29.
Mohamed F, Uvais NA, Moideen S, Cp RR, Saif M. Psychotropic medication prescriptions for home-based palliative care oncology patients. Prim Care Companion CNS Disord. 2024;26(2):54452.
O’Malley K, Blakley L, Ramos K, et al. Mental healthcare and palliative care: barriers. BMJ Support Palliat Care. 2021;11(2):138-144.
Azhar A, Hui D. Management of physical symptoms in patients with advanced cancer during the last weeks and days of life. Cancer Res Treat. 2022;54(3):661–670.
Fleisher J, Klostermann E, Hess S, Lee J, Myrick E, Chodosh J. Interdisciplinary palliative care for people with advanced Parkinson’s disease: a view from the home. Ann Palliat Med. 2020;9(Suppl 1).
Iwasa Y, Saito I, Suzuki M. Differences in home health nursing care for patients with Parkinson’s disease by stage of progress: patients in Hoehn and Yahr stages III, IV, and V. Parkinsons Dis. 2021;2021:8834998.
Sylvie G, Farré Coma J, Ota G, Aoife L, Anna S, Johanne S, et al. Co-designing an integrated care network with people living with Parkinson’s disease: from patients’ narratives to trajectory analysis. Qual Health Res. 2021;31(14):2585-601.
Johnstone G, Davey L, Cato J, Lowthian JA. Enhancing palliative care at home: a generalist community nursing case study. Aust J Adv Nurs. 2023;40(2):41-6.
Cárdenas-Cabello , F. (2024). Nueva política exterior de México, evaluación de la gestión 2018-2021. Estudios Y Perspectivas Revista Científica Y Académica , 4(1), 591–621. https://doi.org/10.61384/r.c.a.v4i1.121
López Valdez, J. M., & García Pineda, E. (2024). Educación inclusiva e integración en las escuelas normales públicas y privadas de México. Revista Científica De Salud Y Desarrollo Humano, 5(1), 126–150. https://doi.org/10.61368/r.s.d.h.v5i1.79
Cárdenas-Cabello , F. (2024). Nueva política exterior de México, evaluación de la gestión 2018-2021. Estudios Y Perspectivas Revista Científica Y Académica , 4(1), 591–621. https://doi.org/10.61384/r.c.a.v4i1.122
Fernández C., F. (2024). Determinación De Erodabilidad En Áreas De Influencia Cuenca Poopo Región Andina De Bolivia. Horizonte Académico, 4(4), 63–78. Recuperado a partir de https://horizonteacademico.org/index.php/horizonte/article/view/19
Medina Nolasco, E. K., Mendoza Buleje, E. R., Vilca Apaza, G. R., Mamani Fernández, N. N., & Alfaro Campos, K. (2024). Tamizaje de cáncer de cuello uterino en mujeres de una región Andina del Perú. Arandu UTIC, 11(1), 50–63. https://doi.org/10.69639/arandu.v11i1.177
Da Silva Santos , F., & López Vargas , R. (2020). Efecto del Estrés en la Función Inmune en Pacientes con Enfermedades Autoinmunes: una Revisión de Estudios Latinoamericanos. Revista Científica De Salud Y Desarrollo Humano, 1(1), 46–59. https://doi.org/10.61368/r.s.d.h.v1i1.9
Mozeluk N, Gallo A, Ferre M, Bobillo M, Donnianni I, Bellomo M, Saimovici J. Medicación potencialmente inapropiada en adultos mayores con necesidades paliativas en domicilio. Medicina (B Aires). 2024;84(3).
Jersak T, Steinfeldt L, Velasquez AL, Ellis KL, Gunya EK, Brooks JV, Sinclair C. Development of Specialty-Based Pediatric Palliative Care Clinics. J Pain Symptom Manage. 2024;67(5):e596.
Ross S, Agrawal M, Griffiths R, Grob C, Berger A, Henningfield JE. Psychedelic-assisted psychotherapy to treat psychiatric and existential distress in life-threatening medical illnesses and palliative care. Neuropharmacology. 2022;216:109174.
Delgado-Silveira E, Mateos-Nozal J, Muñoz García M, et al. Uso potencialmente inapropiado de fármacos en cuidados paliativos: versión en castellano de los criterios STOPP-Frail (STOPP-Pal). Rev Esp Geriatr Gerontol 2019; 54: 151-5
Jaramillo J, Lozano I, Tornero O, Tejada P, Fuentes R, Gómez F. Prevalence of potentially inappropriate prescription in community-dwelling patients with advanced dementia and palliative care needs. Rev Esp Geriatr Gerontol. 2021;56(4):203-7.
Reid E, Kovalerchik O, Jubanyik K, Brown S, Hersey D, Grant L. Is palliative care cost-effective in low-income and middle-income countries? A mixed-methods systematic review. BMJ Support Palliat Care. 2019;9(2):120-9.
Bakitas M, Allen K, Malone E, Dionne J, McCammon S, Taylor R, et al. Forging a new frontier: providing palliative care to people with cancer in rural and remote areas. J Clin Oncol. 2020;38(9):963-73.
Petrova M, Wong G, Kuhn I, Wellwood I, Barclay S. Timely community palliative and end-of-life care: a realist synthesis. BMJ Support Palliat Care. 2021.
Slobogian V, Vig C, Shirt L, Shuman C, Sondermann M, Vanderveen M, Bouchal SR. How family physicians introduce palliative care to patients with chronic illnesses. Chronic Illn. 2024;20(1):135-44.
Gonzalez V, Fuhrer V, Gonzalez N, Kopp D, Eychmüller S, Maessen M. Impact of home-based palliative care on health care costs and hospital use: a systematic review. Palliative Support Care. 2021;19(4):474-487.
Maetens A, Beernaert K, De Schreye R, Faes K, Annemans L, Pardon K, et al. Impact of palliative home care support on the quality and costs of care at the end of life: a population-level matched cohort study. BMJ Open. 2019;9(1)
Connolly M, Bell M, Lawler F, Timmins F, Ryder M. Hospital-based palliative and end-of-life care in the COVID-19 pandemic: a scoping review. Am J Hosp Palliat Care. 2022;39(9):1105-1120.
Seow H, Barbera LC, McGrail K, Burge F, Guthrie DM, Lawson B, et al. Effect of early palliative care on end-of-life health care costs: A population-based, propensity score–matched cohort study. JCO Oncol Pract. 2022;18(1)
Macmillan, P. J., Chalfin, B., Soleimani Fard, A., & Hughes, S. (2020). Earlier palliative care referrals associated with reduced length of stay and hospital charges. Journal of Palliative Medicine, 23(1), 107-111.
Gardiner C, Robinson J, Connolly M, Hulme C, Kang K, Rowland C, et al. Equity and the financial costs of informal caregiving in palliative care: a critical debate. BMC Palliat Care. 2020;19:1-7.
Joo M, Yoo J, Mojtahedi Z, Kim P, Hwang J, Koo J, et al. Ten-year trends of utilizing palliative care and palliative procedures in patients with gastric cancer in the United States from 2009 to 2018-a nationwide database study. BMC Health Serv Res. 2022;22:1-11.
Agency for Healthcare Research and Quality. Healthcare Cost and Utilization Project. HCUP Fact Sheet. https://www.hcup-us.ahrq.gov/news/exhibit_booth/HCUPFactSheet.pdf. Published March 24, 2021. Accessed October, 2024
Kaufman B, Granger B, Sun J, Sanders G, Taylor D, Mark D, et al. The cost-effectiveness of palliative care: insights from the PAL-HF trial. J Card Fail. 2021;27(6):662-669.
Zdun-Ryżewska A, Chojnacka-Szawłowska G, Basiński K, Leppert W, Majkowicz M. Cognitive and emotional representations of pain in cancer patients at an inpatient unit and home palliative care. Curr Probl Cancer. 2019;43(6):100464.
Redondo E, Ibanez C, Cruzado J. Psychological well-being in palliative care: a systematic review. OMEGA-Journal of Death and Dying. 2023;87(2):377-400.
Barrué P, Sánchez-Gómez M. The emotional experience of nurses in the Home Hospitalization Unit in palliative care: A qualitative exploratory study. Enferm Clin (Engl Ed). 2021;31(4):211-21.
Derechos de autor 2025 Gianella Marcela Ávila Alcivar , Ericka Magdalena Parra Gavilanes, Mariana Concepcion Vallejo Martinez
Esta obra está bajo licencia internacional Creative Commons Reconocimiento 4.0.
.png)
.png)
1.png)
