Terapia de aceptación y compromiso en el contexto de cuidados paliativos: revisión narrativa

Autores/as

DOI:

https://doi.org/10.17058/psiunisc.v7i2.18215

Palabras clave:

Cuidados paliativos, Cuidadores, Profesionales de la salud, Terapia de aceptación y compromisso

Resumen

La terapia de aceptación y compromiso (ACT) y cuidados paliativos (CP) parecen coherentes en sus principios para promover la calidad de vida a pesar del sufrimiento, centrándose en aceptar la muerte o enfermedades que no pueden "curarse" y extenderse tanto para la población clínica como la sana. Los pacientes, los cuidadores y los profesionales de la salud se ven afectados por molestias por el contexto de PC. El objetivo del presente estudio de revisión narrativa de la literatura fue explorar la producción científica y comprender el estado del arte sobre el uso del modelo de intervenciones de ACT en pacientes, sus cuidadores informales y profesionales de la salud en el contexto de CP. El método de revisión narrativa y los términos "cuidados paliativos" y "flexibilidad psicológica" y "terapia de aceptación y compromisso” se usaron en Medline, Embase y PsycInfo sin criterio de tiempo. La investigación se realizó en julio de 2022 y se encontraron 35 artículos. Los estudios han demostrado que el proceso de aceptación y valores puede beneficiar a los pacientes con enfermedades que amenazan la vida para vivir con calidad hasta el momento de la muerte. Morir con calidad puede afectar a los cuidadores informales, que aún necesitan lidiar con el duelo. La conexión con los valores también puede ayudar a los profesionales de la salud a lidiar con dilemas éticos y decisiones morales en el contexto de CP. Esta revisión no tiene como objetivo agotar el tema entre la aplicación de ACT en el contexto de CP.

Descargas

Los datos de descargas todavía no están disponibles.

Biografía del autor/a

Franciele Peloso, Universidade do Vale do Rio dos Sinos - UNISINOS

Psicóloga (UNISINOS), especialista em Terapias Comportamentais Contextuais baseada em Processos (CEFI) e mestranda em Psicologia Clínica (UNISINOS). Membra da Association for Contextual Behavioral Science (ACBS mundial e Brasil). Interesse em temáticas que envolvam terapias comportamentais contextuais, análise comportamental clínica, terapia de aceitação e compromisso em contexto de saúde (dor crônica e cuidados paliativos), valores, mindfulness, regulação emocional

Priscila Goergen Brust-Renck, Universidade do Vale do Rio dos Sinos

Possui graduação em Psicologia (2007) e mestrado em Psicologia com concentração em Cognição Humana (2010) pela PUCRS. Doutorado em Psicologia do Desenvolvimento (2015) na Cornell University nos Estados Unidos, por onde também possui mestrado (2011). Realizou pós-doutorado na área de decisão médica (2015-2017) vinculado ao Núcleo Interinstitucional de Bioética (UFRGS, HCPA, PUCRS, UniRitter) e na área de análise do processo decisório em saúde (2017-2020) no Programa de Pós-Graduação em Engenharia de Produção da UFRGS. Atualmente é professora assistente do Curso de Psicologia e do Curso de Medicina da Unisinos. Integra o Programa de Pós-Graduação em Psicologia da mesma Universidade, onde coordena o Laboratório de Pesquisa em Cognição e Saúde - LAPECS. É pesquisadora colaboradora do Laboratory for Rational Decision Making da Cornell University e do Laboratório de Pesquisa e Intervenção Cognitivo-Comportamental da USP. É membro da Society for Judgment and Decision Making, da Society for Medical Decision Making, da Psychonomic Society, e da American Psychological Association. Tem experiência de colaboração interdisciplinar e atua nas áreas de Psicologia da Saúde, Psicologia Cognitiva Experimental, Psicologia do Desenvolvimento, Pesquisa Translacional, Metodologia de Pesquisa e Estatística

Murilo Ricardo Zibetti, Universidade do Vale do Rio dos Sinos

Graduado (2010), Mestre (2013) e Doutor (2017) em Psicologia na Universidade Federal do Rio Grande do Sul (UFRGS). Docente do Programa de Pós Graduação em Psicologia, do Mestrado Acadêmico em Nutrição e Alimentos, bem como, do cursos de graduação de psicologia e de medicina da Universidade do Vale do Rio dos Sinos (UNISINOS). Atua prioritariamente em pesquisas que envolvem avaliação cognitiva, avaliação psicológica (adaptação e validação de instrumentos), reabilitação neuropsicológica e a interlocução com a fisiologia. Também tem atuado em avaliação a quadros psiquiátricos sob uma perspectiva dimensional e transdiagnóstica. É especialista em Neuropsicologia (Conselho Federal de Psicologia) e possui formação em reabilitação neuropsicológica realizada pelo Centro Paulista de Neuropsicologia ligado a Universidade Federal do Estado de São Paulo (CPN-UNIFESP). Possui experiência de ensino na graduação e em programas de pós graduação em Avaliação Psicológica, Neuropsicológica e Reabilitação Cognitiva. Além disso, tem atuação clínica nas áreas de avaliação e reabilitação neuropsicológica.

Citas

A-Tjak, J. G. L., Davis, M. L., Morina, N., Powers, M. B., Smits, J. A. J., & Emmelkamp, P. M. G. (2015). A Meta-Analysis of the Efficacy of Acceptance and Commitment Therapy for Clinically Relevant Mental and Physical Health Problems. Psychotherapy and Psychosomatics, 84(1), 30–36. https://doi.org/10.1159/000365764

Alam, S., Hannon, B., & Zimmermann, C. (2020). Palliative care for family caregivers. Journal of Clinical Oncology, 38(9), 926–936. https://doi.org/10.1200/JCO.19.00018

APA. (2021). Acceptance and Commitment Therapy for Chronic Pain - Society of Clinical Psychology. American Psychological Association (APA) - Division 12. https://div12.org/treatment/acceptance-and-commitment-therapy-for-chronic-pain/

Bai, Z., Luo, S., Zhang, L., Wu, S., & Chi, I. (2020). Acceptance and Commitment Therapy (ACT) to reduce depression: A systematic review and meta-analysis. Journal of Affective Disorders, 260, 728–737. https://doi.org/10.1016/J.JAD.2019.09.040

Bail, J. R., Traeger, L., Pirl, W. F., & Bakitas, M. A. (2018). Psychological Symptoms in Advanced Cancer. Seminars in Oncology Nursing, 34(3), 241–251. https://doi.org/10.1016/J.SONCN.2018.06.005

Barbosa, L. M., & Murta, S. G. (2015). Propriedades psicométricas iniciais do Acceptance and Action Questionnaire - II - versão brasileira. Psico-USF, 20(1), 75–85. https://doi.org/10.1590/1413-82712015200107

Brown, S. L., Roush, J. F., Marshall, A. J., Jones, C., & Key, C. (2020). The Intervening Roles of Psychological Inflexibility and Functional Impairment in the Relation between Cancer-related Pain and Psychological Distress. International Journal of Behavioral Medicine, 27(1), 100–107. https://doi.org/10.1007/s12529-019-09838-8

Clark, D. (2007). From margins to centre: a review of the history of palliative care in cancer. Lancet Oncol, 8, 430–438. https://doi.org/10.1016/S1470-2045(07)70138-9

Dahl, J., Wilson, K. G., Luciano, C., & Hayes, S. C. (2005). Valuing and Pain. In J. Dahl, K. G. Wilson, C. Luciano, & S. C. Hayes (Eds.), Acceptance and Commitment Therapy for Chronic Pain (1st ed., pp. 76–98). New Harbinger Publications.

Davis, E. L., Deane, F. P., & Lyons, G. C. B. (2015). Acceptance and valued living as critical appraisal and coping strengths for caregivers dealing with terminal illness and bereavement. Palliative and Supportive Care, 13(2), 359–368. https://doi.org/10.1017/S1478951514000431

Davis, E. L., Deane, F. P., & Lyons, G. C. B. (2016). Prediction of individual differences in adjustment to loss: Acceptance and valued-living as critical appraisal and coping strengths. Death Studies, 40(4), 211–222. https://doi.org/10.1080/07481187.2015.1122677

Davis, E. L., Deane, F. P., & Lyons, G. C. B. (2019). An acceptance and commitment therapy self-help intervention for carers of patients in palliative care: Protocol of a feasibility randomised controlled trial. Journal of Health Psychology, 24(5), 685–704. https://doi.org/10.1177/1359105316679724

Davis, E. L., Deane, F. P., Lyons, G. C. B., & Barclay, G. D. (2017). Is Higher Acceptance Associated With Less Anticipatory Grief Among Patients in Palliative Care? J Pain Symptom Manage, 54(1), 120–125. https://doi.org/10.1016/j.jpainsymman.2017.03.012

Davis, E. L., Deane, F. P., Lyons, G. C. B., Barclay, G. D., Bourne, J., & Connolly, V. (2020). Feasibility randomised controlled trial of a self-help acceptance and commitment therapy intervention for grief and psychological distress in carers of palliative care patients. Journal of Health Psychology, 25(3), 322–339. https://doi.org/10.1177/1359105317715091

Delalibera, M., Presa, J., Barbosa, A., & Leal, I. (2015). Sobrecarga no cuidar e suas repercussões nos cuidadores de pacientes em fim de vida: revisão sistemática da literatura. Ciência & Saúde Coletiva, 20(9), 2731–2747. https://doi.org/10.1590/1413-81232015209.09562014

Dijxhoorn, A.-F., Brom, L., Van Der Linden, Y. M., Leget, C., & Raijmakers, N. J. (2021). Prevalence of burnout in healthcare professionals providing palliative care and the effect of interventions to reduce symptoms: A systematic literature review Anne-Floor Q Dijxhoorn. Palliative Medicine, 35(1), 6–26. https://doi.org/10.1177/0269216320956825

Dindo, L., Van Liew, J. R., & Arch, J. J. (2017). Acceptance and Commitment Therapy: A Transdiagnostic Behavioral Intervention for Mental Health and Medical Conditions. Neurotherapeutics, 14(3), 546–553. https://doi.org/10.1007/s13311-017-0521-3

Eisma, M. C., Boelen, P. A., van den Bout, J., Stroebe, W., Schut, H. A. W., Lancee, J., & Stroebe, M. S. (2015). Internet-Based Exposure and Behavioral Activation for Complicated Grief and Rumination: A Randomized Controlled Trial. Behavior Therapy, 46(6), 729–748. https://doi.org/10.1016/J.BETH.2015.05.007

Ferrell, B. R., Twaddle, M. L., Melnick, A., & Meier, D. E. (2018). National Consensus Project Clinical Practice Guidelines for Quality Palliative Care Guidelines, 4th Edition. Journal of Palliative Medicine, 21(12), 1684–1689. https://doi.org/10.1089/jpm.2018.0431

Fisher, S., Gillanders, D., & Ferreira, N. (2021). The experiences of palliative care professionals and their responses to work-related stress: A qualitative study. British Journal of Health Psychology. https://doi.org/10.1111/BJHP.12565

Garner, E. V., & Golijani-Moghaddam, N. (2021). Relationship between psychological flexibility and work-related quality of life for healthcare professionals: A systematic review and meta-analysis. Journal of Contextual Behavioral Science, 21, 98–112. https://doi.org/10.1016/j.jcbs.2021.06.007

Gomes, A. L. Z., & Othero, M. B. (2016). Cuidados paliativos. Estudos Avançados, 30(88), 155–166. https://doi.org/10.1590/S0103-40142016.30880011

González-Fernández, S., & Fernández-Rodríguez, C. (2018). Acceptance and Commitment Therapy in Cancer: Review of Applications and Findings. Behavioral Medicine, 45(3), 255–269. https://doi.org/10.1080/08964289.2018.1452713

Hann, K. E. J., & McCracken, L. M. (2014). A systematic review of randomized controlled trials of Acceptance and Commitment Therapy for adults with chronic pain: Outcome domains, design quality, and efficacy. Journal of Contextual Behavioral Science, 3(4), 217–227. https://doi.org/10.1016/J.JCBS.2014.10.001

Harris, R. (2021). When life hits hard: how to transcend grief, crisis and loss with Acceptance and Commitment Therapy (1st ed.). New Harbinger Publications.

Hasson, F., Nicholson, E., Muldrew, D., Bamidele, O., Payne, S., & Mcilfatrick, S. (2020). International palliative care research priorities: A systematic review. BMC Palliative Care, 19(16), 1–16. https://doi.org/10.1186/s12904-020-0520-8

Hayes, S. C. (2004). Acceptance and commitment therapy, relational frame theory, and the third wave of behavioral and cognitive therapies. Behavior Therapy, 35(4), 639–665. https://doi.org/10.1016/S0005-7894(04)80013-3

Hayes, S. C., & Hofmann, S. G. (2021). “Third-wave” cognitive and behavioral therapies and the emergence of a process-based approach to intervention in psychiatry. World Psychiatry, 20(3), 363–375. https://doi.org/10.1002/WPS.20884

Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006). Acceptance and Commitment Therapy: Model, processes and outcomes. Behaviour Research and Therapy, 44, 1–25. https://doi.org/10.1016/j.brat.2005.06.006

Holmberg, J., Kemani, M. K., Holmström, L., Öst, L. G., & Wicksell, R. K. (2020). Psychological Flexibility and Its Relationship to Distress and Work Engagement Among Intensive Care Medical Staff. Frontiers in Psychology, 11, 3010. https://doi.org/10.3389/FPSYG.2020.603986/BIBTEX

Hudson, P. L., Remedios, C., & Thomas, K. (2010). A systematic review of psychosocial interventions for family carers of palliative care patients. BMC Palliative Care, 9(17). http://www.centreforpallcare.org.

Hulbert-Williams, N. J., Hulbert-Williams, L., Patterson, P., Suleman, S., & Howells, L. (2021). Acceptance and commitment therapy (ACT)-enhanced communication skills: development and evaluation of a novel training programme. BMJ Supportive & Palliative Care, 0, 1–9. https://doi.org/10.1136/bmjspcare-2020-002786

Hulbert-Williams, N. J., Norwood, S. F., Gillanders, D., Finucane, A. M., Spiller, J., Strachan, J., ... Swash, B. (2021). Brief Engagement and Acceptance Coaching for Hospice Settings (the BEACHeS study): results from a Phase I study of acceptability and initial effectiveness in people with non-curative cancer. BMC Palliative Care, 20(1), 1–13. https://doi.org/10.1186/S12904-021-00801-7/FIGURES/3

Hulbert-Williams, N. J., Norwood, S., Gillanders, D., Finucane, A., Spiller, J., Strachan, J., ... Swash, B. (2019). Brief Engagement and Acceptance Coaching for Community and Hospice Settings (the BEACHeS Study): Protocol for the development and pilot testing of an evidence-based psychological intervention to enhance wellbeing and aid transition into palliative care. Pilot Feasibility Stud, 5, 104. https://doi.org/10.1186/s40814-019-0488-4

Jones, K., Methley, A., Boyle, G., Garcia, R., & Vseteckova, J. (2021). A Systematic Review of the Effectiveness of Acceptance and Commitment Therapy for Managing Grief Experienced by Bereaved Spouses or Partners of Adults Who Had Received Palliative Care. Illness Crisis and Loss, 0(0), 1–18. https://doi.org/10.1177/10541373211000175

Kashdan, T. B., Disabato, D. J., Goodman, F. R., Doorley, J. D., & Mcknight, P. E. (2020). Understanding psychological flexibility: A multimethod exploration of pursuing valued goals despite the presence of distress. Psychological Assessment, 32(9), 829–850. https://doi.org/10.1037/pas0000834

Kent, W., Hochard, K. D., & Hulbert-Williams, N. J. (2019). Perceived stress and professional quality of life in nursing staff: How important is psychological flexibility? Journal of Contextual Behavioral Science, 14, 11–19. https://doi.org/10.1016/j.jcbs.2019.08.004

Kredentser, M. S., & Chochinov, H. M. (2020). Psychotherapeutic Considerations for Patients With Terminal Illness. Am J Psychother, 73, 137–143. https://doi.org/10.1176/appi.psychotherapy.20190048

Li, H., Wong, C. L., Jin, X., Chen, J., Chong, Y. Y., & Bai, Y. (2021). Effects of Acceptance and Commitment Therapy on health-related outcomes for patients with advanced cancer: A systematic review. International Journal of Nursing Studies, 115. https://doi.org/10.1016/j.ijnurstu.2021.103876

Lin, J., Scott, W., Carpenter, L., Norton, S., Domhardt, M., Baumeister, H., & Mccracken, L. M. (2019). Acceptance and commitment therapy for chronic pain: protocol of a systematic review and individual participant data meta-analysis. Systematic Reviews, 8(140). https://doi.org/10.1186/s13643-019-1044-2

Low, J., Davis, S., Drake, R., King, M., Tookman, A., Turner, K., Serfaty, M., ... Jones, L. (2012). The role of acceptance in rehabilitation in life-threatening illness. J Pain Symptom Manage, 43(1), 20–28. https://doi.org/10.1016/j.jpainsymman.2011.03.020

Luoma, J. B., Hayes, S. C., & Walser, R. D. (2021). Os seis processos centrais da ACT e seus respectivos processos. In J. B. Luoma, S. C. Hayes, & R. D. Walser (Eds.), Aprendendo ACT: manual de habilidades da Terapia de Aceitação e Compromisso para terapeutas (2nd ed., pp. 27–51). Sinopsys Editora.

Majeed, M. H., Ali, A. A., & Sudak, D. M. (2019). Psychotherapeutic interventions for chronic pain: Evidence, rationale, and advantages. International Journal of Psychiatry in Medicine, 54(2), 140–149. https://doi.org/10.1177/0091217418791447

Martin, C. L., & Pakenham, K. I. (2022). The role of psychological flexibility in palliative care. Journal of Contextual Behavioral Science, 24, 160–170. https://doi.org/10.1016/j.jcbs.2022.05.004

Matsumoto, D. Y. (2012). Cuidados Paliativos: conceito, fundamentos e princípios. In R. T. Carvalho & H. A. Parsons (Eds.), Manual de Cuidados Paliativos ANCP (2nd ed., pp. 23–30). Academia Nacional de Cuidados Paliativos (ANCP).

McCracken, L. M., Patel, S., & Scott, W. (2018). The role of psychological flexibility in relation to suicidal thinking in chronic pain. European Journal of Pain, 22(10), 1774–1781. https://doi.org/10.1002/EJP.1273

McCracken, Lance M, Vowles, K. E., & Eccleston, C. (2004). Acceptance of chronic pain: Component analysis and a revised assessment method. Pain, 107(1–2), 159–166. https://doi.org/10.1016/j.pain.2003.10.012

Mccracken, L. M. (1998). Learning to live with the pain : Acceptance of pain predicts adjustment in persons with chronic pain. Pain, 74, 21–27. https://doi.org/10.15064/jjpm.38.6_441

McGuire, D. B., Grant, M., & Park, J. (2012). Palliative care and end of life: The caregiver. Nursing Outlook, 60(6), 351-356.e20. https://doi.org/10.1016/j.outlook.2012.08.003

Nnate, D. A. (2021). Treatment withdrawal of the patient on end of life: An analysis of values, ethics and guidelines in palliative care. Nursing Open, 8(3), 1023–1029. https://doi.org/10.1002/NOP2.777

Pereira, S. M., & Carvalho, A. S. (2011). Burnout in palliative care: A systematic review. Nursing Ethics, 18(3), 317–326. https://doi.org/10.1177/0969733011398092

Prigerson, H. G., Horowitz, M. J., Jacobs, S. C., Parkes, C. M., Aslan, M., Goodkin, K., ... Maciejewski, P. K. (2009). Prolonged Grief Disorder: Psychometric Validation of Criteria Proposed for DSM-V and ICD-11. PLOS Medicine, 6(8), e1000121. https://doi.org/10.1371/JOURNAL.PMED.1000121

Prigerson, H. G., & MacIejewski, P. K. (2014). Predicting Prolonged Grief Disorder: Caregiver Prodrome Turns Bereaved Survivor Syndrome. Commentary on Thomas et al. Journal of Pain and Symptom Management, 47(3), 516–517. https://doi.org/10.1016/J.JPAINSYMMAN.2013.10.002

Robinson, S., Kissane, D. W., Brooker, J., Hempton, C., & Burney, S. (2017). The Relationship Between Poor Quality of Life and Desire to Hasten Death: A Multiple Mediation Model Examining the Contributions of Depression, Demoralization, Loss of Control, and Low Self-worth. Journal of Pain and Symptom Management, 53(2), 243–249. https://doi.org/10.1016/J.JPAINSYMMAN.2016.08.013

Rother, E. T. (2007). Revisão sistemática X revisão narrativa. Acta Paulista de Enfermagem, 20(2), 5–6. https://doi.org/10.1590/s0103-21002007000200001

Saúde, M. da. (2022). Saúde apresenta atual cenário das doenças não transmissíveis no Brasil. Governo Federal. https://www.gov.br/saude/pt-br/assuntos/noticias/2021-1/setembro/saude-apresenta-atual-cenario-das-doencas-nao-transmissiveis-no-brasil

Sepúlveda, C., Marlin, A., Yoshida, T., & Ullrich, A. (2002). Palliative Care: The World Health Organization’s Global Perspective. Journal of Pain and Symptom Management, 24(2), 91–96.

Sercu, M., Beyens, I., Cosyns, M., Mertens, F., Deveugele, M., & Pype, P. (2018). Rethinking End-of-Life Care and Palliative Care: Learning From the Illness Trajectories and Lived Experiences of Terminally Ill Patients and Their Family Carers. Qualitative Health Research, 28(14), 2220–2238. https://doi.org/10.1177/1049732318796477

Silva, T. S. S., Pedreira, R. B. S., Lima, E. R., Santos, L. dos, Reis, T. T., Rocha, M. P. da, ... Silva, R. S. da. (2022). Challenges of the multidisciplinary team in palliative care in Brazil: integrative review. Research, Society and Development, 11(6), e18511628904–e18511628904. https://doi.org/10.33448/RSD-V11I6.28904

Stockton, D., Kellett, S., Berrios, R., Sirois, F., Wilkinson, N., & Miles, G. (2019). Identifying the underlying mechanisms of change during acceptance and commitment therapy (ACT): A systematic review of contemporary mediation studies. Behavioural and Cognitive Psychotherapy, 47(3), 332–362. https://doi.org/10.1017/S1352465818000553

Trindade, I. A., Guiomar, R., Carvalho, S. A., Duarte, J., Lapa, T., Menezes, P., ... Castilho, P. (2021). Efficacy of Online-Based Acceptance and Commitment Therapy for Chronic Pain: A Systematic Review and Meta-Analysis. The Journal of Pain, 22(11). https://doi.org/10.1016/J.JPAIN.2021.04.003

Vilardaga, J. C. P., Winger, J. G., Teo, I., Owen, L., Sutton, L. M., Keefe, F. J., & Somers, T. J. (2020). Coping Skills Training and Acceptance and Commitment Therapy for Symptom Management: Feasibility and Acceptability of a Brief Telephone-Delivered Protocol for Patients With Advanced Cancer. Journal of Pain and Symptom Management, 59(2), 270–278. https://doi.org/10.1016/j.jpainsymman.2019.09.005

World Health Organization [WHO]. (2017). Definition of Palliative Care [Internet]. Genebra: World Health Organization. Recuperado de www.who.int/cancer/palliative/definition/en

##submission.downloads##

Publicado

2023-07-26

Cómo citar

Peloso, F., Brust-Renck, P. G., & Zibetti, M. R. (2023). Terapia de aceptación y compromiso en el contexto de cuidados paliativos: revisión narrativa. PSI UNISC, 7(2), 212-229. https://doi.org/10.17058/psiunisc.v7i2.18215

Número

Vol. 7 Núm. 2 (2023)

Sección

Artículos

Licencia

La presentación de originales para esta revista implica la transferencia, por parte de los autores, de los derechos de publicación impresa y digital. Los derechos de autor para los artículos publicados son del autor, con los derechos de la revista sobre la primera publicación. Los autores solo podrán utilizar los mismos resultados en otras publicaciones indicando claramente esta revista como el medio de publicación original. Debido a que somos una revista de acceso abierto, se permite el uso gratuito de los artículos en aplicaciones educativas y científicas siempre que se cite la fuente según la licencia CC-BY de Creative Commons.

Licença Creative Commons Creative Commons Atribuição 4.0 Internacional.