Planeamento Antecipado de Cuidados para Pessoas com Esquizofrenia e em Situação de Fim de Vida: Uma Revisão Sistemática Qualitativa


  • José Góis Psychiatry Service, Hospital do Espírito Santo, Évora Portugal; Polytechnic Institute of Castelo Branco, Castelo Branco, Portugal



Cuidado Terminal, Cuidados Paliativos, Esquizofrenia, Planeamento Antecipado de Cuidados


Introduction: People with schizophrenia suffer a higher risk of mortality and at the same time receive less palliative care, of which advance care planning is a key element. This review aims to gather available evidence regarding the use of advance care planning in palliative care in people with schizophrenia, its obstacles and the best practices that should be followed. 

Methodology: A systematic review of the literature over the past 20 years, with a qualitative focus, on the use of advance care plans for people with schizophrenia and in end‑of‑life or palliative situations. 

Results: Seven articles were included in the review. Five themes were identified from the thematic analysis, namely decision capacity in severe mental illness, peculiarities of advance care planning in people with schizophrenia, characteristics of schizophrenia that can affect advance care planning, communication and training, and multidisciplinarity and continuity of care. 

Conclusion: More research in this area is urgently needed. Patients face obstacles related to their mental illness, discomfort and doubt from health professionals, and lack of supportive figures. A multidisciplinary and collaborative approach, training and recognition of patients’ inherent ability to make choices and to have effective discussions about their health status, facilitate the process of advance care planning. 


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Rietjens J, Korfage I, Taubert M. Advance care planning: the future. BMJ Supportive & Palliative Care. 2020:bmjspcare-2020-002304. doi:10.1136/bmjspcare-2020-002304

Sudore RL, Lum HD, You JJ, et al. Defining Advance Care Planning for Adults: A Consensus Definition From a Multidisciplinary Delphi Panel. Journal of Pain and Symptom Management. 2017/05/01/ 2017;53(5):821-832.e1. doi:10.1016/j.jpainsymman.2016.12.331

Rietjens JAC, Sudore RL, Connolly M, et al. Definition and recommendations for advance care planning: an international consensus supported by the European Association for Palliative Care. Lancet Oncol. Sep 2017;18(9):e543-e551. doi:10.1016/s1470-2045(17)30582-x

Lei n.º 25/2012 de 16 de julho, Diário da República n.º 136/2012, Série I de 2012-07-16 3728-3730 (2012). Accessed 07-02-2020.

Medline Plus. Advance Directives. Webpage. US National Library of Medicine. Accessed 11-06-2020, 2020.

den Herder-van der Eerden M, Ewert B, Hodiamont F, Hesse M, Hasselaar J, Radbruch L. Towards accessible integrated palliative care: Perspectives of leaders from seven European countries on facilitators, barriers and recommendations for improvement. Journal of Integrated Care (Brighton, England). 2017;25(3):222-232.

Karver SB, Berger J. Advanced care planning--empowering patients for a peaceful death. Asian Pac J Cancer Prev. 2010:23-5. vol. 10.

Agarwal R, Epstein AS. Advance Care Planning and End-of-Life Decision Making for Patients with Cancer. Seminars in oncology nursing. 2018;34(3):316-326.

Lynn J, Goldstein NE. Advance care planning for fatal chronic illness: avoiding commonplace errors and unwarranted suffering. Ann Intern Med. May 20 2003;138(10):812-8. doi:10.7326/0003-4819-138-10-200305200-00009

Sawatzky R, Porterfield P, Lee J, et al. Conceptual foundations of a palliative approach: a knowledge synthesis. BMC palliative care. 2016;15:5-5.

Saha S, Chant D, Welham J, McGrath J. A systematic review of the prevalence of schizophrenia. PLoS Med. May 2005;2(5):e141. doi:10.1371/journal.pmed.0020141

Moreno-Küstner B, Martín C, Pastor L. Prevalence of psychotic disorders and its association with methodological issues. A systematic review and meta-analyses. PLoS One. 2018;13(4):e0195687. doi:10.1371/journal.pone.0195687

Laursen TM, Nordentoft M, Mortensen PB. Excess early mortality in schizophrenia. Annu Rev Clin Psychol. 2014;10:425-48. doi:10.1146/annurev-clinpsy-032813-153657

Palmer BA, Pankratz VS, Bostwick JM. The lifetime risk of suicide in schizophrenia: a reexamination. Arch Gen Psychiatry. Mar 2005;62(3):247-53. doi:10.1001/archpsyc.62.3.247

Olfson M, Gerhard T, Huang C, Crystal S, Stroup TS. Premature Mortality Among Adults With Schizophrenia in the United States. JAMA Psychiatry. Dec 2015;72(12):1172-81. doi:10.1001/jamapsychiatry.2015.1737

Simon GE, Stewart C, Yarborough BJ, et al. Mortality Rates After the First Diagnosis of Psychotic Disorder in Adolescents and Young Adults. JAMA Psychiatry. Mar 1 2018;75(3):254-260. doi:10.1001/jamapsychiatry.2017.4437

Bitter I, Czobor P, Borsi A, et al. Mortality and the relationship of somatic comorbidities to mortality in schizophrenia. A nationwide matched-cohort study. Eur Psychiatry. Sep 2017;45:97-103. doi:10.1016/j.eurpsy.2017.05.022

Irwin KE, Henderson DC, Knight HP, Pirl WF. Cancer care for individuals with schizophrenia. Cancer. Feb 1 2014;120(3):323-34. doi:10.1002/cncr.28431

Cerimele JM, Katon WJ. Associations between health risk behaviors and symptoms of schizophrenia and bipolar disorder: a systematic review. Gen Hosp Psychiatry. Jan-Feb 2013;35(1):16-22. doi:10.1016/j.genhosppsych.2012.08.001

Berti L, Bonfioli E, Chioffi L, Morgante S, Mazzi MA, Burti L. Lifestyles of Patients with Functional Psychosis Compared to Those of a Sample of the Regional General Population: Findings from a Study in a Community Mental Health Service of the Veneto Region, Italy. Community Ment Health J. Oct 2018;54(7):1050-1056. doi:10.1007/s10597-017-0223-7

Buhagiar K, Parsonage L, Osborn DP. Physical health behaviours and health locus of control in people with schizophrenia-spectrum disorder and bipolar disorder: a cross-sectional comparative study with people with non-psychotic mental illness. BMC Psychiatry. Jun 24 2011;11:104. doi:10.1186/1471-244x-11-104

Dickerson F, Schroeder J, Katsafanas E, et al. Cigarette Smoking by Patients With Serious Mental Illness, 1999-2016: An Increasing Disparity. Psychiatr Serv. Feb 1 2018;69(2):147-153. doi:10.1176/

Onyeka IN, Collier Hoegh M, Naheim Eien EMCM, Nwaru BI, Melle I. Comorbidity of Physical Disorders Among Patients With Severe Mental Illness With and Without Substance Use Disorders: A Systematic Review and Meta-Analysis. J Dual Diagn. Jun 4 2019:1-15. doi:10.1080/15504263.2019.1619007

Vasudev K, Martindale BV. Physical healthcare of people with severe mental illness: everybody's business! Mental health in family medicine. 2010;7(2):115-122.

De Hert M, Cohen D, Bobes J, et al. Physical illness in patients with severe mental disorders. II. Barriers to care, monitoring and treatment guidelines, plus recommendations at the system and individual level. World psychiatry : official journal of the World Psychiatric Association (WPA). 2011;10(2):138-151. doi:10.1002/j.2051-5545.2011.tb00036.x

van Hasselt FM, Oud MJT, Loonen AJM. Improvement of care for the physical health of patients with severe mental illness: a qualitative study assessing the view of patients and families. BMC Health Services Research. 2013/10/21 2013;13(1):426. doi:10.1186/1472-6963-13-426

Hahm HC, Segal SP. Failure to Seek Health Care Among the Mentally Ill. American Journal of Orthopsychiatry. 2005/01/01 2005;75(1):54-62. doi:10.1037/0002-9432.75.1.54

Mo PK, Mak WW, Chong ES, Shen H, Cheung RY. The prevalence and factors for cancer screening behavior among people with severe mental illness in Hong Kong. PLoS One. 2014;9(9):e107237. doi:10.1371/journal.pone.0107237

McNamara B, Same A, Rosenwax L, Kelly B. Palliative care for people with schizophrenia: A qualitative study of an under-serviced group in need. BMC Palliative Care. 2018;17(1)doi:10.1186/s12904-018-0309-1

Chochinov HM, Martens PJ, Prior HJ, Kredentser MS. Comparative health care use patterns of people with schizophrenia near the end of life: a population-based study in Manitoba, Canada. Schizophr Res. Nov 2012;141(2-3):241-6. doi:10.1016/j.schres.2012.07.028

Candilis PJ, Foti MEG, Holzer JC. End-of-life care and mental illness: A model for community psychiatry and beyond. Community Mental Health Journal. 2004;40(1):3-16. doi:10.1023/

Foti ME, Bartels SJ, Van Citters AD, Merriman MP, Fletcher KE. End-of-life treatment preferences of persons with serious mental illness. Psychiatr Serv. May 2005;56(5):585-91. doi:10.1176/

Spilsbury K, Rosenwax L, Brameld K, Kelly B, Arendts G. Morbidity burden and community-based palliative care are associated with rates of hospital use by people with schizophrenia in the last year of life: A population-based matched cohort study. PLoS One. 2018;13(11):e0208220. doi:10.1371/journal.pone.0208220

Relyea E, MacDonald B, Cattaruzza C, Marshall D. On the Margins of Death: A Scoping Review on Palliative Care and Schizophrenia. J Palliat Care. Jan 2019;34(1):62-69. doi:10.1177/0825859718804108

Shalev D, Brewster K, Arbuckle MR, Levenson JA. A staggered edge: End-of-life care in patients with severe mental illness. General Hospital Psychiatry. 2016;44:1-3. doi:10.1016/j.genhosppsych.2016.10.004

Shalev D, Brewster KK, Levenson JA. End-of-Life Care for Patients with Schizophrenia #332. Journal of Palliative Medicine. 2017;20(7):787-788. doi:10.1089/jpm.2017.0164

Foti ME, Bartels SJ, Merriman MP, Fletcher KE, Van Citters AD. Medical advance care planning for persons with serious mental illness. Psychiatr Serv. May 2005;56(5):576-84. doi:10.1176/

Cai X, Cram P, Li Y. Origination of Medical Advance Directives Among Nursing Home Residents With and Without Serious Mental Illness. Psychiatric Services. Jan 2011;62(1):61-66. doi:10.1176/

Hanan DM, Lyons KS. Hospice Use Among Individuals With Severe Persistent Mental Illness. Journal of the American Psychiatric Nurses Association. 2020:1078390320910482. doi:10.1177/1078390320910482

Woods A, Willison K, Kington C, Gavin A. Palliative care for people with severe persistent mental illness: A review of the literature. Canadian Journal of Psychiatry. 2008;53(11):725-736. doi:10.1177/070674370805301104

Foti ME. "Do It Your Way": a demonstration project on end-of-life care for persons with serious mental illness. J Palliat Med. Aug 2003;6(4):661-9. doi:10.1089/109662103768253830

Toor H. Palliative care in patients with severe mental illness. Canadian Family Physician. 2019;65(11):799.

Baker A. Palliative and End-of-Life Care in the Serious and Persistently Mentally Ill Population. Journal of the American Psychiatric Nurses Association. 2005/10/01 2005;11(5):298-303. doi:10.1177/1078390305282209

McCasland LA. Providing Hospice and Palliative Care to the Seriously and Persistently Mentally Ill. Journal of Hospice & Palliative Nursing. 2007;9(6)

Trachsel M, Irwin SA, Biller-Andorno N, Hoff P, Riese F. Palliative psychiatry for severe persistent mental illness as a new approach to psychiatry? Definition, scope, benefits, and risks. BMC Psychiatry. Jul 22 2016;16:260. doi:10.1186/s12888-016-0970-y

Whiteford H, Buckingham B, Harris M, Diminic S, Stockings E, Degenhardt L. Estimating the number of adults with severe and persistent mental illness who have complex, multi-agency needs. Australian & New Zealand Journal of Psychiatry. 2017/08/01 2016;51(8):799-809. doi:10.1177/0004867416683814

Carlsson IM, Blomqvist M, Jormfeldt H. Ethical and methodological issues in qualitative studies involving people with severe and persistent mental illness such as schizophrenia and other psychotic conditions: a critical review. Int J Qual Stud Health Well-being. 2017;12(sup2):1368323.

Ruggeri M, Leese M, Thornicroft G, Bisoffi G, Tansella M. Definition and prevalence of severe and persistent mental illness. British Journal of Psychiatry. 2000;177(2):149-155. doi:10.1192/bjp.177.2.149




Como Citar

Góis, J. (2020). Planeamento Antecipado de Cuidados para Pessoas com Esquizofrenia e em Situação de Fim de Vida: Uma Revisão Sistemática Qualitativa. Revista Portuguesa De Psiquiatria E Saúde Mental, 6(2), 77–87.



Revisão Sistemática