Palavras-chave
Conhecimentos, Atitudes e Prática em Saúde
Insuficiência Cardíaca
Entrevistas como Assunto
Enfermagem
Autonomia Pessoal
Como Citar
Resumo
Objetivo: Desenvolver um roteiro de entrevista sobre o conhecimento em Insuficiência Cardíaca (IC), crenças sobre Diretivas Antecipadas (DAs) e a intenção de preencher as DAs, bem como avaliar sua validade de conteúdo e de face. Métodos: Estudo de métodos mistos desenvolvido em três etapas: Etapa 1) Estudo metodológico de desenvolvimento do roteiro baseado nas diretrizes brasileiras de IC, no modelo brasileiro de DAs e na Teoria do Comportamento Planejado. Etapa 2) Avaliação da validade de conteúdo por seis especialistas, que avaliaram os itens quanto à relevância prática, clareza, relevância teórica e dimensionalidade. Todos os itens com valores de Índice de Validade de Conteúdo (IVC) < 80% foram revisados e reavaliados. Etapa 3) Avaliação da validade de face por meio de teste cognitivo (estudo-piloto) realizado com 20 pacientes com IC em acompanhamento ambulatorial. Resultados: O roteiro incluiu 11 itens sobre conhecimento em IC e 21 itens sobre crenças e intenção de preencher as DAs. Treze itens foram revisados na Etapa 2, alcançando IVC > 80% e AC2 de Gwet > 0,80. Os pacientes relataram dificuldades com itens sobre crenças comportamentais, normativas e de controle, sugerindo a necessidade de educação prévia sobre as DAs. Conclusões: O roteiro apresentou validade de conteúdo e de face satisfatórias. Ele pode auxiliar enfermeiros e outros profissionais de saúde a identificar lacunas de conhecimento e crenças que influenciam o preenchimento das DAs, apoiando a autonomia do paciente e a tomada de decisão informada nos cuidados de fim de vida.
Referências
Bozkurt B, Coats AJS, Tsutsui H, Abdelhamid CM, Adamopoulos S, Albert N, et al. Universal definition and classification of heart failure: a report of the Heart Failure Society of America, Heart Failure Association of the European Society of Cardiology, Japanese Heart Failure Society and Writing Committee of the Universal Definition of Heart Failure: Endorsed by the Canadian Heart Failure Society, Heart Failure Association of India, Cardiac Society of Australia and New Zealand, and Chinese Heart Failure Association. Eur J Heart Fail. 2021;23(3):352-380. https://doi.org/ 10.1002/ejhf.2115
Brasil. Ministério da Saúde. Sistema de Informações Hospitalares do SUS - DATASUS. Morbidade hospitalar do SUS por local de internação - Brasil: insuficiência cardíaca, maio 2024-maio 2025 [Internet]. Brasília: Ministério da Saúde; c2025 [cited 2025 Aug 12]. Available from: http://tabnet.datasus. gov.br/cgi/deftohtm.exe?sih/cnv/nibr.def
Truby LK, Rogers JG. Advanced Heart Failure: Epidemiology, Diagnosis, and Therapeutic Approaches. JACC Heart Fail. 2020;8(7):523-536. https://doi.org/10. 1016/j.jchf.2020.01.014
Koshy AO, Gallivan ER, McGinlay M, Straw S, Drozd M, Toms AG, et al. Prioritizing symptom management in the treatment of chronic heart failure. ESC Heart Fail. 2020;7(5):2193-2207. https://doi.org/10.1002/ehf 2.12875
Lee JH, Hwang KK. End-of-Life Care for End-stage Heart Failure Patients. Korean Circ J. 2022;52(9):659-679. https://doi.org/10.4070/kcj.2022.0211
Mosoiu D, Rogozea L, Landon A, Bisoc A, Tint D. Palliative Care in Heart Failure: A Public Health Emergency. Am J Ther. 2020;27(2):e204-e223. https:// doi.org/10.1097/mjt.0000000000001067
Schichtel M, Wee B, Perera R, Onakpoya I. The Effect of Advance Care Planning on Heart Failure: a Systematic Review and Meta-analysis. J Gen Intern Med. 2020;35(3):874-884. https://doi.org/10.1007/s11 606-019-05482-w
Kitakata H, Kohno T, Kohsaka S, Fujisawa D, Nakano N, Shiraishi Y, et al. Preferences on advance care planning and end-of-life care in patients hospitalized for heart failure. ESC Heart Fail. 2021;8(6):5102-5111. https://doi.org/10.1002/ehf2.13578
Kitakata H, Kohno T, Kohsaka S, Fujisawa D, Nakano N, Sekine O, et al. Social Isolation and Implementation of Advanced Care Planning Among Hospitalized Patients With Heart Failure. J Am Heart Assoc. 2022; 11(21):e026645. https://doi.org/10.1161/jaha.122.026 645
Kim J, An M, Heo S, Shin MS. Attitudes toward advance directives and prognosis in patients with heart failure: a pilot study. Korean J Intern Med. 2020;35 (1):109-118. https://doi.org/10.3904/kjim.2018.158
Marcondes-Braga FG, Moura LAZ, Issa VS, Vieira JL, Rohde LE, Simões MV, et al. Emerging Topics Update of the Brazilian Heart Failure Guideline – 2021. Arq Bras Cardiol. 2021;116:1174-1212. https://doi.org/10. 36660/abc.20210367
Graven LJ, Kitko L, Abshire Saylor M, Allen L, Durante A, Evangelista LS, et al. Palliative Care and Advanced Cardiovascular Disease in Adults: Not Just End-of-Life Care: A Scientific Statement From the American Heart Association. Circulation. 2025;151 (21):e1030-e1042. https://doi.org/10.1161/cir.000000 0000001323
Cavanagh CE, Rosman L, Chui P, Minges K, Desai NR, Goodlin S, et al. Advance Care Planning and End-of-Life Education in Heart Failure: Insights From the NCDR PINNACLE Registry. Circ Cardiovasc Qual Outcomes. 2023;16(1):e008989. https://doi.org/10.116 1/circoutcomes.122.008989
Butler J, Binney Z, Kalogeropoulos A, Owen M, Clevenger C, Gunter D, et al. Advance directives among hospitalized patients with heart failure. JACC Heart Fail. 2015;3(2):112-121. https://doi.org/10.1016 /j.jchf.2014.07.016
Kim J, Heo S, Kim BR, Suh SY, Shim JL, An M, et al. The Impact of Advance Directive Perspectives on the Completion of Life-Sustaining Treatment Decisions in Patients with Heart Failure: A Prospective Study. J Clin Med. 2021;10(24):5962. https://doi.org/10.3390/j cm10245962
Prentice TC, Lawson R. The impact of an advance care planning intervention for patients hospitalized with acute decompensated heart failure. Heart Lung. 2021; 50(1):101-105. https://doi.org/10.1016/j.hrtlng.2020.0 8.003
Mathew T, Patel A, DiGrande K, Michelis ND, Mody B, Lombardo D. Improving Advance Care Planning for Hospitalized Patients With Heart Failure. Palliat Med Rep. 2023;4(1):339-343. https://doi.org/10.1089/ pmr.2023.0035
Sampaio C, Renaud I, Leão PP. “The roller coaster ride of heart failure”: nursing staff’s perceptions of dignity. Acta Paul. Enferm. (Online). 2020;33:1-8. https://doi. org/10.37689/acta-ape/2020AO0165
Scherrens AL, Beernaert K, Robijn L, Deliens L, Pauwels NS, Cohen J, et al. The use of behavioural theories in end-of-life care research: A systematic review. Palliat Med. 2018;32(6):1055-1077. https:// doi.org/10.1177/0269216318758212
Ajzen I. The theory of planned behaviour: reactions and reflections. Psychol Health. 2011;26(9):1113-1127. https://doi.org/10.1080/08870446.2011.613995
McEachan RRC, Conner M, Taylor NJ, Lawton RJ. Prospective prediction of health-related behaviours with the Theory of Planned Behaviour: a meta-analysis. Health Psychol Rev. 2011;5(2):97-144. https://doi.org/10.1080/17437199.2010.521684
Ajzen I. Theory of planned behavior diagram [Internet]. Amherst (MA): University of Massachusetts; 2019 [cited 2025 Aug 12]. Available from: https://people .umass.edu/aizen/tpb.diag.html
Ajzen I. The theory of planned behavior: Frequently asked questions. Hum Behav Emerg Technol. 2020;2 (4):314-324. https://psycnet.apa.org/doi/10.1002/hbe2 .195
Comitê Coordenador da Diretriz de Insuficiência Cardíaca, Rohde LEP, Montera MW, Bocchi EA, Clausell NO, Albuquerque DC de, et al. Diretriz Brasileira de Insuficiência Cardíaca Crônica e Aguda. Arq Bras Cardiol. 2018;111(3):436-539. https://doi. org/10.5935/abc.20180190
Dadalto L, Tupinambás U, Greco DB. Diretivas antecipadas de vontade: um modelo brasileiro. Rev. Bioét. (online) [Internet]. 2013 [cited 2025 Aug 12];21(3):463-476. Available from: https://www.scie lo.br/j/bioet/a/SzZm7jf3WDTczJXfVFpF7GL/?lang=pt
Khani Jeihooni A, Jormand H, Saadat N, Hatami M, Abdul Manaf R, Afzali Harsini P. The application of the theory of planned behavior to nutritional behaviors related to cardiovascular disease among the women. BMC Cardiovasc Disord. 2021;21(1):589. https://doi. org/10.1186/s12872-021-02399-3
Lynn MR. Determination and quantification of content validity. Nurs Res. 1986;35(6):382-385. https://doi. org/10.1097/00006199-198611000-00017
Alexandre NMC, Coluci MZO. Validade de conteúdo nos processos de construção e adaptação de instrumentos de medidas. Cien Saude Colet. 2011;16(7):3061-3068. https://doi.org/10.1590/S1413-81232011000800006
Altman DG. Practical statistics for medical research. New York: Chapman and Hall/CRC; 1990. https://doi. org/10.1201/9780429258589
Bhardwaj T, Chambers RL, Watson H, Srividya, Higginson IJ, Hocaoglu MB. Translation and cross-cultural adaptation of the Integrated Palliative Care Outcome Scale in Hindi: Toward capturing palliative needs and concerns in Hindi speaking patients. Palliat Med. 2023;37(3):391-401. https://doi.org/10.1177/026 92163221147076
Křemenová Z, Vlčková K. Translation, cultural adaptation, and validation of the Integrated Palliative Outcome Scale-renal (IPOS-r) to Czech. BMC Palliat Care. 2022;21(1):152. https://doi.org/10.1186/s12904-022-01044-w
Sharkiya SH. Quality communication can improve patient-centred health outcomes among older patients: a rapid review. BMC Health Serv Res. 2023;23(1):886. https://doi.org/10.1186/s12913-023-09869-8
Yang Z, Jia H, Wang A. Predictors of home-based cardiac rehabilitation exercise adherence among patients with chronic heart failure: a theory-driven cross-sectional study. BMC Nurs. 2023;22(1):415. https://doi.org/10.1186/s12912-023-01566-5
Izadpanah P, Saadat N, Kabiri B, Mohammadkhah F, Afzali Harsini P, Khani Jeihooni A. The Effect of Base Theory Educational Intervention on Health-Promoting Lifestyle in Women Susceptible to Cardiovascular Diseases: Application of the Theory of Planned Behavior. Cardiol Res Pract. 2023;2023:8528123. https://doi.org/10.1155/2023/8528123
Whitehead P, Frechman E, Johnstone-Petty M, Kates J, Tay DL, DeSanto K, et al. A scoping review of nurse-led advance care planning. Nurs Outlook. 2022; 70(1):96-118. https://doi.org/10.1016/j.outlook.2021.0 8.002
El Hussein MT, Favel D. Advanced Care Planning Conversations: A Scoping Review of Nurse Practitioners’ Approach. J Nurse Pract. 2025;21(7):105421. https://doi .org/10.1016/j.nurpra.2025.105421
Xu C, Yan S, Chee J, Lee EPY, Lim HW, Lim SWC, et al. Increasing the completion rate of the advance directives in primary care setting - a randomized controlled trial. BMC Fam Pract. 2021;22(1):115. https://doi.org/10.1186/s12875-021-01473-1
Svendsen SJ, Grov EK, Staats K. Patients’ experiences with shared decision-making in home-based palliative care - navigation through major life decisions. BMC Palliat Care. 2024;23(1):101. https://doi.org/10.1186/ s12904-024-01434-2
Macedo JC, Rego F, Nunes R. Perceptions, Attitudes, and Knowledge toward Advance Directives: A Scoping Review. Healthcare (Basel). 2023;11(20):275 5. https://doi.org/10.3390/healthcare11202755
Kim J, Choi J, Shin MS, Kim M, Seo E, An M, et al. Do advance directive attitudes and perceived susceptibility and end-of-life life-sustaining treatment preferences between patients with heart failure and cancer differ? PLoS One. 2020;15(9):e0238567. https: //doi.org/10.1371/journal.pone.0238567
Este trabalho está licenciado sob uma licença Creative Commons Attribution 4.0 International License.
Copyright (c) 2025 Online Brazilian Journal of Nursing