Profile of the palliative care physician in Brazil

2020

Background: An integrated care network between emergency, specialized and primary care services can prevent repeated hospitalizations and the institutionalized death of terminally ill patients in palliative care (PC). To identify the perception of professionals in a pre-hospital care (PHC) service about the outcomes of the assistance provided to patients eligible for PC. Methods: Study with a qualitative approach, of interpretative nature, based on the perspective of Ricouer's Dialectical Hermeneutics. Results: Three central themes emerged out of the professionals' speeches: (1) unpreparedness of the team, (2) decision making, and (3) dysthanasia. Conclusions: It is necessary to invest in professional training associated with PC in the home context and its peculiarities, adopt a specific policy for PC that involves all levels of care, including PHC, and adopt a unified information system, as well as more effective procedures that favor the respect for the patients' will,...

Cadernos de Saúde Pública

In 2022, an important international report was published on the “value of death” not only in the field of health, but in relation to human societies in general. This report proposed to reimagine systems related to end of life in which death is understood not only as a physiological event but also as a relational and spiritual phenomenon with a value of its own and inseparable from life. It identifies the low priority given by most governments worldwide to the issue of alleviating suffering and supporting bereavement, evidenced by the low investment in palliative care. At the same time, we are witnessing in Brazil changes that threaten the feasibility of palliative care policies in primary health care. The denial of finitude within health systems is reflected in global indicators such as the quality of death index of The Economist magazine, in which Brazil ranks 42nd, the global atlas of palliative care of the World Hospice and Palliative Care Alliance, where Brazil is in level 3b, a...

Brazilian Journal of Physical Therapy, 2017

Background: In Brazil there are several challenges to reach a humanized health care. Among them is the well-known lack in academic education and training in palliative care field. This lack is mostly due to the modern medical care culture that prioritize curative medicine ahead of palliative care. As the goal of saving lives is rooted in medical training, death is still confronted as the main enemy of the health professionals. Objective: To analyze the knowledge of palliative care among the physical therapists of a University Hospital. Method: This is a cross-sectional and descriptive study. The volunteers were physical therapists, who had worked in the hospital for more than six months, were included undergraduate students, experienced professionals and graduate students. A questionnaire with closed questions about palliative care was applied during the volunteers working hours. Data were analyzed descriptively. Conclusion: We conclude that, the vast majority of the evaluated professionals presented basic palliative care knowledge, but not in palliative care core components. The palliative care practice seemed often guided by the knowledge acquired in other fields, always with an intuitive character. Therefore, we detected a lack in the physical therapist training regarding palliative care. Summarily, physical therapists should receive a general training in palliative care still as an undergraduate, for a more effective and consistent professional practice later on.

Journal of Nursing Ufpe Online, 2015

Objective: describing the profile of nursing professionals working in a Palliative Care Unit of a Private Hospital. Method: an exploratory, descriptive and cross-sectional study with nursing professionals of the Adult Intensive Care Unit (ICU-A) of Eastern Zone of São Paulo/SP. A questionnaire was applied; then, the data were analyzed by statistics and presented in tables. The research project was approved by the Research Ethics Committee, CAAE: 31803214.0.0000.5597. Results: participants were 19 individuals with an average age of 38,11 years old. Of these, 84% were female, acting in nursing for 118,74 months, median performance in CP of 16 months. 63% had no specialized or advanced courses. Conclusion: it can be concluded that palliative care is a philosophy, which more than alleviate symptoms, should stop the physical and mental decline, helping the client through psychological, family, spiritual and social support. Descriptors: Nursing; Palliative Care; Professional Associations....

Brazilian Journal of Anesthesiology (English Edition), 2014

Background and objectives: in Brazil, palliative care (PC) is not properly structured and that reality transforms this theme in a public health problem; therefore, initiatives become relevant in this context. This paper aims to share the experience that occurred in an oncology referral hospital in the State of Maranhão and present initiatives that helped in the development of PC Service. Experience report: the hospital had an outpatient Pain and PC Service, but without specialized beds. The terminally ill patients stayed in common wards, which caused much unrest. A sensitization process was initiated in the hospital through initiatives, such as a photo contest called Flashes of Life and a ward called Room of Dreams, designed in partnership with the architecture course at the Universidade Estadual do Maranhão. The process culminated in the granting of wards to the PC and in the commitment of the Foundation, sponsor of the hospital, to run the project. Conclusion: this experience was a reproducible local initiative for the establishment of PC in a cancer hospital. Local initiatives are valuable in Brazil because they favor a significant number of patients and show its effectiveness in practice to governments and society. To structure a PC service, it is essential to establish priorities that include the assignment of drugs for management of symptoms, humanization, multidisciplinarity, sensitization and education of professionals.

Journal of Palliative Care & Medicine, 2017

Background: The Brazilian Health System (SUS) faces major challenges to ensure the constitutional right of universal access to health care assistance and technological advances to the entire population. Concerns with the ageing population, the increasing incidence of cancer and the emergence of chronic non-communicable diseases include palliative care as one of the objectives of the Brazilian Health System (SUS). However, considering that each disease and individual present different social and cultural factors, needs, pattern of disease progression, associated co-morbidities and access to health care, the estimation of necessary resources and the definition of specific criteria to structure and adapt palliative care in the health services have been a difficult task in Brazil. Thus, it is necessary to estimate the needs and the resources and to specify parameters to structure and tailor an adequate modality of assistance in palliative care. Aims: 1) To estimate the number of cancer patients with palliative care needs in the population; 2) To simulate palliative care methods for population based estimation. Methods: The present methodology has a quantitative approach, with descriptive, exploratory, retrospective and observational studies of hospitalized cancer patients. This is a cross-sectional study using death certificate and hospital admission data, which was collected from the Mortality Information System (SIM) and Hospital Information System (SIH) of the Brazilian Health System (SUS), obtained from the database of the Health Information Department (DATASUS). Results: Yearly around 1.1 million deaths were reported to the Brazilian Mortality Information System, being 15.9% of these related to people living with cancer. Between 2008 and 2014, there were almost 4.5 million hospitalizations (4,431,685) of patients with cancer in Brazil, and, of all the hospital admissions of cancer patients, 1.189.908 (26.85%) were related to intercurrences of the disease and/or of treatment. The average rate of hospital mortality was 7.7 for cancer in general and 21.4 for clinical intercurrence of cancer patients, while the average length of stay (LOS) was 5.7 days for cancer in general and 7.9 days for clinical intercurrence of cancer patients. Conclusion: considering that the offer and the technical guidance regarding palliative care for users served by health establishments authorized by Brazilian Health System for the specialized assistance in oncology are mandatory, we need to estimate the needs, resources and specify parameters to structure and tailor an adequate modality of assistance in palliative care.

Background: Renal Supportive/Palliative Care is gaining gradual recognition as a patient-centered care approach that should be integrated to the traditional disease-centered model of care, mainly in elder patients with advanced chronic kidney disease (CKD). The objective of this study was to assess knowledge, perceptions, attitude, experience and interest in palliative care among renal care providers. Methods: Online survey, administered between May 23 to June 13, 2017 to members of the Brazilian Society of Nephrology (BSN). Participants self-reported knowledge and behaviors regarding renal palliative care. Results: A total of 3,738 e-mails were sent, 224 (6%) providers completed the survey. Most respondents were under 50 years old (68.5%) and were nephrologists (98.2%). A request from a competent patient to discontinue dialysis would not be honored by 46% and 63% would probably continue dialysis if a patient become severely demented. On the other hand, respondents with ≥15 years of experience were more prone to stop dialysis (P=0.01) in patients who became permanently and severely demented. Respondents working only in private practice were more willing to continue dialysis in a severely demented patient than those working in a public healthcare system or both (P=0.02). Additionally, 87% of respondents would probably withhold dialysis in a permanently unconscious patient and 92% probably would not resuscitate a patient with a Do Not Resuscitate (DNR) order. Among factors that would have importance on a decision to not initiate dialysis, patient preferences (98.2%), advanced dementia (95%), poor clinical conditions (93.7%) and family wishes (92.3%) were top ranked by respondents. Most respondents routinely evaluate HRQoL (62%), pain and other symptoms ( 79%) and were very interested (96%) in improving knowledge about renal supportive care. Conclusions: Brazilian nephrologists are often unaware of patient autonomy, more prone to withholding than withdrawing dialysis and deem wishes of the family quasi as important as patient preferences in the shared decision making process. Most Participants answered to evaluate pain and quality of life related to health (HRQoL) routinely and have great interest to learn about renal palliative care.

methaodos.revista de ciencias sociales, 2017

espanolDefinir el numero de pacientes que necesitan cuidados paliativos, los recursos necesarios y los criterios especificos para estructurar y adaptar los servicios de cuidados paliativos en Brasil ha sido una tarea dificil. Hasta el momento, la cuantificacion de las necesidades de cuidados paliativos en nuestro pais ha sido estimada de un modo aislado y se ha basado en experiencias internacionales. Sin embargo, hay dudas sobre la aplicabilidad de esos parametros considerando la poblacion y las dimensiones territoriales, tan bien como las diversidades regionales. El analisis de los perfiles de morbilidad y mortalidad de la poblacion es necesario para el establecimiento de los posibles parametros para ser empleados en la asistencia a cuidados paliativos, como las admisiones hospitalarias para el tratamiento de las patologias clinicas asociadas a los pacientes de cancer. Objetivos: Desarrollar una estimacion de la situacion, la cobertura y las necesidades actuales de servicios de cui...

Contemporary and Innovative Practice in Palliative Care, 2012

Palliative Medicine is an ancient practice. Some centuries ago the only thing that doctors could do was palliative care (Melo,2003). Palliative comes from palliare, a Latin term that means to cover, to decrease difficulties, exactly what medicine was. An example that shows us how the intention to care and relive people of suffering can be transformed in science is this description from Ambroise Paré, a barber-surgeon from France in 18 th century. It was accepted practice at that time to pour boiling elder oil on an amputated limb to cauterize it and keep away "bad humors". As a military barber-surgeon operating in the Apennine Alps, Paré saw hundreds of patients a day. One night, in the thick of battle, he ran out of elder oil and had to devise a salve of egg, oil of rose, and turpentine. The salve he applied was soothing and causes his patients no pain. The next morning, half the patients treated with elder oil were dead and the other half in agony while all his patients treated with the salve were resting peacefully and healing well. When he saw his new treatment worked more effectively and caused less pain to his patients, Paré would not change his methods (Helliwell,1999).