A estruturação de um serviço de cuidados paliativos no Brasil: relato de experiência

Palliative care practices and policies in diverse socio-cultural contexts: aims and framework of the ERC globalizing palliative care comparative ethnographic study

Background

Palliative care as a specialist professional practice of care for people with advanced illness is becoming increasingly influential worldwide. This process is affected by global health inequalities as well as cultural dimensions of approaching death and practicing care in life-limiting illness.

Objectives

The European Research Council-funded Globalizing Palliative Care (ENDofLIFE) project aims to understand how palliative care policies, discourses and practices are translated, adapted and reconstituted in diverse socio-cultural settings and how cultural dimensions of approaching death and local practices of care shape palliative care implementation.

Methods and Analysis

Using a multi-scalar and multi-sited ethnographic approach, the project uses person-centered ethnography, participant observation, semi-structured interviewing, focus group discussions and policy and discourse analysis at transnational, national and local levels. Ethnographic case-studies are conducted in Brazil, India and Indonesia.

Discussion

The globalizing palliative care project develops a novel ethnographic methodology of studying end-of-life care trajectories through long-term participant observation with individual patients and families as they manage and practice formal and informal health care in advanced illness. By analyzing how patients and families experience and navigate care over time, complemented by stakeholder interviews, the study advances critical theoretical insight into the relation between (large-scale and dynamically traveling) palliative care models, policies and discourses on the one hand and the experience and practice of palliative care in the lives of patients and informal care givers in local health care practices on the other hand. Insights are expected to benefit culturally situated palliative care policies and practices.

Cost Analysis of Cancer in Brazil: A Population-Based Study of Patients Treated by Public Health System From 2001-2015

OBJECTIVES

The aim of this study was to evaluate the federal government expenditures with oncological care, for the most incident cancer types among the Brazilian population, using registries of all patients treated by the Brazilian National Health Service (SUS) between 2001 and 2015. We adopted the formal healthcare sector perspective in this study, with the costs per patient estimated by the reimbursement price paid by the Ministry of Health to service providers.

METHODS

The costs were adjusted by the follow-up time for each patient. We performed multivariate regression analysis using ordinary least squares. We analyzed 952 960 patients aged ≥19 years who underwent cancer treatment, between 2001 and 2015, for breast, prostate, colorectal, cervix, lung, and stomach cancers.

RESULTS

The annual mean costs per patient (in USD purchasing power parity) was $9572.30, varying from $5782.10 for breast cancer to $16 656 for cervical cancer. Several variables predicted higher costs of cancer treatment, namely: to be male (+14%), with younger age ranges at treatment initiation, resident in the Northeast region (+26%), treated for colorectal cancer (+482%), with treatment initiation from 2010 to 2014, tumor stages III and IV (III: +182%; IV: +165%), hospitalization for other reasons besides the cancer treatment, and suffering from some a comorbidity.

CONCLUSIONS

Given the forthcoming Brazilian demographic changes, which strongly suggest that the economic burden of cancer is about to increase in the near future, our estimates provide relevant information to produce useful projections about future cancer-related costs.

Conceptual and operational definitions for the indicators of the nursing outcome classification: Symptom control in patients with heart failure in palliative care

OBJECTIVE

To validate conceptual and operational definitions of Symptom control (1608) indicators for patients with cardiac diseases in palliative care.

METHOD

Definitions were established through a literature review and were validated by consensus among expert nurses. Two rounds of the Delphi method and a meeting with experts were carried out in order to validate the definitions for the indicators and for the magnitude of response for each indicator.

RESULTS

Conceptual and operational definitions for Symptom control (1608) indicators and for the magnitude of response for each indicator were validated.

CONCLUSIONS

All conceptual and operational definitions of 11 indicators of the nursing outcome Symptom control (1608) were validated by experts. Content and clinical validation studies remain necessary to verify the capacity of the indicators to measure the effectiveness of nursing interventions in clinical practice and research.

Educational process in palliative care and the thought reform

OBJECTIVES

To know the contributions of the educational process in Palliative Care during the undergraduate level for the professional action of nurses in the care of patients at the end of life.

METHODS

This is a qualitative research, with discursive thematic analysis, based on Morin's theory of complexity. It was attended by seven newly-trained nurses and six nursing teachers from a Nursing Undergraduate Course.

RESULTS

It has found disruptions and the development of new ways of thinking and caring for patients at the end of life, highlighting that these patients should be treated with therapies to mitigate their signs and symptoms until death, focusing on quality of life; moreover, their psychosocial and spiritual aspects should be appreciated.

CONCLUSIONS

The educational process in palliative care seems to be essential for nurses, as a way of organizing and systematizing patient care. It becomes indispensable that nursing programs also provide the students with the development of the awareness of the complexity of the human being and its relationship with the multiple biopsychosocial and spiritual aspects.

[Survey of adolescent perception of hospital admission. The importance of hospital humanisation]

INTRODUCTION

The humanisation of health care involves considering the patient as an integral human being, providing assistance beyond medical care, and covering other fields such as social, emotional, spiritual, or relational areas.

OBJECTIVE

To evaluate the requirements and concerns of the hospitalised children.

SUBJECTS AND METHOD

A cross-sectional, descriptive study was conducted using an anonymous questionnaire on children aged 12-16.

RESULTS

The study included 39 patients, with a median age of 14 years. The most unpleasant experience during the hospitalisation was the invasive procedures. Almost all (95%) of patients suffered from pain, and 17% of them felt at some point that a procedure was performed without them being fully aware. More than 75% of children asked for more entertainment, with the lack of Wi-Fi being the more demanded item.

CONCLUSIONS

The needs of the population included in this survey, showed the importance to consider cognitive (necessity of obtaining clear and extensive information), social (maintaining everyday relationships), emotional (illness and its diagnostic and therapeutic procedures often generate mood disorders), and practical (environmental and architectural aspects can lead to either an improvement or a worsening of the hospitalisation perception) factors. All of these factors have shown a beneficial contribution, leading to an earlier recovery of health.