Percepção de nefrologistas brasileiros sobre cuidados paliativos em pacientes renais crônicos
Autor(a) principal: | |
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Data de Publicação: | 2024 |
Tipo de documento: | Dissertação |
Idioma: | por |
Título da fonte: | Biblioteca Digital de Teses e Dissertações da PUC_SP |
Texto Completo: | https://repositorio.pucsp.br/jspui/handle/handle/41168 |
Resumo: | Palliative care has been increasingly used to improve the well-being and quality of life of people who have a serius, life-threatening illness. A multidimensional palliative approach can and should be integrated in different contexts to reach patients with life- limiting chronic diseases, such as patients with advanced chronic kidney disease (CKD), especially those on dialysis. A relevant consideration in the CKD context is that the accelerated pace of population aging constitutes an important public health problem, as the care of elderly people with multiple comorbidities becomes more complex and difficult, as damage to various organs appears. Thus, many factors contribute to uncertainty about the balance between the benefits and harms of dialysis in this population. The main objective of this study was to analyze the perceptions of Brazilian nephrologists about palliative care in patients with chronic kidney disease and about the inclusion or withdrawal of patients on dialysis for conservative treatment through a quantitative, cross-sectional, survey-type study. After the necessary ethical approvals, a questionnaire based on the literature and validated by a committee composed of six experts was applied online to nephrologists in the first half of 2023. The results were: 273 respondents presented sociodemographic characteristics equivalent to those found in the Medical Demographics of the Brazilian Federal Council of Medicine [CFM] for the specialty. The majority of nephrologists believe that palliative care is related to terminality and not to the care since the beginning of the disease and associate palliative care with a dignified death and with orthothanasia. In addition, there are no protocols and tools to assist health professionals in the decision to withdraw or not include hemodialysis patients, and this should be seen as an important warning for the specialty community and future studies to create them. There are clear gaps in undergraduate and medical residency so that palliative care (whether or not the patient is on dialysis) can be implemented with solid knowledge, skills and attitudes that allow for good communication; quality of life, more than its quantity; symptom control; respecting the autonomy of the person with CKD, in a perspective centered on their well-being and on decisions shared with their family/caregivers/multidisciplinary team. However, there is an understanding of its importance and motivation to learn. The lack of legislation, structures and teams dedicated to palliative care in SUS [Brazilian Unified Health System] and heath insure is perceived by most nephrologists. Specific research in palliative care in CKD is necessary in Brazil, particularly in the world, that subsidize planning and strategies to overcome problems that will be growing and frightening. This research provided support for an in-depth analysis of nephrology supportive care for people with CKD. Public policies should be designed to improve the panorama of the growing need for physicians and health teams trained to identify, plan and follow up patients with CKD who opt for comprehensive palliative care or conservative support |
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Rodrigues, Cibele Isaac Saadhttp://lattes.cnpq.br/7498326697611689http://lattes.cnpq.br/8928096484826093Bueno, Maria Eduarda2024-03-22T16:05:08Z2024-03-22T16:05:08Z2024-02-26Bueno, Maria Eduarda. Percepção de nefrologistas brasileiros sobre cuidados paliativos em pacientes renais crônicos. 2024. Dissertação (Mestrado em Educação nas Profissões da Saúde) - Programa de Pós-Graduação em Educação nas Profissões da Saúde da Pontifícia Universidade Católica de São Paulo, Sorocaba, 2024.https://repositorio.pucsp.br/jspui/handle/handle/41168Palliative care has been increasingly used to improve the well-being and quality of life of people who have a serius, life-threatening illness. A multidimensional palliative approach can and should be integrated in different contexts to reach patients with life- limiting chronic diseases, such as patients with advanced chronic kidney disease (CKD), especially those on dialysis. A relevant consideration in the CKD context is that the accelerated pace of population aging constitutes an important public health problem, as the care of elderly people with multiple comorbidities becomes more complex and difficult, as damage to various organs appears. Thus, many factors contribute to uncertainty about the balance between the benefits and harms of dialysis in this population. The main objective of this study was to analyze the perceptions of Brazilian nephrologists about palliative care in patients with chronic kidney disease and about the inclusion or withdrawal of patients on dialysis for conservative treatment through a quantitative, cross-sectional, survey-type study. After the necessary ethical approvals, a questionnaire based on the literature and validated by a committee composed of six experts was applied online to nephrologists in the first half of 2023. The results were: 273 respondents presented sociodemographic characteristics equivalent to those found in the Medical Demographics of the Brazilian Federal Council of Medicine [CFM] for the specialty. The majority of nephrologists believe that palliative care is related to terminality and not to the care since the beginning of the disease and associate palliative care with a dignified death and with orthothanasia. In addition, there are no protocols and tools to assist health professionals in the decision to withdraw or not include hemodialysis patients, and this should be seen as an important warning for the specialty community and future studies to create them. There are clear gaps in undergraduate and medical residency so that palliative care (whether or not the patient is on dialysis) can be implemented with solid knowledge, skills and attitudes that allow for good communication; quality of life, more than its quantity; symptom control; respecting the autonomy of the person with CKD, in a perspective centered on their well-being and on decisions shared with their family/caregivers/multidisciplinary team. However, there is an understanding of its importance and motivation to learn. The lack of legislation, structures and teams dedicated to palliative care in SUS [Brazilian Unified Health System] and heath insure is perceived by most nephrologists. Specific research in palliative care in CKD is necessary in Brazil, particularly in the world, that subsidize planning and strategies to overcome problems that will be growing and frightening. This research provided support for an in-depth analysis of nephrology supportive care for people with CKD. Public policies should be designed to improve the panorama of the growing need for physicians and health teams trained to identify, plan and follow up patients with CKD who opt for comprehensive palliative care or conservative supportCuidados paliativos têm sido cada vez mais empregados com a finalidade de melhorar o bem-estar e a qualidade de vida das pessoas que apresentam uma doença grave, que lhes confere risco de morte. Uma abordagem multidimensional paliativa pode e deve ser integrada em diferentes contextos para alcançar pacientes com doenças crônicas limitantes de vida, como é o caso de pacientes com doença renal crônica (DRC) avançada, especialmente aqueles em diálise. Uma consideração relevante no contexto da DRC é que o ritmo acelerado do envelhecimento populacional se constitui em importante problema de saúde pública, pois o cuidado de idosos com múltiplas comorbidades torna-se mais complexo e dificultoso à medida que aparecem danos em vários órgãos. Assim, muitos fatores contribuem para a incerteza sobre a balança entre os benefícios e malefícios da diálise nessa população. O objetivo principal desse estudo foi analisar as percepções dos médicos nefrologistas brasileiros sobre cuidados paliativos em doentes renais crônicos e sobre a inclusão ou retirada de pacientes em diálise para tratamento conservador por meio de estudo quantitativo, transversal e de delineamento do tipo survey. Após aprovações éticas necessárias, um questionário baseado na literatura e validado por comitê composto por seis especialistas, foi aplicado aos nefrologistas, online, no primeiro semestre de 2023. Os resultados encontrados foram: 273 respondedores apresentaram características sociodemográficas equivalentes àquelas encontradas na Demografia Médica do Conselho Federal de Medicina (CFM) para a especialidade. A maioria dos nefrologistas acredita que cuidados paliativos estão relacionados a terminalidade e não ao cuidado desde o início da doença e associam cuidados paliativos a morte digna e a ortotanásia. Além disso, não há protocolos e ferramentas para auxílio dos profissionais da saúde na decisão de retirada ou não inclusão dos pacientes em hemodiálise, devendo isso ser visto como um alerta importante para a comunidade da especialidade e futuros trabalhos para criação destes. Há claras lacunas na graduação e na residência médica para que cuidados paliativos (mantendo ou não o paciente em diálise) possam ser implementados com conhecimentos sólidos, habilidades e atitudes que permitam uma boa comunicação; qualidade de vida, mais que sua quantidade; controle de sintomas; respeitando a autonomia da pessoa com DRC, em uma perspectiva centrada no seu bem-estar e em decisões compartilhadas com sua família/cuidadores/equipe multiprofissional. No entanto, há compreensão sobre sua importância e motivação para aprender. A falta de legislação, de estruturas e equipes direcionadas aos cuidados paliativos no SUS e nos convênios é percebida pela maioria dos nefrologistas. Pesquisas específicas em cuidados paliativos na DRC são necessárias no Brasil, particularmente, e no mundo, que subsidiem planejamento e estratégias de superação dos problemas que serão crescentes e assustadores. Essa pesquisa trouxe subsídios para uma análise aprofundada dos cuidados de suporte em nefrologia para pessoas com DRC. Políticas públicas devem ser delineadas para melhorar o panorama da crescente necessidade de médicos e equipes de saúde capacitados a identificar, planejar e acompanhar pacientes com DRC que optam por cuidados paliativos integrais ou de suporte conservadorporPontifícia Universidade Católica de São PauloPrograma de Pós-Graduação em Educação nas Profissões da SaúdePUC-SPBrasilFaculdade de Ciências Médicas e da SaúdeCNPQ::CIENCIAS DA SAUDEInsuficiência renal crônicaCuidado paliativoTratamento conservadorNefrologiaChronic kidney diseasePalliative careConservative treatmentNephrologyPercepção de nefrologistas brasileiros sobre cuidados paliativos em pacientes renais crônicosBrazilian nephrologists' perception of palliative care in patients with chronic kidney diseaseinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/masterThesisinfo:eu-repo/semantics/openAccessreponame:Biblioteca Digital de Teses e Dissertações da PUC_SPinstname:Pontifícia Universidade Católica de São Paulo (PUC-SP)instacron:PUC_SPTEXTMaria Eduarda Bueno.pdf.txtMaria Eduarda Bueno.pdf.txtExtracted texttext/plain133998https://repositorio.pucsp.br/xmlui/bitstream/handle/41168/2/Maria%20Eduarda%20Bueno.pdf.txt1a5d68524264e0bf1548beaa4fb71b91MD52THUMBNAILMaria Eduarda Bueno.pdf.jpgMaria Eduarda Bueno.pdf.jpgGenerated Thumbnailimage/jpeg1306https://repositorio.pucsp.br/xmlui/bitstream/handle/41168/3/Maria%20Eduarda%20Bueno.pdf.jpg9b789baa90aee25f8ae6e216f6fc9855MD53ORIGINALMaria Eduarda Bueno.pdfMaria Eduarda Bueno.pdfapplication/pdf3045505https://repositorio.pucsp.br/xmlui/bitstream/handle/41168/4/Maria%20Eduarda%20Bueno.pdfd91e7db068be979913925585bbf09bd0MD54handle/411682024-04-05 12:37:25.18oai:repositorio.pucsp.br:handle/41168Biblioteca Digital de Teses e Dissertaçõeshttps://sapientia.pucsp.br/https://sapientia.pucsp.br/oai/requestbngkatende@pucsp.br||rapassi@pucsp.bropendoar:2024-04-05T15:37:25Biblioteca Digital de Teses e Dissertações da PUC_SP - Pontifícia Universidade Católica de São Paulo (PUC-SP)false |
dc.title.pt_BR.fl_str_mv |
Percepção de nefrologistas brasileiros sobre cuidados paliativos em pacientes renais crônicos |
dc.title.alternative.en_US.fl_str_mv |
Brazilian nephrologists' perception of palliative care in patients with chronic kidney disease |
title |
Percepção de nefrologistas brasileiros sobre cuidados paliativos em pacientes renais crônicos |
spellingShingle |
Percepção de nefrologistas brasileiros sobre cuidados paliativos em pacientes renais crônicos Bueno, Maria Eduarda CNPQ::CIENCIAS DA SAUDE Insuficiência renal crônica Cuidado paliativo Tratamento conservador Nefrologia Chronic kidney disease Palliative care Conservative treatment Nephrology |
title_short |
Percepção de nefrologistas brasileiros sobre cuidados paliativos em pacientes renais crônicos |
title_full |
Percepção de nefrologistas brasileiros sobre cuidados paliativos em pacientes renais crônicos |
title_fullStr |
Percepção de nefrologistas brasileiros sobre cuidados paliativos em pacientes renais crônicos |
title_full_unstemmed |
Percepção de nefrologistas brasileiros sobre cuidados paliativos em pacientes renais crônicos |
title_sort |
Percepção de nefrologistas brasileiros sobre cuidados paliativos em pacientes renais crônicos |
author |
Bueno, Maria Eduarda |
author_facet |
Bueno, Maria Eduarda |
author_role |
author |
dc.contributor.advisor1.fl_str_mv |
Rodrigues, Cibele Isaac Saad |
dc.contributor.advisor1Lattes.fl_str_mv |
http://lattes.cnpq.br/7498326697611689 |
dc.contributor.authorLattes.fl_str_mv |
http://lattes.cnpq.br/8928096484826093 |
dc.contributor.author.fl_str_mv |
Bueno, Maria Eduarda |
contributor_str_mv |
Rodrigues, Cibele Isaac Saad |
dc.subject.cnpq.fl_str_mv |
CNPQ::CIENCIAS DA SAUDE |
topic |
CNPQ::CIENCIAS DA SAUDE Insuficiência renal crônica Cuidado paliativo Tratamento conservador Nefrologia Chronic kidney disease Palliative care Conservative treatment Nephrology |
dc.subject.por.fl_str_mv |
Insuficiência renal crônica Cuidado paliativo Tratamento conservador Nefrologia |
dc.subject.eng.fl_str_mv |
Chronic kidney disease Palliative care Conservative treatment Nephrology |
description |
Palliative care has been increasingly used to improve the well-being and quality of life of people who have a serius, life-threatening illness. A multidimensional palliative approach can and should be integrated in different contexts to reach patients with life- limiting chronic diseases, such as patients with advanced chronic kidney disease (CKD), especially those on dialysis. A relevant consideration in the CKD context is that the accelerated pace of population aging constitutes an important public health problem, as the care of elderly people with multiple comorbidities becomes more complex and difficult, as damage to various organs appears. Thus, many factors contribute to uncertainty about the balance between the benefits and harms of dialysis in this population. The main objective of this study was to analyze the perceptions of Brazilian nephrologists about palliative care in patients with chronic kidney disease and about the inclusion or withdrawal of patients on dialysis for conservative treatment through a quantitative, cross-sectional, survey-type study. After the necessary ethical approvals, a questionnaire based on the literature and validated by a committee composed of six experts was applied online to nephrologists in the first half of 2023. The results were: 273 respondents presented sociodemographic characteristics equivalent to those found in the Medical Demographics of the Brazilian Federal Council of Medicine [CFM] for the specialty. The majority of nephrologists believe that palliative care is related to terminality and not to the care since the beginning of the disease and associate palliative care with a dignified death and with orthothanasia. In addition, there are no protocols and tools to assist health professionals in the decision to withdraw or not include hemodialysis patients, and this should be seen as an important warning for the specialty community and future studies to create them. There are clear gaps in undergraduate and medical residency so that palliative care (whether or not the patient is on dialysis) can be implemented with solid knowledge, skills and attitudes that allow for good communication; quality of life, more than its quantity; symptom control; respecting the autonomy of the person with CKD, in a perspective centered on their well-being and on decisions shared with their family/caregivers/multidisciplinary team. However, there is an understanding of its importance and motivation to learn. The lack of legislation, structures and teams dedicated to palliative care in SUS [Brazilian Unified Health System] and heath insure is perceived by most nephrologists. Specific research in palliative care in CKD is necessary in Brazil, particularly in the world, that subsidize planning and strategies to overcome problems that will be growing and frightening. This research provided support for an in-depth analysis of nephrology supportive care for people with CKD. Public policies should be designed to improve the panorama of the growing need for physicians and health teams trained to identify, plan and follow up patients with CKD who opt for comprehensive palliative care or conservative support |
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2024 |
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2024-03-22T16:05:08Z |
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2024-03-22T16:05:08Z |
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2024-02-26 |
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Bueno, Maria Eduarda. Percepção de nefrologistas brasileiros sobre cuidados paliativos em pacientes renais crônicos. 2024. Dissertação (Mestrado em Educação nas Profissões da Saúde) - Programa de Pós-Graduação em Educação nas Profissões da Saúde da Pontifícia Universidade Católica de São Paulo, Sorocaba, 2024. |
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https://repositorio.pucsp.br/jspui/handle/handle/41168 |
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Bueno, Maria Eduarda. Percepção de nefrologistas brasileiros sobre cuidados paliativos em pacientes renais crônicos. 2024. Dissertação (Mestrado em Educação nas Profissões da Saúde) - Programa de Pós-Graduação em Educação nas Profissões da Saúde da Pontifícia Universidade Católica de São Paulo, Sorocaba, 2024. |
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