Os processos de tomada de decisão clínica em cuidados paliativos na perspectiva médica

• Autor(a) principal: Trentin, Leonardo Soares
• Data de Publicação: 2024
• Tipo de documento: Dissertação
• Idioma: por
• Título da fonte: Manancial - Repositório Digital da UFSM
• dARK ID: ark:/26339/0013000002ghq
• Texto Completo: http://repositorio.ufsm.br/handle/1/31556
• topic: Tomada de decisão clínica; Cuidados paliativos; Bioética; Clinical decision-making; Palliative care; Bioethics; CNPQ::CIENCIAS HUMANAS::PSICOLOGIA

In the context of palliative care, clinical decision-making becomes more complex, given the bioethical conflicts and contradictions that arise in healthcare practice. Therefore, this research aims to understand processes of clinical decision-making in palliative care from the perspective of permanent physicians and residents of the Hematology and Oncology Unit (UHO) and the Pulmonology Specialty Clinic of the Clinical Medicine Unit II of a teaching hospital. To this end, an exploratory and descriptive qualitative study was conducted, based on the clinical-qualitative method. This study used semi-structured interviews, which were carried out with physicians from the UHO and Pulmonology Specialty Clinic of the teaching hospital, as a data collection technique. The use of NVivo software version 11 facilitated the organization and analysis of the data in accordance with the Clinical-Qualitative Content Analysis method. This study followed the recommendations of Brazil’s National Health Council and National Council of Psychology. Reflecting on the findings of the research, it becomes evident that the practice of palliative care across the studied institutions is in its initial stages, limited to patients with curative therapeutic limitations. In this context, the elements considered for directing to palliative care were the metastatic stage of the neoplasm, patient’s suffering and guarded prognosis, as well as proximity to the end-of-life stage. With the dissolution of the palliative care team, the physicians of the UHO and Pulmonology Specialty Clinic end up redirecting patients to other specialty clinics within the hospital to look into additional curative therapeutic options, which can be seen as a persistent approach. On the other hand, elderly patients are directed to Geriatric Services or to the Home Care Services (SAD), resulting in a lack of palliative attention for other age groups. Patients may also be directed to other reference hospitals in the city or to long-term care institutions in their hometowns, where they can be closer to their families. Regarding the individuals involved, while physicians assert their technical knowledge about curative treatments, granting them significant influence over decisions, contributions of the multidisciplinary team and the patient’s family were evident. It is important to highlight that some physicians involved in the study do not conceive palliative care as a valid therapy or, if they do, they place it in a secondary position, influenced by patient demand and the hospital’s focus on curative approach. Given these circumstances, it is emphasized that the challenge of implementing palliative care in healthcare institutions begins in the structuring of their systems and concepts, which are based on an organic biomedical perspective. Thus, it becomes essential to provide more humanized training for health professionals, especially physicians, so that clinical decision-making is not limited only to the organic disease and its cure but considers the full spectrum of the patients’ needs and their inherent complexity.