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Advisor(s)
Abstract(s)
Introdução: A integração dos cuidados paliativos e cuidados intensivos vem sendo estudada nos últimos anos. Estudos sugerem iniciativas promotoras desta integração, contudo são focadas em somente uma dimensão de cuidados. Objetivo: Conhecer as perspetivas dos profissionais de saúde sobre a integração de cuidados paliativos e cuidados intensivos, identificando conhecimentos sobre integração, modelos organizacionais, barreiras e fatores promotores envolvidos. Métodos: Estudo de abordagem mista, com uma componente qualitativa (entrevistas) e uma componente quantitativa (questionário). Uma amostragem intencional em “bola de neve” foi realizada no Brasil para recrutamento. Análise temática de conteúdo às transcrições das entrevistas e análise descritiva dos dados quantitativos(testes de Mann Whitney e Exato de Fisher; coeficiente de Spearman (p < 0,05) foram realizadas. Resultados: Vinte e sete profissionais de saúde foram incluídos no estudo, 14 profissionais de cuidados paliativos e 13 de cuidados intensivos. O conceito de integração parece fundamental entre os profissionais de cuidados paliativos, e para os profissionais de cuidados intensivos (UTI) ela é percebida como cuidados de fim de vida. Um modelo de consulta é preferível especialmente nessas situações; a educação integrada é recomendada por profissionais de cuidados paliativos. Comportamento e falta de conhecimento (profissionais de UTI); e falta de políticas institucionais e públicas (profissionais de cuidados paliativos) foram barreiras identificadas. A formação em cuidados paliativos foi o maior fator facilitador. Dados quantitativos demonstraram concordância sobre as dimensões da integração de cuidados, mas não evidentes nas UTIs. Houve diferenças nos itens “compromisso com a visão de que o doente é cliente” (p = 0,005) e “equipas interdisciplinares com papéis bem definidos e preservação da autonomia profissional” (p = 0,0004). Conclusão: As evidências de integração de cuidados paliativos e cuidados intensivos são limitadas, principalmente entre profissionais de UTI. A integração está associada aos cuidados de fim de vida, apesar do reconhecimento de sua importância para pacientes/famílias.
Introduction: The integration of palliative care and intensive care has been studied in recent years. Studies suggest initiatives that promote this integration, however they are focused on only one dimension of care. Objective: To know healthcare professionals’ perspectives on the integration of palliative care and intensive care, identifying knowledge about integration, organizational models, barriers and promoting factors involved. Methods: Mixed approach study, with a qualitative component (interviews) and a quantitative component (questionnaire). A purposive “snowball” sampling was carried out in Brazil for recruitment. Thematic content analysis of interview transcripts and descriptive analysis of quantitative data (Mann-Whitney and Fisher's Exact tests; Spearman's coefficient (p < 0.05) were performed. Results: Twenty-seven health professionals were included in the study, 14 palliative care professionals and 13 intensive care professionals. The concept of integration seems fundamental among palliative care professionals, and for intensive care professionals (ICU) it is perceived as end-of-life care. A consultation model is especially preferable in these situations; integrated education is recommended by palliative care professionals. Behavior and lack of knowledge (ICU professionals); and lack of institutional and public policies (palliative care professionals) were identified barriers. Training in palliative care was the greatest facilitating factor. Quantitative data showed agreement on the dimensions of care integration, but not evident in the ICUs. There were differences in the items “commitment to the view that the patient is a client” (p = 0.005) and “interdisciplinary teams with well-defined roles and preservation of professional autonomy” (p = 0.0004). Conclusion: Evidence of integration of palliative care and intensive care is limited, especially among ICU professionals. Integration is associated with end-of-life care, despite the recognition of its importance for patients/families.
Introduction: The integration of palliative care and intensive care has been studied in recent years. Studies suggest initiatives that promote this integration, however they are focused on only one dimension of care. Objective: To know healthcare professionals’ perspectives on the integration of palliative care and intensive care, identifying knowledge about integration, organizational models, barriers and promoting factors involved. Methods: Mixed approach study, with a qualitative component (interviews) and a quantitative component (questionnaire). A purposive “snowball” sampling was carried out in Brazil for recruitment. Thematic content analysis of interview transcripts and descriptive analysis of quantitative data (Mann-Whitney and Fisher's Exact tests; Spearman's coefficient (p < 0.05) were performed. Results: Twenty-seven health professionals were included in the study, 14 palliative care professionals and 13 intensive care professionals. The concept of integration seems fundamental among palliative care professionals, and for intensive care professionals (ICU) it is perceived as end-of-life care. A consultation model is especially preferable in these situations; integrated education is recommended by palliative care professionals. Behavior and lack of knowledge (ICU professionals); and lack of institutional and public policies (palliative care professionals) were identified barriers. Training in palliative care was the greatest facilitating factor. Quantitative data showed agreement on the dimensions of care integration, but not evident in the ICUs. There were differences in the items “commitment to the view that the patient is a client” (p = 0.005) and “interdisciplinary teams with well-defined roles and preservation of professional autonomy” (p = 0.0004). Conclusion: Evidence of integration of palliative care and intensive care is limited, especially among ICU professionals. Integration is associated with end-of-life care, despite the recognition of its importance for patients/families.
Description
Keywords
Cuidados paliativos Cuidados intensivos Integração de cuidados Modelos organizacionais Organização de serviços Palliative care Intensive care Integration of care Organizational models Service organization