Abstract
Objective: To investigate healthcare professionals’ perceptions regarding palliative care and dysthanasia in hospitalized elderly patients at the end of life. Methods: A qualitative, exploratory, and descriptive study conducted in two public hospitals in the Federal District, Brazil. A total of 101 healthcare professionals participated. Data collection took place in 2023 through semi-structured interviews. The interviews were analyzed using the IRAMUTEQ software, applying Descending Hierarchical Classification and Word Cloud analysis, in addition to descriptive statistics for sociodemographic data. Results: The sample consisted predominantly of women (78.22%) and professionals aged between 20 and 49 years (88.11%). Nurses, physicians, and nursing technicians were the most represented professional categories. Textual analysis identified five thematic classes: dignity at the center of care, professionals’ feelings, personalized care, professional preparedness, and patient beliefs. Participants highlighted the importance of respecting patient autonomy, communication with patients and families, the indication of palliative care, and spirituality as a relevant factor for well-being. Conclusion: The study shows that healthcare professionals recognize palliative care as fundamental for preserving the dignity of elderly patients at the end of life and for avoiding dysthanasia practices.
References
ALVES VP, et al. Non-Communicable Chronic Diseases: Mortality of Older Adult Citizens in Brazil and Italy before the Covid-19 Pandemic. Health Policy Open, 2021; 2: 100041.
APARECIDA DA SILVA L, et al. Therapeutic obstinacy: when medical intervention hurts human dignity. Rev Bioet (Impr), 2021; 29(4): 798-805.
BARDIN L. Análise de conteúdo. Lisboa: Edições 70, 2011.
BOVERO A, et al. A Qualitative Study to Explore Healthcare Providers’ Perspectives on End-of-Life Patients’ Dignity. Journal of Cancer Education, 2020.
BOVERO A, et al. The Health Care Providers’ Perspectives on End-of-Life Patients’ Sense of Dignity. Journal of Cancer Education, 2019.
BRASÍLIA. InfoSaúde-DF. 2022a. Disponível em: https://info.saude.df.gov.br/hospitaisses/.
BRASÍLIA. InfoSaúde-DF. 2022b. Disponível em: https://info.saude.df.gov.br/area-tecnica/gestao-de-pessoa-forca-de-trabalho/.
BRASÍLIA. InfoSaúde-DF. 2022c. Disponível em: https://info.saude.df.gov.br/forcadetrabalho/.
CHOCHINOV HM. Dignity and the essence of medicine: the A, B, C, and D of dignity conserving care. BMJ, 2007; 335(7612): 184-187.
CHOCHINOV HM, et al. Dignity in the terminally ill: a developing empirical model. Social Science & Medicine, 2002; 54(3): 433-443.
CLOSS VE, SCHWANKE CHA. A evolução do índice de envelhecimento no Brasil, nas suas regiões e unidades federativas no período de 1970 a 2010. Rev Bras Geriatr Gerontol, 2012; 15(3): 443-458.
CONASEMS. 2020. O protagonismo feminino na saúde: mulheres são a maioria nos serviços e na gestão do SUS. Disponível em: https://portal.conasems.org.br/orientacoes-tecnicas/noticias/4795_o-protagonismo-feminino-na-saude-mulheres-sao-a-maioria-nos-servicos-e-na-gestao-do-sus. Acessado em: 03 de abril de 2024.
CRESWELL JW. Projeto de pesquisa: métodos qualitativo, quantitativo e misto. 3 ed. Porto Alegre: Artmed, 2010.
Cuidados paliativos. Disponível em: https://www.gov.br/inca/pt-br/assuntos/gestor-e-profissional-de-saude/controle-do-cancer-do-colo-do-utero/acoes/cuidados-paliativos.
DE BRASI EL, et al. Nurses’ moral distress in end-of-life care : A qualitative study. Nursing Ethics, 2020; 28(5).
GATTO JÚNIOR JR, et al. A participação em pesquisas com metodologias participativas : reflexão sobre experiências. Rev Bras Promoc Saude, 2018; 31.
GIL AC. Como elaborar projetos de pesquisa. 4 ed. São Paulo: Atlas, 2002.
GIL AC. Métodos e técnicas de pesquisa social. 7 ed. São Paulo: Atlas, 2019.
HAM L, et al. Potentially inappropriate end-of-life care and its association with relatives’ well-being: a systematic review. Supportive Care in Cancer, 2023; 31(12): 731.
IBGE. Em 2022, expectativa de vida era de 75,5 anos. 2022. Disponível em: https://agenciadenoticias.ibge.gov.br/agencia-sala-de-imprensa/2013-agencia-de-noticias/releases/38455-em-2022-expectativa-de-vida-era-de-75-5-anos.
MENEZES MB, et al. Dysthanasia: nursing professionals’ perception. Rev Latino-Am Enfermagem, 2009; 17(4): 443-448.
MOREIRA DA, et al. Espiritualidade e a velhice: perspectivas na produção científica. Interações, 2021; 16(1).
NASCIMENTO LCN, et al. Theoretical saturation in qualitative research: an experience report in interview with schoolchildren. Rev Bras Enferm, 2018; 71(1): 228-233.
RATINAUD P, MARCHAND P. Application de la méthode Alceste à de “gros” corpus et stabilité des “mondes lexicaux”. In : Actes des 11eme Journées internationales d’Analyse statistique des Données Textuelles. 2012; 835-844.
SECRETARIA DE SAÚDE DO DISTRITO FEDERAL. Atendimento em Cuidados Paliativos. 2022. Disponível em: https://www.saude.df.gov.br/cuidados-paliativos-2.
SECRETARIA DE SAÚDE DO DISTRITO FEDERAL. Plano Distrital de Saúde 2020-2023. Brasília, 2019. Disponível em: https://www.saude.df.gov.br.
SU A, et al. Beyond Pain: Nurses’ Assessment of Patient Suffering, Dignity, and Dying in the Intensive Care Unit. Journal of Pain and Symptom Management, 2018; 55(6).
VERAS RP, OLIVEIRA M. Envelhecer no Brasil: a construção de um modelo de cuidado. Cien Saude Colet, 2018; 23(6): 1929-1936.
VOUMARD R, et al. Geriatric palliative care: a view of its concept, challenges and strategies. BMC Geriatrics,
; 18(1): 220.
WHO. Global Atlas of Palliative Care. 2 ed. London, 2020.
