RESUMEN
O presente Trabalho de Conclusão de Residência multidisciplinar em Saúdepossui o objetivode conhecer a percepção e a prática de profissionais médicos, atuantes na Estratégia de Saúde da Família (ESF), no que concerne aos Cuidados Paliativos (CP) na Atenção Primária à Saúde (APS). Os seis profissionaisdesta amostra estão vinculados aESF de uma Unidade Básica de Saúde (UBS) localizada em Canoas/RS.Oestudo possuimetodologia de natureza qualitativa e abordagem descritiva. Oreferencial teórico utiliza-se deáreas dapsicologia da saúde, medicina paliativa, e do Sistema Único de Saúde (SUS). Os resultados apontamparanecessidade de incluir nas práticas de CPdimensões subjetivasno cuidado e a interdisciplinaridade como método de trabalho.Ademais, identificaram-se lacunas referentes acapacitações e formações especificas em CP,sobrecarga de trabalho e insatisfação profissional. Essa pesquisa pretende ampliar a discussão dos muitos desafios éticos a serem vencidos na APS,referente aos CP.
This article presents the perception and practice in Palliative Care (PC) of physicians working in the Family Health Strategy (FHS), in Primary Health Care (PHC), in connection with the Basic Health Care Unit (UBS) of the city of Canoas/RS. Data were collected between June and August 2019. The analysis followed theoretical-methodological reference in health psychology, palliative medicine, and public policies of the Unified PublicHealth System (SUS). The study points out to the need for comprehensive care of patients in PC, evidencing difficulty in the identification, which makes it impossible to have a proper connection with patient-family-team.The challenge is to find interdisciplinary means of work, including emotional and spiritual dimensions, in addition to clinical practice. Itissuggested trainings, aiming at competenciesthatmeetethicalchallenges in PC. This research aims to subsidies the discussion of PC in public health, and provides information for future studies about this theme.
RESUMEN
Introducción: las enfermedades crónicas no trasmisibles y dentro de ellas el cáncer constituyen problemas priorizados para el sistema de salud cubano. La medicina paliativa se dedica a la atención a pacientes con enfermedades activas, progresivas, irreversibles y avanzadas con pronóstico de vida limitado y se centra en disminuir el sufrimiento y elevar calidad de vida a pacientes y familiares. Objetivo: caracterizar el nivel de información de los médicos residentes de la FCM 10 de Octubre sobre los cuidados paliativos (CP). Métodos: teóricos como el análisis documental, enfoque de sistema y empíricos tales como la encuesta. Resultados: en la muestra 52,1 % de los médicos tenían más de 10 años de graduados. Sobre la medicina paliativa poca información sobre: los aspectos conceptuales, las enfermedades de las que se ocupa el equipo multidisciplinario con integración de todos los niveles de atención. La insuficiente información sobre el tratamiento del dolor hace que los tratamientos analgésicos sean inadecuados, y los opioides infrautilizados. Los conocimientos sobre CP se consideraron como insuficientes en el 87 % de los encuestados. Conclusiones: no hay buena identificación de las enfermedades tributarias de cuidados paliativos, ni manejo de la escalera analgésica de la OMS, con las indicaciones de la morfina. Los residentes aceptan que sus conocimientos CP son escasos y su enseñanza sistematizada debe estar en los programas de pregrado y postgrado.
Introduction: non-communicable chronic diseases like cancer are priority problems in the Cuba healthcare system. Palliative medicine is devoted to giving care to patients with active, progressive, irreversible and advanced illnesses with limited lifetime prognosis and is focused in reducing the suffering and raising the quality of life of the patients and their relatives. Objective: to characterize the level of information that the residents from the medical faculty of 10 de Octubre municipality have on palliative care. Methods: theoretical methods such as the documentary analysis and system approach as well as empirical ones such as survey. Results: in the sample, 52.1 % of physicians had graduated over 10 years ago. They had little information about the palliative medicine, the conceptual aspects and the diseases that the multidisciplinary team should care of. The lack of information on pain relief makes the analgesic treatment be inadequate and opiods be underutilized. Knowledge on palliative medicine was then considered as lacking in 87 % of the surveyed physicians. Conclusions: there is neither a correct identification of diseases in need of palliative care nor good management of the analgesic scale set by WHO with morphine use indications. The residents admitted that their knowledge on this area was poor and that the systematic teaching of the use of palliative care techniques should be included in the undergraduate and the graduate educations.