Implantação de um Programa Multiprofissional de Assistência em Cuidado Paliativo: Relato de Experiência / Implementation of a Multiprofessional Assistance Program in Palliative Care: Experience Report

Resumo: Cuidado paliativo é uma abordagem que ampara a assistência do profissional de saúde nos cuidados aos doentes em situação de intenso sofrimento, decorrente de doença que ameaça a continuidade da vida, tendo como objetivo promover alívio do sofrimento e qualidade de vida do paciente e familiares, dentro das medidas possíveis e até o fim da vida. O estudo teve por objetivo realizar e descrever a implantação e implementação de um programa multiprofissional de assistência em Cuidado Paliativo. O estudo caracterizado como uma pesquisa ação, apresenta 5 fases para o desenvolvimento da proposta do serviço. Com a implementação do programa, pode-se proporcionar a humanização da equipe multiprofissional no trato aos pacientes e familiares. Dentre as expectativas que se atribuíram à proposta de criação de um serviço de cuidado paliativo, sua criação e aplicação foram realizadas dentro do tempo esperado, além de um aproveitamento e resultados maior do que os previamente previstos.Palavras-Chave: Cuidado paliativo; doentAbstract: Palliative care is an approach that supports the assistance of health professionals in the care of patients in situations of intense suffering, resulting from a disease that threatens the continuity of life, aiming to promote relief of suffering and quality of life for patients and their families, within of possible measures and until the end of life. The study aimed to carry out and describe the implementation and implementation of a multiprofessional assistance program in Palliative Care. The study characterized as action research, presents 5 phases for the development of the service proposal. With the implementation of the program, the humanization of the multidisciplinary team in dealing with patients and families can be provided. Among the expectations that were attributed to the proposal to create a palliative care service, its creation and application were carried out within the expected time, in addition to a better use and results than those previously expected. Keywords: Palliative care; chronically ill; assistance.e crônico; assistência.

Death in the Hospital: The Witnessing of the Patient with Cancer

Objectives: The aim of the study was to know the witnessing of death from the perspective of the cancer patient in the hospital environment. Materials and Methods: This is a qualitative and descriptive study, which was carried out in a cancer hospital in southern Brazil, with 27 cancer patients, through semi-structured interview, after the institutional research ethics committee approval. For categorisation and data analysis, Iramuteq software and Creswell content analysis were used. Results: Six classes emerged from the Iramuteq software and four categories were formed: (1) The reflection of the other itself; (2) feelings and emotions aroused; (3) the witnessing of a peaceful death and (4) death as a habitual event. Conclusion: Patients felt sad and distressed, and some perceived death as something natural, often necessary for the relief of suffering. They put themselves in the place of the dying patient and their family members, imagining their loved ones and the suffering they would experience. Participants considered peaceful deaths to be good, unlike those in which patients had some kind of discomfort, described as horrible, distressing, sad and bad.

Compassionate Leadership: Essential for the Future of Tropical Medicine and Global Health

Compassion—the awareness of suffering coupled with the desire to relieve that suffering—is an evolved human capacity that offers significant benefits for individuals and organizations. While the relief of suffering is central to tropical medicine and global health, compassion is more often assumed than explicit. Global health leaders participating in a compassionate leadership program recently reported that the most common personal barriers to compassionate leadership include inability to regulate workload, perfectionism, and lack of self-compassion; while the most common external challenges include excessive work-related demands, the legacy of colonialism, and the lack of knowledge on how to lead with compassion. These barriers can be surmounted. Within organizations, leaders are the primary shapers of compassionate cultures. Now is the time to bring our core compassionate values to bear in addressing the “unfinished business” of ensuring global health equity and deconstructing colonialist structures in global health and tropical medicine. Compassionate leadership offers us tools to complete this unfinished business.

Palliative care aspects of wound healing in complex patients: a case report

Symptom or palliative management for wound care has commonly been reported in the literature as being focused on end-of-life care with less emphasis on being an effective supportive option for any patient with a wound in whom symptom management is indicated. This case report describes a frail older patient with a hard-to-heal pressure injury and multiple comorbidities to highlight palliative symptom management as a viable option to enhance patient comfort. Wound care providers may consider a palliative approach for hard-to-heal wound management that incorporates the whole patient, family and/or caregiver when faced with management of a frail older adult with a hard-to-heal wound to enhance the relief of suffering and improve quality of life. All procedures were performed in compliance with relevant laws and institutional guidelines and the appropriate institutional committee has approved them. Declaration of interest: The authors have no conflicts of interest to declare.

Increasing our understanding of nonphysical suffering within palliative care: A scoping review

Objective Nonphysical suffering is emotional, psychological, existential, spiritual, and/or social in nature. While palliative care is a discipline dedicated to the prevention and relief of suffering — both physical and nonphysical — little is known about existing research specific to nonphysical suffering within the context of palliative care. This scoping review helps to fill this gap. Method Three hundred and twenty-eight unique records were identified through a systematic search of three databases (MEDLINE, CINAHL, and PsycINFO). The following keywords were used: (suffering) AND (palliative OR “end of life” OR “end-of-life” OR hospice OR dying OR terminal* ill*). Thirty studies published between 1998 and 2019 met the inclusion criteria. Results Losses, worries, and fears comprise patients’ primary sources of nonphysical suffering. Patients face numerous barriers in expressing their nonphysical suffering to healthcare providers. The idea that patients can choose how they perceive their circumstances, thereby minimizing their nonphysical suffering, is pervasive in the research. The nature of nonphysical suffering experienced by family caregivers and palliative care clinicians is revealed in the review. The unique and sensitive interplay between nonphysical suffering and both palliative sedation and requests for hastened death is also evident. Overall, seven themes can be identified: (i) patients’ experiences of nonphysical suffering; (ii) patient coping mechanisms; (iii) efforts to measure nonphysical suffering; (iv) palliative sedation; (v) requests for hastened death; (vi) family suffering; and (vii) clinician suffering. Significance of results This is the first scoping review to map palliative care's research specific to suffering that is social, emotional, spiritual, psychological, and/or existential in nature. Its findings expand our understanding of the nature of nonphysical suffering experienced by patients, families, and palliative care clinicians. The review's findings have significant implications for front-line practice and future research.

The epidemiology of death and symptoms

Despite the advances of medicine, many illnesses continue to evade cure. Chronic, progressive, incurable illness is a major cause of disability, distress, suffering, and, ultimately, death. This is true for many causes of cancer, AIDS, and other disorders of vital organs. Such progressive, chronic diseases are most common in late adulthood and old age, but they occur at all ages. Disease-modifying treatments and the relief of suffering through symptom management, care planning, and family support are central to care, and these four domains are core goals of palliative care. This chapter offers an overview of how epidemiological studies may be used to clarify the population/s of people who may benefit from palliative care, to assist the planning for how services may meet the needs of people towards the end of life. Symptoms associated with a series of common, progressive, chronic illnesses will be discussed, thereby further facilitating planning for individual patients and for services.

Life after Domestic Homicide: Examining the Psychosocial Implications on Children-Survivor

Although the problem of domestic violence has received considerable attention, the study of domestic homicide is relatively recent and limited to precipitating conditions or the act itself. Most of the literature on familicide focuses on the personality characteristics of the victim and perpetrator or tries to answer the question, “How did the death happen?” Little notice, however, has been given to the children of the victim and offender who, in the midst of their loss and extreme suffering, inherit the fallout from the death of one parent, and incarceration of the other. The study therefore explored the psychosocial implications of parental absence on account of death and incarceration on surviving children. Qualitative data were obtained from 18 convicted and awaiting trial inmates for spousal homicide in three selected prisons in Lagos state, key informant interviews (KII) with four officials of Office of Public Defenders (OPD), three officials of Directorate of Public Prosecutions (DPP) and two child psychologists. Surviving children of domestic homicide suffer massive upheaval, psychiatric disturbance, ill health, financial difficulties, ostracism, scars from witnessing the domestic violence that preceded the murder and the propensity for future intrafamilial violence. The study concludes that direct and indirect exposure to domestic violence and homicide is negatively associated with children’s emotional, behavioural and developmental well-being. Hence, welfare of such children which should include therapy, relief of suffering, resolution of trauma symptoms, provision of supportive environment and clarification of cognitive or emotional distortions about the homicide should be incorporated in the prosecution process by relevant agencies.

Pharmacological Prophylaxis of Venous Thromboembolism in Terminally Ill Patients: A Need or Futility?

The aim of this case is to clarify the need to maintain the terminally ill oncological patients who have had a thrombotic event in the course of their underlying disease under antithrombotic therapy. This case addresses a 63-year-old man with stage IV gastric antrum adenocarcinoma, completely bed-ridden and anticoagulated with subcutaneous enoxaparin for more than a year, following deep venous thrombosis of the left lower limb. After reviewing the literature, it was found that, for end-of-life patients, anticoagulation seems to have little benefit as the main objective is not the extension of life itself, but rather the preservation of the best quality of life through practices that are well established in the relief of suffering.

Total pain and comfort theory: implications in the care to patients in oncology palliative care

ABSTRACT Objective: To reflect on the possible connections between Katharine Kolcaba's Theory of Comfort and Cicely Saunders’s concept of Total Pain and the implications to the care of the oncology palliative care patient. Method: Theoretical reflection based on a literature review carried out in May 2020, in the PubMed and LILACS databases, which sought to answer the question: “Are there any theoretical-conceptual connections between Kolcaba's Theory of Comfort and the concept of Total Pain by Saunders?” Results: The knowledge of the concepts presented allows redirecting the focus of care towards individualized actions to strengthen the patient and his participation in the choices of comfort interventions. Conclusion: Understanding the connections between the concept and theory presented provides the patient in oncology palliative care with individualized and qualified care, focused on the person and not on the disease and can contribute to a greater effectiveness of nursing interventions aimed at the relief of suffering.