Cuidado em final de vida : perspectivas de enfermeiros e médicos da atenção primária à saúde.

Abstract

The end of life, due to advanced diseases without the possibility of a cure, can be permeated with suffering, due to unnecessary hospitalizations and loss of autonomy for those who are dying. The home is the preferred place for the patient and family to experience the last days of life. Thus, health professionals in primary care can contribute to a more dignified end of life, offering palliative care. The aim of this dissertation was to analyze the speeches of primary care health professionals about end-of-life care. It consists of article: Abstract article I: END OF LIFE IN PRIMARY CARE: a view of health professionals Introduction: Primary care health professionals are able to contribute to the promotion of care at the end of life, humanized, with dignity and autonomy, due to the bond and multidimensional look towards patients. Objective: to understand the meanings produced by the speeches of health professionals in Primary Care about care for patients at the end of life. Method: this is a qualitative research, in which semi-structured interviews were conducted with five doctors and eight nurses from Primary Care. The inclusion criteria were the professional with at least one year of experience and taking care of a patient at the end of life. Results: Four themes emerged from the speeches: “care scenario”, “death at home”, “communication challenges” and “dealing with death”. Conclusion: There is a concern with dignity at the end of life, but the work process is permeated by difficulties, such as: great demand from the family caregiver, absence of a palliative care policy and the lack of a multidisciplinary team. The autonomy of patients, on the other hand, seems to be an even greater challenge, since communication occurs more with the family. Abstract article II: Early Care Planning as a strategy for a dignified end of life: narrative review Introduction: The end of life can be accompanied by major disabilities, including decreased or loss of cognitive functions. This creates difficulties in making decisions about treatment and health care, often overburdening family members with difficult decisions. Thus, prior planning becomes important. Objective: To describe the scientific production on Early Care Planning (PAC). Method: It is a narrative review of the literature, from the last five years, from 2015 to 2020, with the selection of 15 articles published in the databases Pubmed, Medline, Lilacs and BDENF, using the descriptor “advance care planning”. Results: Three themes emerged: Barriers and challenges in the PAC, Communication skills for the PAC and Anticipated Directives of Will (DAV). Conclusion: The PAC is a care strategy, important to guarantee patients an end of life with autonomy and dignity. However, it is not practiced, as it is permeated by ethical dilemmas and ignorance among professionals. General Conclusions: It can be analyzed that, from the perspective of professionals, end-of life care in Primary Care requires greater availability since the demands are not only clinical, but require emotional support. The home may be the most worthy place to experience the last days of life, as recommended by SUS Resolution 41. Patient autonomy is a more delicate issue, since effective communication and planning between staff, patient and family does not occur,