Perspectivas sobre cuidados paliativos e terminalidade : um olhar multiprofissional e de familiares no contexto hospitalar.

Abstract

Palliative care is an approach focused on promoting quality of life for patients and families in the face of life-threatening illnesses. It should be carried out by a multiprofessional team that evaluates the patient in a comprehensive manner, respecting their individuality, encompassing physical, mental, spiritual, and social aspects. End of life is when there is no treatment that can change the course of the disease, being closely linked to death, and can last weeks, days, or hours. This master's research, aligned with the Concentration Area of Mental Health and Social Practices, and the Research Line in Social Practices, Organizations, and Culture, of the Graduate Program in Psychology at the University of Santa Cruz do Sul (UNISC), aimed, in general, to identify how the perspective of the healthcare team at the tertiary level, in a teaching hospital in the interior of Rio Grande do Sul, regarding palliative care and end-of-life care, influences decision-making about the treatment offered. This is a qualitative study, of the intervention-research type. The approach method was phenomenological, and the data were analyzed through Content Analysis, by Bardin. The chosen location was the adult inpatient unit of the Unified Health System (SUS). The research took place in two stages, the first being through an interview conducted with the family members of patients who were in palliative care and at the end of life. The second stage took place through discussion groups with the multiprofessional team, between the months of September 2025 and March 2026. The method used with the family members was the semi-structured questionnaire and the field diary. With the professionals, four discussion groups were conducted, using Google Forms for the collection of demographic data, an open-ended questionnaire applied in person, and the field diary. Afterwards, the collected data were organized into five categories: (a) the perception of the patient's family member who was in Palliative and/or end-of-life care regarding the care provided by the multiprofessional team; (b) the biomedical model in hospitals; (c) the barriers and anguishes experienced by the multiprofessional team in palliative and/or end-of-life care; (d) the emotional support and the multiprofessional team; (e) the distancing of the healthcare professional in the face of the possibility of death. The results showed that the multiprofessional team does not use the terms palliative care and/or end-of-life care with patients. It was also identified that healthcare professionals demonstrate insecurity regarding the use of nomenclatures and how to care for patients in palliative care, which is closely linked to communication failure. From this, a technical product was developed, consisting of a palliative and/or end-of-life care manual, with as offshoots the palliative and/or end-of-life care protocol, through the patient's electronic medical record. It is worth noting that both the manual and the protocol can be replicated in hospitals using the same electronic health record system, reinforcing the importance of a standardized system focused on humanized, patient-centered care in institutions that provide services through the Unified Health System (SUS). Finally, there were future actions, such as the creation of informational flyers for the patient and/or family, inclusion in the patient identification board at the bedside indicating that the patient was receiving palliative and/or end-of-life care, institutional training on the palliative and/or end-of-life care manual and protocol, and an institutional video addressing the nomenclatures as a way to disseminate information to the general population. It is concluded that, although the terms palliative care and terminality have been widely used in the hospital context, healthcare professionals have a bias of confusion between the terminologies. Furthermore, the failure in communication among the team and the incomplete knowledge of the care instituted for the patient who is under this protocol is intrinsically linked to the care offered to the patient and their family.