Morte digna: percepção de médicos de hospital de ensino / Dignified death: the perception of doctors in a teaching hospital / Muerte digna: la percepción de los médicos de un hospital de enseñanza

Resumo Com o objetivo de identificar a percepção de morte digna de médicos de hospital de ensino, propõe-se estudo transversal, com amostra por conveniência (100 médicos), utilizando a versão reduzida da escala de percepção de morte digna. Todos os fatores do instrumento foram considerados de alta necessidade, enfatizando-se boa relação com a família (98,9%), manutenção da esperança e do prazer (97,8%) e não ser um fardo para os demais (92,3%). Mulheres priorizaram boas relações com a família e equipe; médicos com mais de 45 anos, não ser um fardo para os demais; e os sem religião, não ser um fardo e ter controle sobre o futuro. A percepção de morte digna dos médicos valorizou aspectos sociais, como afetividade e convivência, ao priorizar esses três fatores, além de demonstrar que idade, sexo e religiosidade a influenciam. Aprovação CEP-UFSC CAAE 71111317.4.0000.0121

Abstract In order to identify the perception of good death by physicians who work at a teaching hospital, a cross sectional study with a convenience sample (100 physicians) is proposed, using the reduced version of the perceived dignified death scale (Brazilian reduced version of Good Death Inventory). All factors of the instrument were considered as highly needed, emphasizing good relationship with the family (98.9%), maintenance of hope and pleasure (97.8%) and not being a burden to others (92.3%). Women prioritized good relationships with family and team; doctors over 45 years old, not being a burden to others; and those without religion, not being a burden to others and having control over the future. The perception of good death presented by physicians valued social aspects such as affectivity and acquaintanceship, by prioritizing these three factors, in addition to showing that age, sex and religiosity influence this perception. Approval CEP-UFSC CAAE 71111317.4.0000.0121

Resumen Con el objetivo de identificar la percepción de muerte digna por parte de médicos de un hospital de enseñanza, se propone un estudio transversal, con muestra de conveniencia (100 médicos), utilizando la versión reducida de la escala de percepción de muerte digna. Todos los factores del instrumento fueron considerados como de alta necesidad, con destaque para buena relación con la familia (98,9%), mantenimiento de la esperanza y placer (97,8%) y no ser una carga para los demás (92,3%). Las mujeres priorizaron buenas relaciones con la familia y el equipo; médicos con más de 45 años, no ser una carga para los demás; y los sin religión, no ser una carga para los demás y tener control sobre el futuro. La percepción de muerte digna por parte de los médicos valoró aspectos sociales como afectividad y convivencia, al priorizar estos tres factores, además de demostrar que edad, sexo y religiosidad la influencian. Aprobación CEP-UFSC CAAE 71111317.4.0000.0121

Serial Palliative Performance Scale Assessment in a University General Hospital: A Pilot Study.

BACKGROUND: Serial Palliative Performance Scale (PPS) assessments may predict functional decline and prognosis in cancer and noncancer patients and help with end-of-life decision making. OBJECTIVE: To evaluate the functional status of using serial PPS assessments of patients being assisted in collaboration with the palliative care team (PCT). DESIGN: Prospective cohort pilot study. MEASUREMENTS: The sample consisted of 64 cancer and noncancer inpatients being assisted in collaboration with the PCT during the period from 2012 to 2016 (included 12 months). Patients' PPS scores were assessed in three sequential stages: prehospital, first PCT assessment, and outcome (discharge, transference to another unit or death). Functional performance was classified in categories as stable (PPS scores between 70% and 100%), transitional (PPS scores between 40% and 60%), and end of life (PPS scores between 10% and 30%). RESULTS: The mean PPS score during the three assessment stages (respectively, 60.5%, 38.9%, and 25.9%) was significantly different (p < 0.001). Cancer patients had higher PPS scores than noncancer patients; however, both groups exhibited a functional decline along the hospital stay. In both groups there was a negative correlation between the time frame between the different assessment stages and PPS scores (respectively, Pearson -0.4 and -0.6; p < 0.01). The survival curve of the first palliative assessment stage demonstrated earlier death in patients in the end-of-life category. CONCLUSION: Serial PPS assessments are feasible and predicted functional decline in cancer and noncancer patients in this sample. Cancer patients exhibited higher initial functional scores but both cancer and noncancer patients declined in functionality along hospitalization. Earlier deaths occurred in the terminal PPS category than in the transitional PPS category.

A Latin American, Portuguese and Spanish consensus on a core communication curriculum for undergraduate medical education.

BACKGROUND: To present learning outcomes in clinical communication for a Core Curriculum for medical undergraduate students in Latin America, Portugal and Spain (LAPS-CCC) and to establish an expert network to support a transnational implementation. METHODS: Through an iterative process, an international group of 15 experts developed an initial set of learning outcomes following a review and discussion of relevant international and local literature. A two-round Delphi survey involving 46 experts from 8 countries was performed. Quantative and qualitative analisis permited the definition of the final consensus. RESULTS: The initial proposal included 157 learning outcomes. The Delphi process generated 734 comments and involved the modification, deletion and addition of some outcomes. At the end of the process, a consensus was reached on 136 learning outcomes grouped under 6 competency domains with a high overall acceptance (95.1 %). CONCLUSIONS: The learning outcomes of this proposal provide a guide to introduce, support and develop communication curriculae for undergraduate medical studies in the countries involved or in other Spanish- or Portuguese-speaking countries.

II Fórum do "Grupo de Estudos do Fim da Vida do Cone Sul": definições, recomendações e ações integradas para cuidados paliativos na unidade de terapia intensiva de adultos e pediátrica / II Forum of the "End of Life Study Group of the Southern Cone of America": palliative care definitions, recommendations and integrated actions for intensive care and pediatric intensive care units

Cuidado paliativo é uma forma de abordagem que visa a melhoria da qualidade de vida de pacientes e seus familiares que enfrentam doenças ameaçadoras à vida, através da prevenção, da identificação e do tratamento precoces dos sintomas de sofrimento físico, psíquico, espiritual e social. Todo paciente criticamente enfermo deve receber cuidados paliativos desde a internação, o que torna de primordial importância a educação e o treinamento dos intensivistas para a implantação destes cuidados nas unidades de terapia intensiva, tanto para atendimento de adultos como pediátrico. Em continuidade aos planos da Câmara Técnica de Terminalidade e Cuidados Paliativos da Associação de Medicina Intensiva Brasileira e, levando em consideração o conceito previamente apontado, foi realizado em outubro de 2010, durante o Congresso Brasileiro de Terapia Intensiva, o IIºForum do "Grupo de Estudos do Fim da Vida do Cone Sul", com o objetivo de elaborar recomendações pertinentes aos cuidados paliativos a serem prestados aos pacientes críticamente enfermos.

Palliative care is aimed to improve the quality of life of both patients and their family members during the course of life-threatening diseases through the prevention, early identification and treatment of the symptoms of physical, psychological, spiritual and social suffering. Palliative care should be provided to every critically ill patient; this requirement renders the training of intensive care practitioners and education initiatives fundamental. Continuing the Technical Council on End of Life and Palliative Care of the Brazilian Association of Intensive Medicine activities and considering previously established concepts, the II Forum of the End of Life Study Group of the Southern Cone of America was conducted in October 2010. The forum aimed to develop palliative care recommendations for critically ill patients.

II Forum of the "End of Life Study Group of the Southern Cone of America": palliative care definitions, recommendations and integrated actions for intensive care and pediatric intensive care units. / II Fórum do "Grupo de Estudos do Fim da Vida do Cone Sul": definições, recomendações e ações integradas para cuidados paliativos na unidade de terapia intensiva de adultos e pediátrica.

Palliative care is aimed to improve the quality of life of both patients and their family members during the course of life-threatening diseases through the prevention, early identification and treatment of the symptoms of physical, psychological, spiritual and social suffering. Palliative care should be provided to every critically ill patient; this requirement renders the training of intensive care practitioners and education initiatives fundamental. Continuing the Technical Council on End of Life and Palliative Care of the Brazilian Association of Intensive Medicine activities and considering previously established concepts, the II Forum of the End of Life Study Group of the Southern Cone of America was conducted in October 2010. The forum aimed to develop palliative care recommendations for critically ill patients.