Cuidados paliativos para profissionais de saúde: avanços e dificuldades / Palliative care for health professionals: advances and difficulties / Cuidados paliativos para profesionales de salud: avances y dificultades

Esta pesquisa exploratória e qualitativa analisou os discursos sobre cuidados paliativos de 23 profissionais de saúde atuantes num hospital especializado no tratamento em oncologia. Os dados coletados por um questionário e uma entrevista semiestruturada foram analisados mediante a técnica de enunciação. Os resultados descrevem os sentidos de cuidados paliativos para os profissionais de saúde; as ações desenvolvidas; as dificuldades da assistência ao doente oncológico em cuidados paliativos; e as limitações da formação profissional para a atuação profissional neste campo. As conclusões mostram uma evolução no conhecimento do tema pelos profissionais, apontam a fragilidade na formação profissional para atuação em cuidados paliativos e a necessidade de mais investimentos para capacitar os profissionais que assistem doentes em paliação. Em relação à terminalidade e qualidade da morte, os profissionais foram unânimes quanto à carência de discussão durante a formação. Os profissionais reivindicam a criação de uma equipe especializada para o exercício desses cuidados e capacitação para os demais profissionais de apoio, aqueles que dão suporte ao trabalho dos profissionais de saúde, como condição essencial para a prestação de um cuidado de qualidade e humanizado.(AU)

This exploratory and qualitative research analyzed the discourses on palliative care of 23 health professionals working in a hospital specialized in oncology treatment. Data collected by a questionnaire and a semi-structured interview were analyzed by using the enunciation technique. The results describe the meanings of palliative care for health professionals; the actions developed; the difficulties in the assistance to cancer patients in palliative care; and the limitations of the professional training to work in this field. The conclusions demonstrate an evolution in the professionals' knowledge of the subject, the fragility of the professional training to work in this area, and the need for more investments to qualify professionals who assist patients in palliation. Regarding the terminality and quality of death, all professionals reported the lack of discussion during academic training. The professionals call for the creation of a palliative care specialized team for offering this care and training other support professionals, as an essential condition for quality and humanized care.(AU)

Este estudio exploratorio y cualitativo analizó los discursos sobre cuidados paliativos de 23 profesionales de salud actuantes en un hospital especializado en oncología. Los datos tomados por un cuestionario y una encuesta semiestructurada fueron analizados mediante la técnica de la enunciación. Los resultados describen los sentidos de cuidados paliativos para profesionales de salud; las acciones desarrolladas; las dificultades de la asistencia al enfermo oncológico en cuidados paliativos; y las limitaciones de la formación profesional para la actuación en este campo. Las conclusiones muestran una evolución en el conocimiento del tema por los profesionales, apuntan una fragilidad en la formación profesional para actuación en cuidados paliativos, y la necesidad de otras inversiones para capacitar los profesionales que asisten a pacientes en cuidados paliativos. En cuanto a la terminalidad y calidad de la muerte los profesionales fueron unánimes en cuanto a la falta de discusión durante la formación académica. Los profesionales reivindican la creación de un equipo especializado en cuidados paliativos y entrenamiento para los profesionales de apoyo, que son aquellos que apoyan el trabajo de los profesionales de salud, como condición esencial para una asistencia de calidad y humanizada.(AU)

How to structure an oncogenetics service for the public health system: Report of the implementation of the first service in Northeastern Brazil.

INTRODUCTION: Identifying carriers of genetic mutations that increase the risk of developing cancer allows to adopt timely risk-reducing strategies. However, due to the elevated cost of genetic testing, few oncogenetics services are available in the Brazilian public health care system, especially in economically disadvantaged areas. OBJECTIVE: To describe the implementation of an oncogenetics service for patients suspected of hereditary cancer syndromes (HBOC and HNPCC) at a philanthropic referral oncology hospital in Northeastern Brazil, funded by the Ministry of Health's National Oncology Care Support Program (PRONON). METHODS: The service was implemented with the PDCA method (Plan, Do, Check and Act). RESULTS: During the first year of operation (starting in August 2018), 675 individuals were examined, of whom 272 patients and 98 family members were submitted to genetic testing. This included the collection of 338 DNA samples of which 300 were sequenced. The analysis identified 48 (17.1%) mutations for HBOC and 19 (6.8%) for HNPCC. CONCLUSION: In one year, the oncogenetics service was able to benefit over 300 families by generating advanced molecular data which may be used for tailoring cancer prevention and management.

How does genetic testing influence anxiety, depression, and quality of life? A hereditary breast and ovarian cancer syndrome suspects trial.

BACKGROUND: Emotional distress associated with genetic testing for hereditary breast and ovarian cancer syndrome (HBOC) is reported to interfere with adherence to treatment and prophylactic measures and compromise quality of life. OBJECTIVES: To determine levels of anxiety, depression, and quality of life in patients tested for pathogenic BRCA1/2 mutations and identify risk factors for the development of adverse psycho-emotional effects. METHODS: Cross-sectional observational trial involving 178 breast or ovarian cancer patients from a referral cancer hospital in Northeastern Brazil. Information was collected with the Hospital Anxiety and Depression Scale (HADS) and the World Health Organization (WHO) Quality of Life (QoL) questionnaire (WHOQOL-BREF). RESULTS: Patients suspected of HBOC had higher levels of anxiety than depression. The presence of (probably) pathogenic BRCA1/2 mutations did not affect levels of anxiety and depression. High schooling, history of psychiatric disease, and use of psychotropic drugs were directly associated with high anxiety. High schooling was too inversely associated with QoL as such a breast tumor. Anxiety and depression were directly correlated and both reduced significantly QoL. CONCLUSION: Our results highlight the importance of psychological support and screening of risk factors for anxiety and depression and low QoL in HBOC patients at the time of testing.