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Complexidade de necessidades paliativas e consumo de recursos de saúde em estruturas residenciais para idosos
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O presente relatório constitui o trabalho final do Mestrado em Cuidados Paliativos da Escola Superior de Saúde Dr. Lopes Dias do Instituto Politécnico de Castelo Branco. Tem como objetivo principal analisar a complexidade das necessidades paliativas e o consumo de recursos de saúde em estruturas residenciais para pessoas idosas, integrando a prática clínica, a formação de profissionais e a produção científica como pilares das competências avançadas em cuidados paliativos.
O estudo desenvolve-se em três componentes: prática clínica, projeto de intervenção e formação e plano de investigação. Na componente prática, o formando consolidou competências na prestação de cuidados humanizados a doentes com patologias avançadas e respetivas famílias (ou cuidadores), aplicando instrumentos de avaliação como o Instrumento de Identificação de Necessidades Paliativas (NECPAL), o Instrumento Diagnóstico de Complexidade em Cuidados Paliativos (IDC-Pal) e a Escala de Avaliação de Sintomas de Edmonton (ESAS) para identificar necessidades paliativas, gerir sintomas e planear cuidados personalizados. A prática clínica, orientada pela filosofia dos cuidados paliativos, assentou numa abordagem multidisciplinar focada na dignidade, autonomia e qualidade de vida, demonstrando a importância do controlo sintomático, da comunicação terapêutica e da deliberação ética.
Na vertente de formação, foi desenvolvido e implementado um programa formativo dirigido a profissionais de estruturas residenciais para pessoas idosas, com o intuito de promover a difusão da filosofia dos cuidados paliativos e qualificar as equipas na identificação de necessidades, planeamento de intervenções e abordagem relacional com residentes e famílias. A avaliação da formação demonstrou ganhos de conhecimento, atitudes mais centradas na pessoa e maior consciência sobre a importância do trabalho em equipa nos contextos geriátricos e de fim de vida.
O plano de investigação centrou-se na caracterização das necessidades paliativas e do consumo de recursos de saúde em residentes de estruturas residenciais para idosos. Os dados obtidos através dos instrumentos NECPAL e IDC-Pal revelaram uma elevada prevalência de necessidades paliativas complexas e altamente complexas, frequentemente subidentificadas nas práticas convencionais. As correlações estatísticas entre graus de complexidade e consumo de recursos de saúde evidenciaram que um rastreio precoce e a integração de cuidados paliativos nestes contextos podem otimizar a utilização dos recursos e melhorar os resultados em saúde.
As conclusões do trabalho apontam para a urgência de uma maior integração dos cuidados paliativos nas estruturas residenciais para pessoas idosas e para o reforço da formação das equipas como medida estratégica essencial. O formando defende que o domínio das competências avançadas em cuidados paliativos implica não apenas o domínio técnico, mas também a capacidade de articular a investigação com a prática e a formação, gerando conhecimento útil e transformador. Este relatório constitui, assim, um contributo relevante para a compreensão e aperfeiçoamento da resposta paliativa no contexto de estruturas residenciais para pessoas idosas, reforçando o seu papel como espaços de cuidado, dignidade e qualidade de vida até ao fim.
Abstract: The present report represents the final project for the master’s degree in Palliative Care at the Superior School of Health Dr. Lopes Dias, Polytechnic Institute of Castelo Branco. Its main objective is to analyse the complexity of palliative care needs and the use of healthcare resources in long-term care facilities, integrating clinical practice, professional training and scientific research as pillars of advanced competencies in palliative care. The study is developed through three components: clinical practice, an intervention and training project and a research plan. Within the clinical component, the student consolidated competencies in providing humanized care to patients with advanced diseases and their families (or caregivers). Assessment tools such as the Instrument for the Identification of Palliative Care Needs (NECPAL), the Instrument for the Diagnosis of the Complexity of Palliative Care Needs (IDC-Pal) and the Edmonton Symptom Assessment Scale (ESAS) were applied to identify palliative needs, manage symptoms and plan personalized care. Clinical practice, guided by the philosophy of palliative care, relied on a multidisciplinary approach emphasizing dignity, autonomy and quality of life, while demonstrating the essential roles of symptom control, therapeutic communication and ethical decision-making. In the training component, a structured educational program was designed and implemented for professionals working in long-term care facilities. Its purpose was to promote the dissemination of the palliative care philosophy and to enhance team skills in identifying needs, planning interventions and establishing effective relational approaches with residents and their families. Evaluation of the program revealed significant knowledge gains, more person-centered attitudes, and greater awareness of the importance of teamwork within geriatric and end-of-life contexts. The research component focused on characterizing palliative care needs and healthcare resource utilization among residents in long-term care facilities. Data obtained through the NECPAL and IDC-Pal tools revealed a high prevalence of complex and highly complex palliative needs, frequently underrecognized in conventional care practices. Statistical correlations between levels of complexity and healthcare resource utilization indicated that early screening and the integration of palliative care in these contexts can optimize resource allocation and improve health outcomes. The conclusions highlight the urgency of further integrating palliative care within long-term care facilities and strengthening staff training as a strategic priority. The student argues that mastering advanced competencies in palliative care requires not only technical expertise but also the ability to integrate research, practice and education, thereby generating useful and transformative knowledge. This report, therefore, represents a meaningful contribution to understanding and enhancing the palliative response in long-term care facilities, reinforcing their role as spaces of compassion, dignity, and quality of life until the end.
Abstract: The present report represents the final project for the master’s degree in Palliative Care at the Superior School of Health Dr. Lopes Dias, Polytechnic Institute of Castelo Branco. Its main objective is to analyse the complexity of palliative care needs and the use of healthcare resources in long-term care facilities, integrating clinical practice, professional training and scientific research as pillars of advanced competencies in palliative care. The study is developed through three components: clinical practice, an intervention and training project and a research plan. Within the clinical component, the student consolidated competencies in providing humanized care to patients with advanced diseases and their families (or caregivers). Assessment tools such as the Instrument for the Identification of Palliative Care Needs (NECPAL), the Instrument for the Diagnosis of the Complexity of Palliative Care Needs (IDC-Pal) and the Edmonton Symptom Assessment Scale (ESAS) were applied to identify palliative needs, manage symptoms and plan personalized care. Clinical practice, guided by the philosophy of palliative care, relied on a multidisciplinary approach emphasizing dignity, autonomy and quality of life, while demonstrating the essential roles of symptom control, therapeutic communication and ethical decision-making. In the training component, a structured educational program was designed and implemented for professionals working in long-term care facilities. Its purpose was to promote the dissemination of the palliative care philosophy and to enhance team skills in identifying needs, planning interventions and establishing effective relational approaches with residents and their families. Evaluation of the program revealed significant knowledge gains, more person-centered attitudes, and greater awareness of the importance of teamwork within geriatric and end-of-life contexts. The research component focused on characterizing palliative care needs and healthcare resource utilization among residents in long-term care facilities. Data obtained through the NECPAL and IDC-Pal tools revealed a high prevalence of complex and highly complex palliative needs, frequently underrecognized in conventional care practices. Statistical correlations between levels of complexity and healthcare resource utilization indicated that early screening and the integration of palliative care in these contexts can optimize resource allocation and improve health outcomes. The conclusions highlight the urgency of further integrating palliative care within long-term care facilities and strengthening staff training as a strategic priority. The student argues that mastering advanced competencies in palliative care requires not only technical expertise but also the ability to integrate research, practice and education, thereby generating useful and transformative knowledge. This report, therefore, represents a meaningful contribution to understanding and enhancing the palliative response in long-term care facilities, reinforcing their role as spaces of compassion, dignity, and quality of life until the end.
Descrição
Relatório de estágio apresentado à Escola Superior de Saúde Dr. Lopes Dias do Instituto Politécnico de Castelo Branco para cumprimento dos requisitos necessários à obtenção do grau de Mestre em Cuidados Paliativos.
Palavras-chave
Estruturas residenciais para pessoas idosas Avaliação de necessidades paliativas Consumo de recursos de saúde Long-term care facilities Palliative care needs assessment Healthcare resources consumption