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Plano antecipado de cuidados em doentes com necessidades paliativas
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| 5.7 MB | Adobe PDF |
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Advisor(s)
Abstract(s)
O presente relatório foi elaborado no âmbito do 10º Mestrado em Cuidados
Paliativos (CP) da Escola Superior de Saúde Dr. Lopes Dias – Instituto Politécnico de
Castelo Branco, tendo como objetivo a obtenção de grau de Mestre em Cuidados
Paliativos. Este encontra-se dividido em duas partes.
Na primeira parte estão descritas as atividades que foram desenvolvidas durante o
Estágio/Prática clínica de 300 horas numa Equipa Comunitária de Suporte em
Cuidados Paliativos (ECSCP), com o intuito de alcançar os objetivos gerais e específicos
do estágio, bem como a aquisição das competências propostas. Durante o período de
estágio foram acompanhados 30 doentes, tendo sido realizados 279 contactos dos quais
44,8 % foram Visitas Domiciliárias (VD).
Na segunda parte está descrito o projeto de formação e intervenção no âmbito do
Plano Antecipado de Cuidados (PAC), assim como a revisão sistemática de literatura
sobre os programas de treino dos profissionais de saúde na abordagem do PAC em
Cuidados Paliativos.
A Equipa de Saúde Familiar encontra-se numa posição privilegiada para elaborar
um PAC com os seus doentes e famílias, uma vez que existe um relacionamento de longa
duração e confiança terapêutica; contudo estes profissionais identificam a falta de
treino/formação como uma das barreiras para iniciar um PAC com o seu doente. Neste
sentido, e após a realização de uma análise SWOT, foi desenvolvida uma formação
“Decidir é o melhor remédio!” cujo objetivo pedagógico principal era o de capacitar o
profissional de saúde para auxiliar o doente na realização e formalização de um Plano
Antecipado de Cuidados, de forma sistematizada.
Com a realização da revisão sistemática pretendeu-se avaliar qual o plano de
formação/treino mais eficaz e com maior evidência científica, através da inclusão
ensaios clínicos randomizados (ECR) que incidisse em planos de treino dos
profissionais de saúde para abordar o PAC de doentes com doença avançada com
necessidades paliativas. Parece haver um benefício na formação em PAC
nomeadamente na aquisição/consolidação de competências na área da comunicação,
conhecimento teórico, satisfação e confiança em abordar o PAC dos profissionais de
saúde. Contudo, dada a elevada heterogeneidade dos ECR não foi possível concluir
acerca da intervenção mais eficaz. No futuro sugere-se a realização de ECR que avalie
as intervenções realizadas de forma objetiva e comparável. Sendo alcançado um plano
de formação eficaz, seria útil a sua implementação de forma sistemática e normativa
na prática clínica de todos os profissionais de saúde.
Abstract: This report was prepared within the scope of the 10th Master's Degree in Palliative Care of the Escola Superior de Saúde Dr. Lopes Dias from the Instituto Politécnico de Castelo Branco, with the aim of obtaining a Master Degree in Palliative Care. It is divided into two parts. The first part describes the activities that were developed during the 300-hour Internship/Clinical Practice in a Community Palliative Care Support Team with the aim to achieve the general and specific objectives of the internship, as well as the acquisition of the proposed Proficiency recognized by Portuguese Medical Society. During the internship period, 30 patients were followed, with 279 contacts made, of which 44.8% were Home Visits. The second part describes the training and intervention project within the scope of the Advance Care Planning, as well as the systematic review of the literature on the training programs for health professionals in the Advance Care Planning approach in Palliative Care. The Family Health Team is in a privileged position to develop a Advance Care Planning with its patients and families, as there is a long-term relationship and therapeutic trust; however, these professionals identify the lack of training as one of the barriers to starting a Advance Care Planning with their patient. In this sense, and after carrying out a SWOT analysis, a training course "Decidir é o melhor remédio!” was developed, whose main pedagogical objective was to train the health professional to assist the patient in carrying out and formalizing an Advance Care Planning, in a systematic manner. The aim of this systematic review was to evaluate which training plan is most effective and has the most scientific evidence, through the inclusion of randomized controlled trials that focused on training plans for health professionals to address Advance Care Planning in patients with advanced disease with palliative needs. There seems to be a benefit in Advance Care Planning training, namely in the acquisition/consolidation of skills in the area of communication, theoretical knowledge, satisfaction and confidence in addressing the ACP of health professionals. However, given the high heterogeneity of RCTs, it was not possible to conclude on the most effective intervention. In the future, it is suggested that an RCT be carried out to evaluate the interventions performed in an objective and comparable manner. Once an effective training plan is achieved, it would be useful to implement it, in a systematic and normative manner in the clinical practice of all health professionals.
Abstract: This report was prepared within the scope of the 10th Master's Degree in Palliative Care of the Escola Superior de Saúde Dr. Lopes Dias from the Instituto Politécnico de Castelo Branco, with the aim of obtaining a Master Degree in Palliative Care. It is divided into two parts. The first part describes the activities that were developed during the 300-hour Internship/Clinical Practice in a Community Palliative Care Support Team with the aim to achieve the general and specific objectives of the internship, as well as the acquisition of the proposed Proficiency recognized by Portuguese Medical Society. During the internship period, 30 patients were followed, with 279 contacts made, of which 44.8% were Home Visits. The second part describes the training and intervention project within the scope of the Advance Care Planning, as well as the systematic review of the literature on the training programs for health professionals in the Advance Care Planning approach in Palliative Care. The Family Health Team is in a privileged position to develop a Advance Care Planning with its patients and families, as there is a long-term relationship and therapeutic trust; however, these professionals identify the lack of training as one of the barriers to starting a Advance Care Planning with their patient. In this sense, and after carrying out a SWOT analysis, a training course "Decidir é o melhor remédio!” was developed, whose main pedagogical objective was to train the health professional to assist the patient in carrying out and formalizing an Advance Care Planning, in a systematic manner. The aim of this systematic review was to evaluate which training plan is most effective and has the most scientific evidence, through the inclusion of randomized controlled trials that focused on training plans for health professionals to address Advance Care Planning in patients with advanced disease with palliative needs. There seems to be a benefit in Advance Care Planning training, namely in the acquisition/consolidation of skills in the area of communication, theoretical knowledge, satisfaction and confidence in addressing the ACP of health professionals. However, given the high heterogeneity of RCTs, it was not possible to conclude on the most effective intervention. In the future, it is suggested that an RCT be carried out to evaluate the interventions performed in an objective and comparable manner. Once an effective training plan is achieved, it would be useful to implement it, in a systematic and normative manner in the clinical practice of all health professionals.
Description
Relatório 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.
Keywords
Plano antecipado de cuidados Diretiva antecipado de vontade Formação Cuidados paliativos Medicina Geral e Familiar Advance care planning (ACP) Advance will directive Training Palliative care (PC) General practice