Establishing and implementing palliative care services

Kurogi, Luciana Tiemi; Vieira, Caroline Aparecida Leindecker Garçoa; Ramalho, Rosa Maria; Silva, Angelita Wisnieski da

doi:10.1590/1983-80422022304573EN

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Brasil

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Research • Rev. Bioét. 30 (4) • Oct-Dec 2022 • https://doi.org/10.1590/1983-80422022304573EN copy

Establishing and implementing palliative care services

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Abstract

Since expanding palliative care services within general hospitals in Brazil involves confronting obstacles and establishing strategies to enable their implementation in the health system, this study sought to identify the process around establishing and implementing palliative care services in Brazilian general hospitals. An integrative literature review of four articles identified the following steps for establishing and implementing palliative care services: protocol development, humanized care, multidisciplinarity, and education. As for the obstacles, the analysis highlighted the lack of training and education in palliative care, difficulty in reaching consensus on palliative practices, communication, drug supply, and government support. In conclusion, public policy development is essential to guarantee the implementation of palliative care in hospitals.

Palliative care; General hospitals; Hospital services

Origin	Title of the article	Authors and year	Considerations/themes
SciELO	“Concepções da equipe multiprofissional sobre a implementação dos cuidados paliativos na unidade de terapia intensiva”	Silva and collaborators;2013 ¹⁴	This study aimed to analyze the conceptions of the multiprofessional team on the implementation of palliative care in an adult intensive care unit. This is an exploratory-descriptive research, with a qualitative approach, carried out with 14 health professionals from a public teaching hospital. Interviewees reported partial knowledge of the palliative care proposal and in the care practice divergences are observed in the therapeutic conduct of the team, indicating lack of interaction and communication among professionals. It is necessary to elaborate a national policy to support care of terminal critically ill patients, permanent/continued training of professionals and creation of protocols.
Elsevier	“A estruturação de um serviço de cuidados paliativos no Brasil: relato de experiência”	Garcia, Rodrigues, Lima; 2014 ¹⁵	Justification and objectives: in Brazil, palliative care (PC) is not yet adequately structured and this reality transforms this theme into a public health problem and makes relevant initiatives taken in this context. This work aimed to share the experience of a reference hospital in oncology in the state of Maranhão and presented initiatives that helped in the development of the PC service. Experience report: there was an outpatient pain and PC service in the hospital, but without specialized beds. Conclusion: this experience was a reproducible local initiative for the development of PC in a cancer hospital. Local initiatives are of great value in Brazil as they favor an expressive number of patients and show, in practice, their efficacy to governments and society.
SciELO	“Como implementar cuidados paliativos de qualidade na unidade de terapia intensiva”	Costa Filho and collaborators; 2008 ¹⁶	Contents: although still developing worldwide, palliative care is progressively integrating curative care, including in intensive care settings. However, evidence show that this medical approach still needs to improve, either for patients with symptoms of significant discomfort or physical pain, in intensive care units, or in the perception of family members, which is also flawed, especially regarding basic recommendations such as diagnostic, prognostic and therapeutic interventions. Conclusions: the development of research in this area will promote performance indicators, which will guarantee efficiency, operational quality, and constant improvement of this care. This article highlights the importance of palliative medicine and proposes alternatives and plans for promoting palliative approaches in appropriate time, in order to bring general medicine closer to human values and dignity.
SciELO	“Cuidados paliativos para idosos na unidade de terapia intensiva: revisão sistemática”	Fonseca, Mendes, Fonseca; 2012 ¹7	Objective: the use of interventional medical technology in terminally ill older adult patients needs to be associated with palliative care as clinical support measures in intensive care. This resource assists decisions at the end of life of patients and directs the attention of the health team to ensure comfort for patients and satisfaction for families. Prolonging life without the implementation of actions aimed at alleviating symptoms such as pain and dyspnea, contributes to family stress and death with suffering. The objective of this work was to know the advances in the use of palliative care in the intensive care unit. Method: systematic review on the relationship between elderly palliative care and intensive care in MEDLINE and Bireme portals. Results: 29 articles were analyzed, showing experiences of palliative care in intensive care units using the variables “family satisfaction when participating in discussions on palliative care” and “difficulties in implementing this type of care due to lack of technical training of professionals”. Conclusion: “palliative care” should be deepened as a theme, aiming to improve the relationship among patients, families and the healthcare team. Considering the increase in the number of older adults in intensive care, it is essential to improve the training of health professionals to face challenges involving terminality of life.

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[1] Correspondence: Luciana Tiemi Kurogi – Rua Francisco Rocha, 1640, ap. 901, Bigorrilho CEP 80730-390. Curitiba/PR, Brasil.