Palliative Care

O que é e o que não é Cuidado Paliativo

1. Cuidado paliativo é um tratamento multiprofissional, uma abordagem de cuidados que visa a melhoria da qualidade de vida de pessoas com doenças graves. Disso resulta que não existem pacientes paliativos, assim como não existem pacientes diálises, ou mesmo pacientes quimioterapias. Cuidado Paliativo, diálise ou quimioterapia são tratamentos, e não diagnósticos. Todos os pacientes com doenças graves podem se beneficiar dessa abordagem de cuidados. Pacientes com doenças cardíacas, oncológicas, pulmonares, neurológicas, AIDS, diabetes, síndromes das mais diversas e outras condições médicas podem se beneficiar desse tratamento, estejam ou não lidando com o fim de suas vidas.

2. Cuidado Paliativo não é um diagnóstico médico, nem uma fase da doença, mas uma abordagem de cuidados, e portanto um tratamento, o que inclui uma série de medidas específicas, um conjunto de dimensões a serem precisamente avaliadas e um conjunto de ações a serem implementadas, por vezes bastante complexas, se considerarmos algumas condições igualmente complexas. Disso tudo resulta que uma pessoa pode ter uma doença absolutamente avançada, incurável, gravíssima, e ainda assim não estar recebendo nenhum Cuidado Paliativo. Cuidado Paliativo pode ser oferecido inclusive no curso do tratamento curativo de uma doença potencialmente curável, e auxiliar o paciente e sua família a terem seus sofrimentos administrados e cuidados por uma equipe multiprofissional, mesmo que o desfecho dessa história seja a cura.

3. Cuidado Paliativo não é uma possível última alternativa para a vida de alguém, e não significa morte certa. Cuidado Paliativo não significa retirar tratamentos médicos, nem negar às pessoas o melhor que a medicina e as demais ciências da saúde podem lhe oferecer, mas ajudar a pensar em tratamentos hierarquizados e proporcionais entre os benefícios a ser buscados e os malefícios a serem evitados em cada fase da doença.

4. Cuidado Paliativo não é um conjunto de técnicas e procedimentos exclusivos de uma única categoria profissional, e portanto envolvem vários atores no cenário das ciências da saúde e da vida. Cuidado Paliativo de qualidade se faz em equipe multiprofissional, com profissionais treinados na filosofia e na boa prática da paliação.

5. Cuidado Paliativo não deve ser entendido como algo para as pessoas ricas, mas um direito humano como outro qualquer, já que todos devem ter acesso a alívio para os sofrimentos (por vezes muito intensos) gerados por graves condições de saúde. Cuidado Paliativo significa busca para uma vida digna e de melhor qualidade, mesmo diante do fim da vida. Cuidado Paliativo é um exercício de cidadania.

1. What are Palliative Care?

A multidimensional care (in the physical, emotional, family, social and spiritual dimensions) developed and offered by qualified professionals working as a team to provide care for a person suffering with a disease that threatens the continuity of life. Palliative care can be offered from the time of diagnosis until the moment of death, completing with the mourning support offered to family and friends. In this work, all diagnostic and therapeutic resources available are used as a broad support to the quality of life of the patient and family so that they can live this difficult moment with comfort, value and meaning. All the work developed by the team aims to relieve and prevent suffering involved in the evolution of illness, which includes looking at the process of dying and saying goodbye as well as living life to the fullest. A work and wisdom that complement each other so that the patient feels he/she matters until the end.

Article by Ana Claudia Quintana Arantes

According to the World Health Organization, Palliative Care is the comprehensive care offered to patients and family members when faced with a serious illness that threatens the continuity of life. The aim of Palliative Care is to offer effective treatment for the symptoms of discomfort that can accompany the patient, whether caused by the disease or the treatment. (WHO, 2017)

 

2. Who is the patient who benefits from Palliative Care?

All patients who have serious diseases that threaten the continuity of life and experience symptoms of suffering benefit from the assistance of a Palliative Care team. AS mentioned above, this type of care can be offered from the diagnosis of the disease, through all treatments that seek a cure or disease control, as well as the care intensely needed in human finitude. All diseases with this severity profile fit here, not just cancer!

 

3. How does Palliative Care work?

Palliative Care acts on the needs of the patient and his family, committing to assess and treat physical symptoms of discomfort, such as pain, fatigue, tiredness, shortness of breath and others that can cause suffering and worsen the quality of life. While treating the symptoms of the physical dimension, it is oriented towards assessing and caring for the emotional, social, family and spiritual needs of the patient and his family, respecting their values ​​and beliefs.

In the case of Comprehensive Care, we must always count on a team of health professionals who are trained and qualified in treating symptoms of discomfort related to the dimensions of the human being, which are described as: physical, emotional, social, family and spiritual.

The professionals that make up the team are those who control the symptoms of the body – physical dimension – (all health professionals can help with this control!), Of the mind – emotional dimension – (psychologist, psychotherapist, psychoanalyst, psychiatrist), of the spirit – spiritual dimension – (priest, pastor, rabbi, guru, priests of different religious beliefs professed by patients) and the social and family dimension (social worker, volunteer, psychologist).

The curative and palliative treatments are complementary to each other, because with a better control of symptoms the patient and his family can go through the time of curative treatments more effectively, even if these treatments are more aggressive. What happens in general is that as the disease progresses, there is a greater need for palliative care; it is possible that, at some point in the evolution of the underlying disease, the priority of care aims exclusively at comfort and quality of life.

 

The principles of palliative care are:

1. Respect the dignity and autonomy of patients.

2. Honor the patient’s right to choose between treatments, including those that may or may not prolong life.

3. Communicate clearly and carefully with patients, their families and their caregivers.

4. Identify the main objectives of health care from the patient’s point of view.

5. Provide impeccable control of pain and other symptoms of physical suffering.

6. Recognize, evaluate, discuss and offer access to services for psychological, social and spiritual issues.

7. Provide access to therapeutic support, covering the spectrum of life through end-of-life treatments that provide an improvement in the quality of life perceived by the patient, his family and his caregivers.

8. Organize care in order to promote the continuity of care offered to the patient and his family, whether this care is performed in the hospital, in the office, at home or in another health institution.

9. Maintain an attitude of educational support to all those involved in direct patient care.