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RESUMO Introdução: A garantia na oferta de cuidados paliativos (CP) a pacientes e seus familiares que enfrentam doenças graves e ameaçadoras da vida é uma responsabilidade ética dos sistemas de saúde, bem como dos profissionais. Diversas ações contribuem para a garantia na prestação desse tipo de cuidado, podendo-se destacar o ensino em CP para os profissionais de saúde. No Brasil, a inclusão do ensino de CP na graduação é exceção, tanto para o curso de Medicina como de Enfermagem. Objetivo: Este estudo teve como objetivos identificar quais são as competências paliativistas recomendadas para o ensino de CP nas graduações em Medicina e Enfermagem, e caracterizar as evidências das melhores práticas para o ensino de CP para graduandos desses cursos. Método: Trata-se de uma revisão integrativa de literatura, em que foram utilizarados os seguintes descritores: Medical student, Nursing student, education, learning, teaching e palliative care. A busca ocorreu, com o emprego do recurso booleano OR e AND, nas bases de dados eletrônicas Cumulative Index to Nursing and Allied Health Literature (CINAHL), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), PubMed, Scopus e Web of Science. Resultado: A estratégia de busca gerou 182 artigos potenciais para inclusão nesta revisão. Destes, 85 foram excluídos por não estarem dentro dos critérios de inclusão, e 13, por não estarem disponíveis para acesso na plataforma digital. Os artigos incluídos trouxeram aspectos das competências a serem desenvolvidas para prática de CP, estratégias de ensino e estrutura curricular. A maior parte dos estudos incluídos teve como enfoque as estratégias de ensino, com destaque para as metodologias ativas que têm por objetivo não apenas a transferência de conhecimento, mas também o desenvolvimento de habilidades e atitudes para oferta de um cuidado que visa ao alívio do sofrimento. Conclusão: A revisão integrativa de literatura desenvolvida permitiu identificar as competências a serem adquiridas ainda nas graduações em Medicina e Enfermagem para que os futuros profissionais possam ofertar CP primários, bem como as melhores estratégias de ensino utilizadas.
ABSTRACT Introduction: Ensuring the provision of Palliative Care (PC) to patients and their families who face serious and life-threatening diseases is an ethical responsibility of health systems and professionals. Several actions are listed to guarantee the provision of this type of care, with emphasis on the teaching of PC for health professionals. In Brazil, the inclusion of PC training in undergraduate courses is an exception, both for medicine and nursing courses. This study aims to identify which palliative competencies are recommended for the teaching of palliative care in undergraduate medicine and nursing, and characterize the best practices for the teaching of PC for undergraduates of these courses. Method: This is an integrative literature review, with the chosen descriptors being Medical Students, Nursing Students, Education, Learning, Teaching and Palliative Care. The search was performed using the Boolean resource OR and AND, in the electronic databases Cumulative Index to Nursing and Allied Health Literature (CINAHL), Latin American and Caribbean Literature in Health Sciences (LILACS), PubMed, Scopus and Web of Science. Results: The search strategy generated 182 potential articles for inclusion in the review. Of these, 85 were excluded due to failing to meet the inclusion criteria and 13 were excluded because they were not available for access on the digital platform. The articles included brought aspects of the competencies to be developed for the practice of PC, teaching strategies and curricular structure. Discussion: Most of the included studies focused on teaching strategies, especially active methodologies that aimed at not only knowledge transfer, but also the development of skills and attitudes to offer care that aims to alleviate suffering. Final Considerations: An integrative literature review allowed us to identify the competencies to be acquired during the medicine and nursing undergraduate courses so that future professionals can offer primary PC, as well as the best teaching strategies used.
RESUMO
OBJECTIVES: Evaluate patients with breast cancer undergoing chemotherapy with respect to their epidemiologic and clinical variables as well as performance at work or at home. METHODS: this was a cross-sectional study including 52 women interviewed during breast cancer chemotherapy, stratified in two groups: those who continued to work and do household tasks, and did not continue to work or do household tasks. Patients were from two public hospitals in the State of São Paulo, one in Santo Andre and the other in São Bernardo do Campo. The WPAI - GH (Work Productivity and Activity Impairment) questionnaire was used to evaluate work and household performance of professionals or housewives, respectively. RESULTS: Mean age of the patients was 55.7 (SD=13.8), most were Caucasian (88.5%), married (55.8%), employed (65.3%) and the majority had to stop working because of treatment (51.0%), at more advanced stage (p<0.05), fatigue and nausea (p<0.05). Mean WPAI - GH was 67.04 (|SD = 5.62) for patients who stopped working and 49.17 (SD = 6.89) for those who continued to work (Mann-Whitney U test: p = 0.04). CONCLUSION: Chemotherapy leads to a decrease in performance of a sizable fraction of women with breast cancer undergoing chemotherapy. A more advanced stage of neoplasia was positively associated with withdrawal from these activities probably due to side effects such as fatigue and nausea.
Assuntos
Absenteísmo , Neoplasias da Mama/tratamento farmacológico , Emprego/estatística & dados numéricos , Atividades Cotidianas , Antineoplásicos/efeitos adversos , Métodos Epidemiológicos , Fadiga/etiologia , Feminino , Humanos , Pessoa de Meia-Idade , Náusea/etiologiaRESUMO
OBJETIVOS: Analisar os aspectos epidemiológicos, clínicos, desempenho profissional e doméstico nas pacientes com câncer de mama em tratamento quimioterápico. MÉTODOS: O estudo foi transversal, com 52 mulheres entrevistadas, divididas em dois grupos: afastadas e não afastadas das atividades profissionais e domésticas, durante o tratamento com quimioterapia para câncer de mama. As pacientes foram provenientes de dois hospitais, um situado no município de Santo André e o outro no município de São Bernardo do Campo. Ambos são hospitais públicos de referência, que atendem a população de Santo André, São Bernardo do Campo, São Caetano do Sul, Diadema e Mauá, que são municípios vizinhos, pertencentes ao Estado de São Paulo, próximos da capital. Utilizou-se o questionário WPAI-GH (Work Productitity and Actitity Impairment) para avaliar a atividade profissional e/ou doméstica das pacientes. RESULTADOS: As pacientes tinham idade média de 55,7 anos (dp=13,8), a maior parte de etnia branca (88,5 por cento), casada (55,8 por cento), assalariada (65,3 por cento) e a maioria se afastou das atividades (51,0 por cento), com estadiamento da doença mais avançado (p<0,05), fadiga e náuseas (p<0,05). A média do WPAI - GH foi 67,04 (dp = 5,62) para as pacientes afastadas, e 49,17 (dp = 6,89) para as não afastadas do trabalho (teste U de Mann-Whitney: p = 0,04). CONCLUSÃO: A quimioterapia acarreta diminuição da capacidade produtiva em parte significativa das mulheres com câncer de mama. O estadiamento mais avançado da neoplasia associou-se positivamente com o afastamento das atividades diárias das pacientes, provavelmente decorrente dos efeitos colaterais provocados, como fadiga e náuseas.
OBJECTIVES: Evaluate patients with breast cancer undergoing chemotherapy with respect to their epidemiologic and clinical variables as well as performance at work or at home. METHODS: this was a cross-sectional study including 52 women interviewed during breast cancer chemotherapy, stratified in two groups: those who continued to work and do household tasks, and did not continue to work or do household tasks. Patients were from two public hospitals in the State of São Paulo, one in Santo Andre and the other in São Bernardo do Campo. The WPAI - GH (Work Productivity and Activity Impairment) questionnaire was used to evaluate work and household performance of professionals or housewives, respectively. RESULTS: Mean age of the patients was 55.7 (SD=13.8), most were Caucasian (88.5 percent), married (55.8 percent), employed (65.3 percent) and the majority had to stop working because of treatment (51.0 percent), at more advanced stage (p<0.05), fatigue and nausea (p<0.05). Mean WPAI - GH was 67.04 (SD = 5.62) for patients who stopped working and 49.17 (SD = 6.89) for those who continued to work (Mann-Whitney U test: p = 0.04). CONCLUSION: Chemotherapy leads to a decrease in performance of a sizable fraction of women with breast cancer undergoing chemotherapy. A more advanced stage of neoplasia was positively associated with withdrawal from these activities probably due to side effects such as fatigue and nausea.