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Estudo do regime das diretivas antecipadas de vontade em Portugal na ótica dos profissionais de saúde
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RESUMO - Introdução: Os métodos utilizados para cuidar de um utente em fim de vida têm-se vindo a modificar ao longo tempo. Atualmente, com o avanço tecnológico da medicina e dos meios terapêuticos o doente é encaminhado para o hospital, rodeado por alta tecnologia e distanciado do profissional de saúde. Perante o avanço científico e tecnológico no âmbito da saúde é verificada uma maior possibilidade de interferência nos processos de morte, prolongando muitas vezes tratamentos considerados fúteis e sem benefícios para a pessoa em fase terminal de vida.
Nas situações clínicas em que não existem expectativas de recuperação perante a doença diagnosticada, o doente pode assegurar que a sua vontade é respeitada, com recurso às Diretivas Antecipadas de Vontade (DAV) redigidas antecipadamente aquele momento, e recusar cuidados de saúde inúteis ou desproporcionados. A elaboração do Testamento Vital (TV) permite ao utente manifestar a sua vontade acerca dos procedimentos terapêuticos a receber ou não em fim de vida. Os profissionais de saúde são parte fundamental da aplicação do regime das DAV e estão envolvidos em todo o processo de planeamento, conceção e cumprimento das DAV.
Visando perceber a perspetiva dos profissionais de saúde, nomeadamente médicos e enfermeiros, relativamente ao regime que assegura a vontade do doente em fim de vida, colocou-se a questão de investigação: “Qual a perspetiva dos profissionais de saúde relativamente ao Regime das Diretivas Antecipadas de Vontade em Portugal?”. A fim de responder à questão colocada, justificou-se a realização deste estudo.
Objetivo Geral: Análise dos conhecimentos, atitudes, experiências e opiniões dos médicos e enfermeiros acerca do regime das DAV em Portugal.
Metodologia: método qualitativo; população: médicos e enfermeiros do CHLC, EPE; método de colheita de dados: questionário de autopreenchimento com resposta semi-aberta, estruturado por 14 perguntas, divididas por 10 categorias.
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Resultados: Os profissionais de saúde apresentam distintas opiniões acerca da temática de fim de vida, diferenças essas verificadas também no nível de conhecimento que cada profissional dispõe e nas experiências que tenham vivido ou não nesta área. Destacam como necessidades: existência de equipas/ unidades multidisciplinares para discutir o tema; maior trabalho em conjunto da equipa clínica; apoio psicológico/direito à objeção de consciência; formação acerca do regime das DAV; existência de recursos adequados nos serviços hospitalares; desenvolvimento dos procedimentos de validação de existência das DAV; uniformização dos cuidados de acordo com o desejo do utente e maior disponibilidade para alargar conhecimento e alterar métodos clínicos com base no novo regime. É necessário informar o doente antes da redação das DAV e comunicar com a família do mesmo após se verificar que o doente redigiu as mesmas. É importante integrar e apoiar os cidadãos na tomada de decisão, de forma a facilitar o trabalho dos profissionais de saúde, pois o regime das DAV desenvolve estratégias de educação para saúde.
Conclusão: De forma a respeitar a vontade manifestada do utente para procedimentos em fim de vida, é necessário conceder toda a informação à população e toda a formação necessária aos profissionais de saúde. A divulgação, adequação e cumprimento do regime das DAV são responsabilidades de todas instituições e organizações na área da saúde. Um panorama ideal seria aquele onde a maioria dos profissionais de saúde tivessem informações claras e completas das DAV, que as transmitissem aos utentes, assim como as instituições e a comunicação social. Adicionalmente, seria ideal também que os utentes registassem as suas DAV e que os profissionais de saúde verificassem a existência ou não destas diretivas, quando confrontados com uma situação de fim de vida onde o utente não consiga expressar a sua vontade.
ABSTRACT - Introduction: The methods used to nurse terminal patients have been changing over time. Currently, with the technological progress of medicine and therapeutic means the patient is submitted to the hospital being surrounded by high technology and is estranged from the healthcare professionals. In face of the scientific and technological progress in healthcare, there is a higher range of possibilities when interfering with the dying process, often prolonging treatments which are trivial and bring no benefits for terminal patients. When expectation of recovery from the diagnosed illness is nonexistent, the patient can ensure that his wish is respected, using the DAV which are drafted in advance, and refuse unnecessary or disproportionate treatments. The preparations of TV allows the patient to show his will regarding which treatments he sees fit to receive at the end-of-life. Healthcare professionals are a fundamental part of the implementation of the VAS system, being involved at the whole process of planning, designing and enforcement of DAV. In order to perceive the perspective of healthcare professionals, namely doctors and nurses, regarding the system that ensures patient's will in terminal conditions, we posed the question: "What is the perspective of healthcare professionals regarding the DAV in Portugal?". The search for a proper answer to this question resulted on the study hereby presented. General Objective: Analysis of the knowledge, conduct, experiences and opinions of doctors and nurses on the DAV system in Portugal. Methodology: qualitative method; population: doctors and nurses from CHLC, EPE; data collection method: self-answer questionnaire divided into 10 categories with a total of 14 open answer questions. Results: Healthcare professionals exhibit different opinions about the end-of-life matter, which are also verified in the level of knowledge that each professional has and in the experiences that have lived or not in this area. They emphasize as needs: existence of multidisciplinary teams/units to discuss the matter; greater joint work of the clinical team; psychological support/right to V conscientious objection; proper training about the DAV system; adequate resources in hospital services; development of procedure validation of DAV’s existence; standardization of care according to patient wishes and greater willingness to achieve a broader knowledge and change clinical methods based upon it and accordingly to the new system. It is essential to inform the patient before the DAV is drafted and maintain communication with the family after the patient writes them. It is highly important to integrate and support citizens with the decision making process in order to facilitate the work of healthcare professionals, as the DAV system develops health education strategies. Conclusion: In order to respect patients’ expressed wishes of end-of-life procedures it is necessary to concede all the available information to the population, as well as the required training for healthcare professionals. It is of the responsibility of all health institutions and organizations to disclosure, adapt and compliant with the DAV system. An ideal scenario would be where most healthcare professionals would have clear and complete information on the DAVs, which would be transmitted to patients, as well as institutions and the media. Additionally, those patients are able to register their DAVs and healthcare professionals examine the existence of these directives when confronted with an end-of-life situation where the patent is unable to express his will.
ABSTRACT - Introduction: The methods used to nurse terminal patients have been changing over time. Currently, with the technological progress of medicine and therapeutic means the patient is submitted to the hospital being surrounded by high technology and is estranged from the healthcare professionals. In face of the scientific and technological progress in healthcare, there is a higher range of possibilities when interfering with the dying process, often prolonging treatments which are trivial and bring no benefits for terminal patients. When expectation of recovery from the diagnosed illness is nonexistent, the patient can ensure that his wish is respected, using the DAV which are drafted in advance, and refuse unnecessary or disproportionate treatments. The preparations of TV allows the patient to show his will regarding which treatments he sees fit to receive at the end-of-life. Healthcare professionals are a fundamental part of the implementation of the VAS system, being involved at the whole process of planning, designing and enforcement of DAV. In order to perceive the perspective of healthcare professionals, namely doctors and nurses, regarding the system that ensures patient's will in terminal conditions, we posed the question: "What is the perspective of healthcare professionals regarding the DAV in Portugal?". The search for a proper answer to this question resulted on the study hereby presented. General Objective: Analysis of the knowledge, conduct, experiences and opinions of doctors and nurses on the DAV system in Portugal. Methodology: qualitative method; population: doctors and nurses from CHLC, EPE; data collection method: self-answer questionnaire divided into 10 categories with a total of 14 open answer questions. Results: Healthcare professionals exhibit different opinions about the end-of-life matter, which are also verified in the level of knowledge that each professional has and in the experiences that have lived or not in this area. They emphasize as needs: existence of multidisciplinary teams/units to discuss the matter; greater joint work of the clinical team; psychological support/right to V conscientious objection; proper training about the DAV system; adequate resources in hospital services; development of procedure validation of DAV’s existence; standardization of care according to patient wishes and greater willingness to achieve a broader knowledge and change clinical methods based upon it and accordingly to the new system. It is essential to inform the patient before the DAV is drafted and maintain communication with the family after the patient writes them. It is highly important to integrate and support citizens with the decision making process in order to facilitate the work of healthcare professionals, as the DAV system develops health education strategies. Conclusion: In order to respect patients’ expressed wishes of end-of-life procedures it is necessary to concede all the available information to the population, as well as the required training for healthcare professionals. It is of the responsibility of all health institutions and organizations to disclosure, adapt and compliant with the DAV system. An ideal scenario would be where most healthcare professionals would have clear and complete information on the DAVs, which would be transmitted to patients, as well as institutions and the media. Additionally, those patients are able to register their DAVs and healthcare professionals examine the existence of these directives when confronted with an end-of-life situation where the patent is unable to express his will.
Descrição
Palavras-chave
Diretivas Antecipadas de Vontade Testamento Vital Procurador de Cuidados de Saúde Autonomia Profissionais de Saúde Direito Ética Directives Will Testament Attorney RENTEV Doctors Nurses Disease Death Law Ethic