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A utilização da pergunta da dignidade em doentes com necessidades paliativas seguidos em cuidados de saúde primários : um estudo piloto
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Abstract(s)
Enquadramento teórico: A Pergunta da Dignidade (PD) é uma ferramenta clínica desenvolvida com o intuito de reforçar o sentido de dignidade e personhood, promovendo a prestação de cuidados centrados na pessoa doente e não nas suas doenças. Após responderem à PD, é criado um resumo com a informação fornecida por cada doente, podendo depois este ser incluído no seu processo clínico. Objectivos: Este estudo tem como objectivo primário estudar a aceitação e viabilidade da PD em doentes com necessidades paliativas identificadas, seguidos em Cuidados de Saúde Primários (CSP), utilizando um questionário de feedback pós-PD; e como objectivos secundários avaliar o sentido de dignidade dos doentes e averiguar se a resposta à PD modifica o seu sentido de dignidade, utilizando a Escala da Dignidade (EDig). Desenho de estudo: Trata-se de um estudo piloto quantitativo, exploratório, transversal, observacional e descritivo. Amostra: Amostra não probabilística e de conveniência, constituída por 20 doentes com necessidades paliativas identificadas, pertencentes à Unidade de Saúde Familiar Travessa da Saúde - ACeS Loures Odivelas. Materiais e Métodos: No primeiro momento de investigação (T1) aplicou-se a PD e a EDig. Na segunda entrevista (T3) - realizada no período máximo de 15 dias após T1-, procedeu-se à apresentação do resumo final resultante da PD (criado em T2), aplicando-se novamente a EDig e, por fim, o questionário de feedback pós-PD (cada item avaliado através de escala do tipo de Likert de 1 “discordo completamente” a 7 “concordo completamente”). O score total e as diferenças entre cada pergunta da EDig foram calculadas, entre o T1 e T3. Resultados: Foram incluídos 20 participantes, 75% dos quais eram do sexo masculino; a idade média foi de 70 anos (intervalo 56-91 anos). Os pacientes entrevistados consideraram o resumo preciso, claro e completo. Todos os participantes recomendariam a PD a outros doentes e gostariam que fosse disponibilizado o resumo no seu processo clínico. Os participantes sentiram que o resumo da PD aumentava o seu sentido de dignidade (6,4; DP=0,68) e consideraram importante que o seu Médico de Família e Enfermeiro de Família tivessem acesso a esta informação (6,4; DP=0,99) e que esta poderia afetar o modo como os profissionais de saúde os veêm e cuidam. (6,9; DP=0,31), conhecendo os seus valores de vida (6,9; DP=0,37), preocupações e preferências (7,0; DP=0,22) e principais áreas de sofrimento (6,5; DP=0,69). A PD levou em média sete minutos a ser respondida e o resumo dez minutos a ser elaborado. A amostra apresentava um intacto sentido de dignidade já que, em T1, a soma (DP) do score total da EDig foi de 59,7 (13,719), sendo que apenas valores ≥75 nesta escala são representativos de sofrimento global relacionado com o sentido de dignidade. Conclusões: Os resultados mostram que a PD é bem aceite e viável para ser usada em pacientes com necessidades paliativas no contexto de CSP e parece ser uma ferramenta promissora a ser implementada. A PD pode melhorar a relação médico/doente, permitindo uma nova prespectiva de como os profissionais de saúde compreendem e lidam com a pessoa doente no contexto clinico.
Background: The Patient Dignity Question (PDQ) is a clinical tool developed with the aim of probing personhood, reinforcing dignity and enabling health care providers (HCPs) to see patients as people and not solely based on their illness. After answering the PDQ, a summary of the information provided by the patient is created and can be included in his clinical file. Objectives: We sought to study the acceptability and feasibility of the Portuguese version of the PDQ (PDQ-PT) in a sample of palliative care patients cared for in primary care (PC). As a secondary objective, we aimed to evaluate the patients’ sense of dignity and whether the PDQ-PT modifies it, using the Patient Dignity Inventory (PDI). Design: A cross-sectional pilot study. Setting/Subjects: A convenience sample of 20 patients with palliative care needs and cared for in the Primary Care setting, in Unidade de Saúde Familiar Travessa da Saúde - ACeS Loures Odivelas. Measurements: In the first interview (T1) the PDQ-PT and the PDI were used. In the second interview, a maximum of 15 days after the first, the final result of PDQ-PT was presented, the PDI was again applied and, finally, the post-PD feedback questionnaire. (each item rated using a Likerttype scale from 1 “strongly disagree” to 7 “strongly agree”). Differences between each PDI questions and the total PDI score were calculated, between baseline and the end of the study. Results: Twenty participants were included, 75% were male; the average age was 70 years old (range 56-91years). Patients found the summary accurate, precise and complete; all said they would recommend the PDQ to others and want a copy of the summary placed on their family physician´s medical chart. They felt the summary heightened their sense of dignity (6,4; SD=0,68), considered it important that HCPs have access to the summary (6,4; SD=0,99) and indicated that this information could affect the way HCPs see and care for them (6,9; DP=0,31), knowing their values (6.9; SD = 0.37), concerns and preferences (7.0; SD = 0.22) and main areas of suffering (6.5; SD = 0.69). The PDQ-PT´s took seven minutes on average to answer, and ten minutes to complete the summary. The sample had an intact sense of dignity since, at T1, the sum (SD) of the total EDig score was 59.7 (13.719), and only values ≥75 on this scale are representative of overall sense of dignity related suffering. Conclusion: Our results show that the PDQ-PT is well accepted and feasible to use with palliative patients in the context of PC and seems to be a promising tool to be implemented. The PDQ-PT may enhance patient/doctor relationships, allowing a new perspective on how professionals perceive and respond to personhood within the clinical setting.
Background: The Patient Dignity Question (PDQ) is a clinical tool developed with the aim of probing personhood, reinforcing dignity and enabling health care providers (HCPs) to see patients as people and not solely based on their illness. After answering the PDQ, a summary of the information provided by the patient is created and can be included in his clinical file. Objectives: We sought to study the acceptability and feasibility of the Portuguese version of the PDQ (PDQ-PT) in a sample of palliative care patients cared for in primary care (PC). As a secondary objective, we aimed to evaluate the patients’ sense of dignity and whether the PDQ-PT modifies it, using the Patient Dignity Inventory (PDI). Design: A cross-sectional pilot study. Setting/Subjects: A convenience sample of 20 patients with palliative care needs and cared for in the Primary Care setting, in Unidade de Saúde Familiar Travessa da Saúde - ACeS Loures Odivelas. Measurements: In the first interview (T1) the PDQ-PT and the PDI were used. In the second interview, a maximum of 15 days after the first, the final result of PDQ-PT was presented, the PDI was again applied and, finally, the post-PD feedback questionnaire. (each item rated using a Likerttype scale from 1 “strongly disagree” to 7 “strongly agree”). Differences between each PDI questions and the total PDI score were calculated, between baseline and the end of the study. Results: Twenty participants were included, 75% were male; the average age was 70 years old (range 56-91years). Patients found the summary accurate, precise and complete; all said they would recommend the PDQ to others and want a copy of the summary placed on their family physician´s medical chart. They felt the summary heightened their sense of dignity (6,4; SD=0,68), considered it important that HCPs have access to the summary (6,4; SD=0,99) and indicated that this information could affect the way HCPs see and care for them (6,9; DP=0,31), knowing their values (6.9; SD = 0.37), concerns and preferences (7.0; SD = 0.22) and main areas of suffering (6.5; SD = 0.69). The PDQ-PT´s took seven minutes on average to answer, and ten minutes to complete the summary. The sample had an intact sense of dignity since, at T1, the sum (SD) of the total EDig score was 59.7 (13.719), and only values ≥75 on this scale are representative of overall sense of dignity related suffering. Conclusion: Our results show that the PDQ-PT is well accepted and feasible to use with palliative patients in the context of PC and seems to be a promising tool to be implemented. The PDQ-PT may enhance patient/doctor relationships, allowing a new perspective on how professionals perceive and respond to personhood within the clinical setting.
Description
Tese de mestrado, Cuidados Paliativos, Universidade de Lisboa, Faculdade de Medicina, 2020
Keywords
Dignidade Personhood Pergunta da dignidade Cuidados paliativos Cuidados de saúde primário Teses de mestrado - 2020