Availability of palliative care Cancer services in Brazil

International Archives of Medicine, 2017

Background: Chronic non-communicable diseases (CNCD) constitute a health problem of growing magnitude in Brazil, leading concerns, to the Ministry of Health (MOH), about the care of persons with chronic conditions (due to advanced diseases), multiple harms to health, convalescents and in need of long-term care, requiring continuous assistance, physical and functional rehabilitation. However, few data exist on the size of the population potentially in need of palliative care in Brazil. Aim: this study is to estimate the size of the Brazilian population that could benefit from palliative care across 26 federated states and the Federal District. Design: this is a cross-sectional study, using national death certificate and hospital admission data. Brazilian death registration and hospital admission data from 1st of January to 31st of December 2014 were analyzed and compared with estimation methods of Rosenwax and Murtagh. Setting/participants: all adults (≥ 15 years old) who died in the...

Cadernos de Saúde Pública

In 2022, an important international report was published on the “value of death” not only in the field of health, but in relation to human societies in general. This report proposed to reimagine systems related to end of life in which death is understood not only as a physiological event but also as a relational and spiritual phenomenon with a value of its own and inseparable from life. It identifies the low priority given by most governments worldwide to the issue of alleviating suffering and supporting bereavement, evidenced by the low investment in palliative care. At the same time, we are witnessing in Brazil changes that threaten the feasibility of palliative care policies in primary health care. The denial of finitude within health systems is reflected in global indicators such as the quality of death index of The Economist magazine, in which Brazil ranks 42nd, the global atlas of palliative care of the World Hospice and Palliative Care Alliance, where Brazil is in level 3b, a...

Journal of Palliative Care & Medicine, 2016

Background: Cancer figures among the leading causes of morbidity and mortality in Brazil, with approximately 576,000 new cases and around 200,000 cancer-related deaths in 2013. According to the Brazilian National Oncological Policy, cancer control must include health promotion, prevention, diagnosis, treatment, rehabilitation, and palliative care, following the Brazilian Health System (SUS) guiding principles of Universality, Equity, and Integrality of health care. Aims: 1) Outline the hospital admissions of patients for the treatment of clinical cancer intercurrences in the Brazilian Health System (SUS) between 2008-2013; 2) Estimate the number of cancer patients with palliative care needs. Methods: Quantitative methods were employed, through the analysis of descriptive, exploratory, retrospective, and observational studies of hospitalized cancer patients. Data was collected from the Hospital Information System of Brazilian Health System (SIH/SUS) in the database of the Health Information Department (DATASUS). Results: Between 2008 and 2013, there were almost 4 million hospitalizations (3,701,409) of patients with cancer in Brazil. Of all the hospital admissions of cancer patients, 978,322 (26.4%) were related to clinical intercurrences (complications) of the disease and/or for treatment. In the same period, approximately 7 million deaths were reported to the Brazilian Mortality Information System (SIM), 15.9% (1,091,837) of cancer. The average rate of hospital mortality of clinical cancer intercurrences was three times (21.4%) higher than the mortality of patients admitted for treatment of clinical cancer in general (7.7%). The hospital length of stay (LOS) of general cancer patients was 5.7 days against 7.9 days of clinical cancer intercurrence patients. It was verified that approximately 90% of those admissions registered in the procedure "Treatment of Clinical Intercurrences of Cancer Patient" in Brazil were related to palliative care of terminally ill patients. Conclusion: The analysis of the morbidity and mortality profile of cancer patients suggests that palliative care services should be considered as criteria for the treatment of clinical cancer intercurrences. Further study of the hospital procedure "Treatment of clinical complications of cancer patient" should be considered as a parameter for scaling palliative care services in Brazil.

Current opinion in supportive and palliative care, 2013

Current Opinion in Supportive and Palliative Care, 2013

VITTALLE - Revista de Ciências da Saúde

RESUMO No Brasil, os cuidados paliativos têm mostrado um crescimento significativo pela consolidação dos serviços estabelecidos anteriormente, fundação de centros especializados e desenvolvimento do tema nas universidades. Desta forma, este trabalho tem como objetivo avaliar a formação de cursos de bacharel em enfermagem, farmácia e medicina e a compreensão dos alunos sobre cuidados paliativos. Trata-se de um estudo transversal, utilizando-se análise descritiva e exploratória dos cursos e uma pesquisa composta por 30 questões nominais para avaliar as percepções dos estudantes de saúde sobre estarem preparados para lidar com esses pacientes. Os cuidados paliativos são pouco abordados nos cursos de saúde, principalmente nos currículos de farmácia quando comparados a outros cursos. O conhecimento dos alunos sobre cuidados paliativos e tratamento da dor foi notoriamente baixo, além do despreparo para lidar com o sofrimento e a morte. Apenas 20,54% dos alunos se sentiram preparados para ...

2020

Background: An integrated care network between emergency, specialized and primary care services can prevent repeated hospitalizations and the institutionalized death of terminally ill patients in palliative care (PC). To identify the perception of professionals in a pre-hospital care (PHC) service about the outcomes of the assistance provided to patients eligible for PC. Methods: Study with a qualitative approach, of interpretative nature, based on the perspective of Ricouer's Dialectical Hermeneutics. Results: Three central themes emerged out of the professionals' speeches: (1) unpreparedness of the team, (2) decision making, and (3) dysthanasia. Conclusions: It is necessary to invest in professional training associated with PC in the home context and its peculiarities, adopt a specific policy for PC that involves all levels of care, including PHC, and adopt a unified information system, as well as more effective procedures that favor the respect for the patients' will,...

Revista Bioética

Palliative care is a multidisciplinary health care model that seeks to provide comfort to patients with life-threatening or severe and terminal illness. Palliative medicine has only recently been recognized in Brazil, and it is essential that physicians working in this area develop their knowledge. Thus, to improve training models in palliative care and in medical education in Brazil, we must understand the characteristics of this professional, identifying sociodemographic profile, professional training, and work activity. This is a cross-sectional, descriptive, and exploratory study, with a quantitative approach. Data were collected from a national survey conducted by means of questionnaires applied to palliative care physicians in Brazil.

Journal of Pain and Symptom Management, 2007

Many Latin American and Caribbean national health systems mainly focus on disease prevention, prenatal assistance, undernourishment, etc. They still do not have the conditions for developing palliative care (PC). In general, quality of life during the dying process is poor, with fragmented assistance, uncontrolled suffering, poor communication between professionals, patients, and families, and a great burden on family caregivers. The development of PC in the region started around 1981, but it is still not available to an acceptable number of patients.

Journal of Pain and Symptom Management, 2007

The Pain Management and Palliative Care Service in the Department of Anesthesia at Botucatu Medical School, UNESP is a pioneer in Brazil. Based on an interdisciplinary team that provides specialized inpatient, ambulatory outpatient, and home care to patients in Botucatu and the surrounding region, the service is also able to provide extensive educational opportunities in pain management and palliative care for medical students, anesthesia residents, practicing anesthetists, and nurses. J Pain Symptom Manage 2007;33:651e654. Ó

Journal of Palliative Medicine

The Latin American Association for Palliative Care (ALCP) developed 10 indicators to monitor the development of palliative care. The indicators have been applied across Latin American countries, but have not been used internally. The aims of this study were to document the development of palliative care in Argentina at the national and provincial levels by using a selection of the indicators developed by the ALCP and identify the difficulties and needs of healthcare professionals working in palliative care. This is the first study to apply the indicators intra-nationally. Design: This was a cross-sectional pilot study based on two questionnaires with representatives from each province, one workshop, and telephone conversations to corroborate the collected data. These data were used to calculate a preselection of eight ALCP indicators covering four main areas of development: education, policy, service delivery, and medication. Subjects: A total of 30 participants took part in the study. The application of the ALCP indicators at the province level led to the identification of inequalities in the development and distribution of services across the country. The provinces in the north-west were identified as the region with the greatest need for development. The main difficulties for healthcare professionals were lack of national service registries, certified palliative care specialties, and opportunities for continuous training.

Journal of Pain and Symptom Management, 2007

The Regional Palliative Care Program in Extremadura (RPCPEx) was created and fully integrated into the Public Health Care System in 2002. The local health care authorities of Extremadura (a large sparsely populated region in the west of Spain with 1,083,897 inhabitants) decided to guarantee palliative care as a basic right, offering maximum coverage, availability, and equity, functioning at all levels of assistance and based on the complexity of the case. The program provides full coverage of the region through a network of eight Palliative Care Teams under the direction of a regional coordinator. The mobile teams work in acute hospitals and in the community. This paper describes the program, using qualitative and quantitative indicators of structure, process, and outcome. Qualitative indicators assess, among others, the performance of the regional network, including the outcomes of the quality, training, registry, treatment, and research groups. Quantitative indicators applied consisted of the number of professionals (1/26,436 inhabitants), number of patients (1,635/million inhabitants/year), number of activities/million inhabitants/year (6,183 hospital and 3,869 home visits; 1,863 consultations; 14,748 advising services; 11,539 coordination meetings; and 483 educational meetings), cost of care (V2,242,000 per year), and opioid consumption (494,654 daily defined doses/year). Four years after the planning process and three years after becoming operational, the RPCPEx offers an effective and efficient model integrated into the public health care system and is able to offer comprehensive coverage, availability, equity and networking among all the structures and levels of the program. Several structural and organizational tools were developed, which may be adopted by other programs within the scope of public health. The provision of palliative care should not be conditioned by the patient's geographical location, his or her condition or disease or on the ability to pay, but on need alone. This model has successfully implemented palliative care in a region that offered many challenges, including limited resources and a disperse population in a geographically extensive region. These variables are also common in many rural areas in developing countries and the regional palliative care program offers a flexible approach that can be adapted to the needs and Address reprint requests to: Emilio Herrera, MD, Servicio Extremeño de Salud,

Journal of Global Oncology, 2016

Cancer has become a global pandemic with disproportionately higher mortality rates in low- and middle- income countries, where a large fraction of patients present in advanced stages and in need of end-of-life care. Globally, the number of adults needing end-of-life care is greater than 19 million, and up to 78% of these patients are living in low- and middle- income countries. In the Americas alone, more than one million people are in need of end-of-life care, placing an enormous burden on local health systems, which are often unprepared to meet the challenge presented by this complex patient population. In Latin America, cancer care is characterized by the presence of vast inequalities between and within countries, and the provision of end-of-life care is no exception. Disparities in access to advanced care planning, with a lack of provision of adequate palliative care and pain medication, are common in the region. These shortcomings are related in large part to inadequate or inap...

Techniques in Regional Anesthesia and Pain Management, 2013

Revista Brasileira de Medicina de Família e Comunidade, 2017

Objetivo: Apresentar o processo de identificação de pacientes de cuidados paliativos em uma equipe de Estratégia de Saúde da Família no Brasil. Métodos: O processo de identificação ocorreu 1) utilizando o sistema de trabalho de uma Equipe de Estratégia de Saúde da Família e os princípios da atenção primária e 2) aplicando o SPICT, uma ferramenta para ajudar a identificar pacientes que poderiam se beneficiar com cuidados paliativos. Resultados: Vinte e três pacientes foram inscritos no programa de cuidados paliativos no início do projeto. Ao final do período de 12 meses, identificamos 38 pacientes. Seis pacientes morreram durante o período. Assim, durante 2015, 38 pessoas foram identificadas com necessidades paliativas de uma população total de 3.000 (1,2% da população de prática). Destes, 58% (n=22) foram mulheres, 63% (n=24) com mais de 65 anos, 74,7% (n=28) relataram etnia branca. Os diagnósticos principais mais frequentes foram câncer (39,5%), doença psiquiátrica (18,4%), doença ...