Diretivas antecipadas de vontade e a sua execução no âmbito dos cuidados paliativos: estudo convergente-assistencial

Abstract

Aiming to preserve the values of altruism and commitment in care situations that involve fragility and vulnerability, the proposal of Palliative Care arises, which has the philosophy of valuing life and facing death as a natural process, without the patient ceasing to exercise his or her autonomy. It is from this perspective that the Advance Directives of Will emerge as an applicable tool that allows a person, duly informed, to refuse or not a certain type of treatment that in their value framework is (un)acceptable. The objective is to know how the patient care process takes place based on the applicability, manifestation, and execution of Advance Directives of Will in palliative care from the perspective of health professionals and to build a strategy that facilitates this action. This is a qualitative research of the convergent care research type in which seven professionals from the multidisciplinary team (doctor, nurse, nutritionist, speech therapist, occupational therapist, psychologist and social worker) from a Palliative Care Outpatient Clinic of a Hospital from the interior of Rio Grande do Sul. Non-participant observation techniques, semi-structured interviews and convergence groups were used as instruments for data collection. Data processing was carried out through discursive textual analysis, which occurred concomitantly with collection, from May to October 2022. Approval was obtained from the Ethics and Research Committee with human beings, according to opinion number 5402861. Regarding the results, three categories emerged: multidisciplinary approach in palliative care and actions in relation to advance directives, difficulties and facilities in the applicability of advance directives in the context of palliative care and discussion and development of strategies to enhance the approach and execution of advance directives in palliative care: convergent-assistance process. Subsequently, following the precepts of the PCA, the information of the categories was compiled, which subsidized the joint construction with health professionals, creating an instrument to facilitate the applicability of Advance Directives of Will in the context of palliative care. To this end, an educational infographic was organized for patients and another for health professionals. Finally, the findings made it possible to report the difficulties and facilities of the team in relation to the advance directives of will and to subsidize discussions and strategies for introducing the theme in routine consultations of the matrix team of Palliative Care. I also suggest that further research be carried out on the insertion of Advance Directives of Will in other health care settings.