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 health professionals regarding the concept of PC and their care experiences with this type of patient in a pre-hospital care (PHC) service in Brazil. Methods Study with a qualitative approach, of interpretative nature, based on the perspective of Ricoeur’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 principles, such as: affirming life and considering death as a normal process not rushing or postponing death; integrating the psychological and spiritual aspects of patient and family care, including grief counseling and improved quality of life, adopting 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, without generating dissatisfaction to the team and the family.

Objetivo: Refletir acerca da efetivação do princípio da participação e controle social no contexto dos cuidados paliativos. Métodos: Reflexão teórica, fundamentada no princípio organizativo da ‘participação popular’, à luz da Lei n° 8142 de 1990, que dispõe sobre a atuação da comunidade na gestão do Sistema Único de Saúde (SUS) brasileiro e em publicações nacionais e internacionais na temática. Resultados: Experiências referentes à presença popular, na formulação e gestão de políticas de saúde, para os cuidados paliativos nos países, são escassas. O envolvimento social em cuidados paliativos ocorre de forma limitada, em diferentes contextos, contemplando-se condições específicas, tais como avaliação da qualidade dos serviços, acesso a fármacos e decisões envolvendo terminalidade. No Brasil, a inserção dos cuidados paliativos, nas políticas públicas de saúde, é recente, porém deve contemplar os princípios estabelecidos pelo SUS. Acredita-se que o envolvimento popular proporcione ao paciente em cuidados paliativos e seus familiares voz ativa e autonomia e maior controle nas políticas públicas. Conclusão: Torna-se relevante o aprofundamento da discussão acerca da participação e controle social voltados a pacientes em CP e seus familiares, no âmbito da formulação e gestão de políticas públicas, para esses cuidados no Brasil e do papel da enfermagem no fortalecimento desse direito.

Brazil is a country with great diversity and distinct realities, so there is a proportional challenge and complexity in offering a unified and integrated system which is accessible, of quality, and effective. Population aging and the increased incidence of chronic-degenerative noncommunicable diseases (NCDs) increase the need for palliative care (PC); however, public policies still need to be implemented so that this care encompasses adequate funding, professional training, and guaranteed medication. The first national policy for PC was recently proposed, providing guidelines for the organization of PC, emphasizing the importance of integration between the different levels of care and services in the Brazilian health system (SUS). Nevertheless, the challenges of this policy include the training of professionals, communication in the network, the absence of integrated health information systems, and effective mechanisms to finance this new modality of care.All this complexity includes social plurality, more than one level of multidisciplinary and multiprofessional care, which receives resources from various sources and presents structural and technological inequality [4].The organization of health has isolated levels that do not communicate with each other. Primary healthcare (PHC) is not related to secondary care, and none of them are related to tertiary care [1]. Thus, the lack of communication between healthcare levels prevents comprehensive care [6].Comprehensiveness is part of the guidelines of the Unified Health System (SUS). It is a guiding concept of care that aims at treating each individual with respect, in his/her totality, valuing his/her needs and characteristics [7].The healthcare networks (HCN) emerge within this context, mainly to interconnect the care levels and to integrate care itself [4].The concept of HCN proposes a polyarchy, i.e., democratic, person-centered structure where health services communicate at all levels, and no level is more or less important than the other. It allows comprehensive care with promotional, preventive, curative, caregiving, rehabilitative, and palliative interventions. Thus, it offers a humanized and quality service to the population [8].The Administrative Rule 4279, of December 30, 2010, regulates HCNs. It establishes guidelines for the organization of HCNs within the scope of the SUS. The networking system was necessary for a better health policy, a new structure based on the covenants for health, life, and in defense of the SUS, which assume responsibility for the regionalization and the health situation of Brazil and for strengthening the policy, principles, and guidelines of the SUS. PHC is the major coordinator of care, the gateway and communication center between users and health professionals. It distributes and redistributes assistance for all levels of healthcare horizontally, according to the needs. This explains the concept of networks [5].The basic elements for the development of networks are well-defined population, based on registers performed on prim...

In order to respect the patient's right to die at home, with quality and respect, discussions about bioethical problems involving palliative care in the context of primary health care are relevant. Among bioethical problems, communication problems regarding the diagnosis and treatment, the maintenance or discontinuation of futile treatments, the adoption of aggressive and lifelong measures by the emergency mobile service, and the problems involving equal access to care stand out. It is important to emphasize that health systems must incorporate palliative measures in primary care and enable professionals to provide this type of care.

Objetivo: Identi car e analisar as percepções de um grupo de gestores quanto aos desa os na estruturação das Redes de Atenção à Saúde para os Cuidados Paliativos. Materiais e Método: Trata-se de um estudo descritivo, exploratório, qualitativo e fundamentado na Fenomenologia, a coleta de dados foi realizada através de três grupos focais, junto a 12 gestores de serviços de saúde de um município do estado de Mato Grosso do Sul, Brasil. Utilizou-se o método da associação livre, com questões exíveis e disparadoras para o diálogo e os relatos foram gravados e transcritos na íntegra para análise. Resultados: Identi camos cinco categorias e duas subcategorias de análise temática: Paradigmas nos Cuidados Paliativos; Importância da informação na mudança de paradigmas em prevenção e promoção; Falta de aceitação dos familiares quanto aos Cuidados Paliativos; Falta de comunicação e integração entre os serviços da rede de atenção à saúde; Intersetorialidade na atenção às