Posicionamento pessoal de pacientes oncológicos em cuidados paliativos: um estudo de método misto

Abstract

The challenging experience of living daily with an advanced cancer diagnosis directs to understand the human being in a broader context that Palliative Care Cancer advocates. However, the evaluation and treatment of cancer patients are focused on physical questions, highlighting the difficulty in considering the individual in his uniqueness and values. Logotherapy and Viktor Frankl's existential analysis can contribute in this context, by recognizing the specific dimension of the human being, bioethics, in addition to the psychophysical dimensions. The focus is the search for the meaning of life and its importance when facing a life-threatening disease; and being associated with quality of life improvement and reduction of physical/emotional symptoms. The literature needs further analysis of patients' experiences in this confrontation, contributing to a better understanding of their positions and enabling to reorganize the line of care of these patients. Our study aimed to analyze the association between meaning of life, quality of life, anxiety and depression in patients with advanced cancer in palliative care and to contextualize and confront these quantitative data with their experiences of illness described from their own perspective. It was a transversal study of mixed methods with 71 patients analysed with scales to measure the level of meaning of life, quality of life; symptoms of anxiety and depression and functionality. Qualitative data were obtained from 14 patients submitted to an open interview which was recorded and later transcribed, and analyzed in an exploratory way, described according to the phenomenological aspect. All patients were in outpatient follow-up at Clinical Oncology and Palliative Care Services from Hospital of Clinics of Ribeirão Preto Medical School of University of São Paulo. The results demonstrated that patients intentionally turn to live, moving away from the disease condition and the factuality of death; seeking not to fear the future consequences and to be able to focus on what can be accomplished in life. This requires an inner struggle that underpins this stance and, together with life sensitivity, feeds and configures this struggle. These experiences involve some functionality and it was found that it mediated the relationship between cancer treatment and depression reduction, showing the importance of treatment that allows daily activities. Faith in the continuity of life, often inseparable from religious faith, and manifested in various ways in incurable diseases, sustains the hope in this continuity and allows us to consider possibilities of present and near future realization. In this intentional process, there is also a deeper understanding of the reasons/causes why patients are motivated to live. We identified a high sense of life index among patients, being associated with an increased quality of life and decreased in anxiety symptoms, depression and fatigue. The last element that appears and underlies this experience is the intense desire to live and the value of l...

O papel da psicologia hospitalar na atenção à família de pacientes em terminalidade de vida: uma revisão sistemática

“…Assim, a não elaboração do processo de aceitação, refletirá no cuidado e apoio que a família dá ao paciente-familiar, resultando em uma série de alterações (emocionais, comportamentais, relacionais etc. ), que se configuram no processo de luto antecipatório (KOVÁCS, 2008;MACIEL, 2008;REIGADA et al, 2014;SILVA, 2021).…”