Escola de Enfermagem Anna Nery (EEAN), Universidade Federal do Rio de Janeiro (UFRJ), Afonso Cavalcanti Street, Rio de Janeiro, 21211-110, RJ, Brazil.
Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Prof Egas Moniz Avenue, Lisbon, 1600-190, Portugal.
BMC Palliat Care. 2024 Sep 11;23(1):225. doi: 10.1186/s12904-024-01556-7.
Countries with formal policies for palliative care, and advanced and integrated practices in this field, such as Portugal, face challenges in achieving excellence in care, particularly in home-based assistance. Issues include care coordination among providers, confusion regarding the roles of each health care professional in the network, and a lack of monitoring and evaluation of actions. Our objective was to analyze the implementation of palliative care in primary health care in Portugal.
We conducted a qualitative, descriptive, and exploratory study in Portugal involving health care professionals with experience in palliative care. The data were collected through semistructured interviews and focus groups between March and October 2023. Eighteen health care professionals participated. We used the Alceste software for lexicographic analysis. The research was authorized by an Ethics Committee.
Four classes were identified; classes 1 and 2, comprising 77% of the corpus, addressed the study objectives. Participants highlighted inequitable access, strategic development plans with unattainable short-term goals; and low literacy. They emphasized the importance of legislation, professional training initiatives for generalist palliative care at home, and early referral. Home-based challenges included professionals' lack of exclusive dedication, absence of 24/7 coverage, and unavailability of capable family caregivers. The networks' response to hospital admissions and patient transitions from hospital to home, with access to the specialized team, was also inadequate.
Health care professionals aim to increase patients' time spent at home, reduce emergency department visits, and minimize hospitalizations by leveraging the resources of the national palliative care network. In addition to investments to sustain network implementation and legally guaranteed palliative care rights, the country must focus on measurable indicators for evaluating and monitoring actions, providing better guidance in the short, medium, and long term.
葡萄牙等国家制定了正式的姑息治疗政策，并在该领域开展了先进和综合的实践，但在家庭护理方面仍面临着卓越护理的挑战。这些挑战包括提供者之间的护理协调、网络中每个医疗保健专业人员角色的混淆以及对行动的监测和评估不足。我们的目标是分析葡萄牙初级卫生保健中姑息治疗的实施情况。
我们在葡萄牙进行了一项定性、描述性和探索性研究，涉及具有姑息治疗经验的医疗保健专业人员。数据通过 2023 年 3 月至 10 月期间的半结构式访谈和焦点小组收集。共有 18 名医疗保健专业人员参与。我们使用 Alceste 软件进行词汇分析。该研究得到了伦理委员会的授权。
确定了四个类别；类别 1 和 2 占语料库的 77%，涵盖了研究目标。参与者强调了不平等的获取机会、具有不可实现的短期目标的战略发展计划以及低文化素养。他们强调了立法、家庭姑息治疗专业人员的一般培训计划以及早期转介的重要性。家庭护理面临的挑战包括专业人员缺乏专责、24/7 覆盖不足以及缺乏有能力的家庭照顾者。网络对医院入院和患者从医院到家庭的过渡的反应也不足，无法获得专门团队的支持。
医疗保健专业人员的目标是通过利用国家姑息治疗网络的资源，增加患者在家中的时间，减少急诊就诊次数并减少住院治疗。除了投资以维持网络实施和法律保障的姑息治疗权利外，该国还必须关注可衡量的指标，以评估和监测行动，为短期、中期和长期提供更好的指导。
