Cancer is the leading cause of death among the pediatric population with life-limiting conditions. The provision of palliative care at home and on the children's cancer unit has not been surveyed previously on a national scale. A survey of 71 (of 73) German pediatric oncology units (response rate 97%) provided information on the timing of breaking bad news, place of death, orchestrating palliative care at home and on the ward, integration of services and staff, funding of palliative care, bereavement services for siblings and parents, educational needs, level of self-satisfaction, and designated integrated palliative care services for children with cancer. More than 60% of children with malignancies died as inpatients in 2000, fewer than 40% at home. Twenty-nine pediatric cancer departments were able to provide comprehensive medical palliative home care, and nine units incorporate a designated palliative care team or person. Only half of the departments provide bereavement services for siblings. Many health professionals working on pediatric cancer units in Germany provide palliative home care in their free time without any payment. They predominantly use their private vehicles and often are unclear about the legal background and insurance arrangements covering their provision of care. The data suggest an important need for education about palliative and end-of-life care. The majority of children dying from cancer in Germany do not have access to comprehensive palliative care services at home. Our study highlights the necessity of incorporating the palliative paradigm into the care of children with cancer. Barriers to its implementation must be identified and overcome.
Objetivo: conhecer os aspectos motivacionais relacionados ao abandono do hábito de fumar. Métodos: foram realizadas entrevistas semiestruturadas com nove ex-fumantes nos seus respectivos domicílios, em um bairro de Lages-SC em cujo serviço de atenção primária atua o Programa de Residência em Medicina de Família e Comunidade. A amostra foi obtida por conveniência, obedecendo aos critérios de inclusão: indivíduos maiores de 18 anos classificados como ex-fumantes. A análise das entrevistas foi realizada por meio do Discurso do Sujeito Coletivo (DSC). Resultados: os relatos apresentados evidenciaram a motivação como ferramenta de enfrentamento do tabagismo, ressaltando que ela não é exterior às pessoas, mas, pelo contrário, depende de vontade própria. Conclusão: o processo de abandono do tabagismo é complexo e multifatorial. Exige observação atenta do profissional de saúde e habilidade de criar um ambiente capaz de motivar as pessoas para o cuidado de sua própria saúde.
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