Terminalidade da vida em terapia intensiva: posicionamento dos familiares sobre ortotanásia

Abstract

Objectives: This study aimed to assess family member acceptance of orthotanasia as related to symptom management, patient preference and the influence of the medical team's communication on therapy. Methods: This was a descriptive one-year study conducted at the adult intensive care unit of the Hospital do Servidor Público Estadual. A structured questionnaire based on the Quality of Dying and Death (QODD 22) instrument and prior informal interviews were used. Results: Sixty family members were assessed; the mean age was 51.7 + 12.1 years, and 81.7% were female. The patients were hospitalized for a mean of 31 + 26.9 days, and 17.0% of these days were spent in the intensive care unit. Most of the patients had neurological conditions. Most of the patients (53.3%) had discussed their end-of-life care wishes with family members; however, 76.7% of them had not discussed this issue with their doctors (p < 0.00). The family members reported being favorable to orthotanasia in 83.3% of the cases. Most (85.0%) desired the medical team to clearly approach the subject, and 65.0% wished to take part in the quality of end-of-life decision making process. The family members were generally satisfied with information they received from the doctors: 93.3% believed they had received appropriately frequent communications about the clinical conditions; 81.7% were able to clarify their doubts regarding the patient's clinical status; the communication was understood by 83.3% of the respondents; and 80.0% believed that clear and honest information had been provided. Only 43.3% of the respondents wished to be present at the time of their loved ones' deaths. A significant association between family member acceptance of orthotanasia and participation in end-of-life decisions (p = 0.042) was observed. Conclusions: Most of the respondents were favorable to orthotanasia and wished to participate in end-of-life discussions.

Limitação do suporte de vida na terapia intensiva: percepção médica

“…Although the norm authorizes the suspension, in the second speech, only non-instituted therapies are mentioned: no hemodialysis institution; no increase in the flow of vasoactive drugs; and no cardiopulmonary resuscitation. Another study has already observed the same therapies cited by the interviewees as less established 8 …”

“…This aspect is related to the history of life, culture, ideology, myths, among others. It is extremely important to know these factors, which should help understand what families think about LSL 8 .…”

Direito dos pacientes às diretivas antecipadas de vontade

“…These results point to the difficulty of physicians to accept their limitations as "healers" and also as communicators in situations of conflict [41][42][43][44] . It should be emphasized that physicians' fear of legal proceedings directly interferes with end-of-life decisions.…”

No Palco Da Vida, a Morte Em Cena: As Repercussões Da Terminalidade Em Uti Para a Família E Para a Equipe Médica

“…Aspectos considerados importantes no processo comunicacional são citados pelos entrevistados, como o fornecimento de informações claras, honestas e realistas; o respeito às emoções e sentimentos suscitados por esta situação; ter boa capacidade de ouvir; evitar excessos no uso da linguagem técnica e do jargão médico e ter tempo e disponibilidade para conversar com a família sempre que esta demandar atenção ou apresentar dúvidas (SOARES, 2007;SCHAEFER & BLOCK, 2009;SANTOS & BASSITT, 2011;SLEEMAN & COLLIS, 2013). Sobre este último aspecto, a médica 6 aponta uma dificuldade -a impossibilidade de estar disponível sempre que a família demandar.…”

“…O prognóstico deve ser informado para dar tempo para a família se preparar e dizer adeus a seu ente querido. Uma comunicação empática, efetiva e afetiva com as famílias de pacientes em situação de terminalidade pressupõe também que os médicos tenham tempo e disponibilidade para conversar com os familiares sempre que estes demandarem atenção ou apresentarem dúvidas, e que tenham boa capacidade de escuta (SOARES, 2007;SCHAEFER & BLOCK, 2009;NELSON et al, 2010;SANTOS & BASSITT, 2011;SLEEMAN & COLLIS, 2013 O cuidado e o amparo fornecidos pelos médicos-assistentes em nossa pesquisa foram fundamentais para que os familiares entrevistados pudessem se preparar para a morte de seu familiar, mesmo sendo uma experiência penosa, dolorosa e adversa. Entretanto, encontramos também a percepção de que a comunicação foi deficitária, pela falta de clareza, de objetividade e de preparo emocional dos médicos.…”