Implementation of early will directives: facilities and difficulties experienced by palliative care teams

Abstract

Objective: To know the facilities and difficulties the palliative care team professionals experience in the implementation process of advance healthcare directives. Method: Exploratory-descriptive study with a qualitative approach, involving 51 professionals from seven palliative care teams in the state of Rio Grande do Sul, Brazil. The data were collected between December 2018 and April 2019 and discursive textual analysis was applied. Results: The facilities found were: the approach by the palliative care team; listening and respecting patients' wishes; effective communication between professionals, patients, and family members and resolution of difficult situations. The difficulties reported were: legal issues; the lack of knowledge of professionals about the subject; the lack of institutional protocols; the difficulty in talking about death and the family barrier. Conclusion: Despite the perceived facilities and difficulties, palliative care professionals intend to work based on the patients' desires and will, aiming to offer dignity in the dying process.

Cuidados paliativos en la pandemia: el ser humano frente a su finitud

“…Sin embargo, a pesar de la importancia y el beneficio de los cuidados paliativos, todavía hay desafíos para su implementación. Dentro de esa realidad contestataria, se destacan como obstáculos: ausencia de protocolos institucionales, falta de formación de los profesionales, dificultad de diálogo sobre la muerte, riesgo de contaminación, resistencia familiar, falta de autonomía y respeto en la toma de decisiones sobre sus propias condiciones y divergencia de los profesionales en proponer tratamiento paliativo y no curativo 4 .…”

“…En el contexto actual, con el creciente número de enfermos crónicos, los cuidados paliativos se destacan no solo como una ayuda en la promoción de la calidad de vida de los pacientes y sus familiares, sino también por representar un alivio del sufrimiento físico, psicosocial y espiritual 4 . Además, Estos cuidados se recomiendan a las personas que necesitan una atención especial porque no existen tratamientos curativos.…”

Palliative care during the pandemic: being human and facing finitude

“…Palliative care during the pandemic: being human and facing finitude in discussing death, risk of contamination, family resistance, and divergence among professionals in proposing palliative and non-curative treatment 4 .…”

“…The growing number of chronic patients in the current context make palliative care stand out since it not only enhances the quality of life of patients and their families but also relieves them from physical, psychosocial, and spiritual distress 4 . Palliative care is also recommended for individuals who require some kind of special attention due to the curative treatments [not being available].…”

Cuidados paliativos na pandemia: ser humano diante de sua finitude

“…No contexto atual, com o crescente número de doentes crônicos, os cuidados paliativos se destacam não só como auxílio na promoção da qualidade de vida de pacientes e seus familiares, mas também por representarem alívio do sofrimento físico, psicossocial e espiritual 4 . Além disso, tais cuidados são preconizados para indivíduos que necessitam de atenção especial, pois não disponibilizam de tratamentos curativos.…”