A decentralized model of palliative care for patients with advanced incurable cancer

Abstract

Most cancer patients in Brazil are diagnosed in the disease advanced stages; therefore, survival rates are low, meaning that there is a large patient population in need of palliative care. Palliative care models in practice are based on those provided by cancer hospitals. The main limitation to this is their local range, whereas the demand is predominantly regional. The target of this study was to test a decentralized palliative care model based on local public health services and healthcare professionals for the assistance of gynecologic and/or breast cancer patients with incurable disease in partnership with the Center for the Integral Care of Women’s Health (Centro de Atenção Integral à Saúde da Mulher) of the State University of Campinas (Universidade Estadual de Campinas). This was a qualitative descriptive study which followed the directives of a research in development. It was expected that the cities adopted the resolution corresponding to the primary treatment level, having Center for the Integral Care of Women’s Health as a reference center for the conditions demanding a higher complexity level of care. The cities which demonstrated interest and accepted the proposal were: Amparo, Atibaia, Indaiatuba, Mogi-Mirim, São João da Boa Vista and São João do Rio Pardo. Strategy for implementation included prior professionals qualification and accomplishment of specifc meetings in each city to seek political and strategic support for the implementation of these activities. Since data were collected through interviews, analysis included: the raw material preparation and description; reduction in data; decodification; vertical and cross analysis. The model was operational in the cities of: Amparo, Atibaia, Indaiatuba and São José do Rio Pardo. There was an increase in resolution and a positive perception of the biopsychosocial effects regarding patients and family members from the viewpoint of health care professionals and family members. A lack of political and institutional decision seemed to be the main component in cities where the model was not operational due to the absence of the town administrator at local meetings. There were not enough resources available and the activities had been interrupted. Since there was no physician on staff, a clinical resolution of the staff was limited. Extending palliative care to patients with other types of cancers and other diseases see med to optimize staff work and rationalize the resources involved. Thus, there was a greater range of activities. The Family Health Program acted as a facilitator. Professional motivation and initiative may be considered essential conditions for suitable model performance, since these health professionals must work creatively in an environment characterized by problems greater than those related to health. Continuing education is necessary for professional qualification. In conclusion, the model is viable in the sphere of city administration. Recognizing health service decentralization in the process of organizing the Single Health System, results in cities that not only are privileged but essential partners in palliative care decentralization for patients with incurable cancers.