Enfrentamento do câncer e seu tratamento em crianças: uma proposta de programa de intervenção usando práticas de mindfulness

Abstract

Coping is a complex process, studied under different perspectives focusing on favorable intervention practices. The interventions may use mindfulness practices. Mindfulness emphasizes the observation of inner experience without affective, cognitive or physiological distortions. By observing thoughts and emotions from a detached perspective, accepting them without judgment, greater clarity of mental perception is achieved, reducing anxiety and enhancing emotional regulation. Although these practices have their origin in Eastern culture and Buddhist religion, Western researchers and clinicians have introduced mindfulness-based interventions (IBAPs) into mental health treatment programs, teaching and exercising the acquisition of the skills involved regardless of its religious and cultural origins. These programs, however, are still not widespread, especially in the context of cancer, and even more in the context of child cancer treatment. This thesis presents the elaboration, implementation and evaluation of an exploratory program using the practices of mindfulness, designed to help children, by reducing anxiety with the treatment and improving pain management. Four children, aged seven to nine years, undergoing treatment for hematological cancer in the induction phase, participated in the study, at INCA, Rio de Janeiro. Their guardians signed a Free and Informed Consent Form and the children signed a Free and Informed Agreement Form. Identification and sociodemographic information forms and an Assesment of Hospitalization Coping Strategies (AEH) were filled in the first stage of the study. Two to seven days after application of these instruments, the sessions of the Program for Coping with Child Cancer and its Treatment (PECI-MIND) began. After each session, observations of the participants' reactions and speeches were recorded, using a Session Registration Form. Two weeks after the program sessions were held, application of a new AEH and a semi-structured interview were scheduled, both recorded on audio, to evaluate program's contributions and effects. Qualitative analysis focusing on the records of the sessions, the answers to the AEH and to the questions asked in the interview was performed, using the content analysis for multiple case studies method. It was found that the program is fully feasible. It was able to provide the children a range of new resources to deal with the difficult situation of undergoing hospitalization for the treatment of a highly serious illness. All participants adhered well to the program, managing to fully carry out the activities proposed for the totality of its sessions. Therefore, the fulfillment of the objectives defined for the study is emphasized, including the complete structuring of the PECI-MIND program and its subsequent implementation. It was also possible to evaluate the contributions of the program and identify its possible needs of improvement. Regarding contributions, it was noted the development of children’s mastery in directing attention to breathing and other movements and aspects of their corporeality, facing threatening events, improving anxiety regulation and managing pain. Regarding improvement of the program, the challenge to increase children’s participation, in situations of anxiety and agitation, difficulty in grasping concepts like that of feeling, and interference of deviating interests for games and toys that did not belong the proposed activities, was perceived.