Dor em cuidado paliativo oncológico: uma avaliação da percepção do tratamento da dor em pacientes internados em uma unidade hospitalar

Abstract

Pain is one of the most prevalent symptoms among patients in palliative cancer care and has a major impact on quality of life. This study intends to investigate patients' perception about their antalgic treatment in a cancer palliative care unit; identify patients' perception about their pain treatment process; describe the institutional context of the cancer palliative care service; describe the profile of patients admitted to the unit. It is a case study using qualitative methodology conducted in a public hospital for palliative cancer care in Rio de Janeiro. A semi-directed interview was used to evaluate the impact and expectation of anti-allergic treatment, with a sample defined by content saturation. Content analysis performed with discussion in light of Value Based Medicine. In parallel, a descriptive study of the unit, including population and therapeutic profile was prepared which included all patients admitted between 09/01/2016 and 11/30/2016 with longitudinal follow-up of hospitalization through medical record review, obtaining daily Karnofsky Performance Status scale (KPS), Numeric Rating Scale (NRS), medication used, effects. Twenty patients were interviewed, with emerging categories and subcategories: professional-patient relationship (interpersonal and intrainstitutional) and management of their own care (decision making, pain as an indicator, spirituality as a coping strategy and treatment evaluation). The doctor-patient relationship was observed at various stages, from paternalistic to shared. The pain was very impacting, with the observed representations: pain as disease, normal pain, pain as conducting axis (basic and complex activities of daily life and treatment mediation), pain as a source of reflection and pain as a sign of finitude. During the study period, 399 patients made up 461 episodes of hospitalization, 429 (93%) with the pain symptom (controlled or not). The average age was 62 years and average length of stay was 8 days. Hospitalization was motivated by pain in 18% of the cases and in 35% the pain symptom was not controlled. Of these, the NRS was quantified as zero after 2 days on average. According to the WHO Analgesic Ladder, 29% were on the first stage, 11% on the second and 82% on the third. The use of common analgesic and adjuvant was observed in more than 80% of the episodes. The average equivalent dose of oral morphine was 117mg/day. Pain is a complex symptom, as should also be its treatment. Professionals should take a patient-sensitive approach so that the symptom can be effectively controlled. The early preparation of the care plan with active patient participation helps in the proper evaluation of pain control treatment. The pain control obtained in the present study was greater than that described in the literature, with similar average morphine dose, but with a higher proportion of adjuvants and strong opioids.