Palliative care and health coverage: informing is also universalizing

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This article was exclusively written for The European Sting by Ms. Renata Dias and Ms. Virgínia Raquel, two first year medical students at the UFRN Multicampi School of Medical Sciences (EMCM/UFRN), Brazil. They are affiliated with the International Federation of Medical Students Associations (IFMSA), cordial partner of The Sting. The opinions expressed in this piece belong strictly to the writers and do not necessarily reflect IFMSA’s view on the topic, nor The European Sting’s one.


Due to the context of population aging and increasing rates of diseases with no prospect of cure in various locations around the world, Palliative Care (PC) is becoming increasingly significant in medical practice. In this sense, every day millions of people demand such care as a form of prevention and relief of suffering ─ physical, social, psychic and/or spiritual ─ due to the circumstances of the end of life. Unfortunately, although access to palliative care is a right of every citizen, many are unaware of it. In Brazil, for example, the hospital-centric and not very accessible vision of Palliativism is still common, which constitutes an obstacle to the inclusion of this set of actions in the Universal Health Coverage (UHC).

The Brazilian public health system, like that of other nationalities, is structured based on certain levels of care, namely primary, secondary and tertiary. In this aspect, Primary Health Care (PHC) consists of the sector in which most diseases are treated and acts as a gateway to the system, ordering and integrating the services provided by the other levels, of greater complexity ─ including hospitals. This becomes relevant in some countries, such as England, where PHC is considered the home of palliative care, while in others, such as Brazil, a large part of the population is not even aware of the role of primary public health care. The scenario is even more worrying when it is pointed out that approximately 78% of patients in need of PC are concentrated in developing countries, revealing an immense inequality of access.

The misinformation about Palliativism in Primary Care also affects many professionals, who end up not exercising the principles of palliative medicine for the assisted population, besides developing a communication deficit with patients at the end of their lives. Thus, although the quality of death is established as an objective of the Singular Therapeutic Project (PTS) developed in the primary care, barriers are common, such as the training of health professionals that focuses on providing biomedical services, not highlighting the complexity of care that make up the Brazilian health network. Therefore, it is necessary that both the population and the health team have access to primary information on what palliative care is, its importance, in which situations the adoption of such measures is required and where to obtain them, in order to make the care effective.

Deficient notions about palliativism on the part of agents involved in PHC, therefore, lead to: deficits in communication skills, scarcity of connection with patients, labor overload and non-integration within  the healthcare networks, consisting of bureaucratic ruptures that make the integration of the primary public sector and health coverage impossible. Therefore, considering that the democratization of knowledge would lead to a greater exercise and reach of Palliative Care, it can be said that to inform is also to universalize the access to such care.

References

  1. Ribeiro, J. R., & Poles, K. (2019). Cuidados Paliativos: Prática dos Médicos da Estratégia Saúde da Família. Revista Brasileira de Educação Médica, 43(3), 62–72. https://doi.org/10.1590/1981-52712015v43n3rb20180172
  2. Silva, M. L. dos S. R. (2013). O papel do profissional da Atenção Primária à Saúde em cuidados paliativos. Revista Brasileira de Medicina de Família e Comunidade, 9(30), 45–53. https://doi.org/10.5712/rbmfc9(30)718
  3. Atty, A. T. de M., & Tomazelli, J. G. (2018). Cuidados paliativos na atenção domiciliar para pacientes oncológicos no Brasil. Saúde Em Debate, 42(116), 225–236. https://doi.org/10.1590/0103-1104201811618
  4. Carvalho SR, Cunha GT (2006). A gestão da atenção na saúde: elementos para se pensar a mudança da organização na saúde. Tratado de Saúde Coletiva. São Paulo: Hucitec / Rio de Janeiro: Fiocruz; 2006. p. 837-68.
  5. Côbo, Viviane de Almeida, Dal Fabbro, Amaury Lelis, Parreira, Ana Carolina Serafim Prata, & Pardi, Fernanda. (2019). Cuidados Paliativos na Atenção Primária à Saúde: perspectiva dos profissionais de saúde. Boletim – Academia Paulista de Psicologia, 39(97), 225-235.

About the authors

Renata Dias is a brazilian first year medical student at the UFRN Multicampi School of Medical Sciences (EMCM/UFRN), in a city in the interior of the country. She is a member of the team of local coordinators of the International Federation of Medical Students Associations (IFMSA) Brazil UFRN Caicó and the board of directors of the Athletic Academic Association Multicampi Medicine. She identifies itself with the premise “Think global, act local”, because she believes that, to make a difference in the world, it is important to start with changes at the level of the nearest reality.

Virgínia Raquel is a brazilian first year medical student at the UFRN Multicampi School of Medical Sciences (EMCM/UFRN), in a city in the northeast of Brazil. She is a member of the team of local coordinators of the International Federation of Medical Students Associations (IFMSA) Brazil UFRN Caicó. She has technical training in Computer Science from the Federal Institute of Education, Science and Technology of Rio Grande do Norte, Caicó campus. Monitors medical skills and clinical simulation: Child Health, Semiology and Operative Techniques. She has palliativism as one of her areas of interest.

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