Educar para cuidar: intervenções com profissionais do Programa Melhor em Casa acerca dos cuidados paliativos

Abstract

According to the concept developed by the World Health Organization (WHO), Palliative Care is defined as an approach that improves the quality of life of patients—whether adults or children—and their families as they face problems associated with life-threatening illnesses. Regarding practice, palliative care principles can be applied across various levels of healthcare complexity, ranging from community and home-based care to high-complexity hospitals. In this context, the general objective of this research was to conduct educational interventions on Palliative Care with professionals from the Melhor em Casa (PMeC) program in the municipality of Sobral, Ceará. Specific objectives included: diagnosing the main challenges these professionals face regarding patient management and appropriate referrals; identifying strategies used by these professionals to enhance palliative patient care; specifying the influence of multiprofessional teamwork on the care provided by PMeC; planning proposals and actions based on needs identified in the professionals' practice with these service users; and highlighting participants' perceptions regarding the interventions carried out. To achieve this, the study followed the steps outlined by Thiollent for action research, comprising four main stages: the Exploratory Phase, involving familiarization with the aforementioned program and narrative interviews with mid-level and higher-level professionals to identify challenges and strengths in palliative care implementation; the Planning Phase, during which an intervention program was developed based on the diagnosed difficulties; the Action Phase, where the planned interventions were implemented; and the Evaluation Phase, which assessed the effectiveness and impact of the actions on daily work routines and participant knowledge acquisition, using the "What’s Good! What’s a Shame! What If?" methodology. Data analysis was conducted using the *Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires* (IRAMUTEQ) software (version 0.7 alpha 2). A Descending Hierarchical Classification and a word cloud were generated to assist in identifying themes and analytical categories based on the interview transcripts. Four categories emerged, encompassing general understandings of the palliative approach, care directed at family members and informal caregivers, psychosocial aspects involved in palliative care, and the role of the multiprofessional team as both a technical and affective element of care. Each category gave rise to a thematic session focused on discussing the key demands highlighted by professionals during the first phase. Interventions relied on activities guided by active learning methodologies, allowing participants to experience a closer connection between the educational proposals introduced by the researchers and the daily work realities faced within the PMeC setting. Discussions centered on the approach's guiding principles, the multiprofessional perspective required for this patient profile, a compassionate approach attentive to issues surrounding finitude and thanatology, and the vital role of informal caregivers in the palliative therapeutic journey; these discussions fostered conceptual reconstructions and new arrangements based on the constructs underpinning the interventions. It is also worth noting that the interventions had a positive impact on the professionals' daily work; they provided favorable evaluations of the sessions held during the action phase, highlighting effective aspects, weaknesses, and suggestions for future designs. Furthermore, the methodological trajectory—structured around the four phases of action research—enabled the successful achievement of the established objectives, which were closely interconnected. In light of these considerations, the importance of increasingly conducting scientific studies that center on the palliative approach is recognized—particularly when such endeavors seek to combine comprehensive research with intervention methods. Thus, this study stands as an ethical- political resource for disseminating palliative care as a viable and recommended healthcare alternative, while also valuing research as a transformative instrument that catalyzes responsible and humane practices.