Planejamento Antecipado de Cuidados, sentido da vida e atitute religiosa na Atenção Primária à Saúde: percepções de profissionais de saúde

Abstract

Introduction: Primary Health Care (PHC) has several characteristics that allow the application of Advance Care Planning (ACP) in its context, however this approach is not used with adequate frequency. The literature points out several reasons for this fact, among which we highlight the lack of knowledge and misinterpretation of the subject by health professionals. This motive can be related to the way in which they perceive the meaning of life and death and also to the influence of religious aspects. Objective: To analyze the perceptions of PHC health professionals regarding the ACP, the meaning of life and religious attitudes. Methodology: Analysis by Triangulation of Methods was used, the first stage of which consisted of an analytical cross-sectional study, with a quantitative approach, in which participants answered three instruments: the Questionnaire on knowledge and attitudes about Advance Directives (AD); the Meaning of Life Questionnaire; and the Religious Attitude Scale (EAR-20). The second stage was an exploratory study, using the generic qualitative approach as a method, on the knowledge of the participants about the ACP and the perceptions about the meaning of life and death, and the influence of the latter in the application of the ACP. The survey was carried out between December 2021 and May 2022, with professional nurses and doctors who work in the PHC in the cities of Castilho-SP and Três Lagoas-MS. Quantitative data were processed and analyzed using the R Core Team-2020 program. As for the qualitative data, they were analyzed using Bardin's Content Analysis, in which Logotherapy and Existential Analysis, proposed by Viktor Frankl, were used as a theoretical framework for the discussion. The project was approved by the research ethics committee of the proposing institution, CAAE: 52451221.2.0000.0021. Results: 110 professionals participated in the quantitative stage, 55 physicians and 55 nurses. The majority (79.1%) claimed not to have knowledge about AD and the mean scores of the opinion and recommendation and respect components were greater than eight (scale 0-10). Significant correlations were identified between the search for the meaning of life component and the recommendation of AD to family members; search for the meaning of life and affective and cognitive components of the religious attitude and total religious attitude with the intention of making their own AD in the next year. As for the qualitative stage, whose delimitation of participants was made for convenience, there were 30 physicians and 22 nurses interviewed. From the speeches of the professionals, two articles were produced. Two thematic categories emerged from the first: 1) Advance Care Planning as a general care plan and 2) influence of sociocultural factors in the application of Advance Care Planning in Primary Health Care. In the second, from the participants' reports, three main categories emerged: 1) Meaning of Life, 2) Meaning of Death, and 3) Influences on the Advance Care Planning conversations. Conclusion: The perceptions of the participating professionals demonstrate a lack of preparation for the application of AD, not due to the lack of understanding of the importance of this tool, but due to the lack of knowledge necessary for its application. It was also found that religious beliefs and the meaning of life can influence the use of ACP interventions, however, it is important to establish limits between influence and the cultural background brought by professionals. Thus, the development of public policies that encourage training courses for PHC professionals on ACP, Palliative Care and difficult conversations focused on death and dying are necessary.

Keywords: Primary Health Care. Advance Care Planning. Advance Directive. Palliative Care. Health Personnel. Primary Care Nursing.