A quem serve a boa morte? Instrumentos de avaliação clínica e reflexão autoetnográfica no entendimento do cuidado paliativo em cenário de urgência e emergência

Abstract

Introduction: Chronic non-communicable diseases are the main cause of death in the world, leading patients to seek emergency care several times, many of these at an advanced stage of the disease, or even very close to death. Due to issues such as the difficulty in adequately and globally assessing patients, the opportunity to promote clinical care and therapeutic planning with elements of palliative care can be lost. Although there are several tools available to evaluate patients in palliative care, there is a lack of studies that investigate their applicability in emergency situations. In this sense, it is important to identify which clinical assessment tools have already been studied applying to patients in an emergency department from the perspective of palliative care. Objective: to review information about the main instruments for clinical assessment of patients in palliative care applicable in an emergency context, integrating the author's experiences during his medical residency period, as elements of problematization of consolidated medical practices. Material and methods: carry out an integrative review with data found in high-sensitivity searches in the main databases, integrating them with concepts of autoethnography, through reports from the author during the period of medical specialization. Results: in total, 436 studies were found which, after adequate evaluation, were reduced to a number of eight publications that brought the instruments KPSI, PPS, ECOG, PS, ESAS, MSAS, IPOS, SPEED, NEST, MVQOLI, FACT-G and EQ5D5L, which were studied and analyzed regarding their applicability in a clinical emergency context. Regarding the results of the autoethnographic discussion, there are reflections on the difficulties of approaching a patient in a multidimensional way, in recognizing the indication of palliative care in every patient with a life-threatening illness and in seeing death as a natural process of life to be worked on. with the patient and family. Conclusion: after discussing characteristics and applications of these multiple instruments, it's possible to recognize that some of them have strongest indications, and its use can be promissor in evaluating patients in the emergency room. As for the conclusion of the ethnographic reflection, it is identified that many of these difficulties arise from the distance between the doctor and the patient and the professional's separation from their humanity, compromising the care provided to the patient and family.