Conhecimento e percepção de autoeficácia em cuidados paliativos em médicos atuantes na atenção primária à saúde

Abstract

Introduction: The progressive aging of the population, together with changes in the patterns of mortality, morbidity, and disability caused by the demographic and epidemiological transition of the Brazilian population, has caused a growing demand for palliative care (PC). Primary Health Care has been identified as a strategic level for implementing the precepts recommended by Palliative Medicine. The geographic, cultural, and emotional proximity with which health professionals work at this level of care, in theory, would provide early identification, greater accessibility, and continuity of PC, considering the multiple dimensions of the human illness process. Objective: To assess the knowledge and perception of self-efficacy of medical professionals in Primary Health Care concerning concepts, fundamentals, and approaches used in PC. Methodology: This is a cross-sectional study carried out by applying the Bonn Palliative Care Knowledge Test (BPW) questionnaire, in its translated and validated version into Portuguese, applied to physicians working in the Family Health Strategy of the Central-South Region from the Federal District (DF), Brazil, carried out from April 2021 to September 2021. Results: 57 physicians were included, the median age was 40.0 (IQ25- 75%: 35.0 – 43.0) years, most of them female (n=34, 59.6%), 29 had a degree or residency in MFC (50.9%), and only eight reported having attended a CP subject during the Undergraduate Course (14 .0%). The median percentage of correct answers in PC Knowledge was 60.9% (IQ25-75% 52.2%-69.6%) and 73.3% in PC Self-efficacy (IQ25-75% 46.7% -93.3%). A negative correlation was observed between age and PC Knowledge, although weak (r = -0.195, p = 0.044), as well as between Self-efficacy and PC Knowledge (r = -0.303, p = 0.002). Physicians with experience in Primary Health Care between 5 to 10 years had a higher percentage of correct answers in Knowledge in PC than physicians with experience of fewer than five years (p = 0.047) and over ten years (p = 0.043). Regarding knowledge in PC, there was no difference regarding gender, being a qualified Family and Community Physician or with residency, reporting experience in PC, considering themselves able to provide PC, and having experienced the process of death/dying with a close family member. Conclusion: It was observed that the knowledge in PC lower than expected. There is a need to organize adequate care models for patients with life-threatening diseases, including the approach to palliative care within the scope of primary care, as well as the need to implement policies that prioritize palliative care with a focus on assistance and improvement of health care professionals with investment in education both in undergraduate and graduate programs, as well as in continuing education programs for professionals working in PHC.