Avaliação de atitudes relacionadas ao atendimento humanizado pelos estudantes de Medicina

Cardoso, Higor Chagas; Pereira, Edna Regina Silva; Soares, Viviane; Soares, Guilherme Antônio Ferreira de Sena; Cardoso, Vinícius Chagas; Rabahi, Marcelo Fouad

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Revista Brasileira de Educação Médica

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ORIGINAL ARTICLE • Rev. bras. educ. med. 47 (3) • 2023 • https://doi.org/10.1590/1981-5271v47.3-2023-0091.ING copiar

Avaliação de atitudes relacionadas ao atendimento humanizado pelos estudantes de Medicina

Autoria SCIMAGO INSTITUTIONS RANKINGS

Resumo:

Introdução:

O atendimento médico usual tem sido caracterizado por atitudes centradas no profissional e na doença, pouco se preocupando em focar o contexto psicossocial e as expectativas do paciente. Entretanto, o atendimento médico que procura abranger mais globalmente a perspectiva do paciente tem se mostrado mais eficiente ao promover maiores benefícios.

Objetivo:

Este estudo teve como objetivo avaliar as atitudes de estudantes de Medicina a respeito da relação médico-paciente.

Método:

Trata-se de um estudo transversal que avaliou as atitudes de acadêmicos do quarto período de Medicina em relação à atenção aos pacientes a partir da aplicação da Escala de Orientação Médico-Paciente (EOMP) e de questionário com características sociodemográficas e curriculares. Os dados foram analisados no software Statistical Package for Social Science (SPSS), e utilizaram-se o teste de Mann-Whitney, o teste de Kruskall-Wallis com post hoc de Dunn e o teste de qui-quadrado.

Resultado:

Participaram do estudo 83 estudantes de Medicina, com prevalência maior de alunos do sexo feminino (74,7%) e que declararam renda familiar inferior a dez salários mínimos (43,0%), bem como a religião católica (53,0%). A maioria dos acadêmicos (85,5%) apresentou atitudes centradas no médico e na doença (média de escores da EOMP < 4,57), com escores do domínio cuidar superiores aos do domínio compartilhar. As variáveis sexo, renda familiar, bolsa de auxílio financeiro estudantil e religião apresentaram associação positiva (p ≤ 0,05) com os escores da EOMP relacionados às atitudes centradas no paciente. Não foram observadas associações estatisticamente significativas dos escores da EOMP entre as variáveis faixa etária, cidade de procedência, realização de atividades de iniciação científica, estágios extracurriculares, atividades artísticas, antecedentes pessoais e familiares de doença grave, e escolaridade dos pais.

Conclusão:

O presente estudo demonstrou que os acadêmicos de Medicina avaliados apresentaram atitudes centradas no médico e na doença, com média de escores da EOMP abaixo do intervalo relacionado às atitudes da medicina humanizada.

Palavras-chave:
Humanização da Assistência; Educação de Graduação em Medicina; Relações Médico-Paciente; Assistência Centrada no Paciente; Competência Clínica

Sociodemographic and curricular characteristics	Frequency	(%)
Gender
Female	62	74.7
Male	21	25.3
Age range
18 to 20 years	39	47.0
21 to 25 years	39	47.0
26 to 30 years	04	6.0
Family income
< US$ 2,140	36	43.0
Between US$ 2,140 and US$ 4,280	27	32.5
Between US$ 4,280 and US$ 8,560	13	15.7
> US$ 8,560	07	8.4
Place of origin
Goiânia	44	55.5
Brasília	03	3.6
Other	36	40.9
Religion
Catholic	44	53.0
Evangelical	22	26.5
Spiritualist	10	12.0
Buddhist	01	1.2
Other	02	2.4
None	04	4.8
Student Scholarship programs
Yes	23	27.7
No	60	72.3
Extracurricular internships
Yes	24	28.9
No	59	71.1
Artistic Activity
Yes	24	28.9
No	59	71.1
Undergraduate Research
Yes	68	81.9
No	15	18.1
Personal Illness
Yes	04	4.8
No	79	95.2
Family Illness
Yes	42	50.6
No	41	49.4
Parental level of schooling
Elementary	11	13.3
High School	23	27.7
Higher Education	49	59.0
Parent with a medical degree
Yes	06	7.2
No	77	92.8
Intended specialty
Clinical	33	39.7
Surgical	21	25.3
Clinical and Surgical	01	1.2
Does not know	28	33.7

Scores	Frequency	%
Total PPOS
<4.57*	71	85.5
4.57-4.99⁺	12	14.5
≥5.00^§	0	0
Caring
<4.57*	64	77.1
4.57-4.99⁺	12	14.5
≥5.00^§	7	8.4
Caring - psychosocial context
<4.57^a a PPOS scores < 4.57 = physician-centered and disease-centered attitudes;	59	71.1
4.57-4.99^b b PPOS scores between 4.57 and 4.99 = moderately patient-centered attitudes;	17	20.5
≥5.00^c c PPOS scores≥ 5.00 = patient-centered attitudes;	7	8.4
Caring - patient’s perspective
<4.57^a a PPOS scores < 4.57 = physician-centered and disease-centered attitudes;	58	69.9
4.57-4.99^b b PPOS scores between 4.57 and 4.99 = moderately patient-centered attitudes;	18	21.7
≥5.00^c c PPOS scores≥ 5.00 = patient-centered attitudes;	7	8.4
Sharing
<4.57^a a PPOS scores < 4.57 = physician-centered and disease-centered attitudes;	74	89.2
4.57-4.99^b b PPOS scores between 4.57 and 4.99 = moderately patient-centered attitudes;	5	6.0
≥5.00^c c PPOS scores≥ 5.00 = patient-centered attitudes;	4	4.8
Sharing information
<4.57^a a PPOS scores < 4.57 = physician-centered and disease-centered attitudes;	72	86.7
4.57-4.99^b b PPOS scores between 4.57 and 4.99 = moderately patient-centered attitudes;	5	6.0
≥5.00^c c PPOS scores≥ 5.00 = patient-centered attitudes;	6	7.2
Sharing power and responsibility
<4.57^a a PPOS scores < 4.57 = physician-centered and disease-centered attitudes;	48	57.8
4.57-4.99^b b PPOS scores between 4.57 and 4.99 = moderately patient-centered attitudes;	32	38.6
≥5.00^c c PPOS scores≥ 5.00 = patient-centered attitudes;	3	3.6

Sociodemographic and curricular characteristics	Mean total PPOS (SD)	Caring Mean (SD)	Caring -psychosocial context Mean (SD)	Caring - patient perspective Mean (SD)	Sharing Mean (SD)	Sharing information Mean (SD)	Sharing power and responsibility Mean (SD)
Age range
18 to 20 years	4.13 (0.50)	4.32 (0.51)	4.49 (0.63)	4.24 (0.70)	3.95 (0.71)	3.66 (0.89)	4.17 (0.74)
21 to 25 years	4.09 (0.43)	4.21 (0.61)	4.28 (0.66)	4.17 (0.77)	3.97 (0.53)	3.60 (0.81)	4.28 (0.88)
26 to 30 years	4.00 (0.30)	4.27 (0.23)	4.07 (0.43)	4.37 (0.32)	3.73 (0.55)	3.05 (0.57)	4.28 (0.73)
p ^a a Data for p≤ 0.05 statistically. Source: created by the authors.	0.887	0.723	0.110	0.553	0.925	0.470	0.707
Gender
Female	3.96 (0.49)	4.08 (0.66)	4.51 (0.87)	3.87 (0.77)	3.84 (0.59)	3.49 (0.91)	4.12 (0.55)
Male	4.15 (0.44)	4.33 (0.49)	4.31 (0.54)	4.33 (0.66)	3.98 (0.63)	3.64 (0.83)	4.26 (0.70)
p ^a a Data for p≤ 0.05 statistically. Source: created by the authors.	0.121	0.101	0.442	0.011	0.556	0.666	0.248
Family income
< US$ 2,140	4.09 (0.38)	4.19 (0.53)	4.20 (0.60)	4.19 (0.68)	3.98 (0.55)	3.68 (0.79)	4.23 (0.58)
Between US$ 2,140 and US$ 4,280	4.11 (0.48)	4.30 (0.56)	4.51 (0.72)	4.19 (0.77)	3.93 (0.69)	3.60 (0.95)	4.20 (0.72)
Between US$ 4,280 and US$ 8,560	4.20 (0.55)	4.54 (0.49)	4.64 (0.46)	4.48 (0.67)	3.87 (0.68)	3.38 (0.72)	4.26 (0.86)
> US$ 8,560	3.98 (0.60)	4.00 (0.55)	4.14 (0.54)	3.93 (0.76)	3.95 (0.68)	3.57 (1.01)	4.26 (0.59)
p ^a a Data for p≤ 0.05 statistically. Source: created by the authors.	0.549	0.033	0.09	0.266	0.565	0.670	0.595
Place of origin
Goiânia	4.13 (0.50)	4.34 (0.54)	4.37 (0.63)	4.29 (0.63)	3.92 (0.67)	3.57 (0.89)	4.20 (0.71)
Brasília	4.20 (0.50)	4.48 (0.39)	4.33 (0.00)	4.56 (0.59)	3.93 (0.63)	3.25 (0.90)	4.47 (0.61)
Others	4.07 (0.41)	4.17 (0.55)	4.29 (0.67)	4.11 (0.80)	3.98 (0.58)	3.66 (0.80)	4.24 (0.63)
p ^a a Data for p≤ 0.05 statistically. Source: created by the authors.	0.658	0.658	0.389	0.612	0.612	0.640	0.651
Student Scholarship programs
Yes	3.96 (0.49)	4.12 (0.63)	4.13 (0.57)	4.12 (0.91)	3.80 (0.61)	3.41 (0.63)	4.12 (0.78)
No	4.16 (0.44)	4.32 (0.50)	4.46 (0.64)	4.25 (0.63)	4.00 (0.62)	3.67 (0.91)	4.27 (0.62)
p ^a a Data for p≤ 0.05 statistically. Source: created by the authors.	0.157	0.183	0.047	0.519	0.219	0.206	0.619
Undergraduate research activities
Yes	4.10 (0.47)	4.26 (0.55)	4.37 (0.67)	4.21 (0.71)	3.93 (0.63)	3.58 (0.84)	4.22 (0.70)
No	4.13 (0.41)	4.27 (0.54)	4.33 (0.45)	4.24 (0.74)	3.99 (0.58)	3.68 (0.89)	4.24 (0.51)
p ^a a Data for p≤ 0.05 statistically. Source: created by the authors.	0.972	0.938	0.828	0.953	0.665	0.436	0.789
Extracurricular internships
Yes	4.10 (0.51)	4.23 (0.55)	4.41 (0.66)	4.14 (0.65)	3.97 (0.71)	3.56 (0.86)	4.30 (0.78)
No	4.11 (0.44)	4.28 (0.55)	4.34 (0.63)	4.25 (0.74)	3.93 (0.58)	3.61 (0.84)	4.20 (0.62)
p ^a a Data for p≤ 0.05 statistically. Source: created by the authors.	0.880	0.625	0.397	0.621	0.580	0.984	0.355
Artistic activity
Yes	4.08 (0.49)	4.15 (0.55)	4.28 (0.38)	4.08 (0.75)	4.01 (0.61)	3.59 (0.82)	4.35 (0.61)
No	4.11 (0.44)	4.31 (0.54)	4.40 (0.72)	4.27 (0.70)	3.92 (0.63)	3.60 (0.86)	4.18 (0.69)
p ^a a Data for p≤ 0.05 statistically. Source: created by the authors.	0.896	0.215	0.228	0.301	0.365	0.896	0.210
Personal Illness
Yes	4.19 (0.25)	4.14 (0.47)	4.17 (0.84)	4.13 (0.34)	4.25 (0.11)	3.88 (0.63)	4.55 (0.41)
No	4.10 (0.46)	4.27 (0.55)	4.38 (0.63)	4.22 (0.73)	3.93 (0.63)	3.58 (0.85)	4.21 (0.67)
p ^a a Data for p≤ 0.05 statistically. Source: created by the authors.	0.586	0.704	0.798	0.644	0.132	0.416	0.305
Family Illness
Yes	4.09 (0.49)	4.18 (0.56)	4.40 (0.67)	4.08 (0.72)	3.99 (0.60)	3.58 (0.85)	4.33 (0.64)
No	4.12 (0.42)	4.35 (0.52)	4.33 (0.61)	4.36 (0.69)	3.90 (0.64)	3.61 (0.85)	4.13 (0.68)
p ^a a Data for p≤ 0.05 statistically. Source: created by the authors.	0.949	0.162	0.357	0.083	0.256	0.931	0.096
Parental level of schooling
Primary	4.04 (0.48)	4.17 (0.74)	4.27 (0.83)	4.12 (0.80)	3.91 (0.56)	3.57 (0.83)	4.20 (0.68)
Secondary	4.16 (031)	4.23 (0.45)	4.23 (0.52)	4.22 (0.70)	4.09 (0.50)	3.72 (0.72)	4.38 (0.52)
Higher	4.09 (0.51)	4.21 (0.55)	4.45 (0.64)	4.23 (0.72)	3.88 (0.68)	3.55 (0.91)	4.16 (0.72)
p ^a a Data for p≤ 0.05 statistically. Source: created by the authors.	0.339	0.782	0.082	0.904	0.842	0.663	0.950
Parent with a medical degree
Yes	4.01 (0.65)	4.31 (0.63)	4.44 (0.27)	4.24 (0.84)	3.72 (0.73)	3.33 (0.97)	4.03 (0.66)
No	4.11 (0.44)	4.26 (0.54)	4.36 (0.66)	4.21 (0.71)	3.96 (0.61)	3.62 (0.84)	4.24 (0.67)
p ^a a Data for p≤ 0.05 statistically. Source: created by the authors.	0.993	0.486	0.500	0.602	0.537	0.764	0.386

PPOS score domains	Catholic (n=44) n (%)	Evangelical (n=22) n (%)	Spiritualist (n=10) n (%)	Buddhist (n=01) n (%)	Others (n=02) n (%)	None (n=04) n (%)	p ^d d Data for p≤ 0.05 statistically significant;
Total PPOS scores
<4.57^a a PPOS scores < 4.57 = physician-centered and disease-centered attitudes;	39 (54.9)	21 (29.6)	08 (11.3)	0 (0)	01 (1.4)	02 (2.8)
4.57-4.99^b b PPOS scores between 4.57 and 4.99 = moderately patient-centered attitudes;	05 (41.7)	01 (8.3)	02 (16.7)	01 (8.3)	01 (8.3)	02 (16.7)	0.05
≥5.00^c c PPOS scores≥ 5.00 = patient-centered attitudes;	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)
Caring
<4.57^a a PPOS scores < 4.57 = physician-centered and disease-centered attitudes;	37 (57.8)	15 (23.4)	08 (12.5)	01 (1.6)	01 (1.6)	02 (3.1)
4.57-4.99^b b PPOS scores between 4.57 and 4.99 = moderately patient-centered attitudes;	03 (25.0)	07 (58.3)	01 (8.3)	0 (0)	01 (8.3)	0 (0)	0.063
≥5.00^c c PPOS scores≥ 5.00 = patient-centered attitudes;	04 (57.1)	0 (0)	01 (14.3)	0 (0)	0 (0)	02 (28.6)
Caring - psychosocial context
<4.57^a a PPOS scores < 4.57 = physician-centered and disease-centered attitudes;	30 (50.8)	16 (27.1)	09 (15.3)	01 (1.7)	01 (1.7)	02 (3.4)
4.57-4.99^b b PPOS scores between 4.57 and 4.99 = moderately patient-centered attitudes;	12 (70.6)	04 (23.5)	0 (0)	0 (0)	01 (5.9)	0 (0)	0.171
≥5.00^c c PPOS scores≥ 5.00 = patient-centered attitudes;	02 (28.6)	02 (28.6)	01 (14.3)	0 (0)	0 (0)	02 (28.6)
Caring patient’s perspective
<4.57^a a PPOS scores < 4.57 = physician-centered and disease-centered attitudes;	35 (60.3)	11 (19.0)	08 (13.8)	01 (1.7)	01 (1.7)	02 (3.4)
4.57-4.99^b b PPOS scores between 4.57 and 4.99 = moderately patient-centered attitudes;	05 (27.8)	11 (61.1)	0 (0)	0 (0)	0 (0)	02 (11.1)	0.005
≥5.00^c c PPOS scores≥ 5.00 = patient-centered attitudes;	04 (57.1)	0 (0)	02 (28.6)	0 (0)	01 (14.3)	0 (0)
Sharing
<4.57^a a PPOS scores < 4.57 = physician-centered and disease-centered attitudes;	39 (52.7)	22 (29.7)	08 (10.8)	0 (0)	01 (1.4)	04 (5.4)
4.57-4.99^b b PPOS scores between 4.57 and 4.99 = moderately patient-centered attitudes;	03 (60.0)	0 (0)	01 (20.0)	01 (20.0)	0 (0)	0 (0)	0.102
≥5.00^c c PPOS scores≥ 5.00 = patient-centered attitudes;	02 (50.0)	0 (0)	01 (25.0)	0 90)	01 (25.0)	0 (0)
Sharing information
<4.57^a a PPOS scores < 4.57 = physician-centered and disease-centered attitudes;	38 (52.8)	21 (29.2)	08 (11.1)	0 (0)	01 (1.4)	04 (5.6)
4.57-4.99^b b PPOS scores between 4.57 and 4.99 = moderately patient-centered attitudes;	02 (40.0)	01 (20.0)	0 (0)	01 (20.0)	01 (20.0)	0 (0)	0.087
≥5.00^c c PPOS scores≥ 5.00 = patient-centered attitudes;	04 (66.7)	0 (0)	02 (33.3)	0 (0)	0 (0)	0 (0)
Sharing power and responsibility
<4.57^a a PPOS scores < 4.57 = physician-centered and disease-centered attitudes;	29 (60.4)	12 (25.0)	05 (10.4)	0 (0)	01 (2.1)	01 (2.1)
4.57-4.99^b b PPOS scores between 4.57 and 4.99 = moderately patient-centered attitudes;	14 (43.8)	09 (28.1)	05 (15.6)	01 (3.1)	0 (0)	03 (9.4)	0.304
≥5.00^c c PPOS scores≥ 5.00 = patient-centered attitudes;	01 (33.3)	01 (33.3)	0 (0)	0 (0)	01 (33.3)	0 (0)

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