Transição do cuidado de pacientes oncológicos: do hospital para a comunidade

Rodrigues, Caroline Donini; Lorenzini, Elisiane; Romero, Manuel Portela; Oelke, Nelly Donszelmann; Winter, Vanessa Dalsasso Batista; Kolankiewicz, Adriane Cristina Bernat

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Sumário

ORIGINAL ARTICLE • Rev. esc. enferm. USP 56 • 2022 • https://doi.org/10.1590/1980-220X-REEUSP-2022-0308en copiar

Transição do cuidado de pacientes oncológicos: do hospital para a comunidade

Autoria SCIMAGO INSTITUTIONS RANKINGS

RESUMO

Objetivo:

Analisar a transição do cuidado na perspectiva de pacientes oncológicos, em um hospital do sul do Brasil, correlacionando perspectivas com características sociodemográficas e clínicas.

Método:

Estudo transversal utilizando o Care Transitions Measure (CTM) com pacientes oncológicos em tratamento clínico ou cirúrgico após a alta hospitalar. A coleta de dados foi realizada por telefone entre junho e setembro de 2019. A análise dos dados foi realizada por meio de estatística descritiva e inferencial.

Resultados:

A pontuação média do CTM de 74,1, foi considerada satisfatória. Os fatores CTM: compreensão sobre medicamentos (83,3) e preparo para autocuidado (77,7) foram satisfatórios, enquanto: preferências garantidas (69,4) e plano de cuidados (66,1) foram insatisfatórios para uma transição de cuidado efetiva e segura. Não foi encontrada diferença estatisticamente significativa entre as variáveis sociodemográficas e o CTM. Entre as variáveis clínicas, o câncer primário e o fator de preferências garantidas apresentaram diferenças significativas (p = 0,044).

Conclusão

A transição da assistência hospitalar para a comunidade foi considerada satisfatória na avaliação geral.

DESCRITORES
Continuidade da Assistência ao Paciente; Cuidado Transicional; Neoplasias; Segurança do Paciente

Variables	Total sample (n = 213)*
Variables	n	%
Staging
I	6	3.4
II	26	14.5
III	50	27.9
IV	68	38.0
Other^* *Others: Chronic Lymphocytic Leukemias (LLC); Acute Lymphocytic Leukemia (ALL); Acute Myelocytic Leukemia (AML); Polycythemia Vera; Plasmablastic lymphoma.	29	16.2
Metastasis
Yes	92	44.2
No	116	55.8
Comorbidity
Yes	110	52.6
No	99	47.4
Reason for hospitalization
Chemotherapy Treatment/Radiotherapy	95	45.0
Surgical treatment	46	21.8
Clinical complications^ Clinical complications: pain; anemia; fatigue/tiredness/asthenia; pulmonary complications; inappetence; nausea; fever; diarrhea; oliguria; dysphagia; recurrence; jaundice; abdominal pain; convulsion; bleeding.	70	33.2
Use of continuous medication
Yes	146	68.5
No	64	30.0
Do not know	3	1.4
Tumor location^* *Respiratory system (rhinopharynx, oropharynx, lung); Digestive system (pharynx, esophagus, gastric, colon, rectum, liver, pancreas); Reproductive system (ovary, uterus, vulva, prostate, testis); Leukemias/Lymphomas (Chronic Lymphocytic Leukemia; Acute Lymphocytic Leukemia; Acute Myelocytic Leukemia; Polycythemia Vera; Plasmablastic Lymphoma).
Respiratory System Neoplasm	14	6.6
Breast Neoplasm	14	6.6
Digestive System	135	63.4
Reproductive system	15	7.0
Leukemias/Lymphomas	9	4.2
Others^** **Others (CNS, thyroid, urinary, renal, melanomas, soft tissues).	26	12.2
Type of cancer
Primary	128	60.7
Secondary	83	39.3
Oncological treatment
Chemotherapy (neoadjuvant, adjuvant)	128	63.1
Surgical	42	20.7
Others^*** ***Others: radiotherapy; chemotherapy/radiation therapy; hormone therapy.	19	9.4
Does not perform	14	6.9

CTM-15 estimates (n = 213)
Questions	Average	Standard deviation	Amplitude		Median	α C
Questions	Average	Standard deviation	Minimum	Maximum	Median	α C
CTM-15 GENERAL	74.1	10.0	31.3	100.0	73.4	.876
Factors
Preparation for self-management	77.7	12.1	25.0	100.0	75.0	.852
Understanding about medications	83.3	11.5	25.0	100.0	83.3	.819
Secured preferences	69.4	16.5	25.0	100.0	75.0	.932
Care plan	66.1	13.9	25.0	100.0	62.5	.696

Variables
	Preparation for self-management		Understanding medications		Secured preferences		Care plan
	Average	SD	Average	SD	Average	SD	Average	SD
Sex
Male	78.4	11.8	83.2	11.0	69.9	16.5	65.6	14.2
Feminine	76.6	12.5	83.5	12.2	68.7	16.6	66.8	13.6
p value	.295		.844		.615		.523
Age range
25 to 59	78.5	13.0	84.2	11.4	70.8	16.4	67.0	15.4
60 to 69	76.9	11.6	82.9	11.0	69.8	17.5	67.0	13.0
≥70	77.0	11.0	82.1	12.2	66.4	15.6	63.5	11.9
p value	.653		.537		.281		.260
Marital status
Not married	79.0	8.5	82.9	11.3	72.0	14.9	65.3	12.7
Married or in a stable relationship	77.2	12.9	83.3	11.5	68.8	16.9	66.4	14.3
p value	.395		.846		.266		.645
Breed
White	77.3	12.4	83.2	11.6	69.5	16.7	65.8	14.3
Black or brown	79.6	10.1	84.9	11.2	71.0	17.3	66.7	12.2
p value	.353		.454		.659		.739
Education
Illiterate	77.1	14.2	80.9	18.2	76.4	17.7	68.8	18.8
Less than high school	77.1	12.8	82.8	11.1	68.9	17.0	65.8	14.3
High school	77.9	11.4	82.7	10.6	68.6	15.6	65.4	13.3
University education	80.3	8.7	88.9	10.0	70.3	15.5	67.9	10.6
p value	.731		.100		.490		.814
Worked before hospitalization
Yes	76.7	11.1	84.3	10.4	71.3	14.5	64.7	15.0
No	77.8	12.3	83.1	11.7	69.1	16.8	66.3	13.8
p value	.658		.598		.514		.545
Place of residence
Urban area	78.2	11.7	83.3	11.2	68.7	16.5	66.4	13.3
Countryside	76.4	12.9	83.2	12.1	70.9	16.6	65.5	15.3
p value	.316		.970		.366		.684

Variables
	Preparation for self-mana gement		Understanding medications		Secured preferences		Care plan
	Average	SD	Average	SD	Average	SD	Average	SD
Staging
I	81.3	15.3	86.8	13.5	72.2	17.2	75.0	13.7
II	80.0	10.7	84.6	11.8	69.1	16.1	66.1	13.9
III	76.4	15.7	82.7	13.4	70.5	16.8	62.1	16.4
IV	77.0	10.7	83.4	9.6	68.7	16.2	67.9	11.6
Other^* *Other: Chronic Lymphocytic Leukemias (LLC); Acute Lymphocytic Leukemia (ALL); Acute Myelocytic Leukemia (AML); Polycythemia Vera; Plasmablastic lymphoma.	80.2	9.6	84.7	11.2	67.9	20.1	69.1	16.2
p value	.513		.876		.948		.076
Metastasis
Yes	77.0	9.5	83.6	9.5	67.8	16.3	66.6	10.5
No	78.6	13.6	83.3	12.4	70.9	16.8	66.2	15.9
p value	.338		.824		.177		.866
Comorbidities
Yes	76.9	11.2	83.9	11.3	68.2	16.4	65.2	13.0
No	78.4	13.0	82.6	11.8	70.6	16.6	66.8	14.8
p value	.383		.419		.287		.416
Reason for Hospitalization
Chemotherapy Treatment/Radiotherapy	77.2	12.6	83.1	11.3	68.8	16.1	65.6	14.0
Surgery	78.4	12.7	80.8	11.9	73.2	16.8	67.9	14.3
Clinical complications^ Clinical complications: pain; thrombocytopenia; anemia; fatigue/tiredness/asthenia; pulmonary complications; inappetence; nausea; fever; diarrhea; oliguria; dysphagia; cancer recurrence; jaundice; abdominal pain; convulsion; bleeding.	77.6	11.3	85.0	11.5	67.2	16.6	66.1	13.6
p value	.867		.156		.149		.640
Use of continuous medication
Yes	77.4	12.2	84.0	12.0	69.2	16.5	65.7	14.0
No	78.3	12.3	81.5	10.3	69.9	17.1	67.3	14.2
Do not know	75.6	1.1	87.2	4.6	67.4	8.4	63.5	1.7
p value	.857		.311		.947		.704
Tumor location^* *Respiratory system (rhinopharynx, oropharynx, lung); Digestive system (pharynx, esophagus, gastric, colon, rectum, liver, pancreas); Reproductive system (ovary, uterus, vulva, prostate, testis); Leukemias/Lymphomas (Chronic Lymphocytic Leukemia; Acute Lymphocytic Leukemia; Acute Myelocytic Leukemia; Polycythemia Vera; Plasmablastic Lymphoma).
Respiratory system	78.7	9.4	83.3	9.7	63.8	14.9	64.5	11.9
Breast	76.0	17.3	81.8	18.1	73.4	14.6	68.1	16.0
Digestive system	77.8	12.1	83.7	11.4	69.8	16.8	66.0	14.7
Reproductive system	79.3	11.0	82.7	10.7	71.8	16.6	65.2	10.8
Leukemia	82.2	12.2	86.0	12.7	68.7	19.4	72.6	16.1
Others^** **Others (CNS, thyroid, urinary, renal, melanomas, soft tissues).	74.8	10.8	81.4	8.9	67.1	16.4	65.0	10.6
p value	.658		.894		.657		.762
Type of cancer
Primary	78.9	11.9	83.6	11.1	71.4	16.9	66.1	14.9
Secondary	76.2	12.0	82.8	12.2	66.8	15.1	66.1	12.5
p value	.116		.649		.044		.989
Current cancer treatment
Chemotherapy (neoadjuvant/adjuvant)	77.2	11.8	84.0	11.0	67.4	17.3	65.7	13.8
Surgical	77.5	10.8	82.0	10.1	71.8	17.3	66.4	11.2
Others^*** ***Others: Radiotherapy, Chemotherapy plus Radiotherapy, Hormone Therapy.	77.9	16.4	81.4	15.2	71.8	12.1	68.9	17.2
Does not perform	77.1	13.3	80.8	14.2	73.5	13.8	63.8	17.3
p value	.995		.567		.271		.746

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[1] Corresponding author: Adriane Cristina Bernat Kolankiewicz Rua do Comércio, nº 3000, Universitário 98700-000 – Ijuí, RS, Brazil adri.saudecoletiva@gmail.com