Aspectos psicológicos da abordagem nutricional dos pacientes em cuidados paliativos

Malnutrition is considered a high-impact syndrome because it is the source of the disease and its progression. Malnutrition generates physical and psychological repercussions on the patient, and psychological repercussions on the family and the healthcare team. The purpose of this article is to analyze the importance of the patient’s nutrition, the comprehensive approach, and the emotional repercussion, not only on the patient, but also on his or her the family nucleus. After controlling the urgent symptoms, in order of importance, the physical and emotional symptoms and the nutritional facet are managed. Nutrition encompasses physical and emotional aspects. To achieve this, it is essential to carry out a diagnosis of the situation using communication as a basic tool, to be clear about the objective, and to accompany the patient and family in the different stages, providing tools for the adequate management of the patient’s progress and his or her environment.La desnutrición es un síndrome de alto impacto, porque es donde se materializa la enfermedad y su evolución. Esta genera repercusiones físicas y psicológicas en el paciente, así como psicológicas en la familia y en el equipo asistencial. La finalidad de este artículo es analizar la importancia de la nutrición del paciente, el abordaje integral y la repercusión en la esfera emocional no solo del paciente, sino del núcleo familiar. Luego del control de los síntomas urgentes, en orden de importancia, se maneja el resto de los síntomas físicos, los emocionales y el aspecto nutricional. La nutrición engloba lo físico y lo emocional. Para ello se considera primordial realizar un diagnóstico situacional, con base en la comunicación como herramienta fundamental. Se debe tener claro el objetivo, y acompañar en las diferentes etapas al paciente y la familia, brindando herramientas para el adecuado manejo de la evolución del paciente y su contexto. A desnutrição é uma síndrome de alto impacto, pois é onde se materializa a doença e sua evolução. Gera repercussões físicas e psicológicas no paciente e repercussões psicológicas na família e na equipe de saúde. A finalidade deste artigo é analisar a importância da nutrição do paciente, a abordagem integral e a repercussão na esfera emocional, não só do paciente, mas também do núcleo familiar. Depois do controle dos sintomas urgentes em ordem de importância, são gerenciados o restante dos sintomas físicos, emocionais e o aspecto nutricional. A nutrição abrange o físico e o emocional. Para isso, considera-se primordial a realização de um diagnóstico situacional utilizando a comunicação como ferramenta fundamental, ter clareza sobre o objetivo e acompanhar o paciente e a família nas diferentes etapas, fornecendo ferramentas para a gestão adequada da evolução do paciente e seu contexto

Evaluating pain management practices for cancer patients among health professionals: a global survey

Background: Cancer incidence in the world is predicted to increase in the next decade. While progress has been in diagnosis and treatment, much still remains to be done to improve cancer pain therapy, mainly in underserved communities in low-income countries. Objective: To determine knowledge, beliefs, and barriers regarding pain management in both high- and low-income countries (according to the WHO classification); and to learn about ways to improve the current state of affairs. Design: Descriptive survey. Setting/Subjects: Fifty-six countries worldwide; convenience sample of 1639 consisted of 36.8% physicians; 45.1% nurses, and 4.5% pharmacists employed in varied settings. Results: Improved pain management services are key elements. Top barriers include religion factors, lack of appropriate education and training at all levels, nonadherence to guidelines, patients' reluctance to report on pains, over regulation associated with prescribing and access to opioid analgesics, fear of addiction to opioids, and lack of discussions around prognosis and treatment planning. Conclusion: The majority of patients with cancer in low-income countries are undertreated for their pain. Promoting cancer pain accredited program of training and education on pain management for physicians and nurses is crucial, as well as advocating policymakers and the public at large. Keywords: cancer; global; management; opioids; pain