Navegando por Palavras-chave "Cooperação E Adesão Ao Tratamento"

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    Análise qualitativa da adesão ao tratamento pós-transplante hepático em adultos
    (Universidade Federal de São Paulo (UNIFESP), 2019-11-28) Silva, Juliana Dutra De Araujo [UNIFESP]; Roza, Bartira De Aguiar [UNIFESP]; http://lattes.cnpq.br/9049493842666015; http://lattes.cnpq.br/1589752854243094; Universidade Federal de São Paulo (UNIFESP)
    Objective: To understand the experience of adherence to treatment after liver transplantation in adults. Method: An exploratory, descriptive, qualitative study with Laurence Bardin's Content Analysis as a reference for organizing and analyzing data collected in semi-structured interviews. Results: We interviewed 18 adult patients with deceased donor liver transplant, followed in a transplant center in São Paulo. The results emerged from two themes: 1) Illness: patients reported the experience of discovering a silent disease, the severe limitations of illness and the transplant acceptance process, the latter being crossed by coping with illness, waiting for the compatible organ at the ideal time, the information that has no way to cure the disease and finally, the acceptance; 2) Life after transplantation: Patients reflected on whether life after transplantation is normal, evaluating what have improved, which aspects of the health are still recovering, what are the limitations, complications and emotional responses in this new phase. They reported the coping strategies used - such as seeking information, support network, spirituality, and gratitude - and conclude that this is a life of care involving healthy living habits, continuous use of medication, and outpatient followup, to which they will respond adhering or not. Going through all these moments of life after transplantation, the fear of death was a central finding of the study associated with treatment adherence. Patients who adhere to health care team guidelines may be mobilized by the fear of dying that persist even after transplantation with the threat of graft loss. Non-adherence to treatment was associated with the absence of fear of death, either by the absence of symptoms that would approach them to this reality or by the denial of their own finitude. Conclusion: Behaviors of adherence or nonadherence to treatment after transplantation were associated with emotional responses to illness and fear of death. Thus, interventions to promote adherence should alert patients about the risks (sometimes silent risks) that remain after transplantation and take care of those who are suffering feeling their life continually under threat.
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    Não adesão ao tratamento no transplante de fígado
    (Universidade Federal de São Paulo (UNIFESP), 2019-04-25) Oliveira, Priscilla Caroliny De [UNIFESP]; Roza, Bartira De Aguiar [UNIFESP]; Schirmer, Janine [UNIFESP]; http://lattes.cnpq.br/3721636964139813; http://lattes.cnpq.br/9255434835123749; http://lattes.cnpq.br/3558901850783019; Universidade Federal de São Paulo (UNIFESP)
    Objectives: To evaluate the interventions of the multiprofessional team that provide improved adherence to treatment after liver transplantation; to assess levels of non-adherence to immunosuppressive therapy in a sample of liver transplant recipients using the Basel Assessment of Adherence with immunosuppressive medication Scalee to correlate sociodemographic characteristics and clinical factors to non-adherence to medication; to develop a model of evaluation of nonadherence to the treatment in the context of liver transplantation capable of covering several dimensions of the phenomenon, correlating the levels of non adherence to the different methods of measurement applied in liver transplant patients; to reflect on the theoretical and practical aspects related to non-adherence to treatment in the context of liver transplantation and to correlate with the concepts of normality established by Michael Foucault and The Power as Knowing Participation in Change Theory. Methods: This study adopted a mixed method design, in which elements of qualitative and quantitative research were combined. The work was divided into four subprojects: 1- adherence to treatment in liver transplantation: an integrative review; 2- evaluation of adherence to treatment in patients submitted to liver transplantation; 3 - New perspectives of analysis in nonadherence research in liver transplantation by means of data association: pilot study. 4 - subjectivity, adherence in transplantation and biopolitics - possible reflections of power as normative practice in health. The study was and approved by the Ethics and Research Committee under the opinion 623.082 and Certificate of Presentation for Ethical Appreciation nº1643201470005505. Results: The integrative review, which aimed to evaluate the interventions of the multiprofessional team that provides the improvement of adherence to treatment after liver transplantation, initially selected 84 publications. After applying the exclusion criteria, 10 studies were selected. Four significant categories were found: educational interventions; adoption of an individual therapeutic plan; change in immunosuppressive regimen; emotional support, psychological support and strengthening of the support network. The level of nonadherence in liver transplantation was 49% and was directly related to the use of mycophenolic acid (p = 0.007) and administration of multiple doses of immunosuppressants daily (p = 0.004). No statistically significant correlations were found between non-adherence to immunosuppressive therapy and sociodemographic characteristics and other clinical variables analyzed. It was proposed a data triangulation model that evaluated the non adherence to liver transplantation under different aspects: a) direct evaluation of non adherence - through the application of a self-report instrument, associated to the perspective of the patient himself and the specialist responsible for follow-up; b) clinical evaluation, considering the serum immunosuppressive level in use, alterations of the aminotransferases, histological analysis of the graft and previous treatment for rejection; c) behavioral evaluation, which analyzed the existence of reports of therapeutic failure and absences on outpatient return. These indicators were analyzed individually and together. The theoretical essay aimed to develop a systematic reflection on adherence to treatment in the context of transplantation, based on the historicity of its concept of adherence through the construction of parallels between the concepts of adherence and health. The problem of non-adherence questions the team about its role, which requires listening to the demands that come in to everyday praxis. In this perspective, the theory of power as knowledge and participation for change of Elizabeth Barrett is emphasized, for emphasizing the subjective aspect present in health care, emphasizing the role of a dialogue and supported action in the establishment of solidarity and socio- and fostering the social role of users of transplantation actions and services. Conclusion: In view of the gaps highlighted and the results pointed out through the integrative review, it is understood that it is necessary to intensify efforts for the development of research with designs that produce strong evidences regarding the interventions adopted by the multiprofessional team capable of improving the adherence. This study showed that nearly half of the patients stopped adhering to immunosuppressive therapy after liver transplantation. Since unfavorable outcomes in transplantation are closely related to adherence failures, it is important that nurses assess this behavior during outpatient follow-up of liver transplant recipients. The application of triangulation methods to qualitatively assess noncompliance in an adult liver transplant program included 10 indicators in the analysis and identified a non-adherence level of 14.3%. At the end of the reflective study, it was possible to conclude that the phenomenon of adherence is more complex than we have traditionally described, because it depends on the subjective process that involves many questions that are not yet addressed by nurses in general. The threshold between adhesion and nonadherence is unique, even if it is influenced by plans that transcend the strictly individual, such as social, economic, political, historical and cultural.