Palliative Care in Brazil: With a View to Future Needs?

  • Cledy Eliana dos Santos Grupo Hospitalar Conceição
  • José Manuel Peixoto Caldas, PhD University of Porto
  • José Américo Serafim Ministry of Health - Brazil
  • Newton Barros, MsC Hospital Nossa Senhora da Conceição – GHC (Grupo Hospitalar Conceição)
  • Altamiro da Costa Pereira, PhD University of Porto
  • Marcelo Eduardo Zanella Capra, MsC Hospital Nossa Senhora da Conceição – GHC (Grupo Hospitalar Conceição)
  • Airton Stein Hospital Nossa Senhora da Conceição – GHC (Grupo Hospitalar Conceição)
  • Alberto Freitas, PhD University of Porto

Abstract

Background: Chronic non-communicable diseases (CNCD) constitute a health problem of growing magnitude in Brazil, leading concerns, to the Ministry of Health (MOH), about the care of persons with chronic conditions (due to advanced diseases), multiple harms to health, convalescents and in need of long-term care, requiring continuous assistance, physical and functional rehabilitation. However, few data exist on the size of the population potentially in need of palliative care in Brazil.


Aim: this study is to estimate the size of the Brazilian population that could benefit from palliative care across 26 federated states and the Federal District.


Design: this is a cross-sectional study, using national death certificate and hospital admission data. Brazilian death registration and hospital admission data from 1st of January to 31st of December 2014 were analyzed and compared with estimation methods of Rosenwax and Murtagh.


Setting/participants: all adults (≥ 15 years old) who died in the period of 1st of January to 31st of December 2014 in Brazil.


Results: the proportion of individuals who died from diseases that indicate palliative care needs at the end of life ranged from 24.6% to 85.2%.


 


Keywords: palliative care; estimating population; chronic non-communicable diseases; cancer; health planning.

Author Biographies

José Manuel Peixoto Caldas, PhD, University of Porto

Department of Education and Medical Simulation, University of Porto- Portugal; Visiting Professor of Post-Graduate Program in Collective Health from UNIFOR

José Américo Serafim, Ministry of Health - Brazil

Information Technology Department of the Brazilian Health System – SUS (DATASUS). Ministry of Health

Newton Barros, MsC, Hospital Nossa Senhora da Conceição – GHC (Grupo Hospitalar Conceição)

Palliative Care Service. Hospital Nossa Senhora da Conceição – GHC (Grupo Hospitalar Conceição)

Altamiro da Costa Pereira, PhD, University of Porto

Director of the CINTESIS – Center for Health Technology and Services Research, Portugal; Faculty of Medicine, University of Porto, Portugal (FMUP)

Marcelo Eduardo Zanella Capra, MsC, Hospital Nossa Senhora da Conceição – GHC (Grupo Hospitalar Conceição)

Oncology Service. Hospital Nossa Senhora da Conceição – GHC (Grupo Hospitalar Conceição)

Airton Stein, Hospital Nossa Senhora da Conceição – GHC (Grupo Hospitalar Conceição)

Community Health Service and Teaching and Research Management. Hospital Nossa Senhora da Conceição – GHC (Grupo Hospitalar Conceição)

Alberto Freitas, PhD, University of Porto

CIDES – Department of Health Information and Decision Sciences, Faculty of Medicine, University of Porto, Portugal; CINTESIS – Center for Health Technology and Services Research, Portugal

References

1. Lima-Costa MF, Veras R. Saúde pública e envelhecimento. Cad Saude Publica. 2003 Jun;19(3):700-1.
2. Firmo JOA, Barreto SM, Lima-Costa MF. The Bambuí Health and Aging Study (BHAS): factors associated with the treatment of hypertension in older adults in the community. Cad Saude Publica. 2003 Jun;19(3):817-27.
3. Brasil. Ministério da Saúde. Mortalidade – Brasil [Internet]. 2014 [cited 2016 Oct 10]. Available from: http://tabnet.datasus.gov.br/cgi/tabcgi.exe?sim/cnv/obt10uf.def.
4. Lima-Costa MF, Peixoto SV, Giatti L. Tendências da mortalidade entre idosos brasileiros (1980 - 2000). Epidemiol Serv Saúde. 2004 Dec;13(4):217-28.
5. Brasil. Ministério da Saúde. Sistema de Informações Hospitalares/SUS (SIH-DATASUS) [Internet]. 2016 [cited 2016 Oct 07]. Available from: http://sihd.datasus.gov.br/.
6. Camarano AA, editor. Novo regime demográfico: uma nova relação entre população e desenvolvimento? Rio de Janeiro: Ipea; 2014.
7. Brasil. Ministério da Saúde. Portaria GM/MS nº 2413, de 23 de março de 1998. Brasília: MS; 1998.
8. Schmidt MI, Duncan BB, Silva GA, Menezes AM, Monteiro CA, Barreto SM, et al. Chronic non-communicable diseases in Brazil: burden and current challenges. Lancet. 2011 Jun;377(9781):1949-61.
9. World Health Organization. 2008–2013 action plan for the global strategy for the prevention and control of noncommunicable diseases [Internet]. 2008 [cited 2016 Nov 17]. Available from: http://www.who.int/nmh/Actionplan-PC-NCD-2008.pdf.
10. World Health Organization. Global status report on noncommunicable diseases. Geneva: WHO; 2010
11. Brasil. Ministério da Saúde. Sistema de Informação sobre Mortalidade (SIM-DATASUS) [Internet]. Brasília: MS; 2016 [cited 2016 Oct 07]. Available from: http://sim.saude.gov.br/.
12. Brasil. Ministério da Saúde. Diretrizes para o cuidado das pessoas com doenças crônicas nas redes de atenção à saúde e nas linhas de cuidado prioritárias. Brasília: MS; 2013.
13. Brasil. Ministério da Saúde. Portaria GM/MS nº 483, de 1º de abril de 2014. Brasília: MS; 2014.
14. World Health Organization. Cancer control: knowledge into action: WHO guide for effective programmes: module 5. Geneva: WHO; 2007.
15. Brennan F. Palliative care as an international human right. J Pain Sympt Manag. 2007 May;33(5):494-9.
16. World Health Organization. Noncommunicable diseases country profiles. Geneva: WHO; 2014.
17. World Health Organization. Global status report on noncommunicable diseases. Geneva: WHO; 2014.
18. Strengthening of palliative care as a component of comprehensive care throughout the life course [Internet]. In: 67th World Health Assembly Resolution, 24 May 2014 [cited 2016 Feb 12]. Available from: http://apps.who.int/gb/ebwha/pdf_files/WHA67/A67_R19-en.pdf.
19. Murray SA, Kendall M, Boyd K, Sheikh A. Illness trajectories and palliative care. Br Med J. 2005 Apr;330(7498):1007-11.
20. Rechel B, Doyle Y, Grundy E, McKee M. How can health systems respond to population ageing? Policy brief 10. Geneva: WHO; 2009.
21. Brasil. Ministério da saúde. Portaria nº 3.535/GM, de 02 de setembro de 1998. Brasília: MS; 1998.
22. Brasil. Ministério da saúde. Portaria GM/MS nº 19, de 03 de janeiro de 2002. Brasília: MS; 2002.
523. Brasil. Ministério da saúde. Portaria GM/MS nº 2.439, de 8 de dezembro de 2005. Brasília: MS; 2005.
24. United Nations Department of Economic and Social Affairs. World population ageing 1950–2050. New York: United Nations; 2002.
25. Instituto Brasileiro de Geografia e Estatística. Perfil dos idosos responsáveis pelos domicílios no Brasil 2000. Rio de Janeiro: IBGE; 2002.
26. Schmidt MI, Duncan BB, Stevens A, Luft V, Iser BM, Moura L, et al. Doenças Crônicas não transmissíveis no Brasil: mortalidade, morbidade e fatores de risco. In: Brasil. Ministério da Saúde. Uma análise da situação de saúde e da Agenda Nacional e Internacional de Prioridades em Saúde. Brasília: MS; 2010. p. 111-36.
27. Floriani CA. Palliative care in Brazil: a challenge to the health-care system. Palliat Care. 2008;2:19-24.
28. Lima L, Wenk R, Krakauer E, Ferris K, Bennett M, Murray S, et al. Global framework for noncommunicable diseases: how can we monitor palliative care? J Palliat Med. 2013 Mar;16(3):226-9.
29. Brasil. Conselho Nacional de Secretários de Saúde. Assistência de média e alta complexidade no SUS. Brasília: CONASS; 2011.
30. Brasil. Ministério da Previdência e Assistência Social. Portaria Nº 3.046/1982. Brasília: MPAS; 1982.
631. Brasil. Ministério da Saúde. Portaria GM/MS nº 1.101/2002. Brasília: MS; 2002.
32. Brasil. Ministério da Saúde. Secretaria de Atenção à Saúde. Departamento de Regulação, Avaliação e Controle de Sistemas Critérios e Parâmetros para o Planejamento e Programação de Ações e Serviços de Saúde no âmbito do Sistema Único de Saúde. Brasília: MS; 2015.
33. Santos CE, Caldas JMP, Serafim JA, Barros N, Pereira AC, Capra MEZ, et al. Needs for palliative care of cancer patients in Brazil: analysis of data from 2008-2014. J Palliat Care Med. 2016;7(1):294.
34. Santos CD, Caldas JMP, Serafim JA, Barros N, Pereira AC. Hospital Admissions of Cancer Patients in Brazil: Analysis of Palliative Care Needs. J Palliat Care Med. 2016 May;6:263.
35. World Health Organization. Health topics: Chronic diseases. Geneva: WHO; 2013.
36. Pan American Health Organization. Plan of action for the prevention and control of noncommunicable diseases in the Americas 2013-2019. Washington: PAHO; 2014.
37. World Health Organization. Global status report on noncommunicable diseases [Internet]. 2014 [cited 2016 Apr 09]. Available from: http://apps.who.int/iris/bitstream/10665/148114/1/9789241564854_eng.pdf?ua=1.
38. Brasil. Ministério da Saúde. Sistema Nacional de Mortalidade (SIM/DATASUS). Brasília: MS; 2016.
39. Maciel MGS. Organization of palliative care services. In: National Palliative Care Academy. Palliative care manual. São Paulo: ANCP; 2009. p. 72-85.
40 Lunney JR, Lynn J, Foley DJ, Lipson S, Guralnik JM. Patterns of functional decline at the end of life. JAMA. 2003 May;289(18):2387-92.
41. Goméz-Batiste X, Porta J, Tuca A, Stjernsward  J, editors. Organización de servicios y programas de cuidados paliativos. Madrid: Arán; 2005.
42. Stjernswärd J, Foley KM, Ferris F. The Public Health Strategy for Palliative Care. J Pain Symptom Manage. 2007 May;33(5):486-93.
43. McNamara B, Rosenwax LK, Holman DAJ. A method for defining and estimating the palliative care population. J Pain Symptom Manage. 2006 Jul;32(1):5-12.
44. Higginson IJ, Hart S, Koffman J, Selman L, Harding R. Needs assessments in palliative care: an appraisal of definitions and approaches used. J Pain Symptom Manage. 2007 May;33(5):500-5.
45. Herrera E, Rocafort J, Lima L, Bruera E, Garcia-Pena F, Fernandez-Vara G. Regional palliative care program in extremadura: an effective public health care model in sparsely populated region. J Pain Symptom Manage. 2007 May;33(5):591-8.
46. Murtagh FE, Bausewein C, Verne J, Groeneveld EI, Kaloki YE, Higginson IJ. How many people need palliative care? A study developing and comparing methods for population-based estimates. Palliat Med. 2014 Jan;28(1):49-58.
47. Rosenwax LK, McNamara B, Blackmore AM, Holman CD. Estimating the size of a potential palliative care population. Palliat Med. 2005 Oct;19(7):556-62.
48. Kerr K, Rabow MW, Cassel J. Brian, mapping palliative care need and supply in California [Internet]. 2015 [cited 2016 Oct 05]. Available from: http://www.chcf.org/publications/2015/02/palliative-care-data#ixzz4TUZnI2G9.
49. Maciel MGS, Bettega R. Critérios de qualidade para os cuidados paliativos no Brasil. Rio de Janeiro: Diagraphic; 2006.
50. Scholten N, Günther AL, Pfaff H, Karbach U. The size of the population potentially in need of palliative care in Germany: an estimation based on death registration data. BMC Palliat Care. 2016 Mar;15:29.
51. Servo LMS. Perfil epidemiológico da população brasileira e o espaço das políticas públicas. In: Camarano AA, editor. Novo regime demográfico: uma nova relação entre população e desenvolvimento? Rio de Janeiro: Ipea; 2014.
52. Comissão Nacional de Cuidados Paliativos. Plano estratégico para o desenvolvimento dos cuidados paliativos [Internet]. 2016 [cited 2016 Oct 10]. Available from: https://www.sns.gov.pt/wp-content/uploads/2016/09/Plano-Estrat%C3%A9gico-CP_2017-2018-1.pdf.
Published
2017-04-25
How to Cite
DOS SANTOS, Cledy Eliana et al. Palliative Care in Brazil: With a View to Future Needs?. International Archives of Medicine, [S.l.], v. 10, apr. 2017. ISSN 1755-7682. Available at: <http://imedicalsociety.org/ojs/index.php/iam/article/view/2440>. Date accessed: 19 oct. 2019. doi: https://doi.org/10.3823/2418.
Section
Public Health and Health Management