Indicadores de qualidade para os serviços de cuidados paliativos em Portugal

Research output: Types of ThesisDoctoral Thesis


Introduction: The palliative care is both a philosophy of care and an area of knowledge. His main goal is to promote the quality of life of patient, with incurable, advanced and progressive disease, and his family. It must be culturally sensible and based on the values, desires, preferences and objectives of the patients and congruent with the best scientific evidence and ethical values in order to be considered with quality. The quality indicators are simple, valid, reliable and useful tools to monitor the quality of care, allowing the identification of improvement areas, and, thereby creating conditions to promote the quality of care. The goal of this study was to develop/to identify a set of basic quality indicators for the palliative care services of Portugal. Methods: The study was done in two phases. The first, a systematic review, to identify quality indicators used internationally, which then would be evaluated regarding their appropriateness and usefulness to the Portuguese reality. The second, the determination by consensus, through Delphi process, the set of quality indicators suitable for Portugal, using as experts, health professionals who worked in palliative care services and, at least, 3 years of professional experience in this area. After this identification, the palliative care teams were evaluated to assess the degree of achievement of the quality indicators of structure. Results: From a total of 675 publications, found in the systematic review, only 28 were included in the final revision. 385 quality indicators were identified of which were selected 120 to the Delphi process. Only 101 achieved the desired criteria. Of which, 22 are of structure, 63 of process and the other 16 of outcomes. About the domain, 33 belong to the structure and process of care, 16 to the physical aspects of care, 14 to the psychological and psychiatric aspects of care, 9 to the social aspects, 3 to the spiritual, religious and existential aspects, 2 to the cultural aspects, 13 to the care of the imminently dying and 11 to the ethical and legal aspects. Regarding the evaluation of the degree of achievement of the indicators of structure, this ranges from 16% (“provide home care”) and 84% (have the service organization chart, identifying the leaders, describing the hierarchy of elements and their functions). Discussion: The set of quality indicators achieved is synchronized with the several sets used by international organizations and with the founded in the literature. In this set are included the key-aspects which from the point of view of the health professionals, patients and family, must be present in the care delivered to be considered with quality. Also are included quality indicators of the different typologies and domains. In the field of structure indicators there are areas with clear necessity of improvement, which should be given attention by the teams in order to they can meet the requirements for a quality processes and results. Conclusions: It was identified a set of quality indicators for the palliative care services in Portugal, which allow to assess, to monitor and to promote the improvement of the quality of the care delivered. The application of the indicators should be progressive and according to the maturity and development of the teams.
Original languagePortuguese
QualificationDoctor of Philosophy
  • Rosa, Fernando Coelho, Supervisor
  • Nabal Vicuna, Maria, Supervisor, External person
Award date1 Jan 2013
Publication statusPublished - 1 Jan 2013

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