Ciclo de melhoria da qualidade no cuidado centrado ao paciente oncológico em um serviço ambulatorial

Abstract

Introduction: Comprehensive care for cancer patients includes prevention, early detection, diagnosis, treatment, and provision of palliative care for those who need it. Objective: To evaluate the impact of interventions carried out in the quality improvement cycle in the care of patients identified with a Palliative Performance Scale (PPS) equal to or less than 50% in an outpatient oncology service. Methodology: This is a multi-method study that sought to develop a quality improvement cycle in the palliative care service provided in an outpatient oncology institution. The research was configured as a quasiexperimental before-and-after study, without a control group, with the objective of evaluating the effectiveness of the actions implemented. The evaluation of the results was carried out by comparative analysis of the initial evaluation with two other evaluations (in August 2023 and the first quarter of 2024). Results: The analysis of the first and third evaluations identified a reduction in nonconformities from 15 to 8 (46.7%). After implementing the planned improvement actions, criterion 1 had a 50% reduction in nonconformities. Criterion 4 showed a statistical improvement (0.28%) but requires further analysis because it is associated with multiple factors. Conclusions: Different approaches and expectations of patients, staff and family members regarding Palliative Care were identified depending on the context and culture in which they are inserted. Thus, successful practices in other countries may not be suitable for the Brazilian Northeastern reality and vice versa. However, it is noteworthy that the study suggests that analysis through the Improvement Cycle tool can be efficient in other health organizations regardless of their location or the type of patient they serve, by helping to identify and implement multifaceted actions in modifiable causes of any type of improvement opportunity presented.