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Perceção e valorização pelos profissionais de saúde dos problemas da ética clínica: estudo observacional na Administração Regional de Saúde de Lisboa e Vale do Tejo
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Introdução: A ética clínica integra a identificação, análise e resolução de problemas éticos que surgem em contexto assistencial. Assim, os objetivos desta investigação foram os seguintes: caracterizar a forma como os profissionais de saúde identificam e gerem os problemas da ética clínica e identificar quais ferramentas e estruturas de apoio considerariam úteis. Métodos: Estudo transversal, observacional, tendo como população-alvo os profissionais de saúde a trabalhar em cuidados de saúde primários na Administração Regional de Saúde de Lisboa e Vale do Tejo (ARSLVT). Realizou-se uma amostragem aleatória por cluster simples de uma etapa, estratificada, para obtenção de um total de 400 profissionais de saúde. Aplicou-se um questionário de autopreenchimento, previamente aplicado em quatro países europeus, adaptado e submetido a teste-piloto. Resultados: Recolheram-se 204 questionários; 96% dos participantes reportaram experiência com pelo menos um dos sete tipos de problemas éticos descritos. Os problemas mais frequentemente identificados foram o cuidado de adultos cuja capacidade de decisão sobre a própria saúde era desconhecida ou estava comprometida (94%) e situações em que a gestão de recursos obrigou o profissional a optar por uma solução diferente da desejada (81%). Apenas 16% dos profissionais tinham recorrido a algum dos recursos de apoio ético descritos. Os recursos considerados mais úteis na resolução de problemas éticos foram os que ofereciam ajuda na clarificação das questões éticas ao próprio e aos demais profissionais envolvidos (42%). Conclusão: Os problemas éticos são uma parte constitutiva da complexidade do cuidar, o que evidencia a necessidade de um suporte ético adequado na tomada de decisão. Todavia, destaca-se como tendência predominante uma baixa utilização desses recursos pelos profissionais de saúde. Esta situação deverá ser objeto de reflexão no desenho dos modelos organizativos de suporte à decisão ética.
ABSTRACT - Introduction: Clinical ethics involves identifying, analyzing, and resolving ethical problems that arise in healthcare practice. This study aimed to describe how health professionals identify and manage clinical ethics issues and to identify which tools and support structures they consider useful. Methods: A cross-sectional, observational study was conducted among health professionals working in primary care in the Administração Regional de Saúde de Lisboa e Vale do Tejo (ARSLVT). A one-stage, stratified, simple cluster random sampling method was used to select a total of 400 professionals. A self-administered questionnaire, previously applied in four European countries, was adapted and pilot-tested for this context. Results: A total of 204 questionnaires were collected. Ninety-six percent of participants reported experience with at least one of the seven types of ethical problems described. The most frequently identified issues were caring for adults whose decision-making capacity regarding their health was unknown or impaired (94%), and situations where resource management required professionals to make choices different from those they desired (81%). Only 16% of professionals had used any of the described ethical support resources. The most valued resources for resolving ethical conflicts were those providing help in clarifying ethical issues for themselves and other professionals involved (42%). Conclusion: Ethical problems are an inherent part of the complexity of healthcare, highlighting the need for adequate ethical support in decision-making. However, the low use of such resources among professionals stands out as a key finding. This should be considered when designing organizational models for ethical decision support.
ABSTRACT - Introduction: Clinical ethics involves identifying, analyzing, and resolving ethical problems that arise in healthcare practice. This study aimed to describe how health professionals identify and manage clinical ethics issues and to identify which tools and support structures they consider useful. Methods: A cross-sectional, observational study was conducted among health professionals working in primary care in the Administração Regional de Saúde de Lisboa e Vale do Tejo (ARSLVT). A one-stage, stratified, simple cluster random sampling method was used to select a total of 400 professionals. A self-administered questionnaire, previously applied in four European countries, was adapted and pilot-tested for this context. Results: A total of 204 questionnaires were collected. Ninety-six percent of participants reported experience with at least one of the seven types of ethical problems described. The most frequently identified issues were caring for adults whose decision-making capacity regarding their health was unknown or impaired (94%), and situations where resource management required professionals to make choices different from those they desired (81%). Only 16% of professionals had used any of the described ethical support resources. The most valued resources for resolving ethical conflicts were those providing help in clarifying ethical issues for themselves and other professionals involved (42%). Conclusion: Ethical problems are an inherent part of the complexity of healthcare, highlighting the need for adequate ethical support in decision-making. However, the low use of such resources among professionals stands out as a key finding. This should be considered when designing organizational models for ethical decision support.
Descrição
Palavras-chave
Clinical ethics Ethical problems Ethical decision support in healthcare Ethical consultant Ética clínica Problemas éticos Suporte à decisão ética em saúde Consultor ético
Contexto Educativo
Citação
Gaspar IG, Dias CV, Raposo H. Perceção e valorização pelos profissionais de saúde dos problemas da ética clínica: estudo observacional na Administração Regional de Saúde de Lisboa e Vale do Tejo. Rev Port Med Geral Fam. 2025;41(5):423-30.
Editora
Associacao Portuguesa de Medicina Geral e Familiar