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A experiência da doença oncológica na medicina dentária: o lugar da medicina narrativa – caso clínico
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| Projeto de pós-graduação_2023114359 | 1.14 MB | Adobe PDF |
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O cancro oral tem uma origem multifatorial, sendo o tabaco e o álcool considerados os principais fatores predisponentes, atuando de forma sinérgica e podendo aumentar o risco de cancro oral até 10 vezes. A deteção precoce, especialmente nos estádios iniciais, exerce um impacto decisivo no prognóstico, na taxa de mortalidade e na mitigação dos efeitos adversos de tratamentos mais agressivos. Além das suas implicações físicas, o cancro oral impõe desafios emocionais e psicossociais significativos, que podem afetar tanto o tratamento quanto a adesão do paciente. A Medicina Narrativa procura dotar os profissionais de saúde de competências narrativas, nomeadamente, saber escutar, interpretar e integrar as narrativas dos doentes e dos seus familiares no contexto da prática clínica. Para atingir este objetivo, a Medicina Narrativa propõe o uso de ferramentas promotoras das competências já referidas, nomeadamente, leitura imersiva, escrita reflexiva e o registo clínico paralelo. Tal abordagem não só enriquece a comunicação entre todos os envolvidos, mas também contribui para um cuidado que respeita e valoriza a individualidade do paciente. O objetivo deste estudo é promover uma reflexão sobre uma abordagem clínica sensível e centrada nas necessidades de pacientes que passaram por tratamentos oncológicos da cavidade oral. Pretende-se, com esta dissertação, contribuir para a formação dos médicos dentistas, orientando-os para enfrentar os desafios específicos do acompanhamento desses pacientes. A recolha de dados foi realizada por meio de uma entrevista previamente gravada, destinada a fins académicos e conduzida no contexto das Jornadas de Medicina Dentária da Faculdade de Medicina Dentária da Universidade de Lisboa. Este estudo de caso foi submetido à apreciação da Comissão de Ética da FCS-UFP. A literatura subjacente foi elaborada com base numa pesquisa bibliográfica em bases de dados relevantes, como PubMed, SciELO e b-on. Os critérios de inclusão abrangem artigos integralmente disponíveis em português ou inglês, que contribuam para a compreensão da Medicina Narrativa e seu impacto em pacientes oncológicos. Foram excluídos os artigos fora do tema proposto ou não acessíveis na íntegra. O estudo de caso destaca a experiência de uma paciente diagnosticada com cancro oral, com antecedentes de líquen plano oral erosivo e hábitos tabágicos. O relato da paciente evidencia a importância de um tratamento humanizado, no qual a empatia e a atenção às suas preocupações foram fundamentais. A paciente expressou gratidão pelo cuidado recebido no acompanhamento pelo médico dentista, que implementou uma abordagem centrada no paciente, esclarecendo informações e proporcionando um suporte emocional significativo durante todo o tratamento. Em contraste, uma insuficiente abordagem empática em interações anteriores contribuiu para sentimentos de desamparo e perda de orientação por parte da paciente e percepção de desamparado, reforçando a importância da comunicação no tratamento oncológico. Este testemunho demonstra que, mesmo quando a técnica é adequada, a ausência de uma abordagem holística pode causar sofrimento ao paciente, com impacto negativo na experiência e na gestão da doença. No entanto, ainda se revela necessária a realização de mais estudos sobre a Medicina Narrativa em diversos campos da Medicina, incluindo a Medicina Dentária.
Oral cancer has a multifactorial origin, with tobacco and alcohol being considered the main predisposing factors, acting synergistically and potentially increasing the risk of oral cancer up to 10 times. Early detection, especially in the early stages, has a decisive impact on prognosis, mortality rates and mitigating the adverse effects of more aggressive treatments. In addition to its physical implications, oral cancer imposes significant emotional and psychosocial challenges, which can affect both treatment and patient compliance. Narrative Medicine seeks to equip health professionals with narrative skills, namely knowing how to listen to, interpret and integrate the narratives of patients and their families in the context of clinical practice. To achieve this goal, Narrative Medicine proposes the use of tools that promote the aforementioned skills, namely immersive reading, reflective writing and parallel clinical recording. This approach not only enriches communication between all those involved but also contributes to care that respects and values the patient's individuality. The aim of this study is to promote reflection on a sensitive clinical approach centred on the needs of patients who have undergone oncological treatment of the oral cavity. The aim of this dissertation is to contribute to the training of dentists, guiding them to face the specific challenges of monitoring these patients. Data collection was carried out by means of a previously recorded interview, intended for academic purposes and conducted in the context of the Jornadas de Medicina Dentária of the Faculty of Dental Medicine of the University of Lisbon. This case study was submitted to the FCS-UFP Ethics Committee. The underlying literature was compiled on the basis of a bibliographic search of relevant databases such as PubMed, SciELO and b-on. The inclusion criteria include articles available in full in Portuguese or English, which contribute to the understanding of Narrative Medicine and its impact on oncological patients. Articles outside the proposed theme or not accessible in full were excluded. The case study highlights the experience of a patient diagnosed with oral cancer, with a history of erosive oral lichen planus and smoking habits. The patient's account highlights the importance of humanised treatment, in which empathy and attention to her concerns were fundamental. The patient expressed gratitude for the care received during follow-up by the dentist, who implemented a patient-centred approach, clarifying information and providing significant emotional support throughout the treatment. In contrast, an insufficient empathetic approach in previous interactions contributed to feelings of helplessness and loss of direction on the part of the patient and a perception of being helpless, reinforcing the importance of communication in oncological treatment. This testimony shows that even when the technique is adequate, the absence of a holistic approach can cause suffering for the patient, with a negative impact on the experience and management of the disease. However, there is still a need for more studies on Narrative Medicine in various fields of medicine, including dentistry.
Oral cancer has a multifactorial origin, with tobacco and alcohol being considered the main predisposing factors, acting synergistically and potentially increasing the risk of oral cancer up to 10 times. Early detection, especially in the early stages, has a decisive impact on prognosis, mortality rates and mitigating the adverse effects of more aggressive treatments. In addition to its physical implications, oral cancer imposes significant emotional and psychosocial challenges, which can affect both treatment and patient compliance. Narrative Medicine seeks to equip health professionals with narrative skills, namely knowing how to listen to, interpret and integrate the narratives of patients and their families in the context of clinical practice. To achieve this goal, Narrative Medicine proposes the use of tools that promote the aforementioned skills, namely immersive reading, reflective writing and parallel clinical recording. This approach not only enriches communication between all those involved but also contributes to care that respects and values the patient's individuality. The aim of this study is to promote reflection on a sensitive clinical approach centred on the needs of patients who have undergone oncological treatment of the oral cavity. The aim of this dissertation is to contribute to the training of dentists, guiding them to face the specific challenges of monitoring these patients. Data collection was carried out by means of a previously recorded interview, intended for academic purposes and conducted in the context of the Jornadas de Medicina Dentária of the Faculty of Dental Medicine of the University of Lisbon. This case study was submitted to the FCS-UFP Ethics Committee. The underlying literature was compiled on the basis of a bibliographic search of relevant databases such as PubMed, SciELO and b-on. The inclusion criteria include articles available in full in Portuguese or English, which contribute to the understanding of Narrative Medicine and its impact on oncological patients. Articles outside the proposed theme or not accessible in full were excluded. The case study highlights the experience of a patient diagnosed with oral cancer, with a history of erosive oral lichen planus and smoking habits. The patient's account highlights the importance of humanised treatment, in which empathy and attention to her concerns were fundamental. The patient expressed gratitude for the care received during follow-up by the dentist, who implemented a patient-centred approach, clarifying information and providing significant emotional support throughout the treatment. In contrast, an insufficient empathetic approach in previous interactions contributed to feelings of helplessness and loss of direction on the part of the patient and a perception of being helpless, reinforcing the importance of communication in oncological treatment. This testimony shows that even when the technique is adequate, the absence of a holistic approach can cause suffering for the patient, with a negative impact on the experience and management of the disease. However, there is still a need for more studies on Narrative Medicine in various fields of medicine, including dentistry.
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Palavras-chave
Tratamento oncológico oral Cuidados centrados no paciente Registo clínico terapêutico Medicina narrativa Oral oncological treatment Patient-centred care Therapeutic clinical record Narrative medicine