Detecção precoce do câncer de mama: significados, condicionantes e resolubilidade dos serviços de saúde [Digital]
Tese
Português
618.19-006
Fortaleza, 2016.
Introdução: Reconhecer precocemente os sinais e os sintomas do câncer de mama é a principal estratégia de combate dessa neoplasia. Esse tipo de câncer é o mais frequente nas mulheres e de grande impacto social. Objetivos: caracterizar as participantes da pesquisa (mulheres mastectmomizadas) quanto...
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Introdução: Reconhecer precocemente os sinais e os sintomas do câncer de mama é a principal estratégia de combate dessa neoplasia. Esse tipo de câncer é o mais frequente nas mulheres e de grande impacto social. Objetivos: caracterizar as participantes da pesquisa (mulheres mastectmomizadas) quanto ao perfil sociodemográfico e fatores de riscos para o câncer de mama; compreender o significado da detecção precoce do câncer de mama na percepção da mulher mastectomizada; identificar os condicionantes que levaram a mulher mastectomizada a não aderir às estratégias de detecção precoce do câncer de mama; analisar a resolubilidade dos serviços de saúde para detecção precoce do câncer de mama. Metodologia: Pesquisa qualitativa, cujos dados foram coletados nos meses de dezembro de 2015 e janeiro de 2016 por meio do levantamento documental em prontuários, fichários e entrevista individual. Participaram do estudo 26 mulheres mastectomizadas, atendidas pelo Sistema Único de Saúde, no ambulatório de referência em Oncologia do Ceará. Resultados e discussão: organizou-se as temáticas: significados da detecção precoce do câncer de mama para as mulheres; ações e condicionantes da não adesão às estratégias de detecção precoce do câncer de mama e a interpretação da resolubilidade dos serviços de saúde na detecção precoce do câncer de mama. A análise fundamentou-se nos pressupostos do Interacionismo Simbólico e nas políticas públicas de atenção a saúde da mulher. As participantes tinham entre 37 e 66 anos; histórico familiar da doença; maioria casada fez uso de contraceptivo, tinha filhos, católica, branca, não realizava autoexame nas mamas; renda média de um salário e meio; história esporádica de uso de álcool e tabaco; somente cinco estudaram mais de 10 anos. Referindo-se aos fatores de risco para o câncer de mama, sete eram nulíparas; a maioria tinham histórico de câncer na família (mãe e irmã); a idade da menarca variou de 12 a 16 ano.As mulheres centraram seus depoimentos na doença, atribuindo-lhe significado de ¿perda da saúde¿, sinalizada pela incapacidade de trabalhar, divertir-se e viver normalmente. O significado do câncer é de ameaça à vida, sendo referida pelo medo presente em todas as etapas do adoecimento. Surpreendida pela notícia de que tem a doença, a mulher evidencia sentimentos que vão além do medo da dor e da morte. Na concepção das participantes, a detecção, é importante para a manutenção da vida e para minimizar sofrimentos, porque há tratamento e cura. Condicionantes subjetivos como medo, vergonha, religiosidade e outros aspectos culturais predominam como condicionantes de não-adesão às ações de detecção precoce do câncer de mama; seguidos por falta de profissionais e problemas estruturais dos serviços de saúde. Para 21 mulheres, em seu itinerário de descoberta e tratamento do câncer de mama, o posto de saúde foi o lugar que primeiramente buscaram. Para uma parte delas, o acesso garantiu a celeridade no atendimento pelas equipes de saúde. As interpretações convergiram para significar que a falta do médico na equipe compromete a celeridade e a resolubilidade da assistência, determinando peregrinação e sofrimento. Para 19 participantes, o tempo médio para o diagnóstico foi de 2 a 5 meses e de 3 a 6 meses para o tratamento. Dificuldades operacionais de referência e contra-referência são recorrentes, bem como as passagens por vários serviços de saúde antes de iniciar qualquer tratamento. A rede de amizades e a utilização do setor privado para realizar exames confere certa celeridade ao diagnóstico e ao tratamento. Considerações finais: os resultados permitem inferir que as mulheres têm um sério obstáculo à adesão ao autoexame das mamas e destaca-se o medo como uma das principais barreiras que influenciam o postergar do cuidado com a saúde mamária. Para, além disso, há limitações e pouca articulação entre os serviços em face das demandas dos usuários referentes a necessidades em saúde, acesso, satisfação, resolubilidade no atendimento. A centralidade no trabalho médico e a insuficiente utilização da contrarreferência no fluxo de serviços são entraves no cotidiano da atenção primária. A rede de relacionamentos, bem como o segmento privado,vem sendo buscados como formas de obter maior resolubilidade por parte dos serviços de saúde. Recomenda-se que o sistema de saúde deve ser reorientado e adaptado a realidade da demanda, tomando o princípio da resolubilidade como suporte e estreitar parcerias com a sociedade e com o setor privado de forma complementar ao público.
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Introduction: The early recognition of signs and symptoms of breast cancer is the main strategy to fight this neoplasm. This type of cancer is the most common in women and has a major social impact. Objectives: to characterize the research participants (mastectomized women) regarding their...
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Introduction: The early recognition of signs and symptoms of breast cancer is the main strategy to fight this neoplasm. This type of cancer is the most common in women and has a major social impact. Objectives: to characterize the research participants (mastectomized women) regarding their sociodemographic profile and risk factors for breast cancer; to understand the meaning of early detection of breast cancer according to the mastectomized woman¿s perception; to identify the conditioning factors that led the mastectomized woman not to adhere to the strategies for early detection of breast cancer; to analyze the resolubility of health services regarding the early detection of breast cancer. Methodology: Qualitative research whose data were collected from December 2015 to January 2016 through documentary research of medical records and files and through individual interview. Twenty-six mastectomized women served by the Unified Health System at the reference Oncology outpatient clinic of the State of Ceará participated in the study. Results and discussion: themes were organized into: meanings of early detection of breast cancer for the women; actions and conditioning factors for non-adherence to strategies for early detection of breast cancer; and interpretation about the resolubility of health services in the early detection of breast cancer. The analysis was based on the Symbolic Interactionism and the public policies on women¿s health. Participants were between 37 and 66 years old; had family history of the disease; were mostly married and used contraceptives; had children; were catholic; white; did not perform breast self-examination; had a mean income of one and one-half wage; history of sporadic consumption of alcohol and smoking; and only five had studied for more than 10 years. As for risk factors for breast cancer, seven were nulliparous; the majority had a family history of cancer (mother and sister); and the age at menarche ranged from 12 to 16 years. Most of the women focused their testimonies on the
disease and defined it as ¿loss of health¿ due to their inability to work, have fun and live their lives normally. The meaning of cancer refers to a life threat due to the fear that is present in all stages of the disease process. After knowing that she has the disease, the woman experiences feelings that are beyond the fear of pain and death. From the participants¿ perspective, the detection is important for the maintenance of life and to minimize suffering as there is a chance of treatment and cure. Subjective conditioning factors such as fear, shame, religiosity and other cultural aspects predominate as conditioning factors for non-adherence to actions of early detection of cancer, followed by the lack of professionals and structural problems of health services. For 21 women, in their itinerary from the discovery to the treatment of breast cancer, the healthcare center was the first place they sought. For part of them, the access guaranteed that care was provided fast by the health teams. The interpretations converged to mean that the lack of a physician in the team compromises the speed and resolubility of care, leading to pilgrimage and suffering among women. For 19 participants, the average time for diagnosis was 2 to 5 months and it took 3 to 6 months for treatment. Operational difficulties related to referral and counter-referral are common, as well as the travel to various health services before starting any treatment. Friendship network and the use of the private sector to carry out tests can speed diagnosis and treatment. Final considerations: The results allow to understand that women face a serious obstacle to adherence to breast self-examination and highlight the fear as one of the main barriers that influence the postponement of breast health care. In addition, there are limitations and little articulation between services towards users¿ demands regarding health needs, access, satisfaction, and rerolubility care. The focus on the medical work and the insufficient use of counter-referral in the services are obstacles in the daily routine of primary care. The relationship network and the private sector have been sought by health services as ways to achieve greater resolubility. The health system must be reoriented and adapted to the reality of such demand by taking the principle of resolubility as a support and by strengthening partnerships with society and the private sector in order to complement to the public system. Ver menos
disease and defined it as ¿loss of health¿ due to their inability to work, have fun and live their lives normally. The meaning of cancer refers to a life threat due to the fear that is present in all stages of the disease process. After knowing that she has the disease, the woman experiences feelings that are beyond the fear of pain and death. From the participants¿ perspective, the detection is important for the maintenance of life and to minimize suffering as there is a chance of treatment and cure. Subjective conditioning factors such as fear, shame, religiosity and other cultural aspects predominate as conditioning factors for non-adherence to actions of early detection of cancer, followed by the lack of professionals and structural problems of health services. For 21 women, in their itinerary from the discovery to the treatment of breast cancer, the healthcare center was the first place they sought. For part of them, the access guaranteed that care was provided fast by the health teams. The interpretations converged to mean that the lack of a physician in the team compromises the speed and resolubility of care, leading to pilgrimage and suffering among women. For 19 participants, the average time for diagnosis was 2 to 5 months and it took 3 to 6 months for treatment. Operational difficulties related to referral and counter-referral are common, as well as the travel to various health services before starting any treatment. Friendship network and the use of the private sector to carry out tests can speed diagnosis and treatment. Final considerations: The results allow to understand that women face a serious obstacle to adherence to breast self-examination and highlight the fear as one of the main barriers that influence the postponement of breast health care. In addition, there are limitations and little articulation between services towards users¿ demands regarding health needs, access, satisfaction, and rerolubility care. The focus on the medical work and the insufficient use of counter-referral in the services are obstacles in the daily routine of primary care. The relationship network and the private sector have been sought by health services as ways to achieve greater resolubility. The health system must be reoriented and adapted to the reality of such demand by taking the principle of resolubility as a support and by strengthening partnerships with society and the private sector in order to complement to the public system. Ver menos
Disponibilidade forma física: Existe obra impressa de código : 100429
Silva, Raimunda Magalhães da
Orientador
Silva, Raimunda Magalhães da
Banca examinadora
Mamede, Marli Villela
Banca examinadora
Amorim, Rosendo Freitas de
Banca examinadora
Moura, Escolástica Rejane Ferreira
Banca examinadora
Caldas, José Manuel Peixoto
Banca examinadora
Fernandes, Ana Fátima Carvalho
Banca examinadora
Brasil, Christina Cesar Praca
Banca examinadora
Associação Ampla UECE/UFC/UNIFOR
Associação Ampla UECE/UFC/UNIF