A estigmatização das doenças relacionadas com o tabagismo é uma barreira aos cuidados de saúde e o problema pode estar a aumentar
O estigma que os pacientes enfrentam quando são diagnosticados com cancro do pulmão está associado a piores resultados psicossociais, incluindo sofrimento e isolamento, demora na procura de ajuda e preocupações sobre a qualidade dos cuidados...
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)
Domínio Público
O estigma que os pacientes enfrentam quando são diagnosticados com cancro do pulmão está associado a piores resultados psicossociais, incluindo sofrimento e isolamento, demora na procura de ajuda e preocupações sobre a qualidade dos cuidados, de acordo com uma investigação apresentada hoje na Associação Internacional para o Estudo do Cancro do Pulmão. (IASLC) Conferência Mundial sobre Câncer de Pulmão de 2023 em Cingapura.
O estudo, conduzido por uma equipe de pesquisadores liderada por Nathan Harrison, cientista comportamental e Ph.D. estudante da Flinders University, na Austrália, teve como objetivo identificar e sintetizar as intervenções existentes para combater o estigma associado ao câncer de pulmão e às doenças respiratórias relacionadas ao tabagismo , incluindo a doença pulmonar obstrutiva crônica (DPOC).
Enquanto isso, Jill Feldman, defensora dos pacientes da IASLC, apresentou dados na mesma coletiva de imprensa que mostraram que uma porcentagem significativa de pesquisadores de câncer de pulmão adotaram o Guia de Idiomas da IASLC . A comunidade do câncer de pulmão reconhece que algumas palavras e frases comumente usadas na medicina podem estar contribuindo para o problema do estigma do câncer de pulmão. Como resultado, os defensores estão a trabalhar em colaboração com médicos e cientistas para mudar a linguagem utilizada ao discutir tópicos relacionados com o tabagismo, o consumo de tabaco e tópicos relacionados.
Em 2021, a IASLC publicou o Guia de Idiomas da IASLC detalhando o idioma e o fraseado preferidos para todas as comunicações orais e escritas, incluindo apresentações em conferências da IASLC. A análise de Feldman de 519 apresentações na Conferência Mundial da IASLC sobre Câncer de Pulmão 2022 em Viena descobriu que 177 apresentações discutiram o status de tabagista, 77 apresentadores usaram linguagem não estigmatizante, enquanto 100 apresentadores usaram o termo estigmatizante “fumante”.
Assim, em apenas um ano de implementação, um número significativo de apresentadores já tinha adotado as alterações recomendadas que desempenham um papel importante na criação de um ambiente favorável aos pacientes e aos defensores nas reuniões e atividades da IASLC.
O estigma associado às doenças respiratórias relacionadas com o tabagismo conduz frequentemente à desvalorização externalizada, como a discriminação ou comentários críticos, e à auto-culpa ou vergonha internalizada.
Como as estratégias de desnormalização têm sido fundamentais para as respostas de controlo do tabaco a nível da população que desencorajam o tabagismo, as evidências sugerem que o estigma em torno do cancro do pulmão e das doenças respiratórias pode estar a aumentar. Para resolver esta questão, o desenvolvimento de intervenções de redução do estigma para os indivíduos afectados foi identificado como uma prioridade.
Harrison e os seus colegas conduziram uma revisão sistemática que identificou 10 estudos, descrevendo nove intervenções distintas de 427 registos, destinadas a reduzir o estigma relacionado com o cancro do pulmão e doenças respiratórias relacionadas com o tabagismo. A maioria das intervenções centrou-se em orientar a mudança de comportamento através de programas de grupo, proporcionando intervenção psicoterapêutica formal ou oferecendo informação/instrução e materiais de referência aos indivíduos. Estas intervenções visaram principalmente indivíduos sintomáticos ou grupos de maior risco em países de rendimento elevado.
Os pesquisadores pesquisaram quatro bases de dados eletrônicas (PsycINFO, CINAHL, PubMed e Scopus), com foco em câncer de pulmão, DPOC e termos relacionados ao estigma, em busca de registros relevantes publicados até dezembro de 2022. Os estudos elegíveis descreveram uma intervenção projetada para reduzir a externalização ou a internalização. estigma associado às doenças respiratórias relacionadas ao tabagismo e foram avaliados usando ferramentas de avaliação crítica do JBI, conforme apropriado para os diversos desenhos de estudo (relato de caso, ensaio qualitativo, quase experimental e randomizado controlado).
Notavelmente, o estudo revelou que a maioria das intervenções identificadas relataram ter conseguido reduções no estigma. Tanto a prestação de intervenção remota como a digital mostraram efeitos semelhantes aos modos presenciais tradicionais, indicando promessa no aumento da acessibilidade para indivíduos com comorbilidades ou deficiências funcionais relacionadas com doenças respiratórias.
“Precisamos de desenvolver e avaliar ainda mais as intervenções de redução do estigma com amostras maiores em diversos contextos socioculturais”, disse Harrison. “Além disso, a inclusão de avaliações validadas do estigma numa variedade mais ampla de estudos intervencionais poderia ajudar a identificar técnicas mais eficazes para a redução direcionada do estigma”.
Fornecido pela Associação Internacional para o Estudo do Câncer de Pulmão