Bakgrund Palliativ vård är en vårdform som ska lindra lidande och förbättra livskvalitén hos patienter och anhöriga när sjukdom inte längre går att bota och livet går mot sitt slut. Palliativ vård utgår från ett helhetsperspektiv (holism). Det finns en ojämlikhet i tillgänglighet till palliativ vård globalt, då endast en liten andel av de med palliativa vårdbehov får detta tillgodosett. Det blir allt vanligare med palliativ vård i hemmet. Studier visar på bristfällig forskning av patienters upplevelser av denna vårdform. Syfte Syftet med litteraturöversikten var att undersöka patienters upplevelser av palliativ vård i hemmet. Metod En litteraturöversikt med systematisk ansats genomfördes i tre databaser; PubMed, CINAHL Complete och Nursing & Allied Health Premium. Femton vetenskapliga artiklar med kvalitativ data valdes ut och analyserades med Thomas och Hardens tematisk analys. Resultat Resultatet visade att hemmet är en viktig plats för patienter med palliativa vårdbehov för att öka välbefinnande och även öka möjlighet till närhet till anhöriga. Hemmet bidrog till normalitet och oberoende trots svår sjukdom. Det framkom att vården i hemmet kunde upplevas både trygg och otrygg beroende på hur vården var organiserad. Patienterna hade en oro för att svårbehandlade symtom skulle uppstå i hemmet eller att de skulle vara en börda för anhöriga. Det var viktigt för patienterna att ha en god relation till hälso- och sjukvårdpersonalen. Det framkom att patienters emotionella behov blev otillräckligt bemötta. Slutsats Hemmet är en viktig plats för patienter med palliativa vårdbehov. När vårdpersonalen samordnar vården och har ett gott bemötande ökar patienters trygghet och välbefinnande. Alla patienter bör få tillgång till palliativ vård av god kvalitet vid livets slut. Mer forskning behövs som belyser patientperspektivet inom denna kontext. / Background Palliative care is a form of care that is supposed to ease suffering and enhance patients and relatives’ quality of life during terminal illness at the end of life. There is an inequality in access to palliative care worldwide, since only a few of those in need receive it. It´s becoming more and more common with palliative home care. Studies show that there is a lack of knowledge about patients experience of this form of care. Aim The aim of the literature review was to explore patients’ perspective of palliative home-based care. Methods A literature review with a systematic approach were performed in three databases: PubMed,CINAHL Complete and Nursing & Allied Health Premium. Fifteen scientific articles of qualitative data were selected and analysed through three steps based on Thomas and Hardens thematic synthesis. Results The result showed that the patient´s home is an important place for terminally ill patients since it enhanced their wellbeing their ability to be close to relatives. Being at home also gave a sense of normality and independence despite severe illness. Home-based palliative care could be perceived as both safe but also unsafe depending on how well the care was organized. Patient´s worried that intractable symptoms would occur in their home or that they would be perceived as a burden to their relatives. It was important for patient´s to establish a good relationship with the healthcare professionals. Sometimes the patient´s emotional needs were insufficient met. Conclusions The patients home seem to be an important place for patients with palliative needs. When the health care staff coordinates care and have a friendly reception it increases the patients’ security and well-being. All patients should have access to palliative care of good quality at the end of life. More research reflecting the patient’s perspective in this context is needed.

Thesis (DTh (Practical Theology and Missiology))--University of Stellenbosch, 2004. / ENGLISH ABSTRACT: This dissertation aimed to ascertain, in a practical theological way, how to bridge the gulf between the congregation and the AIDS community using home based care as the vehicle of change. The initial hypotheses of the research were based upon a model initially developed by World Vision in Nkhotakota, Malawi. The research question, which the study address, is as follows: 1. Can the negative attitudes, prejudices and behaviours which are held and demonstrated by many in the church towards those suffering with HIV/AIDS, be changed by using deliberate attempts to alter their perspective of this pandemic by providing accurate information, in juxtaposition with the demonstration of Christ’s love and compassion to this community? 2. In conjunction to this first question comes a second: Can the compassionate outreach of the church, as it follows Christ’s mandate to love change the perspective of those in the HIV/AIDS community so that instead of viewing the church (as a whole) as cold and unloving, their perception will change with the demonstration of such love and compassion by its membership that they begin to see the church as a source of hope and love? To describe the contextual situation in which this study takes place, the historical background concerning the church’s response to the issue of the HIV/AIDS pandemic was explored in chapter two. The third chapter discusses the cultural paradigmatic focuses, unique to the African situation, with attention to the role in the church as it seeks to comply with its mandated mission. Chapter four then examines the cultural practices found, specifically in the Malawian context, that promote the spread and transmission of the HIV/AIDS virus amongst the Chewa people and the surrounding tribes. Over and against the identified traditional practices and their interrelationship with the worldviews of the people of Malawi, chapter five focuses on the practical theological implications of the church seeing to find identity in Christ. The ramifications of the praxis process regarding this hermeneutic, in consideration with the response of the Church as it seeks to reflect the character of the God, as represented primarily by the attribute of love towards those who are suffering from being infected or affected by this disease are explored in this chapter. It deals with the theological ramifications concerning the faith community as it represents the body of Christ by providing eschatological hope to this suffering world. The remaining chapters describe the methodology and praxis process utilizing the research hypothesis developed from the Nkhotakota model. Final conclusions were then drawn in order to provide understanding as to how to obediently participate in God’s witness to the world as the faith community addresses the problem of the HIV/AIDS pandemic in very poor areas in Malawi. Although the initial optimistic goals of this research were not met as anticipated, essential discoveries that illuminate the faulty paradigms associated with critical issues such as the effects of abject poverty were exposed. Difficulties that were initially considered secondary to the main thrust of this research, whose complexities are generally misunderstood by the western paradigm came to light as the praxis process unfolded. Attempts to sidestep stark issues such as poverty, in order to address the ‘real’ issues under study served to highlight these problems as their magnitude forced their recognition and consideration. This research has exposed is the necessity for further exploration into the intricate ramifications of issues such poverty by demonstrating the unfortunate fact that for those struggling to survive at the lowest levels of Maslow’s hierarchy, the luxury of benevolent service is simply not possible. For these, there is no other issue but survival. Calling on these sufferers to act as ‘the church’ when their need is so dire is not only unrealistic, it borders on sacrilege. / AFRIKAANSE OPSOMMING: Hierdie tesis beoog om op ‘n prakties-teologiese wyse vas te stel hoe om die kloof tussen ‘n gemeente en ‘n Vigs-gemeenskap te oorbrug met tuisversorging as medium van verandering. Die aanvanklike hipoteses van die navorsing is gebaseer op ‘n model wat oorspronklik deur World Vision by Nkhotakota, Malawi, ontwikkel is. Die navorsingsvraag waarop dié studie gerig word, is die volgende: 1. Kan die negatiewe houding, vooroordele en optrede van baie kerklidmate teenoor MIV/Viglyers verander word deur die gebruik van doelgerigte pogings om hul siening van hierdie pandemie te wysig deur die verskaffing van die korrekte inligting, tesame met blyke van Christus se liefde en medelye aan hierdie gemeenskap? 2. Tesame met hierdie eerste vraag, volg ‘n tweede. Kan die kerk se deernisvolle uitreik, met die betoning en uitvoer van Christus se opdrag om liefde te gee, die siening van mense in die MIV/Vigs gemeenskap só wysig dat, in plaas dat hulle die kerk (as ‘n geheel) ervaar as koud en liefdeloos, hulle hierdie begrip wysig deur die lidmate se betoning van dié liefde en deernis, dat hulle begin om die kerk te beskou as ‘n bron van hoop en liefde? Die beskrywing van die kontekstuele situasie waarin hierdie studie plaasvind, sowel as die historiese agtergrond ten opsigte van die kerk se respons tot die vraagstuk van die MIV/Vigs pandemie, is in hoofstuk twee ondersoek. Die derde hoofstuk bespreek die kulturele paradigmatiese fokusse, uniek aan toestande in Afrika. Dit gee aandag aan die rol van die kerk in sy doelwit om sy sendingmandaat uit te voer. Hoofstuk vier ondersoek die kulturele praktyke wat, spesifiek in die Malawiese konteks, die verspreiding en transmissie van die MIV/Vigs virus onder die Chewa bevolking en omliggende stamme bevorder. Bo en behalwe die geïdentifiseerde tradisionele praktyke en hul betrekking op die Malawiërs se lewens- en wêreldbeskouing, fokus hoofstuk vyf op die prakties-teologiese implikasies van die liefdesgebod. Die uitgangspunt van die hoofstuk is dat die kerk in haar uitreik tot hulle wat ly, iets van die (liefde) karakter van God moet weerspieël. Die praxis proses het dus liefde as hermeneutiese sleutel. Teologies gesproke moet die geloofsgemeenskap, as die liggaam van Christus, eskatologies hoop aan hierdie lydende wêreld verskaf. Die res van die hoofstukke beskryf die metodologie, proses en navorsingshipotese wat ontwikkel is uit die Nkhotakota model. Die finale gevolgtrekkings spreek die probleem aan van hoe om die MIV/Vigs pandemie onder mense wat in uiters arm stedelike areas in Malawi woon, aan te spreek en ‘n Christelike getuienis te lewer. Al is die aanvanklike optimistiese doelwitte van hierdie navorsing deels bereik, is wesenlike ontdekkings gemaak wat die foutiewe paradigmas in verband met kritieke vraagstukke, soos die invloed van volslae armoede, blootgelê. Probleme wat aanvanklik sekondêr beskou is tot die hoofmikpunt van die navorsing het aan die lig gekom in die navorsingsproses. Dit was duidelik dat die ingrype in die gemeenskap die vervreemding tussen die kerk en vigslyers positief verander het. Veel meer waardering en aanvaarding het ontwikkel. Maar: die kompleksiteit van die probleem word in die algemeen deur die westerse paradigma oppervlakkig verstaan. Die navorsing het bepaalde implikasies van armoede en blootgelê. Vir mense wat op die laagste vlakke van Maslow se behoeftes-rangorde ‘n stryd het om te bestaan, is die luukse van vrywillige diens aan ander eenvoudig nie moontlik nie. Vir hulle is een saak oorheersend: oorlewing. Om vanuit ‘n lewe vol sekuriteite hierdie armes op te roep om op te tree as onbetaalde dienswerkers, terwyl hul eie nood so groot is, is nie net onrealisties nie, maar ongevoelig.

published_or_final_version / Social Work / Master / Master of Social Work

published_or_final_version / abstract / Social Work and Social Administration / Doctoral / Doctor of Philosophy

No description available.

Nursing moral philosophy in the care of the terminally ill Abstract The aim of the work The aim of the research part of the diploma thesis was to fid out what ethical dilemmas the medical staff recognizes in the care of the terminally ill and what role it occupies in accompanying the dying. The method to reach the goal To achieve the goal, we chose a qualitative research solution using a semi-structured interview, which ethical dilemmas of the non-medical healthcare staff recognizes and what roles it takes to make decisions at the end of the patient's life. The research group was consisted of 10 nurses who are part of palliative teams in selected health care institutions. The interviews which were provided, were rewritten, and using of coding techniques "paper-pencil", the data was organized into each categories. The gained knowledge and the conclusion The research which we have conducted reveals what ethical dilemmas we see as a non-medical healthcare professionals in their practice and which attitudes and roles we hold to the terminally ill, dying patients and their families. The patients with an incurable illness at the end of their lives find themselves in a very difficult situation. It is very important to improve the quality of the care and to be close to these patients. The medical staff member should be aware that any decision can become an ethical dilemma that we should recognize to find the best solution to meet the needs of the patient, respect his desire with maintain one´s dignity. Only that palliative care can be characterized as a first-rate care, focused on the patient's individuality and uniqueness

Submitted by Filipe dos Santos (fsantos@pucsp.br) on 2018-07-30T12:24:03Z No. of bitstreams: 1 Isabel Cristina Bueno Palumbo.pdf: 2591502 bytes, checksum: b3e0518b87654e1f3ee7324ff00b14d4 (MD5) / Made available in DSpace on 2018-07-30T12:24:03Z (GMT). No. of bitstreams: 1 Isabel Cristina Bueno Palumbo.pdf: 2591502 bytes, checksum: b3e0518b87654e1f3ee7324ff00b14d4 (MD5) Previous issue date: 2018-05-29 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / Fundação São Paulo - FUNDASP / This thesis aimed to analyze the meaning of religion for patients in palliative care and for their relatives. We start from the hypothesis that the approximation of religion and the development of religiosity and spirituality are fundamental to reduce the anguish provoked by the proximity of death among patients in palliative care and among their loved ones. It is an exploratory research of qualitative approach and historical method. To obtain the data, we conducted 11 interviews, 8 with patients and 3 with relatives of patients. The interviews were based on a semi-structured script with questions about the life history, religious experience and religion’s approach after the diagnosis of inability to cure. The interviews were realized at the Premier Hospital, on January 04th, 06th, 09th, 2017, and January 08th, 10th, 11th, 12th, 15th, 17th, 2018. During the month of December 2016, we visited the hospital every day to know the local routine and the hospitalized patients. For the construction of the script of questions and for the analysis of the data obtained from the interviews and the fieldwork, we adopted the historical method elaborated by Franz Boas (2004) and the hermeneutic analysis developed by Gadamer (1997). We also searched the history of the main concepts that guided our study. After analyzing and discussing the data of this research, we confirmed our hypothesis: we found that the majority of respondents came closer to religion after they were known to have incurable diseases / Esta tese teve como objetivo analisar o significado da religião para os pacientes em cuidados paliativos e para seus familiares. Parti da hipótese de que a aproximação da religião e o desenvolvimento da religiosidade e da espiritualidade são fundamentais para diminuir a angústia suscitada pela proximidade da morte entre os pacientes em cuidados paliativos e seus entes queridos. Trata-se de uma pesquisa exploratória de abordagem qualitativa e método histórico. Para a obtenção dos dados, realizei 11 entrevistas, 8 com pacientes e 3 com familiares de pacientes. As entrevistas tiveram como base um roteiro semiestruturado com questões que versavam sobre a história de vida, vivência religiosa e aproximação da religião depois do diagnóstico de impossibilidade de cura, e foram realizadas no Hospital Premier, nos dias 04, 06 e 09 de janeiro de 2017, e 08, 10, 11, 12, 15 e 17 de janeiro de 2018. Durante o mês de dezembro de 2016, visitei diariamente o hospital para conhecer a rotina local e os pacientes internados. Para a construção do roteiro de questões e para a análise dos dados obtidos com as entrevistas e o trabalho de campo, adotei o método histórico elaborado por Franz Boas (2004) e a análise hermenêutica desenvolvida por Gadamer (1997). Pesquisei também a história dos principais conceitos que orientavam nosso estudo. Depois de realizar a análise e a discussão dos dados desta pesquisa, confirmei minha hipótese, ao constatar que a maior parte dos entrevistados aproximou-se mais da religião depois de saber ser portador de doença incurável

Submitted by Filipe dos Santos (fsantos@pucsp.br) on 2018-12-04T11:47:55Z No. of bitstreams: 1 Izabela Aparecida de Almeida Guedes.pdf: 1333237 bytes, checksum: 23525ae5a48b6aafb51d22b3df9a8ac5 (MD5) / Made available in DSpace on 2018-12-04T11:47:55Z (GMT). No. of bitstreams: 1 Izabela Aparecida de Almeida Guedes.pdf: 1333237 bytes, checksum: 23525ae5a48b6aafb51d22b3df9a8ac5 (MD5) Previous issue date: 2018-09-28 / Conselho Nacional de Pesquisa e Desenvolvimento Científico e Tecnológico - CNPq / Receiving the diagnosis of a potentially fatal disease represents a crisis for patients and their families, affecting different life domains and promoting a re-signification of belief systems that are shaken by the threat to the continuity of life. Palliative care emerged as an alternative to the traditional curative model of health, aiming at relieving physical pain and giving comfort to emotional, social and spiritual suffering. This new approach ratified the inclusion of spirituality in the concept of health established by the World Health Organization, indicating the need to consider the spiritual dimension in view of the proximity of death. As a new paradigm of caring, palliative care also aims at encompassing anticipatory mourning experienced by the care unit during patient’s illness, as well as monitoring the mourning family after its relative’s death. The present study utilized a qualitative methodology in order to apprehend the meaning of spirituality assigned by the family member whose a loved one was in a end-of-life process. A collective case study was carried, with the participation of six family members attending a hospice in palliative care, and the investigation was done through field diary and semi-structured interviews. Data were analyzed through content analysis according to Bardin (2011) and the following thematic categories were found: expressions of anticipatory mourning, perceptions on/meanings of spirituality, meanings of mourning, protective factors, risk factors. The results suggest that spirituality is a support for those who are on the verge of losing a loved one and should not be neglected by health professionals. It has proved to be an important protection factor for the experience of mourning processes / O recebimento do diagnóstico de uma doença potencialmente fatal representa uma crise para pacientes e familiares, afetando diferentes áreas que compõem o viver e impulsionando a uma ressignificação dos sistemas de crenças, abalados frente à ameaça da continuidade da vida. Os cuidados paliativos surgiram como uma alternativa ao modelo curativo de saúde, propondo o alívio das dores físicas, emocional, social e espiritual. Essa visão ratificou a inclusão da espiritualidade no conceito de saúde estabelecido pela Organização Mundial de Saúde, demonstrando a necessidade da abordagem da dimensão espiritual frente à proximidade da morte. Apresentando-se como um novo paradigma para o cuidar, visa também o acolhimento do luto antecipatório, vivenciado pela unidade de cuidados durante um processo de adoecimento, bem como o acompanhamento do enlutado após a ocorrência da morte. No desenvolvimento do presente estudo foi utilizado o método qualitativo, a fim de conhecer o significado atribuído pelo familiar à espiritualidade frente ao processo de final de vida de um ente querido. Foi realizado um estudo de caso coletivo, com a participação de seis familiares atendidos em uma hospedaria, tendo sido a investigação feita por meio de diário de campo e entrevista semiestruturada. O instrumento utilizado para analisar os dados colhidos foi a análise de conteúdo segundo Bardin (2011), tendo sido encontradas as categorias temáticas: expressões do luto antecipatório, percepções/significados sobre a espiritualidade, significados sobre o luto, fatores de proteção, fatores de risco. Os resultados evidenciam que a espiritualidade é um suporte para aqueles que estão na iminência de perder uma pessoa amada, não devendo ser negligenciada pelos profissionais de saúde. Ela se mostrou como um importante fator de proteção para a vivência dos processos de luto

Este estudo objetivou conhecer as expectativas do paciente fora de possibilidades terapêuticas e sob cuidados paliativos com relação à assistência de enfermagem durante o processo de morrer, assim como identificar as necessidades destes pacientes relacionadas à comunicação com a equipe de enfermagem. Os dados foram coletados no primeiro semestre de 2005, por meio de entrevistas semi-estruturadas com questões norteadoras, junto a trinta e nove pacientes oncológicos sem prognóstico de cura, com limitação na capacidade de realizar atividades e submetidos à quimioterapia paliativa em uma instituição hospitalar da cidade de São Paulo. Após transcrição fiel das falas, os dados foram analisados segundo a metodologia de análise do conteúdo. Dos discursos dos entrevistados emergiram seis categorias, que evidenciaram o sofrimento multidimensional do câncer e seu tratamento, o fato de que apesar do sofrimento, a vida continua; a espiritualidade e a família enquanto fontes de apoio e estímulo para o enfrentamento da doença oncológica avançada. Revelam ainda a assistência de enfermagem desejada e o papel de destaque que representam a comunicação e o relacionamento interpessoal para quem enfrenta o processo de morrer. Concluiu-se que os pacientes entrevistados resgataram o valor da relação humana baseada na empatia e compaixão como base para o cuidado que esperam, desejando do profissional de enfermagem habilidade técnico-científica para a realização de ações que aliviam o sofrimento, especialmente o adequado controle da dor, comportamento empático e compassivo, informação e suporte emocional. A comunicação interpessoal comprovou ser importante atributo do cuidado paliativo à medida que o valor atribuído à mesma sobressaiu-se dos discursos, evidenciando a atenção dada aos sinais não–verbais do profissional para o estabelecimento do vínculo de confiança, a necessidade da presença compassiva, o desejo de não focar a interação e o relacionamento apenas na doença e morte e a valorização da comunicação verbal alegre, que privilegia o otimismo e o bom humor. / The objective of this study was to know the expectations of the patients who have no therapeutic possibilities and who are under palliative care regarding nursing assistance during the dying process, as well as to identify these patients’ needs related to communication with the nursing team. The data were collected during the first semester of 2005, through half-structured interviews with guided questions, among 39 oncologic patients without healing prognosis, having a limited capacity to perform activities and subjected to palliative chemotherapy in a hospital institution of the city of São Paulo, Brazil. After loyal transcription of the speeches, the data were analyzed according to the methodology of content analysis. From the interviewee speeches six categories emerged that proved the multidimensional suffering of cancer and its treatment, the fact that regardless of the suffering, life goes on; that spirituality and the family while acting as sources of support provide stimulation for confronting an advanced oncologic disease. The interviewees also revealed the nursing assistance which they desire and the role of note which represented the communication and interpersonal relationship for those who face the dying process. Therefore, it can be concluded that the interviewed patients redeemed the value of human relationships based on empathy and compassion as basis for the care they expect, desiring from the nursing professional a technical-scientific ability to perform actions necessary to relieve the suffering, especially an adequate control of pain, empathy and compassionate behavior, well informed and emotionally supportive. Interpersonal communication proved to be an important attribution to palliative care as long as its value has been prominent in the speeches, paying particular attention to the non-verbal signs of the professional for establishing a link of trust, the necessity of compassionate presence, the desire of not focusing the interaction and the relationship only on the disease and death and in its place concentrating on a cheerful verbal communication favoring optimism and good humor.

Este estudo objetivou conhecer as expectativas do paciente fora de possibilidades terapêuticas e sob cuidados paliativos com relação à assistência de enfermagem durante o processo de morrer, assim como identificar as necessidades destes pacientes relacionadas à comunicação com a equipe de enfermagem. Os dados foram coletados no primeiro semestre de 2005, por meio de entrevistas semi-estruturadas com questões norteadoras, junto a trinta e nove pacientes oncológicos sem prognóstico de cura, com limitação na capacidade de realizar atividades e submetidos à quimioterapia paliativa em uma instituição hospitalar da cidade de São Paulo. Após transcrição fiel das falas, os dados foram analisados segundo a metodologia de análise do conteúdo. Dos discursos dos entrevistados emergiram seis categorias, que evidenciaram o sofrimento multidimensional do câncer e seu tratamento, o fato de que apesar do sofrimento, a vida continua; a espiritualidade e a família enquanto fontes de apoio e estímulo para o enfrentamento da doença oncológica avançada. Revelam ainda a assistência de enfermagem desejada e o papel de destaque que representam a comunicação e o relacionamento interpessoal para quem enfrenta o processo de morrer. Concluiu-se que os pacientes entrevistados resgataram o valor da relação humana baseada na empatia e compaixão como base para o cuidado que esperam, desejando do profissional de enfermagem habilidade técnico-científica para a realização de ações que aliviam o sofrimento, especialmente o adequado controle da dor, comportamento empático e compassivo, informação e suporte emocional. A comunicação interpessoal comprovou ser importante atributo do cuidado paliativo à medida que o valor atribuído à mesma sobressaiu-se dos discursos, evidenciando a atenção dada aos sinais não–verbais do profissional para o estabelecimento do vínculo de confiança, a necessidade da presença compassiva, o desejo de não focar a interação e o relacionamento apenas na doença e morte e a valorização da comunicação verbal alegre, que privilegia o otimismo e o bom humor. / The objective of this study was to know the expectations of the patients who have no therapeutic possibilities and who are under palliative care regarding nursing assistance during the dying process, as well as to identify these patients’ needs related to communication with the nursing team. The data were collected during the first semester of 2005, through half-structured interviews with guided questions, among 39 oncologic patients without healing prognosis, having a limited capacity to perform activities and subjected to palliative chemotherapy in a hospital institution of the city of São Paulo, Brazil. After loyal transcription of the speeches, the data were analyzed according to the methodology of content analysis. From the interviewee speeches six categories emerged that proved the multidimensional suffering of cancer and its treatment, the fact that regardless of the suffering, life goes on; that spirituality and the family while acting as sources of support provide stimulation for confronting an advanced oncologic disease. The interviewees also revealed the nursing assistance which they desire and the role of note which represented the communication and interpersonal relationship for those who face the dying process. Therefore, it can be concluded that the interviewed patients redeemed the value of human relationships based on empathy and compassion as basis for the care they expect, desiring from the nursing professional a technical-scientific ability to perform actions necessary to relieve the suffering, especially an adequate control of pain, empathy and compassionate behavior, well informed and emotionally supportive. Interpersonal communication proved to be an important attribution to palliative care as long as its value has been prominent in the speeches, paying particular attention to the non-verbal signs of the professional for establishing a link of trust, the necessity of compassionate presence, the desire of not focusing the interaction and the relationship only on the disease and death and in its place concentrating on a cheerful verbal communication favoring optimism and good humor.