Development of a flowchart for health care for people with hematologic neoplasms.
Hematologic Neoplasms; Comprehensive Health Care; Validation Study; Nursing Methodology Research.
The construction of a flowchart, as a management technology, enables a better
understanding of care practices, the organization of health care, and the structuring
of the work process based on the description of the user's therapeutic journey within
the Health Care Networks. The objective was to develop a flowchart for health care
for people with hematologic neoplasms. This is a methodological study, with a mixed
approach, anchored in Pasquali's psychometrics (2010), structured in three
procedures: theoretical, analytical, and empirical. For the theoretical procedures,
literature searches were carried out through an integrative review focusing on
scientific evidence on health care for patients with hematologic neoplasms and a
focus group consisting of health professionals. In the empirical procedures stage, a
compilation of the information collected in the previous stage was made to support
the construction of the flowchart. The validation of the content and appearance of the
flowchart was carried out through the Delphi technique, with the evaluation of the
criteria proposed by Pasquali and the Suitability Assessment of Materials. Finally, the
analytical procedures occurred through the content validation coefficient and
agreement between the judges. The study was approved by the Research Ethics
Committee of the Federal University of Rio Grande do Norte and obtained approval
under CAAE: 67213623.0.0000.5537. The results of the integrative review showed a
final sample of 17 studies and revealed that the care provided to patients with
hematologic neoplasms is more concentrated in the medium and high complexity
levels of health care, since cancer is a pathology with therapeutic complexity that
requires equipment and human resources appropriate for specialized care. The focus
group included the participation of 10 nurses and one physician in different cities in
the Brazilian regions, and all reported the difficulty in accessing treatment, for various
reasons such as social and economic factors, the lack of qualifications of health
professionals, especially in Primary Care, and timely access to specialized care.
Regarding the content validation process, in the Delphi I round the flowchart reached
a final CVC of 0.82 and an agreement of 53% among the judges. After adapting the
flowchart, according to the judges' suggestions, in the Delphi II round, all criteria were
validated, with a final CVC of 0.99 and an agreement of 93%. That said, the flowchart
is considered useful and valid in its content and appearance as a management
technology for the systematization of care and guidance to health professionals with
elements that contemplate the therapeutic itinerary of onco-hematological patients,
from the moment the user enters primary care. In addition to containing important
information about reception, care flows, decision-making, referrals, consultations with
multidisciplinary and nursing teams.