Construção e validação de conteúdo e aparência de fluxograma para atenção à saúde de pessoas com doenças hematológicas

Abstract

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.