With a trajectory marked by the same objective, Paulina currently continues to have various roles in the country and Latin America to achieve a health care system with active and informed participation on the part of patients.
Millaray Mariqueo, Science in Chile.- The doctor Paulina Bravo Valenzuela currently works as Director of Education and Participation in Health within the Arturo López Pérez Foundation (FALP), a new direction created to promote the active role of people in their health care.
In this area, Paulina faces the challenge of education as part of comprehensive cancer care. In addition to advancing towards people being able to have an active participation in decision-making related to their medical treatments.
Bravo was Director of Doctoral Research and chaired the Research Commission of the School of Nursing of the Pontifical Catholic University of Chile, where the role was to promote talent within the school, creating mentoring programs to promote nursing research, making research consultancies and creating spaces for academic dialogue. However, she left her management position to join the FALP along with new challenges related to shared decision-making.
Role of women in decisions related to breast cancer
Within this framework, Paulina currently leads a regular FONDECYT project awarded last year, where the Pontificia Universidad Católica de Chile participates as a sponsoring research center. The objective of this is to find out what would be the factors that can explain and help to understand the role that women have in decisions related to breast cancer treatment, it is a multi-method study that is being carried out in three health centers in the Metropolitan region. “We have been running for a year, we are finishing the qualitative phase with an ethnographic study that allowed us to observe the Oncological Committees, which are the professional organizations that propose the therapeutic courses for people with cancer. And we are also observing clinical consultations through recordings and interviews with professionals from the health team related to breast cancer, and of course, with women with breast cancer” mentioned the researcher.
shared decision making
Paulina Bravo is also the founder of the Ibero-American Network for Shared Decision Making, an initiative that began in 2013, “what we did was take part in the International Movement for Shared Decision Making, which is usually more developed in the northern globe and We began to make alliances between Spanish-speaking people to see how we could make the participation of patients in clinical meetings more culturally appropriate” he details.
In this same category, the researcher is also a member of the International Network for the Development of Evaluation Tools for Decision Making and a member of the Board of Directors of the International Society for Shared Decision Making (ISDMS). Roles through which she has been able to represent what is happening in Latin America and see those culturally most appropriate elements to promote participation in the region and contribute evidence from this part of the world to the rest. “In addition, a couple of years ago we obtained funding from the German Ministry of Education and Research and launched the International Network for Person-Centered Care, whose focus is to help transfer evidence and good practices from some more developed countries such as Germany towards our region”.
Now, what is shared decision making about?
It is a form of relationship between health professionals and patients, in which both share information so that people can decide in an informed manner and respecting their values and preferences. Thus, they are encouraged to participate actively in health care, recognizing their rights and duties.
To achieve a collaborative health system, Bravo points out the importance of putting health issues in different spheres, for example, in schools, teaching about the role that people have in their health care in general, “there are many initiatives from the curricular program offered by the Ministry of Education but which tend to be more biomedical, and not necessarily towards the active role that young boys, girls and later adults can have in their health care”.
It has to do with being able to make decisions that allow them to balance, for example, what could be the risks or benefits of taking an AB or C option, and what people consider most important, according to their career paths. life.
On the other hand, it also highlights the importance of seeing how professionals are being trained, where “we are still quite weak in relation to how we help professionals to recognize the potential that patients have in their health care and help that these potentialities are transformed into concrete actions”.
Many times it has to do with the way in which some educational materials are written, the idea is that they are understandable, in an appropriate format, “the idea is that as a health team we are aligned in terms of strategy for education and at the same time to be able to position people as the protagonists of each action we do, so that it can finally be noticed that we are an organization focused on people and not on pathology, which is a temptation when you are in a specialist center”.
In summary, it is relevant to be able to make a basic diagnosis and actions that help advance towards a more participatory health, taking into account what has happened internationally in terms of different strategies to promote this so as not to repeat mistakes, because this is not yet a routine practice in the world.
Latin America in shared decision-making
In our Latin American cultural context, Paulina mentions that there is still an inclination for a model that is rather paternalistic, where we still see the figure of the doctor as a figure of authority, often from the role of patient or people in need. in health it is difficult to question.
“When you have problems with access to health, people tend to confuse access to health with health that respects their preferences and their values. We in Chile, in a project, carried out a national diagnosis on the level of participation and there we could see that there was a clear confusion between being able to access care and feeling that one had participated in that care”.
The researcher points out that culturally we still have an important gap, not only in the preparation of patients so that they can recognize their rights and duties in health care, but also in professionals, so that they can have specific strategies that promote participation active of the patients.
“The idea is to help people to feel like key and active agents in the process of their health, so that has been my career in the last 17 years”
Through the roles mentioned above, Paulina highlights that her primary interest has been to be able to move towards a more participatory health, from the front of clinical management and from teaching and research and community work, “in the functions that I fulfill now I have the opportunity to work directly with communities, patient associations or communities, where the idea is to help people become more aware of the possibility of participation they have and can feel like key and active agents in the process of their health So that’s been my career for the last 17 years.”
structural resistance
Paulina details that a few months ago she had the opportunity to participate in training for specific references in primary health care, where she described that professionals report resistance, “it does not only have to do with the expectation that a professional has to do an internship different, but also how the health system restricts you and hinders the possibility of having a health space that is more collaborative, for example, many of our health indicators are still more related to biomedical achievements, so when you have to report as achievement, how many people attended a workshop, that is certainly not going to speak to how effective the workshop was for the participants.”
In other words, there are structural resistances that can hinder a more collaborative and respectful relationship between professionals. “Hopefully this will change, there is a lot of interest in the ministry to do so, so we are making progress, at least in Latin America I would dare to say that we are pioneers in relation to the approach and the intention of advancing towards a model that is more respectful of the needs of the people” ended.
