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End-of-Life Paradigm in Medical Training: Attitudes and Knowledge about Death and Palliative Care

ABSTRACT

Background:

The World Health Organization (WHO) defines Palliative Care as an approach which, by preventing and alleviating suffering, improves the quality of life of patients and their families who face problems associated with life-threatening illnesses. In Brazil, Palliative Medicine has recently been promoted to the category of medical specialty, obliging Brazilian medical schools to review the educational concepts associated to end-of-life care. The personal relationship with death seems to directly influence the premise of care-more-than-healing, as an essential element of the caregiver's relationship with the terminal patient. There is a close relationship between anxiety and fear of death and the medical student's attitude in the face of end-of-life situations. The scholar's view of death may determine their inner disposition, values, concepts, and prejudices regarding death and dying and determine their performance as a professional. Thus, medical education programs must emphasize not only the theoretical-technical aspects in Palliative Care, but also the emotional climate that involves the medics’ attitudes and actions in end-of-life situations.

Objective:

To compare the attitudes of medical students when faced with death and the process of dying according to their theoretical and/or practical training in Palliative Care.

Method:

A cohort study evaluating how the profile of medical students has changed based on questionnaires on Fear of Death and Self-Efficacy in Palliative Care.

Results:

Theoretical reflection reduces anxiety related to practical activity (p < 0.05). Communication and multidisciplinary skills in Palliative Care are performed far better by those who receive complete theoretical and practical training than those who are trained only in theoretical terms or those who rely exclusively on in-service learning (p < 0.05).

Conclusion:

The Palliative Care discipline helps students overcome fears related to death, thus reducing their anxiety when practicing end-of-life care, especially in terms of communication. Students who receive this theoretical and practical training. Students who receive theoretical and practical training in Palliative Care show greater confidence when faced with end-of-life situations.

KEYWORDS
Palliative Care; Hospice Care; Education; Medical; Death

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