Palliative care: challenges for health education

Pereira, Lariane Marques; Andrade, Sonia Maria Oliveira de; Theobald, Melina Raquel

doi:10.1590/1983-80422022301515EN

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Research • Rev. Bioét. 30 (1) • Jan-Apr 2022 • https://doi.org/10.1590/1983-80422022301515EN copy

Palliative care: challenges for health education

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Abstract

This integrative literature review analyzed the scientific production on palliative care and the education of health undergraduates. Data was collected by searching the Periódicos Capes database, using the descriptors “ cuidados paliativos ” (palliative care) and “ ensino ” (education), only in Portuguese, filtering for the last five years. After reading of titles and abstracts, ten articles were selected from the 61 found. Results show that the curricula of most health programs do not include palliative care education, resulting in theoretical, practical, and psychological unpreparedness. The analysis highlighted the key role played by philosophy and bioethics in the education of health professionals, inducing more ethical, appropriate, and humane professional conduct. The theory-practice dynamics was the most suggested as a means of properly introducing palliative care in the training process of health programs.

Palliative care; Teaching; Professional training

Title	Authors	Objective	Journal (year)	Method	Main findings
“Formação em cuidados paliativos: experiência de alunos de medicina e enfermagem”⁵.	Costa, Poles, and Silva.	To know the experience and education of medical and nursing students in caring for patients under palliative care.	Interface: Comunicação, Saúde, Educação (2016).	Descriptive and qualitative study. Data was analyzed by thematic analysis.	The study showed that practical activities, appreciation of multidisciplinary work, suffering by the process of self-identification with the end-of-life patient, and the cycle of empathy and detachment resulting in emotional maturity are essential during palliative care education.
“Avaliação do conhecimento em cuidados paliativos em estudantes durante o curso de medicina”¹¹.	Lemos and collaborators.	To assess knowledge on palliative care among medical students at the Escola Superior de Ciências da Saúde (Brasília, Distrito Federal, Brazil).	Revista Brasileira de Educação Médica (2017).	Cross-sectional study with application of an anonymous questionnaire, with questions about age, gender, and another 19 questions about knowledge on palliative care.	Knowledge on palliative care among students is unsatisfactory. No knowledge gain between the fourth and sixth grades. Need to improve palliative care teaching-learning, especially in internship settings.
“Reflexões sobre o Ensino de Bioética e Cuidados Paliativos nas Escolas Médicas do Estado de Minas Gerais, Brasil”¹².	Oliveira and collaborators.	To analyze the curricula of medical schools in the state of Minas Gerais, assessing how palliative care education is conducted in undergraduate programs.	Revista Brasileira de Educação Médic a (2016).	Qualitative and exploratory case study using fieldwork and three operational instruments (structured questionnaire, interview and computerized document).	Bioethics knowledge emphasizing palliative care during medical education does not sufficiently meet the emerging needs of this area of health care. There is a need for programmatic action for teacher training and subsequent specific and longitudinal curricular introduction of bioethics and palliative care education in undergraduate medical schools in Minas Gerais.
“Adaptação transcultural do Bonn Palliative Care Knowledge Test: um instrumento para avaliar conhecimentos e autoeficácia”¹³.	Minosso, Martins, and Oliveira.	To cross-culturally adapt the Bonner Palliativ wissens test to assess knowledge and beliefs of self-efficacy in palliative care.	Referência Revista de Enfermagem (2017).	Methodological study, based on a theoretical framework for cross-cultural adaptation.	The study showed that the final Portuguese version of the Bonn Palliative Care Knowledge Test has potential to become an important tool for assessing the level of knowledge of professionals and students.
“Ensino da bioética convergente de Ricardo Maliandi nos cursos de medicina”¹⁴.	Mugayar, Carraro-Eduardo, and Sá.	To point out the deficiency in medical curricula compared to the human sciences and to advocate the study of Ricardo Maliandi and Oscar Thüer’s convergent bioethics.	Revista Brasileira de Educação Médica (2017).	Theoretical essay on therapeutic limitation, where the authors sought to combine the literature with the applicability in a real case.	The authors propose the use of Maliandi and Thüer’s bioethics for an in-depth technical analysis of each case as to its prognosis and the establishment of consensus within the medical team, including the understanding of the conflictive structure in question, so that, through ethical reflection, the resources available for health care are used more rationally and morally.
“A ordem dos fatores altera o produto: reflexões sobre educação médica e cuidados paliativos”¹⁵.	Blasco.	To reflect on the humane and technical training of physicians. Work on the correct posture in palliative care, imbued with philosophical values and permeated by ethics.	Educación Médica (2018).	Reflection on the humane and technical training of physicians by means of a literature review.	Medical education must consider comfort as something to always be achieved (high prevalence). The formal introduction of palliative care in the medical curricula will help to prioritize comfort over cure during medical training.
“Processo educativo em cuidados paliativos e a reforma do pensamento”¹⁶.	Carvalho and collaborators.	To know the contributions of palliative care education in undergraduate courses for the professional performance of nurses in the care of end-of-life patients.	Investigación y Educación en Enfermería (2017).	Qualitative research using discursive thematic analysis, based on Morin’s theory of complexity.	Palliative care education is essential for nurses as to systematize patient care. Nursing programs should enable students to develop awareness of the complexity of human beings and their relationship with multiple biopsychosocial and spiritual aspects.
“A morte no cotidiano da graduação: um olhar do aluno de medicina”¹⁷.	Duarte, Almeida, and Popim.	To describe how human medicine students cope with situations involving death.	Interface: Comunicação, Saúde, Educação (2015).	Qualitative research using the theoretical-methodological framework of phenomenology.	Issues related to death and dying require students to have technical and emotional skills for processing and coping. Undergraduate education should provide opportunities for both skills to be enhanced, based on scientific, ethical, and legal knowledge.
“Interface do testamento vital com a bioética, atuação profissional e autonomia do paciente”¹⁸.	Pirôpo and collaborators.	To analyze the relation between living will and bioethical aspects, professional performance – including education and patient autonomy.	Revista de Salud Pública (2018).	Theoretical reflection based on a literature search in the Biblioteca Virtual de Saúde, Pubmed and SciELO databases.	The living will needs greater dissemination and knowledge among health professionals and the population, since its applicability can facilitate medical decision-making, respecting the patient’s wishes.
“Grupo de Educação para a Morte: uma estratégia complementar à formação acadêmica do profissional de saúde”¹⁹.	Oliveira-Cardoso and Santos.	To describe the experience of implementing the Education for Death Group and to understand the participants’ perception regarding this experience.	Psicologia: Ciência e Profissão (2017).	Experience report of an Education for Death Group implemented in a university hospital in the countryside of São Paulo.	The Education for Death Group enabled reflections and led to questioning and reflections about death and dying in the hospital by meaningful learning, integrating cognitive and affective aspects, considering the experience of clinical practice. The authors suggest investing in the expansion of educational work with professors and supervisors in health and education, as well as establishing dialogue beyond the professional and academic environment.

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E-mail: bioetica@portalmedico.org.br

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[1] Correspondence: Lariane Marques Pereira – Rua Hana Abdulahad, 217, bloco D, apt. 10, Jardim Paradiso CEP 79117-008. Campo Grande/MS, Brasil.