Education is as an important factor in palliative care knowledge: results from a survey of physicians attitudes and knowledge in Palliative Medicine

Abstract

Background: According to the Latin America Association for palliative care, Brazil offers only 0.48 palliative care services per 1 million inhabitants. In 2012, no accredited physicians were working in palliative care, while only 1.1% of medical schools included palliative care education in their undergraduate curricula. Aim: The aim of the study is to assess medical knowledge in end-of-life care, in order to identify key factors that could be useful in improving palliative care in Brazilian medical schools and residency. Design: Cross sectional study, conducted in São Paulo, Brazil. Students were invited to voluntarily participate in an anonymous and self-administered questionnaire survey. The latter included demographic information, attitudes, prior training in palliative care, prior palliative care experience and the 20-item Palliative Care Knowledge Test (PCKT). Participants: Physicians applying for the medical residency of the Federal University of São Paulo. Results: Of the 3086 subjects, 2349 (76%) answered the survey, 2225 were eligible for analysis while 124 were excluded due to incomplete data. Although the vast majority (99,2%) thought it was important to have palliative care education in the medical curriculum, less than half (46,2%) reported having received any education on palliative care. The overall performance in the PCKT was poor, with a mean score of 10,79 (± 3). While philosophical questions were correctly answered (81,8%), most participants lacked knowledge in symptom control (50,7% for pain, 57,3% for dyspnea, 52,2% for psychiatric and 43,4% for gastrointestinal problems). The high performance group (> 50% of correct answers) had received more training, showed more interest in learning, had a better sense of preparedness, as well as a higher percentage of experience in caring for terminal patients (p<0,001). Conclusions: Our study showed that Brazilian’s physicians lack not only knowledge, but also training in palliative medicine. Important factors to better knowledge in end-of-life care were prior training, previous contact with dying patients and prior medical residency. Corroborating the literature, training showed to be a key factor in overall knowledge. Therefore, medical schools and residency programs should focus on improving palliative training, especially those involving contact with dying patients.