Introduction: The palliative care (PC) approach is a care modality recommended by the World Health Organization. Suffering and the process of dying are present in everyday clinical practice, affecting people with life-threatening diseases. However, the predominant model of teaching in Brazilian medical schools does not include palliative care. Objectives: The aim of the study was to get to know the Brazilian medical schools that include PC in their curriculum, and how it has been taught. Methods: Descriptive and exploratory study, carried out by searching for medical schools with disciplines in PC, through the analysis of the course syllabi available in the curricular matrices on the official websites of higher education institutions from August to December 2018. They were analyzed considering the offered period of the PC content, workload, scenario, and type of discipline (elective or mandatory). Results: 315 schools registered with the Ministry of Education were found, and only 44 of them (14%) offer courses in PC. These schools are distributed throughout 11 Brazilian states, of which 52% are located in the Southeast region, 25% in the Northeast, 18% in the South, 5% in the Midwest, and none in the North region. The predominant modality of the type of discipline in PC was mandatory in 61% of schools. Most Brazilian medical schools are private entities (57%), a similar percentage to the total number of medical schools identified with the teaching of PC. This course takes place in the 3rd and 4th years of the course; in most schools, the workload was 46,9 hours. The predominant scenario is the classroom, while some institutions provide integration between teaching community service and medical practice. The program contents are diverse, including thanatology, geriatrics and finitude, humanization, bioethics, pain, oncology and chronic diseases. Conclusion: PC education in Brazil is insufficient, which represents a barrier to the training of doctors in line with the recommendations of international entities, the National Curriculum Guidelines and legal frameworks within the scope of SUS. Investments by medical entities and government agencies are necessary to increase teaching in PC and the consequent qualification of medical training.

Introduction: Population aging, longer life expectancy and the increase in the prevalence of chronic diseases have brought new health demands, among them, palliative care (PC). Although present in the clinical routine, this topic has not yet been included in most medical schools in Brazil. Objective: To know the teaching-learning process in PC according to the perception of medical students from schools that have this subject. Method: Qualitative method through interviews with 35 medical students from 14 medical schools located in the Northeast, Southeast and South regions of the country. Results: The reports were classified into three categories: conception of PC, changes perceived after exposure to PC teaching, challenges and successful strategies identified in PC teaching. Students recognize the value of teaching in PC and have a greater understanding of PC approach and its early indication for people with complex chronic conditions. The inclusion of the topic contributed to the overcoming of fears and taboos related to death, providing greater comfort to deal with human suffering, adding emotional skills. The formal education in PC allowed understanding the person in their biopsychosocial and spiritual dimension. They stressed the importance of communication skills to communicate difficult news, symptom management, teamwork and an individualized approach to the person and their family. Although they identify little theoretical-practical integration in the teaching-learning scenario in PC, they report an interest in the topic, and indicated successive experiences as strategies throughout the training, in a humanist axis. Conclusion: PC teaching brings contributions to medical training that go beyond the learning of the subject and reinforces the development of empathy and compassion, recognized as essential in this profession, as well as the relevance of assertiveness in the management of suffering and the comprehensive care of people with advanced diseases.

This study provides an overview of the literature on the cost-effectiveness of homecare services compared to in-hospital care for adults and older adults. A systematic review was performed using Medline, Embase, Scopus, Web of Science, CINAHL and CENTRAL databases from inception to April 2022. The inclusion criteria were as follows: (i) (older) adults; (ii) homecare as an intervention; (iii) hospital care as a comparison; (iv) a full economic evaluation examining both costs and consequences; and (v) economic evaluations arising from randomized controlled trials (RCTs). Two independent reviewers selected the studies, extracted data and assessed study quality. Of the 14 studies identified, homecare, when compared to hospital care, was cost-saving in seven studies, cost-effective in two and more effective in one. The evidence suggests that homecare interventions are likely to be cost-saving and as effective as hospital. However, the included studies differ regarding the methods used, the types of costs and the patient populations of interest. In addition, methodological limitations were identified in some studies. Definitive conclusions are limited and highlight the need for better standardization of economic evaluations in this area. Further economic evaluations arising from well-designed RCTs would allow healthcare decision-makers to feel more confident in considering homecare interventions.

Introdução: Cuidados paliativos (CP) estão no quotidiano dos serviços de saúde, face ao aumento da carga das doenças crônicas, do envelhecimento e incorporação tecnológica na saúde. Há consenso sobre a importância do ensino em CP na graduação, entretanto muitas escolas não o praticam. Esta revisão objetivou sintetizar o conhecimento produzido em estudos científicos sobre ensino em CP na graduação em medicina e seu impacto na formação médica. Métodos:  Foi realizada revisão sistemática de estudos publicados no PubMed, com os descritores: “medical education” OR “curriculum”; ”palliative care” AND “clinical competence”. Foram encontrados 89 artigos, excluídos 67 títulos e resumos e 22 artigos foram analisados.  Resultados: A leitura dos artigos deu origem a três categorias temáticas. Na primeira categoria, elenca-se abordagem biopsicossocial e espiritual, cuidado centrado na pessoa e família, comunicação, trabalho interprofissional, e manejo de sintomas como competências essenciais. Na segunda, os desafios e estratégias apontados foram o escasso tempo curricular no ensino em CP, a falta de contexto clínico para o aprendizado reflexivo, o déficit de docentes preparados e a sua ausência formal nos currículos. O impacto do ensino em CP na aprendizagem na graduação refere-se a ser catalisador do desenvolvimento profissional e propiciar competências emocionais aos futuros médicos. Conclusão: Os estudos analisados demonstram benefícios do ensino em CP na formação médica, através de um ensino longitudinal, uma vez que potencializam a aquisição de competências essenciais no exercício da medicina e em especial no trato de pessoas portadoras de doenças ameaçadoras à vida.

No abstract