Education is an important factor in end-of-life care: results from a survey of Brazilian physicians’ attitudes and knowledge in end-of-life 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. As a reflection of the current scenario, little research about end-of-life care has been published so that studies addressing this subject in the Brazilian setting are crucial. Methods A cross-sectional study study conducted with students applying for the medical residency of the Federal University of São Paulo were invited to voluntarily participate in an anonymous and self-administered questionnaire survey. The latter included demographic information, attitudes, prior training in end-of-life care, prior end-of-life care experience, the 20-item Palliative Care Knowledge Test (PCKT) and a consent term. Results Of the 3086 subjects applying for residency, 2349 (76%) answered the survey, 2225 were eligible for analysis while 124 were excluded due to incomplete data. Although the majority (99,2%) thought it was important to have palliative care education in the medical curriculum, less than half of them (46,2%) reported having received no 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% of correct answers), most participants lacked knowledge in symptom control (50,7% for pain, 57,3% for dyspnea, 52,2% for psychiatric problems and 43,4% for gastrointestinal problems). Doctors that had already concluded a prior residency program and the ones that had prior experience with terminal patients performed better in the PCKT (p < 0,001). The high-performance group (more than 50% of correct answers) had received more training in end-of-life care, showed more interest in learning more about the subject, 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 physicians lack not only the knowledge, but also training in end-of-life 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, for this group, training showed to be a key factor in overall in this area of knowledge. Therefore, Brazilian medical schools and residency programs should focus on improving palliative training, especially those involving contact with dying patients.

Physicians’ and Nurses’ Knowledge in Palliative Care: Multidimensional Regression Models

“…Question 15 was the one that obtained a greater success rate. In contrast, question 6 (“The effect of opioids should decrease when pentazocine or buprenorphine hydrochloride is used together after opioids are used”) was the one with the highest error rate, in line with Ioshimoto et al (2020) [ 22 ]. This could be justified by the lack of management of opioids such as pentazocine, since in Europe, treatment with other types of opioids is more usual.…”

“…Likewise, its psychometry is positive, with an interclass coefficient for the test–retest of 0.88 and an internal consistency of 0.81; its version adapted to Spanish used in the present study has similar results [ 23 ]. The PCKT has been cross-culturally adapted to different languages [ 21 , 22 , 23 , 24 ]; nevertheless, it has only been validated in Spanish [ 23 ] and an extended version in Germany [ 24 ].…”

“…In this sense, the level of knowledge of physicians in Brazil proved to be below the expected average. Most of the participants (51.7%) obtained poor or bad levels of knowledge [ 22 ], with the dimension of philosophy being the best managed by these professionals. In contrast, in the present study, pain was the dimension with the best score in physicians.…”

“…However, a low correlation was shown between the attitudes of nursing professionals and their knowledge [ 17 ]. Other studies have reported that the attitude is a key element in the level of knowledge in palliative care [ 22 , 34 ], since a higher knowledge could be associated with a more positive attitude. Therefore, to improve the training of future professionals, it would be necessary to implement specific training in palliative care at all universities [ 32 , 40 ].…”

“…The original PCKT was used to estimate the effects of the palliative care training program (PEACE) design for 57,664 physicians in Japan [ 20 ]. The PCKT has been translated into other languages [ 21 , 22 , 23 , 24 ] and used in various studies among community health care providers [ 20 , 25 ].…”