Paradigma na Formação Médica: Atitudes e Conhecimentos de Acadêmicos sobre Morte e Cuidados Paliativos

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.

Reflections on the Terminality of Life with Undergraduate Medical Students

“…However, what we observe is that health professionals and studentswho are being introduced to the hospital environment at an increasingly early period -often have to deal with the real scenario of transmitting bad news, without first going through hypothetical and reflective situations involving the "life and death binomial" 16 during their formation. The unpreparedness makes them suffer in a dysfunctional way and, as shown by the study by Mason and Ellershaw 17 , the proposal for theoretical and practical education related to palliative care included in the curriculum would improve the confidence and attitude of future health care professionals.…”

Conhecimento do Acadêmico de Medicina sobre Cuidados Paliativos

“…Durante a coleta de dados, somente uma pequena parcela dos acadêmicos do nono semestre havia participado dessa atividade, enquanto os acadêmicos do décimo semestre haviam participado em sua totalidade, o que, possivelmente, influenciou o desempenho dos entrevistados. Esse resultado vai ao encontro de um estudo da Universidade São Francisco, em São Paulo, no qual participaram 240 acadêmicos e que constatou que as habilidades em comunicação e multidisciplinaridade em CP foram mais bem desempenhadas pelo grupo que recebeu treinamento completo, teórico e prático 33 . Possivelmente, os acadêmicos do décimo segundo semestre do CM-Unisul tiveram resultado inferior aos alunos do décimo por terem passado pelas disciplinas que abordaram essa temática havia mais tempo, o que pode ter ocasionado o esquecimento de determinados conceitos.…”

Qualidade de Vida de Pacientes Oncológicos em Cuidados Paliativos Domiciliares e Desafios da Prática Médica diante da Finitude da Vida

“…Os CP estão intrinsicamente relacionados à busca por melhor QV dos pacientes que enfrentam doenças graves e incuráveis, o que representa um desafio nas práticas em saúde, especialmente pela íntima relação com o tema da terminalidade da vida [6][7][8] . Nos dias atuais, e mesmo na medicina, as questões ligadas à morte e ao morrer ainda permanecem sendo uma área obscura e problemática, o que se reflete no pouco preparo para a atuação em CP 9 .…”