Palliative care and terminality in graduation: a way to enhance access to health

This article was exclusively written for The European Sting by Ms. Renata Dias and Ms. Deborah L. Nóbrega, two first year medical student at the UFRN Multicampi School of Medical Sciences (EMCM/UFRN), Brazil. They are affiliated to the International Federation of Medical Students Associations (IFMSA), cordial partner of The Sting. The opinions expressed in this piece belong strictly to the writers and do not necessarily reflect IFMSA’s view on the topic, nor The European Sting’s one.

According to the World Health Organization, Palliative Care (PC) is defined as an integral approach to confronting life-threatening diseases in order to safeguard the well-being and quality of life of patients and their families, from the period of diagnosis to grief. In this sense, such modality of care adopts the principles of integrality and longitudinality, rather than punctual actions in the terminal context. Unfortunately, in medical schools, it is still common for this subject to be insufficiently explored and approached in a non obligatory way, being seen only as part of other topics. Therefore, these and other gaps in teaching about PC and Terminality can be associated with the scarcity of professionals duly qualified to care for end-of-life patients, as well as with the fact that such care is commonly considered inaccessible by a significant part of the world population.

Students from several countries, such as Holland and Brazil, report a certain deficit in the approach to PC throughout their medical training, which, in turn, detracts from the desired effects on the student’s ability to communicate and make decisions in the context of terminality. Studies show that doctors with specific education in palliative medicine make less aggressive decisions in terminal care regarding the withdrawal of life-long therapies. From this, as palliativism is well understood and conceived as one of the main instruments of medicine, a greater number of professionals tend to act with aptitude and competence in this area, favoring the inclusion of such care in the Universal Health Coverage (UHC).

Under this perspective, in addition to the biomedical aspects addressed in medical education in PC and Terminality, it is important to emphasize that the emotional dimension must be worked out, considering that the personal relationship with death is a factor that can influence an integral, more empathic and humanized assistance. By extension, curricular strategies are necessary in order to train professionals who aim to take care of the patient and not the disease, and one can cite, as an example of such strategies, the satisfactory approach to communication, bioethics and multiprofessional work. As a result, more effective and far-reaching services are expected, improving the access to PCs in health systems.

Therefore, it is necessary to see the doctor and other health professionals as tools for changing the social scenario, especially with regard to the coverage of public services in this sector. Thus, educating and qualifying more and more individuals for health care, paying attention to the principles of integrality and longitudinality of Palliativism and other forms of care, is truly supporting Gandhi’s maxim: “be the change you want to see in the world”.

REFERENCES

1. World Health Organization. Pain Relief and Palliative Care. 2ª ed. Geneva: WHO; 2002.
2. Oliveira RA, coord. Cuidado Paliativo. São Paulo: Conselho Regional de Medicina do Estado de São Paulo, 2008.
3. Diver R, Quince T, Barclay S, et al. Palliative care in medical practice: medical students’ expectations. BMJ Supportive & Palliative Care, 2018; 8: 285-288.
4. Pieters J, Dolmans DHJM, Verstegen DML, Warmenhoven FC, Courtens AM, van den Beuken-van Everdingen MHJ. Palliative care education in the undergraduate medical curricula: students’ views on the importance of, their confidence in, and knowledge of palliative care. BMC Palliat Care. 2019 Aug 28; 18(1):72.
5. Pereira, EAL; Rangel, AB; Giffoni, JCG. (2019). Identificação do Nível de Conhecimento em Cuidados Paliativos na Formação Médica em uma Escola de Medicina de Goiás. Revista Brasileira de Educação Médica, 43(4), 65-71. Epub October 14, 2019.
6. MALTA, Regina; RODRIGUES, Bruna; PRIOLLI, Denise Gonçalves. Paradigma na Formação Médica: Atitudes e Conhecimentos de Acadêmicos sobre Morte e Cuidados Paliativos. Rev. bras. educ. med.,  Brasília,  v. 42, n. 2, p. 34-44,  June  2018. 

About the author

Renata Dias is a brazilian first year medical student at the UFRN Multicampi School of Medical Sciences (EMCM/UFRN), in a city in the interior of the country. She is a member of the team of local coordinators of the International Federation of Medical Students Associations (IFMSA) Brazil UFRN Caicó and the board of directors of the Athletic Academic Association Multicampi Medicine. She identifies itself with the premise “Think global, act local”, because she believes that, to make a difference in the world, it is important to start with changes at the level of the nearest reality.

Deborah L. Nóbrega is a first year medical student at the UFRN Multicampi School of Medical Sciences (EMCM/UFRN), Brazil. In 2020, she became a member of the Academic League of Geriatrics at Rio Grande do Norte (LAGERN), in addition to joining the International Federation of Medical Students Associations (IFMSA) Brazil UFRN Caicó, where she is currently the local coordinator. Her goal in these associations is to combine scientific and academic development with local social interventions, making a difference as a student.