DOI: 10.6084/m9.figshare.28829312
title: Palliative Medicine Education in Undergraduate Medical Programs in Brazil: An Integrative Literature Review

description: <b>1. Introduction</b> Population aging and the increase in chronic-degenerative diseases have significantly impacted healthcare demands, emphasizing the need for comprehensive and humanized medical education. Palliative Care (PC) constitutes a multidisciplinary and interdisciplinary approach aimed at improving the quality of life of patients and families facing serious illnesses by addressing suffering in its physical, emotional, social, and spiritual dimensions. Palliative Medicine (PM), in turn, is a recognized medical subspecialty focusing on the clinical management of complex symptoms and ethical decision-making in end-of-life care. However, the integration of PC and PM into Brazilian undergraduate medical curricula remains incipient, fragmented, and often limited to isolated initiatives.Although the 2014 National Curricular Guidelines (NCGs) for Medical Education in Brazil emphasize humanistic and comprehensive care, they do not explicitly mandate PC education, leading to heterogeneous implementation among institutions. Globally, countries like the United Kingdom, Canada, and the United States have made significant strides in integrating PC education into medical training, setting important benchmarks for Brazilian initiatives. In this context, strengthening PC education in Brazil is critical to prepare future physicians for the epidemiological and ethical challenges posed by aging populations and chronic illnesses.<b>2. Objectives</b> This review aims to analyze the strategies, methods, and educational experiences described in the scientific literature regarding the teaching of Palliative Medicine in Brazilian undergraduate medical programs.<b>3. Methods</b> This is an integrative literature review conducted according to established methodological frameworks for evidence synthesis and the PRISMA 2020 guidelines. The PICo strategy was adopted: P (undergraduate medical students in Brazil), I (Palliative Medicine education), Co (undergraduate medical programs). Searches were conducted in SciELO, LILACS, and MEDLINE/PubMed using DeCS/MeSH descriptors. Inclusion criteria included Brazilian original articles, published in Portuguese or English, without temporal restrictions, focusing on PC education in undergraduate medical settings.Selection was performed by two independent, blinded reviewers through the Rayyan platform. Methodological quality was appraised using Joanna Briggs Institute (JBI) Critical Appraisal Tools, and the level of evidence was classified according to the Oxford Centre for Evidence-Based Medicine (OCEBM) Levels of Evidence.<b>4. Results and Discussion</b> Six studies were included, encompassing a total population of 1,058 medical students. Four main thematic axes emerged:(1) <b>Importance of PC integration</b>: All studies emphasized the urgent need to formally incorporate PC into medical curricula, reinforcing its relevance in comprehensive care and medical humanism.(2) <b>Barriers and challenges</b>: Key obstacles included the lack of specialized faculty, the absence of mandatory curricular components on PC, curricular overload with less relevant subjects, and the institutional undervaluing of PC.(3) <b>Essential competencies in PC</b>: Students' self-assessment revealed a lack of confidence in core PC competencies, including symptom management, communication of bad news, and ethical decision-making.(4) <b>Teaching strategies</b>: Non-specialized clinical rotations and active learning methodologies (e.g., simulations, problem-based learning) were reported as partially effective in enhancing students' self-efficacy and reducing thanatophobia.Comparative analysis with international experiences shows that while countries like the United Kingdom and Canada mandate structured PC education throughout medical training, Brazil still lags in achieving transversal and longitudinal integration of this critical field. The publication of the National Palliative Care Policy (2024) and the CNE/CES Opinion No. 265/2022 represent significant milestones for curricular reform, yet concrete implementation at the institutional level remains pending.<b>5. Conclusions</b> The teaching of Palliative Medicine in Brazilian undergraduate medical programs remains fragmented, inconsistent, and predominantly traditional. Significant institutional and structural barriers hinder its effective integration. There is a pressing need for systematic, transversal, and longitudinal insertion of PC in medical curricula, the development of specialized faculty, and the promotion of active, competence-based learning methodologies.The recent advances in national policy frameworks provide a unique opportunity to transform medical education and align it with contemporary healthcare needs. Future efforts must focus on overcoming institutional inertia, prioritizing the ethical and humanistic training of future physicians, and ensuring that Palliative Care becomes a core, inseparable component of medical education in Brazil.<b>Strengths and Limitations</b> This review presents an original contribution by systematizing Brazilian scientific evidence on PC education, a field still underrepresented in national academic discussions. However, the study is limited by the small number of eligible articles, the possibility of publication bias, and the regional concentration of analyzed studies, which may affect the generalizability of findings.