RSS-Feed abonnieren
PDF herunterladen
DOI: 10.1055/s-0045-1811232
A needs assessment of palliative care education in neurology residency programs in Brazil
Abstract
Background
The importance of integrating palliative care (PC) competencies into the management of neurological diseases is increasingly acknowledged. The National Medical Residency Program Commission (NMRPC) mandates the inclusion of PC in the curricula of neurology residency programs (NRPs).
Objective
To evaluate the implementation of PC training in NRPs across Brazil and to identify barriers to its effective integration.
Methods
We conducted a cross-sectional study using an anonymous online survey distributed to all NRP directors in Brazil through the Brazilian Academy of Neurology (BAN). The survey, approved by the institutional ethics committee, comprised 19 questions assessing PC training in NRPs. The responses were analyzed descriptively using IBM SPSS Statistics for Windows (IBM Corp.) software, version 26.0.
Results
The survey achieved a 32% (29 programs) response rate. Of the respondents, 82.8% (24 programs) reported the presence of an institutional PC team, and 75.9% (22 programs) incorporated PC training into their programs. However, only 1 neurology faculty member had formal PC training, and 37% of the directors expressed dissatisfaction with the quality of PC education. Key barriers included limited faculty availability (72.4%), lack of PC expertise (69%), and insufficient teaching time (58.6%).
Conclusion
Palliative care training in Brazilian NRPs lacks consistency and systematic implementation. There is an urgent need for enhanced faculty training and strategic interventions to address structural and curricular barriers to improve PC education.
Authors' Contributions
MST: Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Writing - original draft; CGL: Conceptualization, Methodology, Writing - original draft; LON: Conceptualization, Formal analysis, Methodology, Writing - review & editing; LCGL: Conceptualization, Data curation, Formal analysis, Methodology, Project administration, Writing - original draft; ACPC: Data curation, Formal analysis; MSP: Writing - review & editing.
Data Availability Statement
The datasets generated and/or analyzed during the current study are available from the corresponding author upon reasonable request.
Editor-in-Chief: Ayrton Roberto Massaro; https://orcid.org/0000-0002-0487-5299.
Associate Editor: Orlando G. P. Barsottini; https://orcid.org/0000-0002-0107-0831.
Publikationsverlauf
Eingereicht: 31. Januar 2025
Angenommen: 16. Juni 2025
Artikel online veröffentlicht:
08. September 2025
© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)
Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil
Maiara Silva Tramonte, Ana Claudia Pires Carvalho, Mariana Soares Pinheiro, Camila Galvão Lopes, Luciana Oliveira Neves, Laura Cardia Gomes Lopes. A needs assessment of palliative care education in neurology residency programs in Brazil. Arq Neuropsiquiatr 2025; 83: s00451811232.
DOI: 10.1055/s-0045-1811232
-
References
- 1 Feigin VL, Forouzanfar MH, Krishnamurthi R, Mensah GA, Connor M, Bennett DA. et al; Global Burden of Diseases, Injuries, and Risk Factors Study 2010 (GBD 2010) and the GBD Stroke Experts Group. Global and regional burden of stroke during 1990-2010: findings from the Global Burden of Disease Study 2010. Lancet 2014; 383 (9913) 245-254
- 2 Boersma I, Miyasaki J, Kutner J, Kluger B. Palliative care and neurology: time for a paradigm shift. Neurology 2014; 83 (06) 561-567
- 3 Dallara A, Tolchin DW. Emerging subspecialties in neurology: palliative care. Neurology 2014; 82 (07) 640-642
- 4 World Health Organization. National cancer control programmes: policies and managerial guidelines. 2nd ed.. Geneva: World Health Organization; 2002. . Available from: https://iris.who.int/bitstream/handle/10665/42494/9241545577.pdf?sequence=1&isAllowed=y
- 5 Creutzfeldt CJ, Kluger B, Kelly AG, Lemmon M, Hwang DY, Galifianakis NB. et al. Neuropalliative care: Priorities to move the field forward. Neurology 2018; 91 (05) 217-226
- 6 Kluger BM, Hudson P, Hanson LC, Bužgovà R, Creutzfeldt CJ, Gursahani R. et al. Palliative care to support the needs of adults with neurological disease. Lancet Neurol 2023; 22 (07) 619-631
- 7 Holloway RG, Arnold RM, Creutzfeldt CJ, Lewis EF, Lutz BJ, McCann RM. et al; American Heart Association Stroke Council, Council on Cardiovascular and Stroke Nursing, and Council on Clinical Cardiology. Palliative and end-of-life care in stroke: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2014; 45 (06) 1887-1916
- 8 Mehta AK, Najjar S, May N, Shah B, Blackhall L. A Needs Assessment of Palliative Care Education among the United States Adult Neurology Residency Programs. J Palliat Med 2018; 21 (10) 1448-1457
- 9 Goyal T, Robinson MT, Gold CA. Opinion & Special Articles: Competency in Serious Illness Communication for Neurology Residents. Neurology 2021; 96 (12) 587-589
- 10 Castro AA, Taquette SR, Marques NI. Inclusion of palliative care teaching in medical schools in Brazil. Rev Bras Educ Med 2021; 45 (02) e056
- 11 Horowitz R, Gramling R, Quill T. Palliative care education in U.S. medical schools. Med Educ 2014; 48 (01) 59-66
- 12 Ministério da Educação. Secretaria de Educação Superior. Resolução CNRM no 13, de 6 de julho de 2021. Aprova a matriz de competências dos programas de Residência Médica em Neurologia no Brasil. Brasília: Diário Oficial da União; 2021. ; Available from: https://www.gov.br/mec/pt-br/residencia-medica/crm/2021/resolucao-cnrm-no-13-de-6-de-julho-de-2021-resolucao-cnrm-no-13-de-6-de-julho-de-2021-dou-imprensa-nacional.pdf
- 13 Kluger BM, Kramer NM, Katz M, Galifianakis NB, Pantilat S, Long J. et al. Development and Dissemination of a Neurology Palliative Care Curriculum: Education in Palliative and End-of-Life Care Neurology. Neurol Clin Pract 2022; 12 (02) 176-182
- 14 Kramer NM, Besbris J, Hudoba C. Education in neuropalliative care. Handb Clin Neurol 2023; 191: 259-272
- 15 Creutzfeldt CJ, Gooley T, Walker M. Are neurology residents prepared to deal with dying patients?. Arch Neurol 2009; 66 (11) 1427-1428
- 16 Araujo LZS, Araujo CZS, Barros LHR, Santo MNE, Silva GFd. Palliative Care in the Brazilian Health System. Palliat Med Care Int J. 2019; 2 (04) 118-123
- 17 Bombaci A, Di Lorenzo F, Pucci E, Solari A, Veronese S. Società Italiana di Neurologia–Società Italiana di Cure Palliative Intersociety Table. Education needs in palliative care and advance care planning of Italian residents in neurology: an online survey. Eur J Neurol 2024; 31 (09) e16376
- 18 Bruera E, Higginson I, Von Gunten CF, Morita T. editors. Textbook of Palliative Medicine and Supportive Care. 3rd ed.. Boca Raton, FL: CRC Press; 2021.
- 19 Sarmet M, Cavalcanti de Oliveira ERN, Cirne Franco H, Zeredo JL, Mehta AK. The Current State of Neuropalliative Care in Brazil: Trends in Representation and Advocacy. J Palliat Med 2022; 25 (03) 343-344
- 20 Ministério da Educação. Conselho Nacional de Educação. Despacho do Ministro, publicado no D.O.U. de 3/11/2022, Seção 1, Pág. 95. Brasília: Diário Oficial da União; 2022. ; Available from: http://portal.mec.gov.br/docman/marco-2022-pdf/238001-pces265-22/file
- 21 Harrigan E, Taylor BL, Kirsch HL, Ghoshal S, Kwei KT, Brizzi KT. et al. Curriculum Research: Disseminating Neuropalliative Care Education Through an Adaptable Curriculum: A Multisite Feasibility Trial. Neurol Educ 2024; 3 (02) e200133
- 22 Cook T, Arnold R, Jeong K, Childers J. Opinion & Special Article: Next Steps in Palliative Care Education for Neurology Residents. Neurology 2021; 97 (24) 1134-1137