A needs assessment for palliative care training in undergraduate students at the University of Stellenbosch

Master Thesis


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University of Cape Town

BACKGROUND: The number of patients with cancer and other life-limiting diseases continues to increase. The WHO estimate that by 2050 there will be 24 million new cancer cases diagnosed annually. Seventeen (17) from the 24 million cancer cases in 2050 will come from developing countries. The vast majority of patients in the Third World Countries do not have access to modern diagnostic and therapy facilities and for them palliation is all they can hope for. Palliative care is a basic human right when curative care is no longer appropriate. The World Health Assembly (WHA) stated that each health care practitioner and health system has an ethical duty to relieve the pain and suffering of patients. This is only possible if the health care professionals are effectively trained to provide holistic, end-of-life care. The World Health Organisation (WHO) challenged training institutions to ensure that palliative care is compulsory and given high recognition. The 67th WHA (resolution A67.19) published a document in 2014 with nine recommendations to ensure effective palliative care delivery. There should be emphasis on palliative care teaching to all levels of health care workers and palliative training should be implemented as part of the curricula to all health care workers. PURPOSE: To conduct a needs assessment for palliative care training in undergraduate students at the University of Stellenbosch. METHODS: Two validated assessment scales were distributed via a questionnaire to all the fifth year medical students: * The Self-efficacy in palliative care scale (SEPC) assesses the confidence/anxiety the student experience in performing certain tasks. * The Thanatophobia scale assesses the student's attitudes towards caring for dying patients. The results of the above two scales provided a valid measure of the impact of the current undergraduate palliative curriculum at the University of Stellenbosch. RESULTS: A total of 135 from 179 students responded to the questionnaire (response rate of 75.4%) A minority (21%) of the students felt that their training and skills in palliative care was sufficient. Only 28% of students feel comfortable to discuss death with a patient. 52.7% of students felt anxious about their communication skills. Certain topics were highlighted as challenges: Discussing death with the patient and family, answering questions on pain and suffering and "How long will I live?", as well as the knowledge and management of symptoms in palliative patients. In 2013, the University of Stellenbosch dedicated six hours to the palliative care curriculum. Since 2014, palliative care training has been removed from the curriculum. The study indicated that communication and patient management skills were experienced as challenging by students and this correlated with the curriculum that focused only 15% respectively on these two concepts. CONCLUSION: According to the literature, a lack of palliative care training can result in poor symptom control and inevitably a decrease in quality of care for the patients. The need for palliative care is increasing. To address the palliative care needs of the population, health care professionals should be effectively trained in palliative care. This study highlights the need for a dedicated undergraduate palliative care curriculum that should focus more on communication and patient management's skills to empower the next generation of medical practitioners to care for dying patients with confidence and a positive attitude.

Includes bibliographical references