Special Report: Furthering Palliative Care Training in Latin America
Key findings
- There is a critical shortage of palliative care (PC) in Latin America, partly due to a great need for clinician education
- In 2019-2020, Massachusetts General Hospital/Harvard Medical School partnered with Pontificia Universidad Catolica of Chile on an advanced diploma course in PC
- The course comprised six days of in-person training; six months of monthly virtual case-based discussion, didactics, and educational project mentorship; and another six days of in-person training
- Reported self-efficacy increased significantly in all categories both immediately and six months after the course, and participants were highly satisfied with the quality of the course and the teaching methods
- During the COVID-19 pandemic, the two universities began to collaborate on monthly Project ECHO videoconferences, and a second iteration of the advanced diploma course began in the fall of 2022
Only a small number of low- and middle-income countries have integrated palliative care (PC) into mainstream health care. Globally, a lack of clinician training is a most critical barrier to PC delivery.
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Latin America is no exception; fewer than half of Latin American countries recognize PC as a medical specialty. However, in 2004 the Chilean Congress began requiring health insurance programs to guarantee access to care for certain health problems, including PC for cancer patients. The Pontificia Universidad Catolica of Chile (UC) School of Medicine established a subspecialty PC fellowship in 2017.
In 2018, Massachusetts General Hospital/Harvard Medical School partnered with the UC School of Medicine on a five-day basic course for a multidisciplinary group of PC clinicians. To build on its success, the partners conducted an advanced PC diploma course in 2019–2020 to bridge the gap between the basic PC course and the UC fellowship.
Bethany-Rose Daubman, MD, and Mark Stoltenberg, MD, MPH, MA, attending physicians in the Division of Palliative Care and Geriatric Medicine at Mass General, and colleagues give the details in the Journal of Pain and Symptom Management.
Course Description
The two sponsoring institutions reviewed the proposed curriculum, adapted from a Harvard Medical School course, with PC leaders, stakeholders, and clinicians across Chile. The reviewers made adjustments to ensure the sessions would be culturally appropriate and meet the needs of both Chilean and broader Latin American audiences.
In the end, the course was structured as follows:
- Six days of in-person training
- Six months of monthly virtual case-based discussion, didactics, and educational project mentorship
- A second six days of in-person training
Each week of in-person training consisted of didactic sessions and small-group exercises covering five main topics: communication, symptom management, ethics and psychosocial issues, leadership in PC (advocacy and building a PC team), and education (an explicit goal of the course was to train participants to educate others in their home institutions about PC).
Participants
Thirteen physicians participated in the training. Twelve were from different parts of Chile, and one was from Colombia. For nine participants, the only previous PC training was conferences or short courses.
Course Evaluation
Participants were assessed before the course, immediately after, and six months after:
- Knowledge examination—The advanced course required applicants to have at least some prior PC experience, and pre-course scores were high (mean, 79%) for most of the knowledge questions. On the immediate post-test, the mean score was 96%, and at six months, it was 85%
- Self-reported PC behaviors all increased in frequency from pre-course to six months afterward, although the only statistically significant change regarded conducting conversations about goals of care. Free-text comments suggested most participants were teaching PC six months after the course
- Reported self-efficacy increased significantly in all categories both immediately and six months after the course
Participant Satisfaction
100% of participants ranked the course as being of very high or high quality, 100% responded that the teaching methods were very easy or easy to understand, and 100% endorsed roleplay as a very useful teaching tool.
In six-month survey comments, some participants said instruction on resiliency and self-care helped prepare them for the new clinical and personal hardships they faced as waves of COVID-19 peaked in Latin America.
Ongoing Efforts
During the pandemic, team members from Mass General and UC School of Medicine began to offer monthly Project ECHO videoconferences for Latin American PC clinicians. They are continuing that telementoring, and a second iteration of the advanced diploma course began in the fall of 2022.
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