A Systematic Review of Training in Symptom Management in Palliative Care Within Postgraduate Medical Curriculums

Abstract

ContextSymptom management is a priority area within palliative care core competencies for generalist providers. Although several educational initiatives exist, a comprehensive evidence synthesis on the effectiveness of symptom management training on trainees' learning and patient-reported outcomes is lacking. ObjectivesThe objective of this study was to determine the effectiveness of training in symptom management in palliative care providers in nonpalliative specialties. MethodsThis is a systematic review following Best Evidence Medical Education methods from searches of MEDLINE, EMBASE, ERIC, CINAHL, PsycINFO, Cochrane database of systematic, Clinical Trials.gov, and ISRCTN databases to September 2017. Prospective controlled studies testing the impact of symptom management educational interventions on physicians in training in nonpalliative specialties were included. Data were summarized narratively, grouped by curriculum description, and effectiveness on trainees' learning or patient-reported outcomes. ResultsOf 5062 records identified, six studies met the inclusion criteria: two randomized controlled trials and four quasi-experimental. Pain management and use of opioids and their side effects were most frequently covered. Clinical decision support tools, Web-based teaching, palliative care rotation, and mixed educational methods were used. Most studies used self-reported, original, or modified evaluation instruments, although psychometric properties were seldom reported. Despite methodological considerations, all educational methods improved trainees' learning outcomes. However, the effects on trainees' behavior and patient-related outcomes were not evaluated. ConclusionCurrent educational training programs in symptom management appear to improve trainees' comfort, preparedness, and knowledge in assessing and managing patients' symptoms at the end of life. More rigorous research to evaluate the impact of this training on residents and organizational performance is now required.