The Improvement in the Clinical Management of Patients Undergoing Palliative Care After Training the Primary Care Team by a Specialized Team: A Systematic Review

Background: Primary Health Care plays an important role in the provision and coordination of palliative care in many healthcare contexts. Education and training of healthcare professionals are relevant strategies to support the delivery of quality palliative care. Objective: To evaluate whether training healthcare professionals working in Primary Health Care improves symptom assessment and clinical management of patients eligible for palliative care. Methodology: Systematic review conducted according to PRISMA 2020 guidelines, with a protocol registered on the PROSPERO platform under the number CRD420261370621. The eligibility criteria were structured according to the PICO approach: population composed of healthcare professionals working in primary care; educational interventions in palliative care; comparator without training or with different modalities; outcomes of symptom assessment and clinical control. The searches were conducted in seven databases: PubMed/MEDLINE, Embase, Web of Science, Scopus, Cochrane Library, SciELO, and LILACS. Results: Eight studies were included in the review, with varied designs: a pilot randomized clinical trial, a quasi-experimental study, two evaluations of educational programs, a feasibility study, a retrospective population cohort, and two qualitative approaches. The findings revealed a generalist predominance in the provision of palliative care: 95% of the care was provided by generalists, 53% of patients did not receive identifiable palliative care in the last year of life, and specialists were virtually nonexistent in rural areas, where family doctors were responsible for nearly all care. Conclusions: Training of primary care teams is necessary, but insufficient on its own. Although it improves the confidence and knowledge of professionals, there is no robust evidence that it sustainably transforms patient clinical outcomes. The problem is structural: there is a lack of adequate clinical time, compatible remuneration, integration with specialists, and support infrastructure. It is necessary to go beyond education and promote reforms in the healthcare system so that palliative care in primary care is effectively qualified.