Palliative and end-of-life care from an education lens. An international systematic review of undergraduate medical and nursing students’ knowledge, perceptions, and orientation towards palliative and end-of-life care

Introduction: Nursing and medical schools and universities are increasingly integrating palliative and end-of-life care education in their curricula. However, research on the impacts of training and education on future nurses and physicians remains sparse. Aim of the review: The aim of this review was to systematically appraise existing research evidence on undergraduate nursing and medical students' knowledge, perception, and orientation towards palliative and end-of-life care. Methods: This international systematic review was conducted between April and May 2021 and was updated in May 2024. A systematic search was conducted in four databases: Hinari 'Research4Life', Cumulated Index to Nursing and Allied Health Literature (CINAHL), Google scholar and PubMed. Methodological quality of the included studies was assessed using the Mixed-Methods Appraisal Tool. A data extraction sheet was developed for this review. A convergent integrated approach to mixed-method data synthesis and integration was used to analyse and report the evidence. Braun and Clarke's inductive and deductive thematic analysis approach was used to identify main themes. Results: A total of 64 peer-reviewed research articles met eligibility criteria and were included in the review. Of the 64 eligible research articles, 34 employed a descriptive quantitative cross-sectional design, 11 studies were qualitative, 14 used a quantitative non-randomised design and 5 were mixed methods. The review identified three major thematic categories: (1) students' knowledge of palliative and end-of-life care, (2) attitude, perception and orientation towards palliative and end-of-life care and (3) predictors of knowledge, orientation, attitude and perception towards palliative and end-of-life care. Conclusion: Findings suggest inadequacy and variability in knowledge levels, self-efficacy, willingness, perception and orientation towards palliative care and end-of-life care. Surprisingly, this is common across studies, including those from high-resource countries. Inadequate, limited and/or inconsistent curricula and training content about palliative and end-of-life care is a common theme in the literature.