Evidence for the benefits of specialist palliative care is already compelling – it’s time to move on to research on comparing different ways of care delivery

WE’RE DELIGHTED TO PRESENT THIS MONTH’S ‘EDITOR’S CHOICE’ FROM PALLIATIVE MEDICINE, THE OFFICIAL RESEARCH JOURNAL OF THE EAPC    

Each month, Professor Catherine Walshe, Editor-in-Chief of ‘Palliative Medicine’, chooses an article that readers may find particularly interesting or useful and invites the authors to draw out the key points on the EAPC blog. Focusing on research that is novel, a robust review, from a specific country or just slightly left of field, the ‘Editor’s Choice’ post aims to share experience and stimulate ideas. We hope you’ll read the longer article in ‘Palliative Medicine’.

Professor Yin-Bun Cheung (left) and Assistant Professor Grace Yang

Grace Yang, palliative medicine physician in National Cancer Centre Singapore, and Yin-Bun Cheung, epidemiologist and biostatistician in Duke-US Medical School in Singapore, explain the background to their longer article, selected as ‘Editor’s Choice’ in the September 2021 issue of ‘Palliative Medicine’. And EAPC members can download a PDF of the full-text article from EAPC website.


Not whether, but how?

People with advanced cancer have high rates of hospitalisation, with the chief reason for admission being disease progression or uncontrolled symptoms such as pain. Specialist palliative care consultation for cancer patients in the acute inpatient hospital setting is associated with better patient outcomes. In Singapore General Hospital, like many hospitals worldwide, the Supportive and Palliative Care team from the National Cancer Centre Singapore runs a consult service where referrals were made to a separate specialist palliative care team. Is there a better way for us to be more integrated with the oncologists?

The question is not ‘Should we integrate specialist palliative care with oncology?’ The evidence for the benefits of palliative care is already compelling. The question is HOW this integration should be implemented to optimise health outcomes. Our study compared two ways of delivering specialist palliative care – the consult model versus the co-rounding model. Both provided the same content of specialist palliative care but differed with regard to integration with oncologists.

What study design should be used?

In our institution, oncologists had been asking us to co-round with them for many years. We had also piloted the co-rounding model – there was preliminary evidence of shorter hospital length of stay and the qualitative study found better communication between oncologists and specialist palliative care physicians.1,2 A randomized controlled trial would not be acceptable because no one wanted to be in the control group. We decided on using a stepped-wedge cluster-randomized design – this is an efficient and pragmatic design that allows for all clusters to receive the intervention but starting at different times.

Does it matter how palliative care is delivered?

We found that compared to the consult model, the co-rounding model was associated with a marginally shorter hospital length of stay among all admissions (0.70 days, p=0.065). A shorter hospital length of stay for the co-rounding model was observed in patients with stage 3-4 cancer (0.85 days, p=0.038) and in patients who received specialist palliative care (2.62 days, p=0.010). There was no difference in the proportion of patients who were readmitted within 30 days of discharge.

The mechanisms by which a shorter hospital length of stay can be achieved are not entirely clear. It could be that the co-rounding model fostered more effective collaboration between oncology and specialist palliative care clinicians, thereby improving both the timeliness and the quality of specialist palliative care. Further research is warranted to explore the active components of the co-rounding model and the impact of contextual features on its implementation and effect on patient outcomes.

What next? 

As part of a multi-faceted evaluation, we will be reporting on the patients’ experience of care in the consult model versus the co-rounding model. We also plan to assess end-of-life outcomes such as acute healthcare utilisation in the last 30 days of life and chemotherapy in the last 14 days of life. Look out for these forthcoming papers!

References

  1. Yang GM, Kanesvaran R, Neo SH, Yee ACP, Block SD and Cheung YB. Pilot Study of a Palliative Care and Medical Oncology Co-Rounding Model for Advanced Cancer Inpatients in a Tertiary Hospital in Singapore. J Palliat Med. 2018; 21: 95-8.
  2. Yang GM, Yoon S, Tan YY and Liaw K. Experience and Views of Oncology and Palliative Care Professionals on a Corounding Model of Care for Inpatients with Advanced Cancer. Am J Hosp Palliat Care. 2018; 35: 1433-8.

VIEW THE FULL ARTICLE IN ‘PALLIATIVE MEDICINE’
This post relates to the longer article, ‘Comparing the effect of a consult model versus an integrated palliative care and medical oncology co-rounding model on health care utilization in an acute hospital – an open-label stepped-wedge cluster-randomized trial’ by Grace M Yang,  Siqin Zhou, Zhizhen Xu, Stella SL Goh, Xia Zhu, Dawn QQ Chong, Daniel SW Tan, Ravindran Kanesvaran, Alethea CP Yee, Patricia SH Neo, Yin-Bun Cheung, published in Palliative Medicine 2021 Volume 35 issue:8, page(s): 1578-1589. First published 15 September 2021. https://doi.org/10.1177/02692163211022957

Links    

EAPC MEMBERS – DOWNLOAD THIS, AND ALL OTHER ‘EDITOR’S CHOICE’ ARTICLES, FREE OF CHARGE
If you are currently an Individual or Associate EAPC Member you have full access to the Members Area of the EAPC website, and the chance to download a free PDF of all ‘Editor’s choice’ articles, as well as many other membership benefits. Just click here,  enter your email address and membership password and choose from the list of journal articles under 2021.

Join, or renew your membership, here. Members of our national associations can join the EAPC for free at https://www.eapcnet.eu/join-as-an-associate-member/

 


EXPLORE NEW DIMENSIONS at #EAPC2021. The EAPC 17th World Congress Online offers interactive online sessions from 6 to 8 October 2021, an entire day dedicated to Paediatric Palliative Care and a selection of pre-congress sessions on 5 October.

  • Register for the congress here. (Up to 25% discount for EAPC members)
  • View the live scientific programme here.
  • Enter the Science Slam here.
  • Enjoy lots of on-demand content from 27 September until 31 January 2022.
  • Get a sneak peek of congress presentations on the EAPC blog.
  • Follow latest congress news @EAPCvzw #EAPC2021and via the EAPC blog.
Posted in EAPC-LINKED JOURNALS, Palliative Medicine: Editor's Choice, RESEARCH, Uncategorized | Leave a comment

A year of fighting the racial inequality of COVID

CONTINUING OUR SERIES ON COVID-19 AND THE PALLIATIVE CARE RESPONSE – AND A CHANCE TO DOWNLOAD THE LATEST COVPALL STUDY FINDINGS OPEN ACCESS…

Today’s Guest Writer is Dr Sabrina Bajwah, Clinical Senior Lecturer, King’s College London and Honorary Palliative Care Consultant at King’s College Hospital, London UK, which serves one of the most ethnically diverse and socioeconomically deprived populations in Europe.  


Dr Sabrina Bajwah

In the past year, I have worked on the National Health Service (NHS) COVID frontline for two waves of the pandemic. In between these two waves, we had the tragic death of George Floyd and the rising of the Black Lives Matter movement. As the daughter of working-class Pakistani immigrants growing up socioeconomically deprived, I have seen how COVID-19 has affected those from ethnic minority groups, both professionally and personally.

As a Clinical Senior Lecturer, I normally work clinically 50 per cent of the time as a Palliative Care Consultant and 50 per cent as an academic, with a focus on respiratory research. In March 2020, when COVID hit the UK, I returned to clinical work full time. Our palliative care team at King’s College Hospital, London has been one of the busiest in the UK. We have seen more than 500 COVID patients in the past year alone. It became clear very quickly, that respiratory colleagues were struggling to manage symptoms and desperately needed guidance. Whilst working full time clinically, I convened and led a team of international palliative care and respiratory experts to publish an editorial in the European Respiratory Journal. This editorial not only provided urgent detailed symptom control guidance to respiratory physicians early in the first wave, but also included information leaflets developed in collaboration with the European Lung Foundation. These information leaflets directly address unmet COVID information for both patients and families. I saw quickly that patients whose first language was not English, were struggling to communicate with health professionals. Most of these patients had lost their translators because of visiting restrictions. To mitigate this, I urgently reached out to translation services to request pro-bono translation. By the end of April 2020, 24 different translations were available, including the top ten ethnic minority languages spoken in the UK. These leaflets are now being used globally and have been downloaded over 15,000 times. I recently took part in a webinar supporting doctors in India who were incredibly grateful for these resources – especially those leaflets translated in Hindi, Gujarati, Punjabi and Urdu.

New CovPall study shows UK COVID policies may have disproportionately impacted ethnic minority patients and families at end of life and the UK palliative care response may have been equal but inequitable

Against the backdrop described above, I was extremely fortunate to be asked to be a co-investigator for the CovPall study. CovPall is a collaborative study between Cicely Saunders Institute at King’s College London, and the Universities of Hull, York and Lancaster. It aims to understand the multinational specialist palliative and hospice care response to COVID-19. I led a team to focus specifically on the challenges that services faced managing the palliative care needs of those from ethnic minority groups during the first wave. This research has been published in BMJ Supportive and Palliative Care. We found that even though services reported delivering personalised care for patients from ethnic minority groups, UK wide COVID-19 policies may have disproportionately impacted people from ethnic minority groups at the end of life. In addition, the UK palliative care response may have been equal but inequitable. We provide clear recommendations on how to close the gap between those who receive the “best and most” and “least and worst” palliative care.

As we took a deep breath and tried to recover from the first wave, we knew that it was important to analyse our local data. King’s College Hospital serves one of the most ethnically diverse and socioeconomically deprived populations in Europe. Our data from the first wave of 344 patients has been the largest COVID palliative care dataset to date. It is also the largest ethnic minority palliative care dataset and the first to look at socioeconomic deprivation. The results of our data published in Palliative Medicine show that there was no significant difference between time from admission to palliative care referral for our patients from ethnic minority or socioeconomically deprived backgrounds. It felt meaningful to provide methods to the wider palliative care community on how they too could analyse if they are delivering equitable care to these groups.

When I was approached by Dr Jamilla Hussain to co-author an editorial on racism in palliative care, I knew the time was right. Stepping up to this editorial published in Palliative Medicine, as a British Pakistani Muslim from a poor socioeconomic background, I have felt incredibly vulnerable. I have been reflecting on why that is. I have concluded that it is because this work is not just about professional experience, but also about personal experience. Mine, my family’s and my community’s personal experiences. All things inherently part of me. So often over the years, I have seen people’s eyes glaze over when I talk about racial inequality and I have felt disheartened that some don’t care. That has been soul destroying and it is hard to keep going when you experience that. The support this editorial has generated in the palliative care community has left me feeling empowered. I hope we can build on this positive response going forward to result in meaningful change.

The personal and professional lived experiences of the past year have changed me. Previously, when I saw or experienced racial inequality, I would often keep quiet, not wanting to make a fuss. The notion that it is important to blend in as a person from an ethnic minority group was, I think, at the heart of this. But more important than my insecurities, are those people that I know personally and professionally who have no voice and no advocate. I have a vision of equitable palliative care for all and I am hopeful for what the future may hold.

Links and resources


EXPLORE NEW DIMENSIONS at EAPC 17th World Congress Online with a great line-up of plenary speakers, oral communications, posters, Science Slam, Yoga sessions and lots of opportunity for online networking

  • Register for the congress here. (Up to 25% discount for EAPC members)
  • View the live scientific programme here.
  • Enter the Science Slam here.
  • Enjoy lots of on-demand content until 31 January 2022.
  • Get a sneak peek of congress presentations on the EAPC blog.
  • Follow latest congress news @EAPCvzw #EAPC2021and via the EAPC blog.

 

 

 

 

 

Posted in Coronavirus and palliative care, Minority Communities, PATIENT & FAMILY CARE, RESEARCH | Leave a comment

Inclusivity in palliative care – are we as good as we think?

NEW SERIES: EXPLORING NEW DIMENSIONS AT #EAPC2021 …

There are just 22 days to the 17th World Congress Online of the European Association for Palliative Care (EAPC). With live sessions on 6 to 8 October and lots of on-demand content before and after the congress.

Ahead of the congress, we’re delighted to give some highlights of what to expect at #EAPC2021. Today, we give a glimpse of the plenary presentation that will be given on Wednesday, 6 October by Professor Richard Harding, Herbert Dunhill Professor of Palliative Care & Rehabilitation, Director of the Cicely Saunders Institute & Vice Dean (International) of the Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King’s College London, United Kingdom.


Professor Richard Harding

You matter because you are you, and you matter all the days of your life.

Dame Cicely’s words have greater resonance for us now as we develop greater awareness of health inequalities in society and make efforts to reduce them. Minority and low-income groups may experience discrimination and social exclusion and have worse health outcomes. If our commitment is to palliative care for all who would benefit from it, then we must make concerted efforts towards inclusivity.

People with progressive illness may have faced health inequalities that made them more likely to develop their illness. Minority stress theory explains why experience of discrimination may lead to greater prevalence of some life-limiting illnesses. The challenge for us is whether we can recognise that inequality, understand how it may reduce access to palliative care, and how it may influence needs and preferences.

Dame Cicely Saunders 1918 – 2005  (Photograph with kind permission of St Christopher’s Hospice).

The notion of “values-based care” is useful in considering how our values as clinicians, managers, or researchers influence the evidence we generate, the services we develop and the care we deliver. The promotion of the values of ‘inclusivity’ and that “you matter because you are you” are key to achieving our shared goal of palliative care for all.

Experience suggests that people do want to deliver inclusive care, but that sometimes it isn’t clear what actions to pursue. Within existing healthcare evidence, research samples are often homogenous, and standard recruitment methods may not engage minority groups. However, there are many examples of innovative practice to help us consider how we plan, promote and deliver inclusive palliative care services.


Join Richard Harding in his plenary presentation, Inclusivity in palliative care – are we as good as we think?’ at 3pm on Wednesday, 6 October 2021. Professor Harding is one of many leading international practitioners and researchers who will be presenting at the EAPC 17th World Congress. His lecture will be recorded and released for on-demand viewing by registered delegates until January 2022. Everyone, whether registered or not, will be able to read the abstract in the congress book of abstracts, published by Palliative Medicine, from 27 September 2021.

Read more about Richard Harding and the Cicely Saunders Institute.


The 17th EAPC World Congress Online offers interactive online sessions from 6 to 8 October 2021, including an entire day dedicated to Paediatric Palliative Care. Congress platform goes live 27 September!

  • Register for the congress here. (Up to 25% discount for EAPC members)
  • View the live scientific programme here.
  • Enjoy lots of on-demand content until 31 January 2022.
  • Enter the Science Slam here.
  • Get a sneak peek of congress presentations on the EAPC blog.
  • Follow latest congress news @EAPCvzw #EAPC2021 and via the blog.

 

 

Posted in 17th EAPC World Congress, ADVOCACY & POLICY, EAPC World Congresses, Minority Communities | Tagged , | Leave a comment

The need for early referral to palliative care especially for Black, Asian and minority ethnic groups in a COVID-19 pandemic

AN OPPORTUNITY TO CATCH UP WITH OUR ‘PAST POSTS’ – Today we’re republishing a research article from the United Kingdom that was selected as ‘Editor’s Choice’ in October 2020.

Each month, Professor Catherine Walshe, Editor-in-Chief of  ‘Palliative Medicine’, chooses an article that readers may find particularly interesting or useful and invites the authors to draw out the key points on the EAPC blog. Focusing on research that is novel, a robust review, from a specific country or just slightly left of field, the ‘Editor’s Choice’ post aims to share experience and stimulate ideas. We hope you’ll read the longer article in ‘Palliative Medicine’, which is Open Access, or EAPC members can access a free copy from the EAPC website. 

Today, Claude Chidiac, Lead Nurse Palliative Care, Homerton University Hospital NHS Foundation Trust, London, and Visiting Lecturer, City, University of London, UK, gives the background to his longer article selected as Editor’s Choice in the October 2020 issue of ‘Palliative Medicine’.


Claude Chidiac

We are delighted that our paper has been selected as ‘Editor’s choice’, for the October 2020 issue of Palliative Medicine.

During the first peak of the COVID-19 pandemic in the UK, we had to make significant changes to how our hospital-based palliative care service in East London was operating. Our service, like many others, faced a lot of challenges in trying to adapt and respond to the surge of COVID-19 cases. We were still learning form colleagues in Italy and Switzerland about the gravity of the situation and we knew that palliative care was going to be a core aspect of the wider COVID-19 planning. We did not have time to plan, and we had to learn and develop new skills every day as we were experiencing the surge of COVID-19 cases. Our palliative care planning focused on the following domains: developing service capacity, educating the generalist workforce, care of family caregivers, collaborating with community partners, and supporting the workforce.1

We realised that the clinical characteristics of patients referred to us had changed, and that they were deteriorating and dying quickly when compared to before the pandemic. It was from this stance that we decided to evaluate the impact of COVID-19 on clinical characteristics, symptoms, and outcomes of patients referred to our service. This was an important step to inform a responsive and equitable service planning and future research initiatives.

We found that patients with COVID-19 had lower comorbidity scores, with diabetes and hypertension being the most common. They had higher prevalence of symptoms, lower performance status, and deteriorated and died quicker. Although palliative care is often overlooked in humanitarian responses to emergencies and crises, our findings indicate the importance of early referral to palliative care and ensuring that it is visible and embedded within wider COVID-19 planning and response.

We found that patients from Black, Asian and minority ethnic groups, especially women, tended to be referred later to palliative care compared to White ethnic patients, especially during the pandemic. This suggests that COVID-19 may create compounding experiences of inequality for a structurally disadvantaged group or community. While global ethnic health inequalities are widely documented, we need to understand why this is happening in the context of COVID-19. Health inequalities tend to be related to wider societal and structural issues; however, we all have a role to play as researchers, clinicians, services, and organisations.

In order to find solutions to setting up responsive and equitable palliative care services, we need further research on gender bias and palliative care from an intersectional lens. This means that our research approaches in palliative care need to consider the interlocking of social categories such as ethnicity and gender as organising structures of society. They also need to recognise their significance as key components that influence oppression, identity, equality, and the potential for any form of social justice.

Reference

  1. Chidiac C, Feuer D, Naismith J, et al. Emergency Palliative Care Planning and Support in a COVID-19 Pandemic. Journal of palliative medicine. Epub ahead of print 20 April 2020. DOI: 10.1089/jpm.2020.0195.

Links

DOWNLOAD A COPY OF THE FULL ARTICLE IN PALLIATIVE MEDICINE – OPEN ACCESS

This post relates to the longer article, ‘The need for early referral to palliative care especially for Black, Asian and minority ethnic groups in a COVID-19 pandemic: Findings from a service evaluation’ by C Chidiac, D Feuer, M Flatley, A Rodgerson, K Grayson and N Preston; published in Palliative Medicine 2020, Vol. 34 (9), pages: 1241–1248. First Published July 31, 2020. Issue published October 1, 2020. https://doi.org/10.1177/0269216320946688

  • Read earlier Palliative Medicine ‘Editor’s choice’ posts on the EAPC blog.
  • Follow Palliative Medicine on Twitter @palliativemedj 

EAPC MEMBERS – DOWNLOAD THIS, AND ALL OTHER ‘EDITOR’S CHOICE’ ARTICLES, FREE OF CHARGE

If you are currently an Individual or Associate EAPC Member you have full access to the Members Only Area of the EAPC website, and the chance to download a free PDF of all ‘Editor’s choice’ articles and many other papers too.  Just click here, enter your email address and membership password and choose from the  journal articles listed under 2020.

How to join as an Individual/Associate Member, or to renew your membership

  • Individual members are invited to join the EAPC or renew their membership here.
  • Associate Members – all current members of our National Associations are invited to join the EAPC or renew their membership for FREE. Click here.

Editorial note: This post is among the Top Ten most-viewed posts on the EAPC blog in the second six months of 2020.

 

 

 

 

 

 

 

 

 

Posted in Coronavirus and palliative care, EAPC-LINKED JOURNALS, Palliative Medicine: Editor's Choice | Tagged , | 1 Comment

Making ‘invisible’ nursing work visible: The work of oncology nurses in introducing early palliative care

AN OPPORTUNITY TO CATCH UP WITH OUR ‘PAST POSTS’ – Today we’re republishing a research article from Canada that was selected as  ‘Editor’s Choice’ in February 2020.

Each month, Professor Catherine Walshe, Editor-in-Chief of ‘Palliative Medicine’, chooses an article that readers may find particularly interesting or useful and invites the authors to draw out the key points on the EAPC blog. Focusing on research that is novel, a robust review, from a specific country or just slightly left of field, the ‘Editor’s Choice’ post aims to share experience and stimulate ideas. We hope you’ll read the longer article in ‘Palliative Medicine’, or EAPC members can access a free copy from the EAPC website.

Shan Mohammed RN, PhD is an Assistant Professor, Teaching Stream at Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, and a Fellow of the Centre for Critical Qualitative Health Research, Toronto, Canada. Here, Shan explains the background to his research study and longer article published in the February 2020 issue of  ‘Palliative Medicine’ which has been selected as ‘Editor’s Choice’ for February…


Most of us have been cared for by a nurse at some point in our lives – nurses are skilled at treating disease and providing physical care and emotional comfort when people are most vulnerable. In my 15 years as an oncology nurse, I have cared for many people with haematological diseases such as leukaemia and lymphoma; this work has been the most meaningful of my career. Despite this, I have sometimes found it difficult to describe what nursing work was to people who were not nurses. Since it is part of the everyday rhythm of care and personalised comfort, nursing work is often thought of as ‘invisible’ and behind the scenes. When I teach undergraduate students about this idea, I use the example of the nurse who advocates for a patient with unrelieved pain to get a pain medication increased – yet often the patient only acknowledges the physician who prescribes the medication.

Nurses make a major contribution in introducing palliative care to patients (and families) who are receiving medical treatment for their disease but have not been referred to palliative care. However, nursing work in this area has not been formally examined because nurses often do not have the formal authority to refer patients to palliative care. Yet, as a nurse, I was there with the patient ‘24/7,’ speaking to patients and families about their goals of care and witnessing the physical impact of advanced disease and cancer treatments. Nurses may be well positioned to have these challenging discussions about palliative care with patients and families, yet I wondered if this work was also invisible.

To examine the role of nurses in introducing palliative care (and to render this work visible), we interviewed registered nurses, advanced practice nurses, and nurse practitioners about the role they played in introducing palliative care in several ambulatory oncology clinics (Mohammed et al., 2020). The results of our study showed that nurses played an important role in finding a space to have these challenging conversations, building trust with patients and families, and providing education about the many benefits of palliative care for patients with advanced disease (Mohammed et al., 2020).

Palliative care is inherently interdisciplinary. Our study suggests that the introduction of palliative care is a team effort that also must involve nursing. Nurses have the knowledge and skill to direct this process and can anticipate which vulnerable patients might benefit most from access to this care. Nurses, in turn, need to be supported by being offered opportunities to have these close relationships with patients, receiving respect from the healthcare team, and being provided with education in palliative care.

The results of our study are exciting because they demonstrate that relational work is the foundation of both oncology nursing practice and palliative care. As a university professor, I know that teaching undergraduate students about relational care is difficult but essential. A recent US Gallup poll showed that nurses are perceived by the public as the most trusted profession.Yet, despite the trust we hold with patients, nurses are susceptible to downsizing and cutbacks because of cost saving measures. The findings from our study suggest that promoting patient access to palliative care might be hampered if nurses are not directly engaged in relational work with patients.

Nurses on the front lines need to recognize, value, and voice the unique knowledge they have of patients and families as they advocate with other members of the healthcare team for improved access to palliative care. At a broader professional level, nurse leaders and educators need to advocate for more comprehensive and ongoing training on how relational care is linked to introducing palliative care.

 

VIEW THE FULL ARTICLE IN ‘PALLIATIVE MEDICINE’
This post relates to the longer article,“I’m going to push this door open. You can close it”: A qualitative study of the brokering work of oncology clinic nurses in introducing early palliative care by Mohammed, S., Savage, P., Kevork, N., Swami, N., Rodin, G., & Zimmermann, C. published in Palliative Medicine 202034 (2); pages: 209–218. https://doi.org/10.1177/0269216319883980 Article first published online: 29 October 2019. Issue published: 1 February 2020.

EAPC MEMBERS – DOWNLOAD THIS, AND ALL OTHER ‘EDITOR’S CHOICE’ ARTICLES, FREE OF CHARGE

If you are currently an Individual or Associate EAPC Member you have full access to the Members Only Area of the EAPC website, and the chance to download a free PDF of all ‘Editor’s choice’ articles and many other papers too.  Just click here, enter your email address and membership password and choose from the list of journal articles published in 2020. (Please search under the journal article title,“I’m going to push this door open. You can close it”: A qualitative study of the brokering work of oncology clinic nurses in introducing early palliative care”).

How to join as an Individual/Associate Member, or to renew your membership

 

  • Individual members are invited to join the EAPC or renew their membership here.
  • Associate Members – all current members of our National Associations are invited to join the EAPC or renew their membership for FREE. Click here.

 

 

Posted in EAPC-LINKED JOURNALS, Nursing, Palliative Medicine: Editor's Choice | Tagged | 1 Comment