We can’t just stand by: Palliative care education and training needs in the Community of Independent States (CIS), and in Georgia, Ukraine and the Baltic Countries

PACED (The Foundation for Palliative Care Education) supports the advancement of education and training in palliative care in countries worldwide where palliative care is undeveloped. It is a non-profit organisation committed to promote educational initiatives that ultimately result in the provision of compassionate assistance to those at the end of life’s journey.

Robert Twycross (Trustee, PACED, and Emeritus Clinical Reader in Palliative Medicine, Oxford University), Fiona Rawlinson (Advisory Board, PACED, and Postgraduate Palliative Medicine/Care Course Director, Cardiff University) and Yulia Yudina, Chief Executive Officer, PACED, explain.   

Left to right: Dr Robert Twycross, Dr Fiona Rawlinson and Yulia Yudina.

We can’t just stand by – we are here to support each other. An ongoing major challenge for palliative care internationally is the provision of appropriate education and training for healthcare students and professionals. Adequately trained and knowledgeable medical staff is a key component for the successful and sustainable development of palliative care services in any country.

But what does palliative education and training look like in countries that rarely become a focus of palliative care research? In late 2019, in collaboration with the European Association for Palliative Care (EAPC), PACED conducted an online survey followed by telephone interviews with local palliative care champions to gain an understanding of medical specialists’ educational needs in the CIS, and in Georgia, Ukraine and the Baltic Countries. The data collected across 13 countries (Armenia, Azerbaijan, Belarus, Estonia, Georgia, Kazakhstan, Kyrgyzstan, Lithuania, Moldova, Russian Federation, Tajikistan, Ukraine, Uzbekistan) demonstrate that medical practitioners face a number of challenges including a lack of funding and an acute shortage of palliative care specialists and trainers.

Although palliative care education features in the curricula of leading medical schools and colleges at undergraduate and postgraduate levels, there are few certified trainers able to disseminate knowledge among medical professionals, and there are few champions promoting palliative care at a national level. Even though palliative care courses are available for medical students in nine of the 13 surveyed countries, they are reported to lack quality. All survey participants highlighted the low quality of palliative care training as a key challenge in the development of palliative care services.

Data analysis demonstrated that the three key priorities for palliative care education and training in the surveyed countries are:

  • Development of educational programmes for doctors and nurses

There are no compulsory courses in palliative care for doctors and nurses in most countries. If there are, they tend to be short and taught by clinicians without extensive palliative care experience.

Palliative care practitioners teach on short courses in Kazakhstan, Kyrgyzstan and Moldova, sponsored by charitable organisations. For instance, Soros Foundation funded four courses for mobile teams in four regions of Moldova. However, of those who received training, only one mobile palliative care team is still functioning.

  •  Training of Trainers (TOT) courses

Armenia, Kazakhstan, Kyrgyzstan, Moldova, Uzbekistan and Ukraine have certified palliative care trainers who have completed Education in Palliative and End-of-Life Care (EPEC) courses or TOT courses. However, the aim to create an expanding cadre of trainers has not been achieved. Expert advice on methodology is required, with trainer selection criteria, and emphasis on sustainability of such courses.

  • Development of clinical basis

Findings indicate that the low quality of palliative care training is rooted in the lack of a clinical base for students to observe and practise. One respondent suggested the possibility of establishing national Centres of Excellence to serve as both the clinical and educational base for palliative care.

In the light of these findings we can’t just stand by

So, what can we do to make a real positive change when it comes to palliative care development in these countries?

First, we can share the most valuable resources – time and expertise. Through sharing best practice in relation to teaching and learning, disseminating methodology and understanding of effective tools, we can help medical professionals in many countries to acquire the necessary competencies to deliver palliative care at a high standard.

Second, we can share the expertise gained in other countries from successfully introduced TOT courses, and implement pilot projects in two or three different countries. The countries can be of different size and stage in palliative care development. For instance, Kazakhstan (a large and resourceful state), Kyrgyzstan (a smaller country with limited palliative care resources), and Uzbekistan (a state where palliative care is still very much in its infancy).

Third, with regard to clinical training, there are many Centres of Excellence in Europe and elsewhere. Potentially, they can provide an opportunity for visiting palliative care professionals to observe the delivery of palliative care in various ways and to widen the vision of local champions seeking to promote palliative care on a national level.

We can’t just stand by – but we can support our colleagues

Through collaborative projects, knowledge exchange programmes and sharing financial resources, the international palliative care community can provide serious support to colleagues in the CIS and in Georgia, Ukraine and the Baltic Countries, thus helping to make palliative care available to many more people in desperate need.

We hope to report progress and solicit more support at the 17th World Congress of the European Association for Palliative Care in 2021.

If you have any ideas on how best to implement TOT programmes in these countries, please do email Yulia Yudina with your suggestions.  


PACED – The Foundation for Palliative Care Education.

A blend of: On-demand Sessions, Live Presentations, Live Panels hosted by international experts, Children’s Seminar, Poster Sessions, and EAPC Group Meetings will bring you all of the latest research from the world’s top researchers in palliative care. CME accreditation will be available. Masses of content will be available on demand from late September until January 2021.

Be a part of the first-ever EAPC World Research Congress Online
Learn and interact with leading researchers and chat with other registered delegates from the global palliative care community – all in the safety of your own home or office.

LATE-BREAKING ABSTRACTS… Share your experience of COVID-19 and the Palliative Care Response. More information and how to submit your abstract here. Deadline: 31 July 2020.


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