Hurdle Hopping: collaborating to overcome challenges in palliative care education.

According to the World Health Organization (WHO), insufficient knowledge about palliative care and the capacity of health workers to deliver it are significant barriers to accessing palliative care. For today’s blog, Professor Piret Paal from the newly founded Institute of Palliative Care at the Paracelsus Medical University in Salzburg, Austria tells us about the work underway to address these barriers.

Dr. Irina Slugotska and colleagues discussing ethical challenges at the 2019 training in Ukraine.

The WHO European Region in collaboration with the EAPC Reference Group for Education and Training in Palliative Care and the WHO Collaborating Centre at Paracelsus Medical University in Austria, have been working on innovative solutions to promote and support interprofessional collaboration across different health sectors to improve access to palliative care education. This initiative was launched in 2016, with its aims set out in the EAPC blogpost here, and I’m delighted to update you on the significant developments that have taken place since then.

We began by undertaking a European survey in 2017 to find out what healthcare generalists (such as family doctors, ICU staff, radiologists, or neurologists) should learn in order to provide palliative care to European citizens. The results were published here and we found significant agreement about the key elements of palliative care education.

In 2018, a survey was sent to low- and middle-income countries in the WHO European region. We found that post-graduate training in palliative care does not exist in one third of the twenty-one countries surveyed. The main obstacles to the development of such education were limited political interest, educational structures, lack of curricula, lack of trainers and no support from health systems to provide palliative care (for example, no investment in this area, work force or health insurance provision). As our paper highlights, 93% of respondents agreed that a WHO recommended interprofessional curriculum would help promote palliative care.

In our qualitative interviews, palliative care experts from twenty-three countries were asked whether an introduction of a post-graduate European curriculum would be useful and culturally acceptable. The analysis indicated that palliative care is seen as a universal idea, which in practice means accepting that people with different backgrounds and expectations live and die within national healthcare systems. This makes teaching palliative care a very special task, because accepting the societal diversity and uniqueness of each patient and caregiver, may frequently challenge the personal beliefs and values of both teacher and student. Our paper indicates that, in theory, a European curriculum is seen as useful to convince governments and other key stakeholders of the importance of postgraduate palliative care education. In practice, such a curriculum needs to be adapted to local possibilities, values and needs.

Combining the results of these surveys and interviews, we introduced a one-week interprofessional training in palliative care for capacity building and empowerment. The idea was to ‘train the trainers’ and we used a toolkit as the basis of the course. This training was tested and evaluated in Ivano-Frankivsk, Ukraine in 2019. Currently, Ukrainian colleagues are working on creating an information technology platform for communication between hospices and for educational programmes on palliative care, as such co-operation and communication are particularly important in times of war.

Our research has shown that professionals working in healthcare in Europe currently acquire the relevant and necessary palliative care knowledge mainly through training, seminars and conferences, organised by public and non-profit organisations. In countries where palliative care is not recognised as a subspecialty or as a specialisation in its own right, any training represents a major individual effort and financial burden. Without official recognition of the professional and financial benefits, the acquisition of palliative care competencies remains professionally unattractive and/or unachievable by individuals.  Therefore, educational recommendations and quality assessment criteria for all professionals involved in the delivery of palliative care services, validated by high-level non-governmental organisations, governments or professional bodies, are crucial to advance postgraduate education both nationally and globally.

We are proud of the significant work undertaken over the last six years.  We hope these collaborations for better access to palliative care education will continue across the region, continuing to break down barriers to help people have high quality palliative care when they need it.

Thank you to all the people who participated in our studies and provided us with important support, information and feedback. Special thanks go to the EAPC past and present board members, EAPC Educational Reference Group, Prof. Dr. Jürgen Osterbrink (Salzburg), Dr. Andreas Stähli (Münster), Dr. Elisabeth Jentschke (Würzburg), Dr. Johannes Bükki (Stuttgart), Prof. Anna Ersteniuk and Dr. Irina Slugotska (Ivano-Frankivsk) as well as to Paracelsus Medical University for providing extra funding for the six month field research, as well as for a one-week training in Ukraine.

Links and resources

About the author

Professor Piret Paal is director of the Institute of Palliative Care in Salzburg, Austria. From 2017 to 2022, she worked as Deputy Director of the WHO Collaborating Centre at Paracelsus Medical University. Her research interests include global health, palliative care education and spiritual care. She is an active member of the EAPC Reference Group for Education and Training in Palliative Care. ORCID ID: 0000-0002-1341-3248 Twitter: @pal_pmu.

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This entry was posted in ADVOCACY & POLICY, EAPC ACTIVITIES, EAPC Task Forces/Reference Groups, EDUCATION & TRAINING, RESEARCH. Bookmark the permalink.

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