Education and training for healthcare professionals sit at the heart of any effective health system. This drives PACED in our work to ensure quality education reaches more practitioners who provide primary, secondary and tertiary palliative care.
EDUCATION AND TRAINING
IN PALLIATIVE CARE
Education and training for healthcare professionals sit at the heart of any effective health system. This drives PACED in our work to ensure quality education reaches more practitioners who provide primary, secondary and tertiary palliative care.
EDUCATION AND TRAINING
IN PALLIATIVE CARE
Education and training for healthcare professionals sit at the heart of any effective health system. This drives PACED in our work to ensure quality education reaches more practitioners who provide primary, secondary and tertiary palliative care.
EDUCATION AND TRAINING
IN PALLIATIVE CARE

The World Health Organization describes four ‘pillars’ that need to work together for high quality palliative care to be received by everyone who needs it. These are policy – integrating palliative care into a country’s health policies and strategies; education – undergraduate and post-qualification education and training for all relevant professions; medication availability – policies and processes to provide essential pain relieving medicines; and implementation – providing funded services to meet the needs of the whole population.


Developing a trained workforce is critical for delivering high-quality care. But more than that – a skilled palliative care community can advocate for services to be provided to everyone within a country. This creates a ‘virtuous spiral’ of palliative care being provided to more of the population by a skilled and growing workforce.

The World Health Organization describes four ‘pillars’ that need to work together for high quality palliative care to be received by everyone who needs it. These are policy – integrating palliative care into a country’s health policies and strategies; education – undergraduate and post-qualification education and training for all relevant professions; medication availability – policies and processes to provide essential pain relieving medicines; and implementation – providing funded services to meet the needs of the whole population.


Developing a trained workforce is critical for delivering high-quality care. But more than that – a skilled palliative care community can advocate for services to be provided to everyone within a country. This creates a ‘virtuous spiral’ of palliative care being provided to more of the population by a skilled and growing workforce.

The World Health Organization describes four ‘pillars’ that need to work together for high quality palliative care to be received by everyone who needs it. These are policy – integrating palliative care into a country’s health policies and strategies; education – undergraduate and post-qualification education and training for all relevant professions; medication availability – policies and processes to provide essential pain relieving medicines; and implementation – providing funded services to meet the needs of the whole population.


Developing a trained workforce is critical for delivering high-quality care. But more than that – a skilled palliative care community can advocate for services to be provided to everyone within a country. This creates a ‘virtuous spiral’ of palliative care being provided to more of the population by a skilled and growing workforce.

Particularly within medicine and nursing, all students should acquire basic knowledge about palliative care before they qualify to practice. Although few students will pursue a career in palliative care, this is important for the reasons described below.
WHY UNDERGRADUATE EDUCATION IS ESSENTIAL?
WHY UNDERGRADUATE EDUCATION IS ESSENTIAL?
It is often seen as a failure of medicine if a cure cannot be offered to a patient.
In palliative care, death is seen as a natural and inevitable end point of life. Critically, we advocate for curative treatment not to be pursued when it is futile or excessively burdensome to the patient. A palliative care approach can make people’s final weeks or months of life easier to bear, with less pain and distress. Teaching this philosophy from the beginning of a career can positively influence students’ perspectives for the rest of their working lives.
The knowledge gained and skills learned through palliative care can make every doctor and nurse a better professional.
Learning how to understand a patient’s needs and address the full range of their concerns is not only relevant when someone is dying – it should be part of everyday medical and nursing practice, and it can be taught effectively through the prism of palliative care.
Palliative care can be given at the same time as treatment aimed at curing or helping control a disease.
It is important to teach from early in a medical career that these two types of care can work together, with palliative care helping control pain and address a patient’s wider concerns and needs.
A patient’s ‘first point of care’ is usually the family doctor.

A family doctor might refer a patient to a hospital or specialist service when higher levels of expertise or equipment are needed. Family doctors continue to support their patients through serious illnesses and as they approach the end of life, so it is important for these doctors to have the best possible palliative care skills and to develop them from the start of their education.

Strong opioids, such as morphine, are rarely available to everyone who needs them in developing countries.

The absence of strong opioids is a key barrier to effective palliative care. This is a complex issue, partly caused by understandable concern about the addictive potential of opioids or the risk of them being diverted onto the illegal ‘street’ market. As a result, there is often overly restrictive legislation that prevents doctors being able to prescribe pain relief to patients who desperately need it. It is important to educate doctors early in their careers about the critical need for drugs that control pain, and about international strategies to make them available to patients while at the same time managing the risk of their misuse. 


Palliative care, however, is taught on a mandatory basis in only 8% of medical and nursing schools in EECA and, outside the Russian Federation, is offered as an optional subject in only another 11% of schools. PACED works with its partner organisations to advocate for wider inclusion of palliative care on curricula across the region.

It is also essential that, whenever possible, palliative care education includes spending time at a palliative care service. As PACED’s Trustee Robert Twycross has written, “It is important to recognise that the approach to care typically seen in hospitals is fundamentally different from the approach in palliative care. When they qualify, most doctors have been enculturated into a bio-medical model by the environment in which most or all of their clinical training took place – with bio-medical role models. The move into palliative care generally requires a period of re-orientation – with exposure to holistic care role models. Palliative care cannot be taught just in the classroom.”
Specialty status
Most doctors practise a speciality area of medicine, following a structured postgraduate training programme to qualify and enter onto the specialty register. In many EECA countries palliative care does not have speciality status, so medical schools may not teach palliative care at postgraduate level. And when they do, its teachers might not have the technical and administrative back-up of a properly resourced palliative care education department.
PACED objectives
For PACED, this means there are two key objectives. One is to raise standards of palliative care education, supporting medical and nursing schools and the educators working in them to provide the best possible education and training. The second is to advocate for countries to allocate speciality status to palliative care (or sub-speciality status, where it comes under the umbrella of a more established speciality such as internal medicine or family medicine).
Raising standards
As doctors, nurses and other care providers progress through their careers, they undertake continuing professional education (CPD) to keep their knowledge and skills up to date. CPD is a wonderful opportunity for people to share the experience they gain during their careers. As palliative care becomes more widely available and provided by more caregivers, there will be increasing possibilities for PACED to support CPD initiatives that lead to higher standards of palliative care.
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