Capacity Building and Empowerment

One-week multidisciplinary specialist training in palliative care

 

Training Content and Course Module (40 hours):

  • Principles of Palliative Care - 8 modules
  • Management of complex symptoms - 16 modules
  • Diagnosis and handling of demented patients, relatives of palliative patients, and those in grief and mourning - 6 modules
  • Self-care, team-building factors, communication - 10 modules

Target Group: Physicians, Nurses, Psychologists, Social workers, Chaplains and allied professionals
Certificate: At the end of the course, participants receive a certificate issued by the PMU

Lesson Plan
Teaching UnitPrinciples of Palliative Care
TitleDay 1: Principles of Palliative Care
Learning ObjectivesUnderstanding of the Palliative Care Philosophy, which describes the multi-dimensionality of human existence, including death as the natural end of life.
SummaryBrief introduction a) main features (multi-professional and interdisciplinary approach, patient autonomy, and relational autonomy), b) core competencies, c) definitions (WHO, CAPC, IAHPC), d) ethical principles, e) historical development
Factors influencing the needs/usage/effect of palliative care
Learning Content
A - Attitude
K - Knowledge
S - Skills
Attitude: Participants understand the core values of palliative care as:
- Patient-centred approach
- Acceptance of non-curative therapeutic goals and dying and death as integral elements of life,
- Diversity of the human being (bio-psycho-socio-spiritual model and the concept of diversity).
Knowledge: Participants know the basics of palliative care, definitions of WHO, IAHPC and CAPC and general ethical principles. They are aware of
- the importance of timing (e.g. early vs. late integration), diagnosis (e.g. non-oncological diseases)
- the prognosis (e.g. chronic diseases),
- the social background,
- access to palliative care and barriers, such as the wishes and cultural preferences of the patient/family
Skills: Participants are able to identify palliative needs in patients or families, appreciating the symptom-oriented approach, reflecting on the therapeutic goals and addressing end-of-life decisions.
Teaching Methods 
  • Meet Ali... (getting to know each other)
  • Lecture
  • Small group discussions
  • Popcorn-style feedback
 
Time scheduling

Day 1: Principles of palliative care
Welcome and general introduction:

  • Welcome
  • Introduction and overview of the course week
  • Introduction of the participants
  • Experience in palliative care

A brief history of hospice and palliative care

  • Contents: a. Meanings of words and the beginning of modern hospice work; b. What does "living the pioneering spirit" mean today?

Palliative care as an independent subject in the health care system (see Astana Conference 2018)

  • Definitions (WHO; IAHPC, CAPC) and Needs Assessment Palliative Care
  • Values and principles in palliative care - aspects of its philosophy
  • Forms of care (e.g. outpatient hospice work), their levels and "how" (e.g. Advance care planning, EAPC White Paper on Standards and Norms)

Ten core competencies (EAPC White Paper on Education) Note: The contents of the EAPC White Papers will be clarified/deepened by means of examples/case studies, e.g. in the case of the core competencies the meaning of the spiritual dimension, or in the definition the meaning of Early Integration.

LiteratureWHO palliative Care Definition, www.who.int/cancer/palliative/definition/en/
CAPC Palliative Care Definition, www.capc.org/about/palliative-care/
IAHPC Palliative Care Definition, hospicecare.com/what-we-do/projects/consensus-based-definition-of-palliative-care/definition/
GAMONDI, et al. 2013. Core competencies in palliative care: an EAPC White Paper on palliative care education – part 1. EUROPEAN JOURNAL OF PALLIATIVE CARE, 20, 86-91.
ELSNER, et al. 2016. Early integration needs early education. PallMed, 30, 805-6.
CALLAWAY, et al. 2018. World Health Organization Public Health Model: A Roadmap for Palliative Care Development. Journal of Pain and Symptom Management, 55, 6-13.
GÓMEZ-BATISTE, et al. 2018. Ethical Challenges of Early Identification of Advanced Chronic Patients in Need of Palliative Care: The Catalan Experience. Journal of Palliative Care, 33, 247-251.
BONE, et al. 2018. The future of end-of-life care. The Lancet, 392, 915-916.
PAAL, et al Postgraduate palliative care education for all healthcare providers in Europe: Results from an EAPC survey. Palliative & Supportive Care, 26 January 2019, pp. 1-12
PAAL, et al 2018. Spiritual leadership as an emergent solution to transform the healthcare workplace. Journal of Nursing Management 26(4) 335-337.
BEST, et al 2020. An EAPC white paper on multi-disciplinary education for spiritual care in palliative care, BMC Palliative Care, Jan 15;19(1):9. doi: 10.1186/s12904-019-0508-4.
BÜKKI, J. et al. (2013). Palliative care needs, symptoms, and treatment intensity along the disease trajectory in medical oncology outpatients: a retrospective chart review. Supportive Care in Cancer, 6.
PLESCHBERGER 2006. Die historische Entwicklung von Hospizarbeit und Palliative Care. In: Knipping, C. (Hg.). Lehrbuch Palliative Care. Bern: Verlag Hans Huber.
CLARK 2018. Cicely Saunders. A Life and Legacy. Oxford, New York: Oxford University Press.
PAYNE et al. (2009). White Paper on standards and norms for hospice and palliative care in Europe: Recommendations from the European Association for Palliative Care: part 1. European Journal of Palliative Care 16(6):278-289.
AssessmentNone

 

Lesson Plan
Teaching UnitManagement of complex symptoms
TitleDay 2: Symptom management: symptoms, assessment, therapy
Day 3: Profession-specific forums, Case study with discussion
Learning ObjectivesSituation-specific assessment and therapy of complex symptoms in palliative car
SummaryManagement of physical, social, psychological and spiritual needs
Learning Content
A - Attitude
K - Knowledge
S - Skills

Attitude: Participants understand the individual significance of advanced/final stage diseases for patients and their relatives, the influence of symptoms and treatment on quality of life (e.g. "total pain") and the way decisions are made.

Knowledge: Participants know pathogenesis, symptoms and findings, assessment and pharmacological and non-pharmacological treatments for the most common problems in advanced/final stage diseases.

Skills: Participants are able to discuss a multidimensional and evidence-based symptom management of a patient.

Teaching Methods 
  • Lecture
  • Profession-specific case review
  • Interdisciplinary group work (small groups and plenum) based on palliative questions; posters, presentation of results
  • Small groups discussions, popcorn-method plenum discussion
 
Time scheduling

Day 2: Symptom management: symptoms, assessment, therapy

  • Pain, difficulty breathing, gastrointestinal symptoms, anxiety, depression, delirium
  • Dry mouth (xerostomia) and oral hygiene in the last phase of life
  • Eating and drinking / Nutrition and fluid intake at the end of life

Discussion in the context of exemplary clinical pictures, taking into account the Total Pain concept, the multi-professional team, and ethical questions (change of therapy goals).

Note: Assessment instruments are mentioned, but are not in the foreground

Day 3: Profession-specific forums, Case study with discussion
Morning: profession-specific workshops:

  • Physicians 
  • Nurses 
  • Psychologists, social workers and chaplains 

Profession-specific topics are dealt with in case studies and discussions.

Afternoon: from profession-specific to multidisciplinary
Case study with discussion

LiteratureHUGHES, et al 2014 Core competencies for palliative care social work in Europe: an EAPC White Paper - part 1, European Journal of Palliative Care 21(6): 300-305
HUGHES, et al 2015 Core competencies for palliative care social work in Europe: an EAPC White Paper - part 2, 22(1):38-44
BEST, et al 2020. An EAPC white paper on multi-disciplinary education for spiritual care in palliative care, BMC Palliative Care, Jan 15;19(1):9. doi: 10.1186/s12904-019-0508-4.
GIJSBERTS, et al 2019 Spiritual Care in Palliative Care: A Systematic Review of the Recent European Literature. Med Sci (Basel) 2019 Feb 7;7(2).
CHERNY, et al (ed.) (2015). Oxford Textbook of Palliative Medicine (the Fifth edition). Oxford: Oxford University Press.
LEXA 2013. Pflege von Palliativpatienten. Stuttgart: Verlag Kohlhammer.
KERN 2017. Palliativpflege. Richtlinien und Pflegestandards (10. Auflage, bearbeitet von B. Uebach). Bonn: PalliaMedVerlag.
ELLERSHAW et al. 1995. Dehydration and the Dying Patient. Journal of Pain and Symptom Management, 10 (3), 192-197.
AULBERT, et al. (Hg.) (2008): Lehrbuch der Palliativmedizin (2. Aufl.). Stuttgart: Schattauer.
BAUSEWEIN, et al. 2007. Leitfaden Palliative Care (5. Aufl.). München: Elsevier.
FERREL, et al. 2015. Oxford Textbook of Palliative Nursing (4th edition). New York: Oxford University Press.
KRÄNZLE, et al. 2007: Palliative Care (2. Aufl.). Heidelberg: Springer.
NAPIWOTZKY & STUDENT 2007. Palliative Care. Stuttgart: Thieme.
BORASIO, et al. 2003 Verbindlichkeit von Patientenverfügungen gestärkt. Deutsches Ärzteblatt 100: A2062-A2065
ELLERSHAW, et al. 1995. Dehydration andtheDyingPatient. Journal of Pain and Symptom Management, 10 (3), 192-197.
MCCANN, et al. 1994.The Journal of the American Medical Association272(16): 1263-1266
Oehmichen et al. (2013). Leitlinie der Deutschen Gesellschaft für Ernährungsmedizin (DGEM). Ethische und rechtliche Gesichtspunkte der Künstlichen Ernährung. AktuelErnaehrungsmed.38: 112-117
AssessmentNone

 

Lesson Plan
Teaching UnitDiagnosis and handling of demented patients, relatives of palliative patients, and those in grief and mourning.
TitleDay 4: Dementia, family and communication, grief
Learning ObjectivesProfessional and communicative competence of the participants in dealing with demented patients, relatives of palliative patients and mourners
Summary 
  • Presentation of the clinical pattern of dementia, communication of a dignified attitude and psychological intervention options
  • Raising awareness of the needs of relatives of palliative patients and teaching systemic approaches and interview techniques
  • Presentation of different mourning models and obstacles in the mourning process
 
Learning Content
A - Attitude
K - Knowledge
S - Skills

Attitude: Participant learns how to deal with patients with dementia in a dignified manner. Is sensitized to the needs and challenges of relatives in a palliative setting.

Knowledge: Participant acquires comprehensive knowledge about dementia, dignified treatment of patients with dementia, as well as communication techniques and intervention offers (reminder therapy, dignity-centred therapy). Participant learns about systemic approaches and offers for relatives of patients. He or she is familiar with different models of grief and with obstacles in the grief work.

Skills: Participant is able to communicate adequately with people suffering from dementia and to recognize limitations, especially pain. He can fall back on different intervention offers. In addition, the participant is able to adequately accompany relatives of patients. He can distinguish normal grief from pathological manifestations.

Teaching Methods 
  • Lecture (short overview of the theoretical possibilities)
  • Case studies
  • Group work with subsequent feedback in the plenum
 
Time schedulingDay 4: Dementia, family and communication, grief, ethics
  • Dementia Care: clinical picture and ways of dealing with it; communication - validation, biographical memory, SPIKES
  • Dementia Care: Aspects of ethics
  • Systemic work, family and relatives and communication (e.g. circular questioning)
  • Grief
 
LiteratureTymoshevska V. & Shapoval-Deinega, K. (2018). Palliative Care Development in Ukraine. Journal of Pain and Symptom Management, 55(2), 85-91.
PAAL & BÜKKI 2017 "If I had stayed back home, I would not be alive any more…" - exploring end-of-life preferences in patients with migration background". PLOS ONE.
PAAL 2018. Culturally sensitive palliative care research: what should we do with ‘those people’, or what should we do with ourselves? Kuehlmeyer et al. Ethical, Legal and Social Aspects of Healthcare for Migrants: Perspectives from the UK and Germany. Routledge, 162-175.
FUCHS, et al. (Hrsg.) (2012). Palliative Geriatrie. Stuttgart: W. Kohlhammer.
GRATZ, et al. 2018. Palliative Fallbesprechung etablieren. Ein Leitfaden für die Praxis. Stuttgart: W. Kohlhammer.
KOJER & SCHMIDL (Hrsg.) (2011). Demenz und Palliative Geriatrie in der Praxis. Wien: Springer-Verlag.
KLINKHAMMER (2012): Mutmaßlicher Wille: Eine Entscheidung im Miteinander. DtschArztebl109(24): A-1228 / B-1056 / C-1044.
AssessmentNone

 

Lesson Plan
Teaching UnitSelf-care and communication
TitleDay 5: Self-care, team-building factors, communication
Learning ObjectivesRecognizing and dealing with stress at work and promoting protective factors.
Summary 
  • Reflecting on the special stresses/strain factors at work
  • Stress and Burnout
  • Protection factor team
  • Relaxation methods and their effectiveness
 
Learning Content
A - Attitude
K - Knowledge
S - Skills

Attitude: Participants understand the importance of teamwork, continuous self-reflection and mindful self-care in dealing with stress.

Knowledge: Participants are familiar with multifactorial stresses in everyday working life, know their health risks (e.g. burn-out) as well as adequate protective factors at team level (supervision) and individually (body-mind-method).

Skills: Participants are able to reflect on stresses and resources, communicate and implement a mindful approach to themselves and others.

Teaching Methods 
  • Lecture
  • Self-awareness exercise (meditation)
  • Exchange in small groups and in the plenum
 
Time scheduling

Day 5: Self-care, team-building factors, communication

  • Self-care: Mindfulness (theoretical input, exercises, also relaxation exercises)
  • Factors promoting and inhibiting teamwork
  • Communication (in team)
  • Conclusion: Assessment, feedback, presentation of certificate
 
LiteratureBURISCH, M. (2006). Das Burnout-Syndrom: Theorie der inneren Erschöpfung (3. Auflage), Berlin: Springer.
HARDOERFER, K. & JENTSCHKE, E. (2018). Effect of Yoga Therapy on Symptoms of Anxiety in Cancer Patients. Oncology Research and Treatment, 41(9), 526-532.
MÜLLER, M. & KERN, M. (2006). Kommunikation im Team. Zeitschrift für Palliativmedizin, 7(3), 65-70.
MÜLLER, M. et al (2009). Wie viel Tod verträgt das Team? Eine bundesweite Befragung der Palliativstationen in Deutschland. Der Schmerz, 23, 600-608.
MÜLLER, M. & PFISTER, D. (2014). Wie viel Tod verträgt das Team? Belastungs- und Schutzfaktoren in Hospizarbeit und Palliativmedizin. Göttingen: Vandenhoeck & Ruprecht.
SCHULZE, B. (2009). Energiekrise in der Arbeitswelt? Psychotherapie im Dialog, 10(3), 201-208.
VAITL, D. & PETERMANN, F. (2009). Handbuch der Entspannungsverfahren. Psychologie Verlags Union Weinheim. Online abrufbar unter: d-nb.info/930044096/04
AssessmentThe evaluation form included four sections:
1. demographical data (7 questions)
2. comparative self-assessment (40 statements, 6-item Likert scale from 1 (fully agree) to 6 (completely disagree))
3. organizational aspects (7 statements, 4-item Likert scale)
4. two open questions for feedback and constructive criticism.

 

Related Publications

Paal et al. 2020. One-week multidisciplinary post-graduate palliative care training: an outcome-based program evaluation. BMC Medical Education 20, Article number: 276 (2020)

Stähli et al. 2020: Postgraduate palliative care education and curricular issues in Central Asia, Eastern and South-Eastern Europe: Results from a quantitative study. Palliative Medicine in Practice,2020;14(2):81-88.

Paal et al. 2019: Postgraduate palliative care education for all healthcare providers in Europe: Results from an EAPC survey. Palliative and Supportive Care, Volume 17, Issue 5 October 2019, pp. 495-506. 

Evaluation Forms

The course evaluation form in Ukrainian language.