Last Aid Courses as a Means for Public Palliative Care Education—A Narrative Review of the Literature and 10 Years of Experience Around the World with Implications for Future Research

Care for seriously ill and dying people at home is a public health issue and should according to Kellehear be everyone’s business (1,2). In the future we do need a cooperation of citizens and professionals in order to provide palliative care at home for all in need (1-5). The COVID-19 pandemic has shown that end-of-life care is especially challenging in times of a pandemic with limited healthcare resources and the need for isolation measures. We have been told a number of stories of people who did not receive adequate palliative care or relatives who were not able to say farewell to dying people due to isolation measures. In nursing homes isolation and lack of contact to relatives and others may lead to psychological, social and existential suffering. Last Aid courses for citizens have been started in 2015 in Norway, Germany and Denmark in order to raise awareness about death and dying, to encourage the public debate and to improve the citizens knowledge about palliative care (4). The so-called public knowledge approach as described by Bollig seeks to make knowledge about palliative care and end-oflife care part of public knowledge of all citizens (3). The aim of Last Aid courses is to provide public palliative care education (PPCE) for citizens in order to enable them to participate in end-of-life care provision at home (3-5). At present Last Aid courses have already been established or are being introduced in 16 countries in Europe and Australia.

Due to demographic changes, the need for palliative care in the community and at home is expected to rise in the coming years. The care that is given by family members and general practitioners plays a vital role in basic palliative care. Knowledge in palliative care is very limited or totally absent in most communities, and information about the effects of educational procedures in teaching non-professionals in basic palliative care is sparse. In the Last Aid course, the public knowledge approach and the initial experiences from the implementation process are described. In addition, a review of the literature on educational efforts regarding palliative care for non-professionals and the existing literature on Last Aid courses is provided. An international working group has established a curriculum for Last Aid courses based on four teaching hours (45 minutes each). The feasibility of Last Aid courses for the public has been tested in pilot courses. The experiences with Last Aid courses in different countries are overall very positive. Last Aid courses are well-attended. The evaluation of questionnaires in a German pilot study has shown a favorable response. Last Aid courses may form the educational basis of compassionate communities, and are well-suited to inform the public about palliative care and end-of-life care.

To provide a narrative overview of the current knowledge on Last Aid Courses (LAC) and experiences from the implementation process in different countries. Major challenges for public health palliative care include supporting all people who wish to die at home and educating the public about death, dying and palliative care. LAC commenced in 2015 in order to educate and empower citizens to participate in end-of-life care and to improve the public debate about death and dying. The International Last Aid project and the International Last Aid working group were established to provide and evaluate public palliative care education (PPCE) using LAC. A literature search in PubMed/Medline was performed and a narrative overview of the existing literature on LAC and PPCE is provided. In addition, experiences from the implementation process are presented. An International Last Aid working group was established with representatives from different countries and national organisations. This group revises the curriculum and contents of LAC in regular intervals with the latest revision in October 2020. Scientific evaluation of LAC is coordinated by the international Last Aid Research Group Europe (LARGE). Work on LAC has commenced in 18 countries. The overall results show that LAC are feasible and very well accepted in many different countries and cultures. Adults, children, and other groups, such as hospital employees and police officers, have participated in LAC. LAC for citizens is also possible in an online course format that was established and tested during the COVID-19 pandemic. Scientific work on the effects of LAC and cultural issues connected to LAC are ongoing in a number of countries. LAC are feasible and well accepted by citizens in different countries. The courses can contribute to a public debate on death, dying and palliative care and may contribute to empowering citizens in providing end-of-life care.

Background: Last Aid Courses (LACs) for the public aim to enhance the public discussion about dying, death and grief and to increase the awareness for palliative care throughout the whole society. Based on the wishes and needs of professionals from health and social care and results from previous studies on LACs, a longer Last Aid Course Professional (LACP) was developed. The aim of the present study was to evaluate the experiences and views of course participants and instructors on the Last Aid Course Professional (LACP) with ten teaching hours including the foundations of palliative care based on the storyline method. Methods: A mixed-methods approach was used including qualitative and quantitative data from a questionnaire for LACP participants and focus group interviews of LACP instructors. Results: A total of 394 of the 422 participants participated in the study by returning a questionnaire (response rate 93%). The age ranged from 21 to 81 years (median 45 years). In addition, 14 instructors participated in two focus group interviews. The results from the questionnaires showed that 84% of all participants assess the course as useful for all professionals working in health and social care. The qualitative data show that the LACP was well accepted by different organizations and participants from different professions. The participants welcome the opportunity for interprofessional exchange and the possibility for a change in perspective, as well as getting insight from different perspectives, reflecting on ethical challenges, and working on different options for action in palliative care. Lack of staff was the main barrier for participation in the LACP. Conclusions: The LACP is very well accepted by the participants and is a good option for palliative care education for professionals from health and social care.

To determine the perceptions of good death and death literacy levels of Turkish nurses working in palliative care services and the factors affecting their perceptions of good death. Death literacy is defined as the acquisition of the knowledge and skills necessary to understand end-of-life care and contribute to a good death. For this cross-sectional study, sample consisted of 162 Turkish nurses working in palliative care services. The data were collected using the Socio-demographic Information Form, Good Death Scale (GDS), and Death Literacy Index (DLI). The data were analyzed by Pearson correlation, independent sample t test, and one-way ANOVA. Hierarchical regression analysis was performed to determine the predictors of good death perception. The STROBE checklist was used in the study. The mean GDS score was 59.53 ± 4.49, and the mean DLI score was 100.70 ± 12.11. It was determined that those who are older, male, married, have worked longer in the clinic, and have knowledge about a good death have higher average scores on the GDS. The models explain 91.8% of the variance in the perception of good death. Our study shows that as death literacy increases, nurses' perceptions of a good death tend to decrease. This situation suggests that as nurses' knowledge and awareness of death increase, the inadequacies of the healthcare system and the impact of limited resources may cause them to develop a more negative perception. Death literacy in nurses is a new concept, and further studies are needed in different cultures. In the study, it was observed that death literacy levels and good death perceptions of nurses were above average, and as the death literacy level of nurses increased, their good death perceptions decreased. Age, gender, marital status, working time in the clinic and knowledge about good death affect the perception of good death of nurses working in palliative care. By improving their understanding of death literacy and the principles of a good death, palliative care nurses can achieve greater job satisfaction and develop a more positive attitude toward end-of-life care. In addition, systematically incorporating death literacy into nursing education curricula and continuing professional development programs, and the establishment of evidence-based clinical guidelines and standard care protocols will improve the quality of palliative care services.

This chapter is about palliative care education for everybody including both professional health care workers and all citizens. A six-step approach to life-long palliative care education (as first described by Bollig in 2008 and published as a conference poster in 2009 and a book in German in 2010) will be proposed and discussed. The chapter will summarize the public knowledge approach to palliative care implementation (Bollig 2008) and other strategies to educate the public about palliative care. The concept of Last Aid courses for citizens will be introduced, and international experiences with this concept will be discussed. A possible combination of Last Aid courses and the compassionate community approach might improve palliative care provision in the community.

Background: Last Aid Courses (LAC) for adults have been established in 21 countries in Europe, Australia and America to improve the public discussion about death and dying and to empower people to participate in end-of-life care provision. In 2018, the first Last Aid Courses for kids and teens (LAC-KT) were introduced. The aim of the study was to explore the views and experiences of the course participants and Last Aid Course instructors on the LAC-KT. Methods: A mixed-methods approach was used. The views of the LAC-KT participants, aged 7 to 17 years, on the LAC-KT were collected using a questionnaire. In addition, the experiences of the Last Aid Course instructors were explored in focus group interviews. Results: The results show that 84% of the participants had experiences with death and dying and 91% found the LAC-KT helpful for everyone. The majority of the participants appreciate the opportunity to talk and learn about death, dying, grief and palliative care. Conclusions: The LAC-KT is feasible, very well accepted and a welcome opportunity for exchanging and obtaining information about dying, grief and palliative care. The findings of the study indicate that the LAC-KT should be offered to all interested children and teenagers and included in the school curriculum.

Background/Objectives: Promoting access to palliative care education at all levels and in diverse contexts is essential. In Brazil, however, despite progress, awareness remains limited. The Last Aid approach provides accessible ways for the public to engage in discussions about serious illness, death, dying, and grief, while also suggesting practical actions to support. The present study aimed to investigate whether Last Aid Courses are accepted and contribute to increasing knowledge and awareness of Palliative Care to different settings in Brazil. Design/Methods: To obtain more in-depth views, a mixed methods approach was chosen, and participants from all Last Aid Courses offered in Brazil between March and November 2024 were invited to respond to a mixed qualitative–quantitative questionnaire provided after the course. Results: Thirty-two courses were offered, with 343 participants. Most of the Last Aid Courses participants came from the general public (53.2%), followed by health students (28.1%). 98.8% of all respondents indicated they had acquired new knowledge. Qualitative analysis identified four themes: death as part of life, communication about dying, dignity and respect for patients’ wishes, and the need for palliative care education. Participants highlighted autonomy, compassion, and dialogue as essential, reinforcing the urgency of expanding public education. Conclusions: The course implementation in Brazil showed positive results, indicating its potential to raise awareness about the topic, regardless of the context.

The Last Aid Course (LAC) has been established to enhance the discussion about dying, death and grief and to raise the public's awareness of palliative care. The aim of this study was to explore the views and experiences of German Last Aid Course instructors with the LAC as means for Public Palliative Care Education (PPCE), including their opinion about the course content and format and practical aspects of teaching in different settings. A longitudinal mixed-methods approach was used to explore the views and experiences of the Last Aid Course instructors over a period of five years. Social space orientation was used as the framework for the data analysis. The LAC participants felt empowered after the LACs. Continuing development was a characteristic of the LAC project. The positive effects of the LACs included empowerment and positive interactions between the instructors and participants. In addition, the LACs had a positive impact on all five principles of social space orientation. LACs can contribute to raising public awareness about dying, death, grief and palliative care and empower people to participate in caring for those who are serious ill, dying and grieving.

Educating and raising awareness among lay members of the public about palliative care can significantly improve the care for terminally ill patients and their quality of life. This paper reports on the survey aimed at assessing the experience and expectations of participants in the Last Aid course launched in Slovenia in 2019 to train hospice volunteers and promote dialogue on death and dying. The course implementation was supported by materials prepared, translated, and/or adapted from German under the PO-LAST project, which linked Slovenian medical and healthcare professionals, hospice representatives, and university students. The Last Aid course follows an international four-module curriculum that has been successfully applied in 18 countries so far. In Slovenia, the course was delivered 30 times with 21 in-person deliveries and 9 online events attended by 450 participants of different sexes, ages, and professions. The surveyed population included 250 people who returned the evaluation questionnaires by October 2020. The aim of the analysis was to gain insight that can be applied broadly in future work and research on adult education on palliative care and the erasure of death-related taboos.

This chapter provides an overview over the Last Aid Course (LAC) as measure for Public Palliative Care Education (PPCE) and the experiences from different countries on the implementation of Last Aid Courses. The concept of Last Aid and the public knowledge approach to teach Palliative Care for the public were first described by Bollig in 2008. Last Aid Courses can be seen as educational basis of compassionate communities and have now been spread to 21 countries worldwide. Experiences show differences and similarities in the national implementation process of LAC in four different countries.

Russia: The State-of-the-Art of Palliative Care

ObjectiveThe demand for mortality-related education among hospice care providers in China remains high; however, the overall level of death literacy in China is comparatively low. Given that nurses constitute the primary workforce in hospice and palliative care delivery, enhancing nursing education in death literacy is essential for the effective implementation of related services.MethodsA Strengths, Weaknesses, Opportunities, and Threats (SWOT) analysis was conducted to examine the internal advantages and limitations, as well as external opportunities and challenges, associated with death literacy nursing education in China.ResultsThe strengths lie in the strong policy support for healthcare and the advancement of palliative care pilot programs, as well as the growing demand for palliative and end-of-life care accompanied by the successful localization of international experience. The weaknesses include limited educational and faculty resources, a shortage of qualified professionals and institutions, and persistent cultural taboos and traditional moral barriers that hinder development in this field. The opportunities are from shifting public awareness toward end-of-life care, increased international collaboration, and the adoption of more diverse and innovative teaching methods. The threats involve the uneven distribution of medical resources, growing industry competition and talent loss, the complexity of legal, regulatory, and ethical issues, and the continuing challenges of achieving effective interdisciplinary collaboration.ConclusionThis study is the first to systematically apply SWOT analysis to provide empirical evidence for the strategic planning of death literacy education in nursing in China. It suggests that to improve death literacy nursing education in China, it is recommended to enhance policy implementation, incorporate international best practices, and promote the integration of intelligent technologies and interdisciplinary collaboration. These efforts should aim to extend educational outreach and resource accessibility to community-level and primary care settings. These strategic initiatives are expected to directly enhance nurses’ communication and care competence at the end of life, thereby improving patients’ quality of life in their final stages and advancing the goals of the Healthy China 2030 initiative in the field of palliative care.

PC-FACS

Background: To provide quality care at the end of life or for chronically sick patients, nurses must have good knowledge, attitude, and practice about palliative care. Lack of knowledge about palliative care, negative attitudes towards it, as well as gaps in evidence-based practice among nurses, are some of the most common obstacles to quality palliative care. Methods: To collect data, a cross-sectional questionnaire was administered to 565 nurses working in primary health care organisations in Astana, Kazakhstan. Data collection was completed from January 2022 to March 2023. The questionnaire contained demographic and professional characteristic questions, the Palliative Care Quiz for Nurses (PCQN), the Frommelt Attitudes Towards Care of the Dying (FATCOD), and the Evidence-based Practice Questionnaire (EBPQ). Descriptive statistics, independent t-tests, and one-way ANOVAs were used for analysis. Results: The sample size was 565 nurses. Nurses’ palliative care knowledge level was low (mean score: 9.06±2.93). The largest number of the correct answers on the PCQN questionnaire was received in the category "Management and control of pain and other symptoms" (49.95%). The majority of nurses (93%) have a neutral or negative attitude towards caring for dying patients (mean score: 94.50±12.41). Only 6.7% of respondents had a positive attitude. The obtained score (4.39 ± 1.05) on the EBPQ scale indicates an average level of competence in evidence-based practice. Age, work experience, educational level, attendance at palliative care training, and good competencies in evidence-based practice are statistically significant factors that affect knowledge of palliative care. The aspect of knowledge/skills in EBP is the most significant (β=0.122; p=0.005). Conclusions: An insufficient level of nurses' knowledge about palliative care and a neutral or negative attitude towards caring for dying patients was revealed. Health care providers are encouraged to expand palliative care-related training programs, which together can improve the quality of palliative care nursing services for patients. The results also indicate that much attention, and resources should be directed to improving the level of knowledge of nurses in the field of evidence-based practice, because this aspect significantly affects the level of knowledge on palliative care. Implications for research, policy, and practice: Further research is needed to identify the factors contributing to nurses' inadequate knowledge of palliative care, including gaps in training and cultural or systemic barriers. Policymakers should develop national frameworks for palliative care training and certification, while healthcare institutions should regularly assess and enhance nurses' knowledge through continuous professional development. What is already known about the topic Most nurses do not receive training in palliative care. The benefits of using evidence-based medicine in palliative care are described. The most common barriers to providing quality palliative care have been described many times. What this paper adds Primary care nurses have insufficient knowledge of palliative care. Primary care nurses have a negative or neutral attitude towards palliative care. The use of evidence-based medicine by nurses contributes to the formation of a high level of knowledge about palliative care and a positive attitude towards it.