The World Health Organization (WHO) is clear about what constitutes palliative care and its goals: ‘Palliative care is a crucial part of integrated, people-centred health services. Relieving serious health-related suffering, be it physical, psychological, social or spiritual, is a global ethical responsibility,’ (WHO, 2022). Regardless of the cause of suffering among people who are at the end of life, the provision of palliative care should be readily available. This has implications for training, education and preparing healthcare students for this specialist field of practice.
Healthcare students from nursing, physiotherapy, midwifery and medicine will care for a dying person later in their career or during their training on placement. Palliative care comes with the added difficulty of being emotive and it can be frighteningly sensitive to openly talk about death and dying. It is human nature to save lives and most healthcare professionals are trained to do just that. Yet palliative care asks the same professionals to perform a 360-degree attitude shift and accept dying as an appropriate outcome or end point for people in the palliative care phase. Instead of saving lives and treating patients to recover functionality in their lives, with goals and ambitions, palliative care is about person-centred care providing comfort from pain and psychological symptoms in order to promote a dignified death.
According to the WHO (2018), people in the palliative care phase are left with negative experiences when the preparation and education of students is below expected standards. Students need palliative care knowledge during training and key skills as they go out on palliative care placements, and these should be provided for all. The same students will become post-registered healthcare professionals working in palliative care and will need more and specialised education in palliative care issues like pain and symptom control.
The WHO (2020) asserted that the palliative care phase is challenging and emotive because people at the end of life present with and share innermost thoughts, emotions, fears and anxieties. It is often the case when innermost thoughts are spoken by people who are dying that healthcare professionals end up answering their existential questions. Healthcare students should be introduced to the philosophical ideas around palliative care, and understand the theoretical imperatives driving the subjectivity of death and dying experiences. Such preparation will serve them well when they care for palliative care patients on hospital wards and in their homes in the community.
Without adequate education and training, healthcare students and professionals working in palliative care may feel ill prepared psychologically and can either feel guilty about or distance themselves from care. Both positions are unhealthy, because they not only impact on healthcare professionals' wellbeing but may lead to lack of compassion for patients that are dying. I have written elsewhere about the link between lack of compassion and the second phase in the development of the burnout syndrome. We The importance of healthcare professionals compassion in palliative care cannot be underestimated; dying people are faced with the thoughts of non-existence and these thoughts can bring to the fore loss of hope, goals and aspirations in others. These losses have the potential to impact a person's quality of life and the relationship with their loved ones. According to the WHO (2018) it is equally likely that environmental and financial worries will be highlighted at this stage, which often impacts on the dignity of dying.
According to WHO 2022, it is still the case that only 14% of people who need palliative care receive it. This figure suggests that we are not achieving Goal 3 of the United Nation's sustainable development goals (‘ensure healthy lives and promote wellbeing for all at all ages’) (United Nations, 2015) and that we need to prepare students here and globally to help strengthen palliative care provision for all. Governments can play their part by providing funding for the palliative care workforce and availability of medicines such as opioids, which are much needed for pain and symptom control.
Palliative care is central to enhancing dignity in death for all and well-prepared healthcare students are the future of palliative care workforces and can ensure dignity remains a permanent feature of dying.