Invisible threads connect us with the people we love. They cannot be seen or touched, but they can be felt. This text is taken, with minor revisions, from: M. Torrens, M. Portales, Intervention of the Psycho-Oncology Team of the Palliative Care Unit of Clínica Alemana, Chile. Photo by Javier Quilodran used with permission.
Chilean Universal Palliative Care Mandate Sparks Distance Education System
By Alejandra Palma, MD
IAHPC Board Member
Palliative care (PC) education is an urgent global need to bridge the gap between the demand for quality PC and its provision. In Chile, although progress has been made in integrating oncological PC and ensuring the availability of opioids, significant gaps remain in the training of health care professionals, both at the undergraduate and postgraduate levels. This need has been heightened by a universal PC plan, which aims to provide PC to non-oncological patients by strengthening primary health care.
In this context, in 2016 a group of Chilean palliative care physicians created an accessible training strategy for professionals in various regions of the country, developing a distance education system known as the Interregional PC Tele-committee.
Chile's national Universal Palliative Care Law was passed by Parliament in 2021.
Each year, the Tele-committee has focused on a single topic:
- 2022: Management of advanced non-oncological chonic diseases
- 2023: Ethical & legal aspects applied to palliative care
- 2024: Updates in pharmacological symptom management
The first steps
A central teaching team was formed, composed of academics and regional leaders from PC services, creating a representative network from different geographic areas of the country. The program of the first tele-education initiatives consisted of monthly one-hour virtual meetings focused on clinical case discussions and aimed at promoting practical learning and experience exchange among various clinical teams.
With the support of the University of Chile, the REUNA virtual platform was used to securely centralize sessions and store them on this freely accessible YouTube channel:
Initial results highly positive
Between 2016 and 2021, uninterrupted monthly sessions were held with high participation from teams across the country. Annual impact surveys showed that 65% to 80% of participants perceived that the tele-committee meetings had a positive impact on their work performance, noting an improvement in knowledge, diagnostic and treatment confidence, and emotional well-being in the workplace.
Expansion of the system
In 2022, after five years of uninterrupted monthly tele-committee sessions with the described format, a formal agreement was struck to collaborate with six Chilean universities and the Chilean Society of Palliative Care (SMCP).
This established an interuniversity teaching committee responsible for managing PC tele-education programs. This new version, named the Inter-university PC Tele-committee, has been operating regularly since 2022, with annual themes and certification for participants who complete the programs and pass the evaluations.
Focus on pharma care in 2024
This year, 2024, the theme of the Tele-committee was "Updates in Pharmacological Symptom Management." Six sessions on the topic were held between April and September. The education program consisted of monthly classes, a bibliography, and a multiple-choice quiz at the end of each module. A 60% attendance rate and minimum measured performance were required to obtain SMCP certification.
Evaluation survey
Of the 736 professionals who registered, 206 responded to the final evaluation survey: 65% were between 20 and 40 years old, and 19% were between 41 and 50. Professionals from all 16 regions of the country participated. Among the professionals, 56% were physicians, of whom 50% were general practitioners and 24% were family medicine specialists. Among nonmedical professionals, most were nurses (53%) and kinesiologists (12%). Currently, 81% of the professionals who took the program are practicing palliative care.
Close to 100% 'very satisfied'
Of the survey respondents, 98% were very satisfied with the topics and their complexity, and 99% rated the quality of the speakers positively. Most expressed a high level of agreement with the following statements about the program:
- "[It] allowed me to update my theoretical knowledge."
- "[It] gave me greater confidence in diagnosing and treating."
- "[It] gave me more confidence to support decision-making processes."
- "[It] increased my interest in palliative care as a professional development area."
A collaborative effort
The tele-education initiative described here is the result of a collaborative effort between academics and PC units across the country, expanding professional training opportunities and strengthening connections among professionals from different regions. This project represents a free initiative led by a scientific society that contributes to the standardization of best practices and supports the implementation of public policies to reduce the gap in quality PC provision.
Special thanks to Dr. Alfredo Rodríguez, who has actively contributed for years to the implementation and development of the tele-committee, as well as to the collection of the data.
Alejandra Palma is a professor in the Department of Internal Medicine, Faculty of Medicine, at the University of Chile in Santiago. She is also the Continuous and Palliative Care Section Head at the University of Chile Clinical Hospital. Read her bio.
Read more of this week's issue of Pallinews
Book Review
Intentionally Interprofessional Palliative Care is both a comprehensive textbook and practical guide, says reviewer Anna Keedwell.
A Regional Powerhouse
Introduction to PACED's many projects to expand and extend palliative care knowledge among health care professionals.
IAHPC Tidbits
Plus
Two Surveys Underway An international survey of health care professionals is underway to understand how palliative care is provided for patients with heart failure. It is part of the Horizon-EU-funded RAPHAEL project. Those who work with patients with heart failure are invited to take this anonymous, five-minute survey.
An international survey about access to non-pharmacologic interventions for managing children's pain in palliative care, as well as regulatory limitations and barriers to providing quality pain relief to children, is being done by ICPCN and St. Jude's Global Palliative Care Program. Pediatric health care professionals are invited to take this survey, which requires a maximum of 15 minutes.
Like to Speak with Students? Interviews are being arranged in January between volunteers and Master's in Palliative Care students from a variety of health care fields studying in Germany and the Netherlands. Interviews are estimated to last around 30-45 minutes, and palliative care professionals around the globe are being sought as volunteers. If interested, contact [email protected].
IAHPC resources
Always available to all
Global Directory of Educational Programs in Palliative Care, a searchable, continually updated compilation with detailed listings.
Always available to members
Advanced Pain Assessment and Management Course consisting primarily of a discussion of clinical cases.
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