The last aid course - A Simple and Effective Concept to Teach the Public about Palliative Care and to Enhance the Public Discussion about Death and Dying

Mini Review

Austin Palliat Care. 2016; 1(2): 1010.

The last aid course - A Simple and Effective Concept to Teach the Public about Palliative Care and to Enhance the Public Discussion about Death and Dying

Bollig G1,2,3* and Heller A4

¹Department of Pulmonology and Oncology, Hospital of Southern Jutland, Denmark

²Department of Clinical Medicine, University of Bergen, Norway

²Sunniva center for Palliative Care, Haraldsplass Deaconess Hospital, Norway

4Institute of Palliative Care and Organizational Ethics, IFF (Faculty for Interdisciplinary Research and Further Education), University of Klagenfurt, Austria

*Corresponding author: Georg Bollig, Palliative Care Team, Department of Pulmonology and Oncology, Medical Center, Hospital of Southern Jutland, Sønderborg, Sydvang 1, 6400 Sønderborg, Denmark

Received: July 27, 2016; Accepted: September 30, 2016; Published: October 03, 2016


At present scientific knowledge about concepts for the education of the public in palliative care is lacking. Based on the experiences of teaching first aid to the public the concept of a last aid course was introduced. An international working group has established a curriculum for a last aid course with four teaching hours only. Pilot courses have proven the feasibility of the concept in Norway, Denmark, Austria and Germany. At present instructor courses are running and further scientific evaluation of the concept and the courses is ongoing. In addition a review of the literature on palliative care education for the public is provided.

Keywords: Palliative Care; Last Aid Course; Dying; Death at home


Several authors have suggested that the demographic change will lead to a worldwide increase of the number of elderly people suffering from dementia, multimorbidity and frailty [1,2]. This implies a growing demand of elderly care and end-of-life care. Many people want to die at home. In Germany 66% would like to die at home, whereas just 20% actually died at home in 2012 [3]. Although 55% of the Danish population wants to die at home, 48% die in hospitals, 26% in nursing homes and only 17% at home [4]. In Norway only 15% of all deaths registered occurred at home in 2012 [5].

As most people want to die at home the need for palliative care and end-of-life care at home will rise and there will not be enough professionals to take care of all severely ill and dying people with the need for palliative care. To meet this increased demand all citizens do need basic knowledge and skills in palliative care in order to find the important and fitting information for different situations in end-oflife care. Public education in basic palliative care can enable everybody to participate in support for their family members, friends, neighbors or others in need. The aim of this article is to give an introduction to the concept of last aid courses and to provide an overview of the current knowledge and publications about palliative care education for the public.


This article is based on our own experiences from the work with the idea of last aid and the “public knowledge approach” as well as the concept of last aid courses including the development of the courses. It summarizes already published articles about last aid. In addition a literature search using the terms “palliative care education” and “public” and “caregivers” was performed in Pubmed and MEDLINE. An overview of the existing literature on this topic is provided. Challenges of the implementation processes in different countries are addressed.

Results and Discussion

Palliative care education for the public

In the international scientific literature many publications on education of health care professionals in palliative care can be found. The views and experiences of citizens with death and dying have been included in education for professionals. For example have bereaved family caregivers and cancer survivors been involved in palliative care education for health care providers [6].

In contrast the published knowledge about educational efforts to teach citizens in basic palliative care and end-of-life care is extremely limited. Several authors have stated a need to educate the public about palliative care [7-11]. Singer and Wolfson [10] have described public palliative care education as important challenge for the future:

“Today, the challenge is to develop systematic and comprehensive information on the quality of end of life care at the population level.”

In Australia, a group education program consisting of three weekly sessions has been used to prepare family careers to support dying relatives at home [12,13]. Although there are other innovative concepts and efforts to engage citizens to discuss death and dying as for example the so called “death cafe” [14] and the “death chat” that is offered at St. Christopher’s hospice in London [15], these have not been published in the international scientific literature. The death chat is an offer to citizens who drop in to talk about death and dying without a commitment to join a course or to attend more than once [15].

The last aid course concept

The current last aid course concept uses a course curriculum that has been designed by an international working group from Norway, Denmark and Germany [16,17]. It comprises a short basic last aid course with four modules (each lasting 45 minutes) only. The four modules are about: Care at the end of life, Advance Care planning and decision making, symptom management, and cultural aspects of death and bereavement (Table 1). The course is given once during an afternoon or evening with four teaching units (45 minutes each). Usually it consists of two parts with 1.5 hours and a 30-minute break. Pilot courses have been started in Norway, Germany and Denmark from December 2014 [16,17].