Chapter 1 14 grief, and existential distress; assist with conflict resolution regarding goals or methods of treatment; and assist with addressing cases of near futility. Both generalist and specialist palliative care are provided with a multi-dimensional perspective. Responsibilities of generalist and specialist palliative clinicians are described by Henderson et al.23 From January 2017, every hospital in the Netherlands proving oncological care has a palliative care consultation team.24 Specialist palliative care consultation teams support patients, family and primary care teams. They also have nonclinical responsibilities, such as teaching generalist palliative care clinicians, reporting delivered care and conducting or participating in palliative care research.4, 23 From 2014 to 2020, the Dutch government funded the National Palliative Care Programme called Palliantie, meer dan zorg.25 This programme aimed to raise awareness and guarantee good palliative care for every citizen in the right place and at the right moment and provided by the right healthcare professionals. Themes of the Palliantie programme were awareness and culture; organisation; continuity of care; care-related interventions; and patient participation.26 These themes are worked on within three main pillars: research; education; and implementation. Palliantie has made it possible to further develop tools to improve identification of palliative care needs, care for family, advance care planning and a care protocol for the dying phase.4 Consensus-based guidelines have been developed. Lastly, support for healthcare professionals working in general practice and in hospitals by specialist palliative care consultation teams has been initiated. 2.2 Education on palliative and end-of-life care Studies performed in the United Kingdom, Switzerland, Germany, and the United States of America have shown that medical students do not feel prepared and lack essential knowledge and skills to provide palliative or end-of-life care.27-30 The quality of palliative care or end-of-life care education in the compulsory medical curricula has been evaluated in several European countries. These evaluations have led to recommendations to change compulsory curricula, for example by adding internships in hospices and teaching more theory about care for patients in the palliative phase.28-33 A systematic review published in 2015 demonstrated that compulsory palliative or end-of-life care education varies in quantity and quality across European countries. The authors advised education programmers to include interdisciplinary education and to integrate palliative care education longitudinally through the medical curricula.34 The generalist plus specialist palliative care model requires that all healthcare professionals should at least be educated to provide palliative care on a generalist level.22, 23 In 2009, centres of expertise in palliative care in the Netherlands published their assessment on palliative care in general education of healthcare professionals. Medical curricula were not reviewed. They found only few pre-defined endpoints, even for education for medical specialists in training.35 Competencies for healthcare professionals
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