The diversity Last Aid Course formats
Georg Bollig*1,2
1Last Aid International, Schleswig, Germany; 2Department of Anesthesiology, Intensive Care, Palliative Medicine and Pain Therapy, HELIOS Klinikum, Schleswig, Germany
*Correspondence should be addressed to: georg.bollig@helios-gesundheit.de
Background: Today Last Aid Courses are provided as method for public palliative care education (PPCE) in 20 different countries in Europe, Brazil, Canada, and Australia. Diversity is an important factor and a key word in our modern societies. Therefore, the question has been raised, whether different Last Aid Course formats for different groups are needed.
Methods: Different adaptations of the Last Aid Course for different groups have been established by working groups of Last Aid International and a number of cooperating partners. All adapted course formats were tested and evaluated in pilot studies.
Results: Many people from the International Last Aid community have provided a huge number of hours of voluntary work in official working groups. This lead to a number of different Last Aid Course formats: the classic Last Aid Course with four teaching modules (with 45 min each), the Last Aid Course for kids and teens (4 teaching hours), the Last Aid Course for healthcare professionals (10 teaching hours), the Last Aid Course for people with learning impairments (4 teaching hours), the Last Aid Course online (4 teaching hours), the Last Aid Course for deaf people (4 teaching hours), and the Last Aid Course multicultural (6 teaching hours). The COVID-19 pandemic has made it complicated to hold courses for children and people with learning impairments because of national regulations and the decision not to provide these course types as online courses.
Conclusion: The first scientific pilot-evaluations of special Last Aid Course formats for special audiences are very promising. It seems that adaptation of the Last Aid Course concept for different groups can help to enable more people to participate in Last Aid Courses worldwide and to raise public awareness for the topics palliative care, death, and dying. The Last Aid Movement is as diverse as the people around the globe.
Keywords: awareness, education, Last Aid Course, palliative care
Compassionate communities, access, and diversity
Allan Kellehear*1
11College of Nursing and Health Sciences, University of Vermont, Burlington, VT, USA
*Correspondence should be addressed to: allan.kellehear@uvm.edu
Access to palliative care for diverse populations is commonly problematised as a health services challenge rather than, rather ironically, a community challenge. Successive reports and academic articles continue to pose the question of access and its solution in terms that ask what a service can do rather than what a service can become. However, the question is not: what can we do for disadvantaged communities, but rather, what can we do together with them as fellow citizens working in palliative care. This presentation critically reviews the most common recommendations offered for increasing access to palliative care in a context of diversity by reviewing key access and diversity reports from UK palliative care charities and research organisations. These reports suggest that current troubles that dog population access has to do with organisational and direct service reach limitations. The solutions therefore focus on organisational and service capacity building instead of population strength and partnership capacity. I argue that only by addressing community capacity and partnership building will palliative care services overcome the diversity and access challenge of current service provision approaches. Only by adopting a compassionate community approach can palliative care break the cycle of limitations created by a self-referential health services approach that sees itself – rather than communities – as crucial to opening up access.
Keywords: compassionate communities, diversity, palliative care
Last Aid Courses for kids and teens
Georg Bollig*1,2
1Last Aid International, Schleswig, Germany; 2Department of Anesthesiology, Intensive Care, Palliative Medicine and Pain Therapy, HELIOS Klinikum, Schleswig, Germany
*Correspondence should be addressed to: georg.bollig@helios-gesundheit.de
Background: Last Aid Courses for adults were introduced in Germany in the year 2015. Many children and teenagers have relations to seriously ill and dying people in their family or community. Therefore, a special Last Aid Course format for children and teenagers from 8 to 16 years suited to the needs of this group has been established and tested in Germany.
Methods: A working group of Letzte Hilfe Deutschland created a curriculum for a Last Aid Course suited for children and teenagers. The curriculum includes the same topics as the Last Aid Course for adults but uses more practical teaching and short videos in addition to short lectures and discussions. The evaluation was based on a mixed-methods approach with a combination of quantitative and qualitative data. A questionnaire was used to evaluate the views and experiences of the participants. In addition to the questionnaire, many children and teenagers provided oral feedback after the course.
Results: The overall results from the pilot study show that children and teenagers want to talk about death and dying. The majority of the children appreciated the possibility to talk about death and dying and to learn what everybody can do to support seriously ill and dying people. Most of the participants found the teaching easy to understand, and the majority of the participants would recommend the course to others.
Conclusion: Unfortunately, the COVID-19 pandemic has hampered the wide implementation of Last Aid Courses for kids and teens in Germany. The courses were very well accepted by the participants. In order to provide information about palliative care throughout society and to improve the public discussion about dying and end-of-life care, the courses should be included in the school-curricula and spread further. A larger evaluation of the Last Aid Course for kids and teens is ongoing.
Keywords: awareness, children, community palliative care, Last Aid Course, teenager
Last Aid across the German–Danish border
Georg Bollig*1,2
1Department of Anesthesiology, Intensive Care, Palliative Medicine and Pain Therapy, HELIOS Klinikum, Schleswig, Germany; 2Last Aid International, Schleswig, Germany
*Correspondence should be addressed to: georg.bollig@helios-gesundheit.de
Background: Since 2015, Last Aid courses have been introduced in 20 countries in Europe, Australia, Brazil, and Canada. The aim of the study was to investigate the views of German and Danish people living in the German–Danish border region on cultural aspects of death and dying and the Last Aid Course.
Methods: The views of Last Aid Course participants and their opinions about the course and cultural differences in relation to care and nursing at the end of life in the border region of Germany and Denmark were collected and analysed using a mixed-methods approach. Data were collecting during 1-day workshops including Last Aid courses in German and Danish, focus group interviews, and open discussions by the participants.
Results: The majority of the participants appreciate the Last Aid Course as an option to talk and learn about death and end-of-life care. The informants from the pilot-study found individual differences more important than cultural differences in end-of-life care. Some of the participants described important differences connected to regulations and organisation of service on the different sides of the border. Some participants had suggestions for the future adaptation of the Last Aid Course. These suggestions included organisation and support across the border, religions and cultures, and supporting people in grief.
Conclusion: The findings of the study suggest that individual differences are more important than cultural differences across the German–Danish border. The results will be discussed in connection with the revision of the Last Aid curriculum 2022. Future projects across the border should help to respect and include the views and needs of minorities.
Keywords: community, culture, awareness, Last Aid Course, palliative care
Online Last Aid Courses – experiences from Scotland and Germany
Siobhan Neylon1, Georg Bollig*2,3
1Highland Hospice, Inverness, Scotland; 2Last Aid International, Schleswig, Germany; 3Department of Anesthesiology, Intensive Care, Palliative Medicine and Pain Therapy, HELIOS Klinikum, Schleswig, Germany
*Correspondence should be addressed to: georg.bollig@helios-gesundheit.de
Background: Last Aid Courses aim to educate the public about palliative care and to enhance the public discourse about death and dying. Usually, Last Aid Courses are held in a classic classroom setting with two facilitators and 6–20 participants. When the COVID-19 pandemic started, classroom teaching had to be abandoned due to the risk of infection. In order to maintain Last Aid Courses for the public despite the pandemic, an online course was adapted to online delivery to enable continued and safe public palliative care education.
Methods: In Germany, a working group consisting of experienced Last Aid facilitators of Letzte Hilfe Germany created an online Last Aid Course. In Scotland, experienced facilitators took the in-person course and adapted it to online delivery. A mixed-methods study was performed in both countries to examine the feasibility of delivering the Last Aid Course online. Data collection included participant questionnaires with qualitative and quantitative data, observations, and a focus group discussion. Data were analysed using descriptive analysis and qualitative description.
Results: The results from both countries show an overall course satisfaction for the online courses in line with previous findings for classroom teaching, along with increasing death literacy. Interestingly, the online platform enabled course participation from people previously unable or unwilling to attend, for example, caregivers to dying relatives and younger people. The facilitators showed an ability to teach online. Some instructors expressed frustration over reduced interaction and technical challenges. Many lacked face-to-face interaction and networking with fellow participants.
Conclusion: The scientific evaluation from Scotland and Germany demonstrates the feasibility of the online Last Aid course. Special attention is needed to increasing both participant-to-participant and instructor-to-participant interaction. Participants suggested to continue online Last Aid Courses after the pandemic to give participants the possibility to choose between classroom and online teaching.
Keywords: awareness, Last Aid, online course, palliative care
Last Aid Course in easy language – a new course format for people with disabilities
Alexandra Hieck1,2, Georg Bollig*3,4
1Outpatient Hospice Service, Johannes Hospice Münster, Münster, Germany; 2Hospiz Am Ostpark, Bethel.regional, Dortmund, Germany; 3Last Aid International, Schleswig, Germany; 4Department of Anesthesiology, Intensive Care, Palliative Medicine and Pain Therapy, HELIOS Klinikum, Schleswig, Germany
*Correspondence should be addressed to: georg.bollig@helios-gesundheit.de
Background: Last Aid Courses for the public were introduced in Germany in 2015. Some people asked about courses for people with learning disabilities or cognitive impairment in easy language. These people should have the opportunity to participate in Last Aid Courses in order to talk about death and dying and receive information about palliative care and advance care planning.
Methods: An adapted Last Aid Course format was established by a working group with experts from the fields of palliative care, education, pastoral care, parents of children with handicaps and integration assistance. The course presentation was assessed and approved by people with learning disabilities and a German organisation for easy language. The first pilot evaluation used questionnaires for the participants and interviews of the instructors.
Results: The results from the pilot courses show that people with learning disabilities or cognitive impairment appreciate the Last Aid Course and that they want to talk about death and dying. The used approach with easy language, and short and simple sentences has proofed useful. The pilot courses have revealed that there is a need to have an assistant present during the courses who can help the participants to go to the bathroom, etc. After the pilot courses, the participants received a Last Aid box. The Last Aid Box contains material for palliative oral care: an oral care swab, sweet almond oil, a spray bottle, and flower seeds. These boxes helped to establish communication about death, dying, and palliative care with others who had not attended the course. This might be an easy option to improve the conversation about death and dying at home or in institutions with others.
Conclusion: The first experiences with the Last Aid Course in easy language are very promising. A larger evaluation in different regions in Germany is ongoing.
Keywords: cognitive impairment, education, Last Aid Course, learning disabilities, palliative care
Last Aid in Brazil
Karin Schmid*1
1Last Aid Brazil, São Paulo, Brazil
*Correspondence should be addressed to: karin.cuidadospaliativos@gmail.com
Background: Believing in the idea of discussing and teaching death and dying in the community, in 2019, based on the existing literature, a Last Aid Course (own version) was developed by two palliative care professionals in Brazil. In 2020, after contacting Last Aid Germany, the official Last Aid Course was translated and adapted for Brazil.
Methods: Due to a peculiar health care structure in Brazil, the Last Aid partner in Brazil is a natural person (Palliative Nurse), which attended a Last Aid online curse in 2020. This was the starting point of the Brazilian Last Aid Team, which today has an additional of 10 co-facilitators. Because of the COVID-19 pandemic, the Last Aid courses were first held online and only in 2022 the face-to-face courses started.
Results: All facilitators in Brazil are women, coming from different areas (nursing, medicine, psychology, and speech therapy). They live in the southeast region of Brazil, mostly around São Paulo. Until September 2022, eight courses were held, mostly online (75%), with a total number of 69 participants (84% were women and an estimative of 30% health professionals). The online courses had 50 participants and 32 answered the questionnaire after the course. Some of the findings were 87.5% considered the course very good and 12.5% good; 93.75% believed they were better prepared to accompany a dying person after the course, and all would recommend the course to others.
Conclusion: Although the topic of death and dying still being a taboo, participants recommending the course shows a difference. With every course, the finitude issue is spreading, and in addition to individuals, also institutions began asking for courses.
Keywords: Brazil, Last Aid Course
Raising awareness with police workforce on death and dying through Last Aid Courses – perspectives from Scotland and Germany
Siobhan Neylon*1, Boris Knopf2
1Highland Hospice, Inverness, UK; 2Würdezentrum, Frankfurt am Main, Germany
*Correspondence should be addressed to: siobhneylon@gmail.com
Background: As part of the Last Aid pilot in Scotland, 2019, Police Scotland were invited to attend. It was felt that the police force would be active members of the community and would benefit for their own personal well-being if they attended. Based on the experiences of colleagues from Scotland, and other interactions through Last Aid movement in Germany, Last Aid courses were offered to police force in Germany.
Method: The general public awareness course was used, and rolled out across Scotland, including more branches of Police Scotland. Face-to-face sessions were delivered and during the COVID-19 pandemic, online sessions were delivered to different regions in Scotland. The German Last Aid providers adapted the concept and began delivering Last Aid Professional to the police force in Germany.
Results: Members of the Scottish police force gave mainly positive feedback for the general Last Aid course. Our attendees varied in gender, age, and ranking/roles. Some attendees had understood the course to be professional training to help them break bad news to the public (akin to Mental Health First Aid initiatives), and as a result several were disappointed. While in Germany, the pilot courses show that, in addition to the general content of the courses, it is helpful to provide specific information about the support options. In different federal states, there are initial pilot courses on this, which are being evaluated by Letzte Hilfe Deutschland.
Conclusion: The Last Aid General course as a health and well-being initiative, will provide a new approach to ensuring the workforce are confident and empowered in their personal life; therefore, being better equipped in their professional life. The Last Aid Professional course provides an extra opportunity for the workforce to understand their professional role in community members facing death, and how they can respond.
Keywords: community responders, emergency response services, Last Aid Course, last aid professional, palliative care, police officers, police service
Last Aid requires cultural sensitivity
Stefan Meyer*1
1Akademie für Hospizarbeit und Palliativmedizin Nürnberg gGmbH, Nürnberg, Germany
*Correspondence should be addressed to: Meyer@hospiz-team.de
Background: In Germany, the number of nurses and nurse aids with various cultural and religious backgrounds is increasing, and they have a different approach to palliative care and end-of-life care.
Methods: In a pilot project, the Paula-Kubitscheck-Vogel-Foundation commissioned Last Aid Germany to develop and test a Last Aid course with the focus on cultural awareness, aimed at nurses, nurse aids, staff members working in long-term care. It is open to other interested people with a different cultural and ethnic background.
Results: Three pilot courses for nursing staff working in residential care homes for the elderly showed that the Last Aid course was received very well, and that the course slides do not need to be adapted specifically. Therefore, an important part of the course should be an open discussion with the participants about their different cultural experiences in dealing with end-of-life care. During our preparations, we realised that we need six course units to have enough time for dealing sufficiently with the subjects: truth, eating and drinking at the end of life, rituals and spirituality, and how to create a dignified hour of death. This additional time facilitates personal reflexion and increases the appreciation of other cultural backgrounds.
Conclusion: Last Aid Courses provide the opportunity to talk to people from other ethnic backgrounds about topics such as dying, death, and grief, to identify care networks, and to be there for each other in the spirit of a caring community. This requires a culturally sensitive understanding and an open approach to others on equal footing, so that exchange of experiences becomes possible. Last Aid is a learning system, aiming at a better understanding of careers from other ethnic backgrounds, and to enable them to provide the best possible End-of-Life Care for their patients.
Keywords: cultural awareness, cultural sensitivity, end of life care, residental care home
Bridging cultural and linguistic barriers in teaching Last Aid
Pandeli Pani*1
1IDEM Institute, Berlin, Germany
*Correspondence should be addressed to: pani@idem-institute.org
Background: Death is a difficult issue to discuss in any language. Around the word major cultural differences can be observed in discussing death. Cultural factors shape patients’ and their families’ preferences around talking about death and dying. Therefore, terms such as Death Literacy and Last Aid may sound neutral in English or German, and can be calqued in different languages, but depending on their cultural background, people understand those terms differently. In courses run to date, it has been noted that cultural differences play an important role in delivery of the content of Last Aid courses.
Methods: The aim of this study was to investigate what people think when they are first introduced to the term Last Aid and if or how this term fits within the target cultures. Furthermore, the aim was to find out how important it is for them to talk openly about dying. To figure this out, qualitative data was collected through semi-structured interviews with 12 ordinary people from six non-Western countries (Albania, Brazil, Georgia, North Macedonia, Philippines, and Ukraine).
Results: The first association all participants had when hearing Last Aid was First Aid. About 60% of respondents equated Last Aid with palliative or hospice care. About 10% interpreted the term as dealing with family members as they enter the final stages of their life, while for 30%, the term was incomprehensible. After learning about the content of Last Aid courses, 90% of them said that they can imagine attending one.
Conclusion: Last Aid courses offered in Western societies with ethnically diverse population and societies in other geographic areas should be designed multi-dimensionally. Further cross-cultural research is needed to adapt and refine the holistic and culturally appropriate approach for different societies.
Keywords: cultural sensitivity, Last Aid, linguistic sensitivity
Informal care in outpatient end-of-life care–proposal of a mixed-methods study for the evaluation of Last Aid Courses in Germany
Chantal Giehl*1, Nino Chikhradze1, Ina Otte1, Horst Christian Vollmar1
¹Institute of General Practice and Family Medicine (AM RUB), Faculty of Medicine, Ruhr University Bochum, Bochum, Germany
*Correspondence should be addressed to: chantal.giehl@rub.de
Background: Many people are not confident in caring for dying relatives at home, as they often lack the necessary knowledge of end-of-life and palliative care. Last Aid Courses offer participants the acquisition of knowledge and the opportunity to reflect on their own experiences with death and dying. To date, there is less data on the effects and no evaluation of the courses concerning their impact on informal care in Germany.
Methods: A mixed-methods approach is selected: first, a literature review is conducted to provide an overview of the existing literature regarding the needs of caring relatives and the already-known effects of comparable interventions. Afterward, three to five participatory observations are conducted in the courses to trace the content and processes of the courses as well as the participation and interaction of course participants. Based on that, interviews with 30 course participants are conducted to gather individual experiences and expectations. In addition, two focus groups with course participants and two focus groups with course participants and instructors (eight participants per focus group) are conducted. The collected qualitative data are analysed according to the qualitative content analysis by Kuckartz. Based on that, hypotheses are formulated about which factors influence informal care positively and negatively. In the next step, these factors are tested by a questionnaire that is send to all participating courses. The hypotheses are then statistically tested by confirmatory factor analysis. A statistical model is developed to examine the predefined factors in terms of their impact on informal care.
Results: The exploratory design will enable an examination of facilitating and inhibiting factors concerning the implementation of informal care in relation to the courses.
Conclusion: Based on the results, the courses will be adapted to the needs of informal caregivers and people in the final phase.
Keywords: caring relatives, focus group discussion, Germany, interview, Last Aid Course, palliative care, qualitative research
