News Report / Profile
Boethics Centre FMUL - Palliative Care Unit
INTRODUCTION
Today palliative care represents a reference standard of care provided to patients suffering from advanced chronic diseases and to their families. This field of knowledge stemmed from population ageing and corresponding change in the patterns of mortality and morbidity, from a societal context of growing individualization of family ties, and also as a reaction to the increasing suffering of vulnerable population groups through abandonment or reluctance to therapy in an increasingly technologized society.
In the last decade, palliative care has been gradually pervading clinical practice, research, education, and society.
Training plays a critical role in the quality of the support given, which is expected to become more rigorous and humane.
Of the various recommendations on this area, the following stand out:
- European Association of Palliative Care (1994) "…we recommend the adoption of a syllabus in palliative care at three levels (undergraduate, general clinicians/other specialties with clinical practice and palliative care specialists); palliative care should be a core and fundamental subject taught (and if possible tested) in the clinical years of undergraduate education..."
- Recommendations of the Council of Europe (2003) "…we recommend the adoption of measures, legislative or otherwise, that allow a coherent national policy for palliative care as well as the promotion of international research networks between institutions actively engaged in palliative care..."
- Recommendations of the WHO (2004) "…the training of health professionals in the specific area of palliative care must be guaranteed, and also that these professionals can be regularly updated in this subject..."
- National Plan for Palliative Care (June 2004)..."The complexity of clinical situations in palliative care...require a solid and differentiated preparation that should involve both undergraduate education and postgraduate training of the professionals who undertake this type of care, requiring technical preparation, theoretical education, and effective practical experience...”
- The priority of the current National Plan for Palliative Care is also training in this field.
BACKGROUND
The Palliative Care Unit was set up in 2004, coordinated by Professor António Barbosa, who is also the president of the Council of the Master Degree in Palliative Care. In its first edition, its members were Professor Luís Costa and Professor Luís Rebelo, who was subsequently replaced by Professor Isabel Monteiro Grillo who, in turn, was replaced in 2011 by Professor Carlos Ferreira. Dr Isabel Galriça Neto has been a consultant of the Council of the Master Degree since the beginning, and from 2011 Dr Filipa Tavares has also been involved.
Isabel Galriça Neto (MSc) is guest assistant lecturer and Dr. Filipa Tavares and Dr. Miguel Julião are independent lecturers at the Palliative Care Unit of the Bioethics Centre
OBJECTIVES
O Núcleo de Cuidados Paliativos do Centro de Bioética foi criado com o objectivo de:
The Palliative Care Unit of the Bioethics Centre was set up with the purpose of:
• Being a dynamic hub for the teaching and research in palliative care of the Faculty of Medicine of the University of Lisbon and in Portugal;
• Foster synergies and partnerships with organizations that also promote quality palliative care;
• Collaborate with the appropriate entities in setting quality standards for education in its different levels in this field of medicine and in the health sciences.
The main activities of the Palliative Care Unit include:
• Development of a postgraduate course in blended-learning providing training for 184 health professionals from the Regional Health Areas of Alentejo, Algarve, the North and the Autonomous Region of the Azores (2005-2007);
• Promote and participate in postgraduate lecturing in pain and palliative care;
• Regularly organize (every year) updating postgraduate courses in palliative care;
• Supervise, support and participate in lecturing (at undergraduate and postgraduate levels) organized by other entities.
ACTIVITIES
Education
Undergraduate
Additional training course for year 6 students
This elective course was designed to promote the quality of life of patients in a state of advanced or incurable disease by preventing their suffering and that of their caregivers (families and health professionals). At the end of their training students should be able to: determine the needs of patients in palliative care and of their families; address and monitor the most frequent symptoms of advanced and terminal diseases both in a home environment and in hospital; know how to adjust health care in the presence of agony and be familiar with communication skills with patients at the end of their lives.
The main contents of the course are: philosophy applied to palliative care; control of symptoms - pain, dyspnoea, nausea and vomiting, among others; support families and their mourning; care in agony; communication with patients at the end of their lives; major ethical issues at the end of life
Palliative Care elective subject
This subject started as an open-access course in Terminal Care and aims to contribute to maximizing the quality of life of patients in a state of advanced or incurable disease by preventing their suffering and that of their families and health professionals.
The teaching consists of theoretical, theoretical-practical lectures and practical classes focusing on cultural, spiritual and religious aspects of death, types of psychosocial suffering at the end of life, skills for communicating with the terminally ill, and strategies for dealing with socio-family issues and with the mourning process. It includes treatment of symptoms (pain, cough and dyspnoea, nausea and vomiting, anorexia/cachexia, asthenia, confusion/agitation) and care during agony and ethical issues at the end of life
Postgraduate Education
Advanced (master and doctoral degrees)
Master Degree in Palliative Care
Following the organization of the first postgraduate courses (2000 and 2001), the Faculty of Medicine of the University of Lisbon set up the first master degree in palliative care in the country (2002-2003).
Accordingly, the Faculty of Medicine of the University of Lisbon has contributed to professional postgraduate training (about 200 health professionals) and to the development of scientific research in this area.
We are very pleased to see many of our former master students and trainees in palliative care creating and developing palliative care teams and units all over the country, as well as disseminating this field of knowledge.
From the outset, the master degree has been offered in collaboration with prestigious international universities: University of Sheffield, University of Texas M. D. Anderson Cancer Centre, Medical College of Wisconsin Palliative Care Centre, University of California, Universitat de Barcelona, University of Navarra, La Paz and Gregorio Marañon University Hospitals – Madrid, Universitat de Vic – Catalonia, and University of Ottawa.
The objectives of the Master in Palliative Care are:
1. Teach appropriate and updated theoretical and practical information in the field of palliative care;
2. Foster the ability to handle evaluation techniques and therapies that enable a clinical approach to palliative care;
3. Encourage the acquisition of pedagogical competencies for the development of in-service training for health professionals in palliative care;
4. Stimulate the capacity for critical and ethical reflection and for questioning human and technical issues brought about by the exercise of palliative care;
5. Offer methodological preparation enabling research in the health services.
Syllabus:
• Principles and challenges in palliative care
• Treatment of pain in palliative care
• Treatment of symptoms II in palliative care
• Communication and psychological aspects
• The mourning process: family and professional support
• Education and training in palliative care
• Organization and management of services in palliative care
• Research in palliative care
• Research seminars I and II
Updating and improvement
The Master in Palliative Care has been complemented by symposia and open access courses for other participants that the Bioethics Centre/ Palliative Care Unit regularly organizes, at least once a year:
• 8 Updating Postgraduate Courses in Palliative Care
• 2011, 2012 - Workshop “Therapy of Dignity”
• 2012 – Updating Postgraduate Course “Compassion in Palliative Care”
• 2012 – Workshop “Coaching in Palliative Care: teamwork and burnout prevention”
Research/Intervention
With regard to research in palliative care, 57 master dissertation have already been successfully conducted, focusing on the following core areas: needs assessment (8); validation of instruments (6); evaluation of symptoms /clinical research (12); quality of life (10); prognosis (2); experience/competencies of health professionals (7); caregivers (6); communication (6); mourning (3); existential problems (6); ethical issues (1).
Gulbenkian Chair in Palliative Care
The Calouste Gulbenkian Chair was set up in May 2001 through a collaboration protocol between FMUL and the Calouste Gulbenkian Foundation which was backed by the Rector of the University of Lisbon. It aims to foster knowledge in the areas of humanization and the social dimension of medicine in a global and multidisciplinary perspective, strengthening the connection with social sciences and culture.
Its primary objective is to reinforce the academic nature of medical action by fostering research, staff training and the development of new areas of integration of knowledge and social action.
Within this framework, it was decided that the action programmes of the Calouste Gulbenkian Chair would run for a minimum of three years and that their activity would be assessed independently, this collaboration focusing on the area of palliative care in the first three years.
Professor Peter Lawlor from the University of Ottawa was chosen as Professor of the Chair. He is a renowned academic in the field of palliative care
Dissemination
Publications
Barbosa, A., & Galriça Neto, I. (Eds) (2006). Manual de cuidados paliativos. Lisbon: Palliative Care Unit /Bioethics Centre /Faculty of Medicine of the University of Lisbon, 511 pages.
Barbosa, A., & Galriça Neto, I. (Eds) (2010). Manual de cuidados paliativos. 2nd ed, rev. and enlarged. Lisbon: Palliative Care Unit /Bioethics Centre /Faculty of Medicine of the University of Lisbon, 814 pages.
Barbosa, A. (Coord.) (2012). Investigação qualitativa em cuidados paliativos. Lisbon: Palliative Care Unit /Bioethics Centre /Faculty of Medicine of the University of Lisbon, 269 pages.
Barbosa, A. (Coord.) (2012). Investigação quantitativa em cuidados paliativos. Lisbon: Palliative Care Unit /Bioethics Centre /Faculty of Medicine of the University of Lisbon, 328 pages.
Presentations at scientific meetings
Barbosa, A, Galriça Neto, I., & Guerreiro, V. (2006, October). Requisitos para a formação: Curso Pós-Graduado em Cuidados Paliativos (blended learning version). Paper presented at the 3rd National Conference on Palliative Care, Porto.
Gama, G., Barbosa, F., & Barbosa, A. (2007, June). Satisfaction with home and hospital palliative care. Poster presented at the 10th Congress of the European Association for Palliative Care, Budapest.
Barbosa, A., Galriça Neto, I, & Guerreiro, V. (2007, June). Effectiveness of two different training methodologies in postgraduate learning in palliative care. Poster presented at the 10th Congress of the European Association for Palliative Care, Budapest.
Galriça Neto, I., Guerreiro, V., & Barbosa, A. (2007, June). Online discussion forum during a blended learning course on palliative care in Portugal. Poster presented at the 10th Congress of the European Association for Palliative Care, Budapest.
Guerreiro, V., Galriça Neto, I., & Barbosa, A. (2007, June). Experience of blended learning course on palliative care in Portugal. Poster presented at the 10th Congress of the European Association for Palliative Care, Budapest.
Gama, G., Barbosa, F., & Barbosa, A. (2008, June). Cancer patients’ satisfaction with care in different settings: general hospital and palliative care units. Poster presented at the IPOS 10th World Congress of Psycho-Oncology, Madrid.
Barbosa, A., Guerreiro, V., & Galriça Neto, I. (2008, September). Teaching communication skills in two postgraduate courses on palliative care. Poster presented ate the 2008 International Conference On Communication In Healthcare, Oslo.
Barbosa, A., Guerreiro, V., & Galriça Neto, I. (2009, May). New resources for teaching palliative care: an evaluation of a blended learning and a face-to-face master course. Paper presented at the 11th Congress of the EAPC 2009, Vienna.
Barbosa, A., Guerreiro, V., & Galriça Neto, I. (2009, May). Multi-professional learning and teaching in palliative care. Paper presented at the 11th Congress of the EAPC 2009, Vienna.
Barbosa, A., & Barbosa, F. (2009, June). Suffering modalities in solid and liquid tumours. Poster presented at the IPOS 11th World Congress of Psycho-Oncology, Vienna.
Barbosa, A. (2009, October). Palliative care research in Portugal. Paper presented at the PRISMA International Conference on Symptom Measurement, Porto.
Barbosa, A. (2009, November). Consultation-liaison psychiatry in oncology and palliative care settings. Paper presented at the DGPPN CONGRESS 2009, Berlin.
Barbosa, A., Galriça Neto, I., & Guerreiro, V. (2010, June). Symptoms control in palliative care: assessment of two different teaching methodologies. Poster presented at the 6th Research Congress of the European Association for Palliative Care, Glasgow.
Barbosa, A. (2010, Junho). Ensino e formação em cuidados paliativos. Paper presented at the Conference to Celebrate the 3rd Anniversary of the Palliative Care Unit UCP-R of IPO-Porto, Porto.
Barbosa, A. (2010, November). A model of spiritual assessment and care in consultation-liaison psychiatry. Poster presented at the International Symposium on Psychiatry & Religious Experience, Ávila, Spain.
Matos, A., & Barbosa, A. (2011, May). Type and levels of information received by oncologic patients in palliative care. Poster presented at the 12th Congress of the European Association for Palliative Care, Lisbon.
Barbosa, A. (2011, May). Palliative care research in an academic centre of palliative care in Portugal. Poster presented at the 12th Congress of the European Association for Palliative Care, Lisbon.
Today palliative care represents a reference standard of care provided to patients suffering from advanced chronic diseases and to their families. This field of knowledge stemmed from population ageing and corresponding change in the patterns of mortality and morbidity, from a societal context of growing individualization of family ties, and also as a reaction to the increasing suffering of vulnerable population groups through abandonment or reluctance to therapy in an increasingly technologized society.
In the last decade, palliative care has been gradually pervading clinical practice, research, education, and society.
Training plays a critical role in the quality of the support given, which is expected to become more rigorous and humane.
Of the various recommendations on this area, the following stand out:
- European Association of Palliative Care (1994) "…we recommend the adoption of a syllabus in palliative care at three levels (undergraduate, general clinicians/other specialties with clinical practice and palliative care specialists); palliative care should be a core and fundamental subject taught (and if possible tested) in the clinical years of undergraduate education..."
- Recommendations of the Council of Europe (2003) "…we recommend the adoption of measures, legislative or otherwise, that allow a coherent national policy for palliative care as well as the promotion of international research networks between institutions actively engaged in palliative care..."
- Recommendations of the WHO (2004) "…the training of health professionals in the specific area of palliative care must be guaranteed, and also that these professionals can be regularly updated in this subject..."
- National Plan for Palliative Care (June 2004)..."The complexity of clinical situations in palliative care...require a solid and differentiated preparation that should involve both undergraduate education and postgraduate training of the professionals who undertake this type of care, requiring technical preparation, theoretical education, and effective practical experience...”
- The priority of the current National Plan for Palliative Care is also training in this field.
BACKGROUND
The Palliative Care Unit was set up in 2004, coordinated by Professor António Barbosa, who is also the president of the Council of the Master Degree in Palliative Care. In its first edition, its members were Professor Luís Costa and Professor Luís Rebelo, who was subsequently replaced by Professor Isabel Monteiro Grillo who, in turn, was replaced in 2011 by Professor Carlos Ferreira. Dr Isabel Galriça Neto has been a consultant of the Council of the Master Degree since the beginning, and from 2011 Dr Filipa Tavares has also been involved.
Isabel Galriça Neto (MSc) is guest assistant lecturer and Dr. Filipa Tavares and Dr. Miguel Julião are independent lecturers at the Palliative Care Unit of the Bioethics Centre
OBJECTIVES
O Núcleo de Cuidados Paliativos do Centro de Bioética foi criado com o objectivo de:
The Palliative Care Unit of the Bioethics Centre was set up with the purpose of:
• Being a dynamic hub for the teaching and research in palliative care of the Faculty of Medicine of the University of Lisbon and in Portugal;
• Foster synergies and partnerships with organizations that also promote quality palliative care;
• Collaborate with the appropriate entities in setting quality standards for education in its different levels in this field of medicine and in the health sciences.
The main activities of the Palliative Care Unit include:
• Development of a postgraduate course in blended-learning providing training for 184 health professionals from the Regional Health Areas of Alentejo, Algarve, the North and the Autonomous Region of the Azores (2005-2007);
• Promote and participate in postgraduate lecturing in pain and palliative care;
• Regularly organize (every year) updating postgraduate courses in palliative care;
• Supervise, support and participate in lecturing (at undergraduate and postgraduate levels) organized by other entities.
ACTIVITIES
Education
Undergraduate
Additional training course for year 6 students
This elective course was designed to promote the quality of life of patients in a state of advanced or incurable disease by preventing their suffering and that of their caregivers (families and health professionals). At the end of their training students should be able to: determine the needs of patients in palliative care and of their families; address and monitor the most frequent symptoms of advanced and terminal diseases both in a home environment and in hospital; know how to adjust health care in the presence of agony and be familiar with communication skills with patients at the end of their lives.
The main contents of the course are: philosophy applied to palliative care; control of symptoms - pain, dyspnoea, nausea and vomiting, among others; support families and their mourning; care in agony; communication with patients at the end of their lives; major ethical issues at the end of life
Palliative Care elective subject
This subject started as an open-access course in Terminal Care and aims to contribute to maximizing the quality of life of patients in a state of advanced or incurable disease by preventing their suffering and that of their families and health professionals.
The teaching consists of theoretical, theoretical-practical lectures and practical classes focusing on cultural, spiritual and religious aspects of death, types of psychosocial suffering at the end of life, skills for communicating with the terminally ill, and strategies for dealing with socio-family issues and with the mourning process. It includes treatment of symptoms (pain, cough and dyspnoea, nausea and vomiting, anorexia/cachexia, asthenia, confusion/agitation) and care during agony and ethical issues at the end of life
Postgraduate Education
Advanced (master and doctoral degrees)
Master Degree in Palliative Care
Following the organization of the first postgraduate courses (2000 and 2001), the Faculty of Medicine of the University of Lisbon set up the first master degree in palliative care in the country (2002-2003).
Accordingly, the Faculty of Medicine of the University of Lisbon has contributed to professional postgraduate training (about 200 health professionals) and to the development of scientific research in this area.
We are very pleased to see many of our former master students and trainees in palliative care creating and developing palliative care teams and units all over the country, as well as disseminating this field of knowledge.
From the outset, the master degree has been offered in collaboration with prestigious international universities: University of Sheffield, University of Texas M. D. Anderson Cancer Centre, Medical College of Wisconsin Palliative Care Centre, University of California, Universitat de Barcelona, University of Navarra, La Paz and Gregorio Marañon University Hospitals – Madrid, Universitat de Vic – Catalonia, and University of Ottawa.
The objectives of the Master in Palliative Care are:
1. Teach appropriate and updated theoretical and practical information in the field of palliative care;
2. Foster the ability to handle evaluation techniques and therapies that enable a clinical approach to palliative care;
3. Encourage the acquisition of pedagogical competencies for the development of in-service training for health professionals in palliative care;
4. Stimulate the capacity for critical and ethical reflection and for questioning human and technical issues brought about by the exercise of palliative care;
5. Offer methodological preparation enabling research in the health services.
Syllabus:
• Principles and challenges in palliative care
• Treatment of pain in palliative care
• Treatment of symptoms II in palliative care
• Communication and psychological aspects
• The mourning process: family and professional support
• Education and training in palliative care
• Organization and management of services in palliative care
• Research in palliative care
• Research seminars I and II
Updating and improvement
The Master in Palliative Care has been complemented by symposia and open access courses for other participants that the Bioethics Centre/ Palliative Care Unit regularly organizes, at least once a year:
• 8 Updating Postgraduate Courses in Palliative Care
• 2011, 2012 - Workshop “Therapy of Dignity”
• 2012 – Updating Postgraduate Course “Compassion in Palliative Care”
• 2012 – Workshop “Coaching in Palliative Care: teamwork and burnout prevention”
Research/Intervention
With regard to research in palliative care, 57 master dissertation have already been successfully conducted, focusing on the following core areas: needs assessment (8); validation of instruments (6); evaluation of symptoms /clinical research (12); quality of life (10); prognosis (2); experience/competencies of health professionals (7); caregivers (6); communication (6); mourning (3); existential problems (6); ethical issues (1).
Gulbenkian Chair in Palliative Care
The Calouste Gulbenkian Chair was set up in May 2001 through a collaboration protocol between FMUL and the Calouste Gulbenkian Foundation which was backed by the Rector of the University of Lisbon. It aims to foster knowledge in the areas of humanization and the social dimension of medicine in a global and multidisciplinary perspective, strengthening the connection with social sciences and culture.
Its primary objective is to reinforce the academic nature of medical action by fostering research, staff training and the development of new areas of integration of knowledge and social action.
Within this framework, it was decided that the action programmes of the Calouste Gulbenkian Chair would run for a minimum of three years and that their activity would be assessed independently, this collaboration focusing on the area of palliative care in the first three years.
Professor Peter Lawlor from the University of Ottawa was chosen as Professor of the Chair. He is a renowned academic in the field of palliative care
Dissemination
Publications
Barbosa, A., & Galriça Neto, I. (Eds) (2006). Manual de cuidados paliativos. Lisbon: Palliative Care Unit /Bioethics Centre /Faculty of Medicine of the University of Lisbon, 511 pages.
Barbosa, A., & Galriça Neto, I. (Eds) (2010). Manual de cuidados paliativos. 2nd ed, rev. and enlarged. Lisbon: Palliative Care Unit /Bioethics Centre /Faculty of Medicine of the University of Lisbon, 814 pages.
Barbosa, A. (Coord.) (2012). Investigação qualitativa em cuidados paliativos. Lisbon: Palliative Care Unit /Bioethics Centre /Faculty of Medicine of the University of Lisbon, 269 pages.
Barbosa, A. (Coord.) (2012). Investigação quantitativa em cuidados paliativos. Lisbon: Palliative Care Unit /Bioethics Centre /Faculty of Medicine of the University of Lisbon, 328 pages.
Presentations at scientific meetings
Barbosa, A, Galriça Neto, I., & Guerreiro, V. (2006, October). Requisitos para a formação: Curso Pós-Graduado em Cuidados Paliativos (blended learning version). Paper presented at the 3rd National Conference on Palliative Care, Porto.
Gama, G., Barbosa, F., & Barbosa, A. (2007, June). Satisfaction with home and hospital palliative care. Poster presented at the 10th Congress of the European Association for Palliative Care, Budapest.
Barbosa, A., Galriça Neto, I, & Guerreiro, V. (2007, June). Effectiveness of two different training methodologies in postgraduate learning in palliative care. Poster presented at the 10th Congress of the European Association for Palliative Care, Budapest.
Galriça Neto, I., Guerreiro, V., & Barbosa, A. (2007, June). Online discussion forum during a blended learning course on palliative care in Portugal. Poster presented at the 10th Congress of the European Association for Palliative Care, Budapest.
Guerreiro, V., Galriça Neto, I., & Barbosa, A. (2007, June). Experience of blended learning course on palliative care in Portugal. Poster presented at the 10th Congress of the European Association for Palliative Care, Budapest.
Gama, G., Barbosa, F., & Barbosa, A. (2008, June). Cancer patients’ satisfaction with care in different settings: general hospital and palliative care units. Poster presented at the IPOS 10th World Congress of Psycho-Oncology, Madrid.
Barbosa, A., Guerreiro, V., & Galriça Neto, I. (2008, September). Teaching communication skills in two postgraduate courses on palliative care. Poster presented ate the 2008 International Conference On Communication In Healthcare, Oslo.
Barbosa, A., Guerreiro, V., & Galriça Neto, I. (2009, May). New resources for teaching palliative care: an evaluation of a blended learning and a face-to-face master course. Paper presented at the 11th Congress of the EAPC 2009, Vienna.
Barbosa, A., Guerreiro, V., & Galriça Neto, I. (2009, May). Multi-professional learning and teaching in palliative care. Paper presented at the 11th Congress of the EAPC 2009, Vienna.
Barbosa, A., & Barbosa, F. (2009, June). Suffering modalities in solid and liquid tumours. Poster presented at the IPOS 11th World Congress of Psycho-Oncology, Vienna.
Barbosa, A. (2009, October). Palliative care research in Portugal. Paper presented at the PRISMA International Conference on Symptom Measurement, Porto.
Barbosa, A. (2009, November). Consultation-liaison psychiatry in oncology and palliative care settings. Paper presented at the DGPPN CONGRESS 2009, Berlin.
Barbosa, A., Galriça Neto, I., & Guerreiro, V. (2010, June). Symptoms control in palliative care: assessment of two different teaching methodologies. Poster presented at the 6th Research Congress of the European Association for Palliative Care, Glasgow.
Barbosa, A. (2010, Junho). Ensino e formação em cuidados paliativos. Paper presented at the Conference to Celebrate the 3rd Anniversary of the Palliative Care Unit UCP-R of IPO-Porto, Porto.
Barbosa, A. (2010, November). A model of spiritual assessment and care in consultation-liaison psychiatry. Poster presented at the International Symposium on Psychiatry & Religious Experience, Ávila, Spain.
Matos, A., & Barbosa, A. (2011, May). Type and levels of information received by oncologic patients in palliative care. Poster presented at the 12th Congress of the European Association for Palliative Care, Lisbon.
Barbosa, A. (2011, May). Palliative care research in an academic centre of palliative care in Portugal. Poster presented at the 12th Congress of the European Association for Palliative Care, Lisbon.