What is meant by palliative care staff training?
Older people receiving aged care—whether in their own home or a residential care facility—should have access to effective, person-centred palliative and end-of-life care. [1] To provide this, aged care staff need key competencies and practical knowledge, much of which is likely to be provided in the workplace. [2]
Palliative care is a holistic approach that extends beyond physical symptom management to address the social, cultural, psychological, and spiritual needs of the dying person. It also involves supporting families and carers throughout the process. [1]
Some of the key areas where aged care staff may require training include:
- Providing person-centred, rights-based, culturally safe, trauma aware and healing informed care
- Communication skills for discussing death and dying with older people, families, and colleagues
- Symptom management and comfort care, using both pharmacological and non-pharmacological approaches
- Care of people with complex needs such as dementia, mental illness, frailty, or multimorbidity
- Recognising the dying process and responding appropriately
- Providing psychosocial and spiritual support tailored to individual needs
- Understanding legal and ethical considerations in end-of-life care such as informed consent and substitute decision-making
- Recognising and resolving feelings of moral distress and burnout in themselves. [3,4]
Training and education for aged care staff can take various forms, including self-guided online learning, lectures and seminars, face-to-face workshops, simulation or case-based training, and on-the-job mentoring. [5]
Why this training matters in aged care
Building the palliative care capacity of aged care staff is essential for improving end-of-life care for older people. [6] In Australia, 35% of all deaths among people aged over 65 years occur in residential aged care facilities, [7] and this proportion is expected to rise with an ageing population. Providing care in this setting is complex with high rates of multimorbidity, mental illness, and advanced dementia and increased rates expected in the future. [8] Residential and homes care staff need certain practical skills and confidence in providing palliative care and communicating effectively across a range of chronic illnesses, including dementia. [2,5] This requires skills in recognising and managing distressing symptoms, such as pain and breathlessness, and helping people discuss and plan for their end-of-life care. Staff also need to understand when hospitalisation can be avoided and when specialist palliative care input is necessary. [5] Many nurses new to aged care feel underprepared for dealing with the end-of-life care issues they confront in the workplace. [2,9] Careworkers also report a perceived need and desire for education on caring for the dying that aligns with their role and responsibilities. [10]
Palliative care training is also important for home care staff, as many older people would prefer to be supported to die in their own home. [11] Careworkers engaged in home care spend a lot of their time providing emotional and social support to their clients, in addition to personal care. [12] As home care services enable more older Australians to age and die in their own homes, home care workers will need to be able to assess and manage the palliative care needs of their clients and be part of their care as they are dying. [13]
Ongoing training and development help aged care nurses grow in their careers. It may also make aged care a more appealing setting of care, encouraging staff to stay in the sector, take on leadership roles, and gain recognition for their important work in the community. [14]
Under the Aged Care Quality Standards, aged care staff are required to demonstrate competencies in providing palliative and end-of-life care (Outcome 5.7). [15] Providers are also charged with responsibility for ensuring staff have the right qualifications, skills and experience to provide the care older people need. This will necessitate having a training system in place that offers workers ongoing training and supervision to effectively perform their role (Outcome 2.9.4). [15]
What the evidence tells us
Effectiveness of staff training initiatives
Research on the effectiveness of palliative care training in aged care settings has produced mixed findings. [16,17] Studies have assessed a wide range of training approaches, including lectures, seminars, webinars, coaching, train-the-trainer programs, and case-based learning. However, comparisons between programs are difficult due to variations in educational quality, program content, delivery methods, and evaluation measures. [5,16]
Most research focuses on staff-reported outcomes, such as improved knowledge, confidence, and communication skills. [16-18] Despite differences in training models, studies suggest that palliative care training can improve frontline staff ability to manage symptoms and conduct end-of-life care discussions. [10,19] However more research is needed to confirm these findings.
A few studies have examined resident outcomes following staff training. One trial of an organisation-tailored workshop found that residents experienced improved palliative care symptom management after six months, as measured by the Edmonton Symptom Assessment Scale (ESAS). [20] Other studies on Palliative Care Needs Rounds—a model where specialist palliative care teams work with aged care staff to discuss residents with the highest symptom burden—reported several positive outcome. These included gains in staff knowledge and confidence, increased self-perceived improvement in the quality of resident death and dying, and greater completion of anticipatory care documents, such as advance care plans. [21] Needs Rounds were also linked to fewer hospital transfers for older people approaching the end of life. [22]
Facilitating palliative care training and education
Staff training alone does not guarantee improvements in the quality of end-of-life care. The reality—much like the aged care setting itself—is far more complex. Lasting change requires more than just knowledge; it depends on staff understanding why high-quality palliative care matters. When staff recognise its importance and see their role in delivering it, they are more likely to engage and contribute to meaningful improvements in care. [23]
Management support plays a key role in fostering a strong end-of-life care culture within an organisation. Evidence suggests that services can facilitate staff participation in training and encourage the application of new learning by:
- Creating a shared vision for palliative care
- Providing adequate funding for training within budgets
- Allocating protected time for staff to attend training
- Involving all staff across the organisation in learning palliative care principles
- Clarifying staff roles and responsibilities
- Paying staff to attend if training falls outside their normal working hours
- Awarding certificates or continuing professional development credits
- Ensuring staff have access to computers and reliable internet for e-learning. [17,18,23]
Although research has explored a wide range of education approaches, no single best method for delivering palliative care training in aged care has emerged. However, some characteristics of the training appear to be important. These include programs where:
- Sessions are of short duration
- Training options are tailored to the needs of the organisation
- Face-to-face sessions allow staff to discuss complex issues and ask questions
- Formats such as eLearning or video recordings facilitate staff to integrate training with work schedules
- Training is part of an ongoing professional development strategy, rather than a brief, one-off event. [14,18,23]
Staff also need management support and opportunities to share and apply new knowledge in practice. [19] Without this, knowledge is often lost despite staff best intentions. Engaging facilitators can help sustain practice changes and organisational improvements. However, to mitigate the effects of staff turnover, evidence suggests facilitation must be consistent, regular and led by someone with substantial experience. [18]
Challenges to staff education and training
Several factors are known to inhibit palliative care staff training and its effectiveness in aged care settings. Chief among them are high rates of staff turnover and absenteeism which contribute to loss of learning across the organisation. Frequent changes of management might also lead to lack of training continuity, [17] while negative staff attitudes on discussing dying with families, training that fails to acknowledge the strong bonds between careworkers and those they care for, and poor communication with the medical team could also hinder training efforts. [2,16,17]
Page updated 12 March 2025