"The rate of medical advance during 20th century was enormous, due to improvements of technology as well as new scientific discoveries. Modern palliative care, as part of the health system, has developed rapidly in western countries, then all over Europe in the last part of the twentieth century.In the process of developing palliative care, an important role is to educate professionals and that is a concern included in all partners’ organization activity.Although major steps in the process of integration and delivering palliative care trainings for graduated clinicians, designing competencies frames for PC professionals, introduce this clinical specialty in the university curricula, provide post university specialized programs, a SWOT analysis conducted by the consortium partners revealed low capacity to effectively read and understand research literature and few studies made in palliative care in an evidence-based clinical practice framework. As research skills are needed for lifelong learning and level of research in the formal education varies between countries and between different PC professionals/ educators the project RESPACC is aiming to include core research competences as part of the general education related to clinical practice of palliative care professionals.The project will address the following objectives:1: Designing effective education strategies for enhancing basic research competences acrossmembers of multidisciplinary teams in palliative care.2. Stimulating the development and use of innovative approaches to increase the effective uptakeevidence-based research in palliative care.3. Increase the research capacity for a number of 48 practitioners in palliative care.4. Raise awareness among PC clinicians regarding the importance research integration in clinicalpracticeThe project has an innovative approach in developing mixed intellectual outputs considering the wide access to internet, most of educational materials being available in digital format:- research/ study report on specific palliative care competences to address the necessities of population cared- the analysis will be the main point for a whitepaper paper disseminated to stakeholders by EAPC- developing a handbook for introducing palliative care clinicians to critical reading and academic writing mixed with webinars – the curriculum developed will be presented in a short term learning event attended by 26 palliative care professionals- a toolkit for guidance the palliative care professionals in developing their own research proposal – this will include videos that will provide the mentoring process with real cases;- handbook and guidance materials for understanding qualitative and quantitative research – the curriculum will be presented in a short term face to face event and eLearning material, attended by 22 palliative care professionalsEducational materials are in English and national languages, practice based and easy to connect with daily clinical experience.- Education and project website- where all elearning materials will be uploaded will be promoted and disseminated.- a whitepaper with recommendations of inclusion of core research competencies into the training of Palliative Care cliniciansSpecifically, the project expects the following number of direct participants from the partner countries to be attracted in the project the various activities and short-term training events:48 trainees attending the 2 Short-term joint staff training events (“Introducing palliative care clinicians to critical reading and academic writing"" and "" Translating clinical issues into research projects”; 245 participants in 4 Multiplier events. Invitations to the multiplier events may be include interested practitioners from other countries listed under Participant and Partner countries in the Erasmus+.The long-term cooperation between partners’ organizations and their experience covering the fields of palliative care services, education and research will ensure the quality of intellectual outputs produced within the project. Regarding impact on European and international levels, a strong asset on this matter is the presence of EAPC in the RESPACC partnership. All the results will be disseminated at national level and by EAPC to the 56 member associations out of 32 countries, being applicable and transferable to other countries (through European conference, website, taskforce)."

<< Background >>Palliative care (PC) “is fundamental to human dignity and a component of the human right to health” (Resolution 2249 – 2018 of the European Parliamentary Assembly) and this is why education and training on PC are essential components of undergraduate medical education. Nevertheless, PC is not yet fully developed in the EU and the lack of services and teachers with a specific expertise in the PC domain also hamper the design and implementation of effective educational programs on PC for undergraduate students. Worldwide, many countries developed a core competencies catalog for PC at the undergraduate level and, in Europe, the European Association for Palliative Care (EAPC) issued a White Paper listing and discussing the core competencies on PC education.The various forms of technology-enhanced learning and – more in particular – synchronous and asynchronous online learning are promising pedagogies to foster effective teaching of the PC core competencies, overcoming the constraints of resources, at least for most of the cognitive and technical- manual learning outcomes and for the basic relational skills.<< Objectives >>The main goal of the ELPIS project is to enhance the quality of PC in the EU through a better and more uniform education at the undergraduate level. This goal is relevant not only because of the already mentioned importance of PC, as stated by the European Parliament but also because of the increasing cross-border mobility of medical graduates across the Union, seeking both post-graduate education and occupation. To achieve this goal, the ELPIS project has five intertwined objectives:1. to promote the design of internally coherent and comparable online undergraduate medical education programs on PC, through the development of a theoretical educational framework2. to promote effective implementation of online programs on PC, through the development of practice guidelines that are flexible enough to be- suitable for the local organizational context of higher education and PC- fit for the local cultural approach to palliative care and other end-of-life issues, including the students’ point of view3. to broadcast sharable educational resources, in different European languages4. to validate the theoretical framework and guidelines through testing and comparing the effectiveness of some local implementations of an online program on PC5. to design and implement faculty development programs to sustain the design of curricula in PC and the use of the educational resources<< Implementation >>The ELPIS project has four Work PackagesWP 1: DEFINITION OF THE THEORETICAL FRAMEWORK AND DRAFTING OF THE COURSE ON PCThis WP will define a theoretical educational framework to design an online undergraduate course on Palliative Care (PC). We chose the realist synthesis method to develop the theoretical framework from international literature. The final result of a realist review is a “final program theory”. The final output of WP1 will be the template of a course, ready to be reviewed by the experts of each partner institution. The structure of the template will be: according to the program theory, for this type of educational outcome, in this type of context, this type of structure of the course, use of technology, teaching, learning and assessment activities is likely to be the best choice.The theoretical framework and the draft design of an online course on PC are valuable products in themselves, addressed to all teachers in the field of PC education.WP2: EDUCATIONAL DESIGN AND IMPLEMENTATION OF THE LOCAL COURSESThe aim of WP2 is to develop and implement the local online courses on PC of the seven participating partners. The courses will be comparable, because they are based on the same template, but also adapted to the local organizational and curricular context. WP2 will also account for the production of the contents (text, exercises, tests of assessment) of the course both in English and in each partner’s language. The WP has three steps.1. The structure of each local training course will be designed, according to the general template developed in WP1. The course will aim to achieve two learning outcomes: a cognitive outcome of high taxonomic level (prescribing, planning, managing) and a relational-communication outcome. 2. The contents of the courses will be developed. The contents of all six courses will be translated into English language, to have an English version of every course, which will act as a template for possible further national translations in the future. Every single course will be delivered in the national local language (Italian, German, Hungarian, Romanian, Spanish) for local use. 3. Six partners will implement the course for delivery, according to the resources and rules of the local level, ready to be offered to the students in the experimental phase.WP3: PILOT & TESTING OF THE LOCAL COURSESThe aim of the WP3 is to empirically validate the theoretical framework through testing and comparing the effectiveness of the local implementations of the online courses on PC.The partners will run a quasi-experimental trial with a group of students attending the online course and a control group attending face-to-face teaching. The educational outcomes and the course contents will be the same, the two courses will differ only for the method of delivery and the implicated differences in the activities. WP4: QUALITY ASSURANCE OF DATA, STATISTICS AND ELECTRONIC REPOSITORY OF CONTENTSThis WP is aimed to assure the quality of experimental data and to gather the data and all the produced electronic contents (texts, exercises, tests).validation of the instruments for the assessment of learning outcomes. creation and delivery of a survey on students’ satisfaction of the course (both online and face-to-face), perception of relevance, utility, difficulty, self-confidence about the outcome.design and creation of an electronic repository for all the produced and tested contents. The repository will have a web interface and will be accessible to all academic centers and palliative care facilities involved in training, upon free registration. design of Faculty development programs for the design and implementation of online courses<< Results >>The results of the ELPIS project will be:-a theoretical framework to describe elements and methods for an effective design of online PC courses.-practice guidelines for the implementation and assessment of PC courses at the undergraduate level.-a core of multilingual educational resources in an open access repository-new knowledge and perspectives about the feasibility and comparative effectiveness of different forms of online learning vs in face-to-face learningThe outcome will be the impact of the ELPIS project on the target categories: undergraduate medical students and teachers at medical schools. We shall also consider the impact on the other relevant stakeholders: the national academic and scientific community, political decision-makers, the resonance of the information media. We expect an increase in knowledge and clinical skill in students participating in both online and face-to-face courses. We also expect a high level of student's satisfaction with the online course. If a substantial equivalence is demonstrated, this will increase the propensity of teachers to use online teaching to overcome the lack of resources (few hospices) and the ethical problems of exposing end-of-life patients to a large number of students.The multiplier events that will run during the project will raise the awareness of the academic community and local political stakeholders on the importance of education and policies for end-of-life.

Patients living with cancer and other non-oncological diseases require palliative care (PC) for uncontrolled symptoms, for their social, psycho-emotional and spiritual suffering to improve their quality of life. Across Europe, the provision of PC training for medical undergraduates is rather inconsistent and newly qualified physicians are entering practice with variable skill sets and may be unprepared to meet the needs of PC for an increasing number of patients and their families. In Romania, the country were the project lead is coming from, a recent quality insurance framework for higher education is requesting that all medical and nursing schools include Palliative care as a compulsory discipline in their curricula. At the beginning of the project only 2 out of the 12 universities were complying with this regulation The aim of the project was to produce and test a complex European PC undergraduate Program for medical students by - developing a model blended undergraduate PC curriculum based on the European Association for Palliative Care (EAPC) recommendations for undergraduate training available in RO, GE, EN and credited with 3 ECET points and - to produces adjacent training material in RO and EN for face to face and online training format. - to increase capacity of trainers to incorporate modern teaching and assessment techniques and technology in their teaching and improve their capacity as mentors. Online courses or materials were produce regarding interactive teaching methods, use of technology, mentoring of students and innovative assessment methods ( both in RO and EN) To be able to implement this program academic trainers received tuition through 3 short term trainings. CONCRETE RESULTS and PARTICIPANTS Reviewed EAPC recommendation for undergraduate training available on the EAPC website European Model Palliative Care Curriculum for undergraduate medical training with 3ECTS available in English, Romanian and German 10 updated online courses covering topics on symptom control, psychosocial issues, available in English and Romanian and 9 new developed online courses on topics like basic palliative care, symptom management, psychosocial issues, nursing available in Romanian with free registration https://learningplatform.thepalliativehub.com/login/index.php; https://edu.unitbv.ro/login/index.phpTrainers toolkit including - 31 lesson plans for all topics in the curriculum available in Romanian and English- 14 power point presentations for all theoretical courses available in Romanian and partially English - 28 organizers of seminars with case studies, exercises, role plays etc available and Romanian and partially English Online platform available in Romanian and English with free access concerning - Use of technology to support the innovate delivery of undergraduate education- Technology in teaching and in learningOpen online course on mentoring available in Romanian and English and online Mentoring manual for academic trainers, freely available in Romanian and English Open Online Resource Interactive teaching and novel assessment methods in Romanian and English Objectives based assessment for medical students for trainers use in Romanian Two articles published in ISI journals in 2020Resolution on palliative care education in undergraduate training in Romanian and agreements signed with 2 other Romanian medical schools ) to transfer the curriculum and the teaching materials. As result 7 Medical schools increased their educational offer and adapted it to actual demographic and health problems, including pandemic context Blended curriculum tested on around 1521 medical students in Romania and Ireland EDUPALL online courses and trainers toolkit used in postgraduate training on 220 doctors Three short -term trainings with 89 participants from partners and associated partners, Three multiplier events: two for English speakers and one for Romania and Republic of Moldavia totaling over 350 participants . Project’s implementation had a main impact over the teachers, mentors and students involved in creating/ teaching/ learning palliative care new curriculum. New and innovative approach of teaching methods that teachers used during implementation of curriculum lead to an increased efficiency of teaching/learning process. On medium and long term, the impact of the project will be seen at doctor’s and patient’s level, by increased level of quality of care. In the same time, on short term, the impact of the project was perceived on indirect beneficiaries (teachers, mentors, students) that had access to the intellectual outputs resulted from the team-work of the partners, by posting them on project and coordinator website access free. The results are reflected in: -new competencies of future doctors ; good practices (89 academic staff participated in short-term trainings, over 4500 participants to other indirect dissemination events)

Worldwide more than 10.74 million people are currently being held in penal institutions and the global prison population rate is increasing. Mental illness is prevalent in prison populations, by far exceeding the rate of mental disorders in the general population. Prisoners are also a high-risk group for suicide and self-harm. These mental health issues are exacerbated with age: over 20% of adults aged 60 and over suffer from a mental or neurological disorder. As the world’s population ages rapidly, the number of the elderly in jails and prisons is increasing as well, at an exponential rate of 3 times that of the general prison population. Palliative care (PC) and dying with dignity are considered human rights to those who need essential pain treatment. This topic is even more important considering that the prison population is getting old and that there are negative attitudes about compassionate release. The aim of the project was to increase the response to mental health disorders within prisons and the quality of palliative and end of life care services provided by enhancing the competences of management and frontline staff to address prisoners’ mental health needs and the special needs of older prisoners. The project includes a partnership composed of 8 public and private institutions working in mental health, geriatrics and in corrections. The strategic partnership brings together multi-agency and cross-sectorial agencies (a PC foundation- HCS, 4 prison administrations – DGRSP, ANP, FOD Justitie, a private company specialized in prison staff training & innovation- IPS, a health sciences faculty- UBI, a university hospital- Helse Bergen, and the European representative of prisons and corrections-Europris) to develop new, innovative and integrated approaches to the field of adult education in prison and probation settings. In order to achieve the project objectives, MenACE partnership undertook the following activities: a state of the art and best practices review was made in the fields of mental health, ageism and PC, with a clear focus on these realities in the prison environment (IO1). Particularly, a questionnaire was developed to collect information in the partner countries. The literature review and collection of approaches underpinned the development of the second and third intellectual outputs, namely the training curricula and program (IO2) and the e-learning training course (IO3), addressing the current and future needs of prison staff in 3 key areas of learning: mental health, geriatrics, PC in prison. The integrated training program was designed to be delivered on a blended format, combining an e-learning course with classroom sessions. In parallel, a train the trainer course (IO4) was developed with the aim of ensuring dissemination and sustainability of the proposed approach over time. All outputs were piloted and fined-tuned by the Romanian, Belgian and Portuguese Prison Services. In the end, the partnership delivered a European roadmap with policy recommendations (IO5), that presents transversal and specific proposals regarding staff training, legal framework and services / resources / infrastructure for the 3 areas under analysis: mental health, geriatrics and PC in prison. The following tangible results were achieved during the project: 1 state of the art and best practices report• 1 panel of experts• 1 training toolkit• 1 training guide with detailed competences, skills and indicators• 6 training courses (The essentials of prison health, Mental health in prison, Geriatrics in prison, Palliative care in prison, Staff health and well-being in prison and Dynamic security) •1 learning management system•1 train the trainer course• 1 European roadmap with policy recommendation• 3 course manual• 304 participants to 6 multiplier event • 71 participants in the short term joint staff training events•133 trainees in the piloting of the training program and e-learning course.The project’s results contributed to the development and enhancement of prison staff’s transversal skills. All participants gained new knowledge and tools which are helpful and useful for their everyday work-related challenges and for the effective identification, supervision and care of prisoners. In specific an enhanced capacity of staff to recognize and manage mental health disorders• an improved capacity of staff to identify prisoners at risk of particular distress and anxiety• a greater awareness of age-related needs and challenges regarding social rehabilitation of older inmates• an improved healthcare and palliative care in the targeted prisons• a beneficial impact on the quality of life of prisoners and an improved diagnosis and treatment of mental disorders and age-related diseases in correctional settings. Further, as long-term results, we expect to raise awareness among policy makers about these important challenges that are part of public health.

Challenge: many patients with advanced cancer in the final phase of life leave the hospital without continuity of information, and certainty about further treatment and care provision. Often, communication between healthcare providers in different settings is suboptimal and this leads to poor continuity and coordination of care, negatively impacting the quality of life and increasing preventable hospital admissions. Solution: the PAL-CYCLES programme: a transitional palliative care programme for patients with advanced cancer, adaptable to local cultures and healthcare systems. The programme contains an intervention aiming for a smooth transition from hospital care to community care, consisting of five cornerstone components: (1) identification of a patient with palliative and supportive care needs in collaboration with the oncologist and the hospital palliative care team; (2) compassionate communication towards the patient and their family; (3) a collaborative multidimensional care plan and follow-up in the home care setting; (4) periodic evaluation of the care plan with patients and relatives; (5) identification of the terminal phase (if there) based on the periodic evaluations, with appropriate intensification of care and end-of-life talks depending on local possibilities and habits, including consultation with patient and families about ethically and legally sensitive issues. Plan: we intend to develop, adapt, implement, and evaluate the PAL-CYCLES programme in seven European countries using a stepped wedge randomized controlled trial design. Patient, relatives, and health care provider experiences, as well as ethical and equity issues will be addressed with qualitative methods. Impact: the PAL-CYCLES programme will facilitate patient-centred communication and continuity of palliative cancer care in the community care setting, reducing unplanned hospital admissions and improving quality of life for patients with advanced cancer at the end of life.