Training of palliative care teams on children’s palliative care in Moldova.

Children’s palliative care is a relatively new concept in the Republic of Moldova and so on the 30th and 31st May 2023, a two-day workshop was held at the Complex Turistic Codru near to Chișinău. The workshop was organsied by Hospices of Hope Moldova and was attended by five palliative care teams who are part of the Hospices of Hope network. Forty participants attended the workshop including doctors, nurses, psychologists, and physiotherapists. The workshop was facilitated by Prof Julia Downing from the International Children’s Palliative Care Network (ICPCN) and Dr Emily Harrop from Helen and Douglas House in the UK.

The workshop aimed to introduce participants to some of the core components of children’s palliative care, whilst recognising that it is not possible to cover everything in two days. The facilitators spoke in English with simultaneous translation into Romanian and some consecutive translation into Russian, and we are grateful to the translators who helped with this.

On the first day, participants were introduced to the concept of children’s palliative care, why it is important and the global status of children’s palliative care. Having set the scene the rest of the morning was spent looking at communication in children’s palliative care – discussing some of the key concepts, including the use of frameworks such as SPIKES and NURSE. Following the demonstration of both ‘good’ and ‘bad’ communication by Julia and Emily, participants were given the opportunity to role play a clinical scenario, followed by discussion as a group. It was wonderful to see how enthusiastically the delegates engaged with practical communication skills education, despite the need for two-way translation with the facilitators.

During the afternoon Emily discussed pain assessment and management in children, including procedural pain, and also specific issues in neonates and adolescents. Alongside this Julia discussed some of the psychosocial and spiritual issues. Following on from the days workshop some of the participants went out for a walk up to a local monastery enjoying the good weather.

The second day started with Emily discussing some more general symptom management and then focused on a few of the more challenging symptoms. This was followed by an exploration of grief and bereavement for children but also for families whose child has died, along with end -of-life care. Throughout the sessions there was discussion about the local context, the culture, availability of medicines etc. The importance of team collaboration and effectiveness along with self-care were also stressed and the workshop finished with some key considerations of the integration of children’s palliative care into the health care system and a couple of stories of children and their families who received palliative care.

Participants appreciated the workshop commenting that thanks to the informational support and presentations, they managed to gain a much better understanding about the concept of paediatric palliative care. The team from Hospice of Hope Moldova also said that the teams improved their knowledge in symptom and pain management skills in a stepwise manner. Participants also gained solid skills in teamwork and communication with patients and their families.

Following the workshop Julia and Emily had the chance to meet with the team at the newly opened day care programme in Chișinău, to discuss some of their challenges, and also to review a few of the patients that they are currently seeing and explore different options for their care.

It was great to be able to spend time with the teams discussing children’s palliative care and a follow up call with participants is planned in a few weeks time. On her time in Moldova Emily writes: “It was a previledge to be able to travel to Moldova with the ICPCN to support Hospices of Hope. I was humbled by the possitive approach and can-do attitude of our colleagues in the region. We were made to feel very welcome and multi-disciplinary participants were extremely well engaged with the sessions, despite the need for translation. Although I have had an interest in paediatric palliative education for many years, this was my first experience of delivering training with real-time translation. It was made smoothly possible by the skill of our interpreting team, and has opened my eyes to the possibilites of more international collaboration in the future.”