Challenges and perspectives of palliative medicine: A webinar by the Paediatric Virology Study Group

Medicine International · 3 authors, 5 centres

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TL;DR

This article summarizes a webinar on palliative medicine presented to the Paediatric Virology Study Group, detailing its recognition as a distinct medical specialty in the UK since 1987 and its structured training curriculum implemented in 2022. Key challenges include global disparities in access—only 14% of the ~40 million people needing palliative care receive it, mostly in high-income countries. The discussion highlights palliative care's role beyond end-of-life, its ethical complexities, and its potential as a model for emerging fields like paediatric virology.

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**Background:** This article presents a webinar held on October 20, 2022, as part of the '8th Workshop on Paediatric Virology' organized by the Institute of Paediatric Virology (IPV) based on Euboea, Greece. Dr Fergus Maher, Consultant in Palliative Medicine at Norfolk and Norwich University Hospitals and Honorary Associate Professor at Norwich Medical School, provided an overview of palliative medicine as a distinct medical specialty. The discussion aimed to explore the challenges and future perspectives of palliative medicine, using it as a potential model for the proposed subspecialty of paediatric virology.

**Methods:** The webinar was conducted in a question-and-answer format, covering topics such as the definition and aims of palliative care, its recognition as a specialty, ethical issues, the impact of the COVID-19 pandemic, and implications for paediatrics. The article also reviews the new palliative medicine curriculum by the Joint Royal Colleges of Physicians Training Board (JRCPTB), approved by the General Medical Council (GMC) and implemented in August 2022.

**Key Results:** Palliative care is defined by the WHO as an approach that improves quality of life for patients facing life-threatening illnesses, preventing and relieving suffering through early identification and treatment of physical, psychosocial, or spiritual problems. Palliative medicine was recognized as a distinct medical specialty in the UK in 1987, driven by pioneers including Cicely Saunders, Derek Doyle, Robert Twycross, and Richard Hillier. The new JRCPTB curriculum (August 2022) defines training competencies for managing patients with advanced, progressive, life-limiting diseases across all settings (acute hospital, community, hospice, prisons). Globally, approximately 40 million people need palliative care annually; 8 out of 10 live in low- or middle-income countries, and only about 14% of those in need can access it, predominantly in Europe and North America. A 2014 UK survey found only 4% of palliative care doctors favored physician-assisted suicide. The article compares palliative medicine (a recognized medical specialty in the UK since 1987, but not in Greece) with paediatric virology (not yet recognized as a subspecialty in either country).

**Clinical Implications:** The article underscores that palliative care is increasingly accepted as relevant not only at end-of-life but also earlier in the disease trajectory, and for non-malignant conditions such as chronic kidney disease, heart failure, chronic lung conditions, and neurodegenerative diseases. Key ethical issues include decisions around withholding/withdrawing medical interventions and use of sedating drugs at end of life. The COVID-19 pandemic increased recognition of palliative care's role in supporting colleagues from other specialties. The authors argue that palliative medicine serves as a successful model for introducing new specialties, demonstrating the importance of defining a unique body of knowledge, standardizing training, and proving the specialty's distinct value. The article concludes that with aging populations across Europe and the USA, demand for palliative care specialists will continue to grow.

STUDY TYPE

narrative_review

SPECIALTY

palliative medicine

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ORIGINAL PAPER

PMC10155253

Challenges and perspectives of palliative medicine: A webinar by the Paediatric Virology Study Group

Medicine International

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ABSTRACT

Abstract Palliative medicine focuses on the quality of life of patients with incurable conditions, who require the adequate relief of physical symptoms, adequate information to make decisions and spiritual wellbeing. Generalist palliative care is provided by family members, general practitioners, care home workers, community nurses and social care providers, as well as non-specialist hospital doctors and nurses. Patients with more complex, physical or psycho-social problems require the shared work of specialized doctors in palliative medicine, nurses, social workers and allied professionals. It is estimated that ~40 million patients require palliative care annually, worldwide; of these, 8 out of 10 patients reside in low- or middle-income countries, and only ~14% are able to access this type of care. Palliative medicine was recognised as a distinct medical specialty in the UK in 1987, with its own specialist curriculum and training pathway, which was recently revised in 2022. The main obstacles that palliative medicine had to overcome in order to be accepted as a separate specialization were the following: i) Defining a unique body of knowledge; ii) standardisation of training; and iii) proving that it warranted being a specialty in its own right. Over the past decade, it has been accepted as more than end-of-life care, supporting patients with an incurable illness at much earlier stages. Given the current absence of specialized palliative care in low- or middle-income countries, as well as the aging population across most European countries and the USA, it is estimated that there may be an increasing need and demand for specialists in palliative medicine in the ensuing years. This article is based on a webinar on palliative medicine, which was performed on October 20, 2022 in the context of the ‘8th Workshop of Paediatric Virology’ organized by the Institute of Paediatric Virology based on the island of Euboea (Greece). Keywords: palliative medicine, medical specialty, paediatric subspecialty, training programme, paediatric virology

CITATION EXPORT

Fergus Maher, Ioannis N Mammas, Demetrios A Spandidos. Challenges and perspectives of palliative medicine: A webinar by the Paediatric Virology Study Group. Medicine International. (2023). https://doi.org/10.3892/mi.2023.84

AUTHORS

3 · 5 CENTRES

Fergus Maher, Ioannis N Mammas, Demetrios A Spandidos

1Department of Palliative Medicine, Norfolk and Norwich University Hospitals, NHS Foundation Trust, NR4 7UY Norwich, UK
2Norwich Medical School, University of East Anglia, NR4 7TJ Norwich, UK
3Paediatric Clinic, Aliveri, 34500 Island of Euboea, Greece
4First Department of Paediatrics, University of Athens School of Medicine, 11527 Athens, Greece
5Laboratory of Clinical Virology, Medical School, University of Crete, 71003 Heraklion, Greece