In order to empower citizens to care for seriously ill and dying people at home Last Aid Courses have been started in Norway, Germany and Denmark in 2014/2015. The main aims of the Last Aid movement are to raise citizen’s awareness and knowledge of Palliative Care and to empower them to care for seriously ill and dying people at home. As children do often have contact with seriously ill and dying people in their families a Last Aid Course for children aged 8-14 years was established. The first pilot course has shown that the children appreciate the Last Aid Course concept and suggests that children want to talk open about death and dying. Scientific evaluation should be an integrated part of the further work and implementation of Last Aid Courses for children and teenagers in different countries

Keywords: palliative care, end-of-life care, last aid course, children, teens

Most people want to die at home. One of the barriers for home death is lack of support from laypersons as family and friends. Therefore Last Aid Courses for adults have been introduced to educate the public about Palliative care, to enhance the public discussion about death and dying and to empower citizens to participate in end-of-life care.^1,2 Today Last Aid Courses have been successfully introduced in a number of European countries. 11 Countries participate in the International Last Aid working group, more than 22000 citizens have participated in last Aid Courses with four teaching lessons and more than 2000 instructors have been trained to provide Last Aid Courses. The aim of the present study was to perform a first pilot test and to investigate the feasibility and acceptance of a Last Aid Course adapted to the needs of children.

A multidisciplinary group of German experts established a working group to establish a Last Aid Course for children. Members of the group were Kirsten Mainzer (specialized palliative care nurse), Raymund Pothmann (pediatrician and consultant in pain therapy and palliative medicine), Holger Fiedler (specialized palliative care nurse), Franca Barra (educator) and Georg Bollig (anesthesiologist and consultant in pain therapy and palliative medicine; founder of Last Aid Courses). Based on the well-established and tested Last Aid Course for adults,^1–4 the above named multi-professional working-group adapted the curriculum for children between 8 and 14 years. More information about the international Last Aid Movement and the contents of the Last Aid Course for adults can be found in the literature and the Internet.^1–4 A short summary of the course contents for the Last Aid Course for kids and teens are shown in Table 1. The evaluation of the first pilot-course was performed by an oral feedback round with the children directly after the course. The feedback round did use some questions from a questionnaire for adults that have participated in a Last Aid Course.¹ The questions were adapted for children and teenagers by the working group.

Questions included the following topics:

1. Do you have personal experience with death and dying in your family or neighbourhood?
2. Is the Last Aid Course helpful for children and teenagers?
3. Would you recommend the Last Aid Course to others?
4. Should all school children participate in a Last Aid Course?
5. Should your parents participate in a Last Aid Course?
6. Should children and parents visit a Last Aid Course together?
7. Did you learn something new?
8. Were the contents of the course easy to understand?

In addition the participants could state their overall impression of the course and had’s the possibility to ask open questions. GB and KM documented the informants’ answers.

10 children between 9 and 14 years participated in the Last Aid course that was held within 3 hours on one afternoon.⁵ Table 2 shows the age and gender of the participating children.

9 out of 10 participants had experience with the death of family members. All children stated that they would recommend the course to other children and that also adults should participate in Last Aid courses. The children appreciated the course and most felt somehow more prepared for a potential death in their social network. Almost all children stated that they welcomed the possibility to talk open about death and dying in a group with other children. All participants liked the inclusion of practical parts and game like teaching. The practical parts included e.g. a network game with a group that had to keep a ball in balance (Figure 1) and painting a stone as example for helpful ritual. Every teaching module included a short video that is freely accessible on the Internet. In the feedback round the children pointed out to exchange a song used in module 4 that was about grief and that they found very sad. Instead a song describing a really bad day with a positive end was seen as more appropriate by the children. They also suggested to expand the age range and to include teenagers up to the age of 16 years.

Figure 1 Practice: networking – working together.

The need to teach the public about palliative care and end-of-life care has been stated by different authors.^6–8 The feasibility of a Last Aid Course for the public has been shown already.¹ At present there are research projects on the Last Aid Course ongoing in different countries. Beside the Last aid Course there are a few other options to inform the public about palliative care and to discuss death and dying.^9–12 Nevertheless the Last Aid Course is the first structured option that is applicable to provide basic information about palliative care in an extremely short timeframe. There are so far just few options for children and teenagers to talk about death and dying. In Germany a program called “Hospiz macht Schule” uses a whole project week to introduce school children to death and dying.¹³ Unfortunately the huge time consumption is a restriction for the nationwide implementation of the program. An education program for teenagers could raise awareness for palliative care in Portugal.In order to raise awareness and to implement palliative care within the school curriculum for children and teenager a short and structured educational program about palliative care is needed. The Last Aid course for kids and teens is such a short and structured educational program that might be used widely to teach children and teenagers about palliative care, death and dying.

The present study with a first pilot test has shown the feasibility of the Last Aid Course for kids and teens. The course has undergone a minor revision of some parts due to the children’s suggestions. It is currently in a second pilot phase with a greater number of instructors that are providing a larger number of courses. More Last Aid Courses for kids and teens and more instructor courses are already planned in Germany. After the end of the pilot phase and evaluation the aim is to revise the curriculum and to spread the course to other countries. Scientific evaluation should be an integral part of the wider implementation.

The results of the pilot-test are very encouraging. Most children appreciate the course and the possibility to talk open about death and dying in a safe group. More Last Aid courses for children will be taught within the next year. More research is needed to investigate the effects of a Last Aid Course for kids and teens on their awareness, palliative care knowledge and willingness to provide end-of-life care. A scientific evaluation with a mixed-methods approach will be part of the further testing-phase.

None.

Many thanks to all the children who participated in the course and who helped to evaluate and improve the concept.

GB and KM might have potential conflicts of interest. GB and KM receive financial compensation for giving Last Aid Instructor courses. GB owns the trademark Last Aid. HF and RP declare that they do not have competing interests.

1. Bollig G, Kuklau N. Der Letzte Hilfe Kurs - ein Angebot zur Verbesserung der allgemeinen ambulanten Palliativversorgung durch Information und Befähigung von Bürgerinnen und Bürgern. (The Last Aid Course–A Means to Improve Palliative Care in the Community Through Information and Education of Citizens.) Z Palliativmed 2015; 16:210-216
2. Bollig G, Heller A. The last aid course-a simple and effective concept to teach the public about palliative care and to enhance the public discussion about death and dying.  Austin Palliat Care. 2016;1(2):01–05.
3. https://www.letztehilfe.info/
4. Bollig G. The “Last Aid” Course—An Approach to Promoting Public Discussion, Awareness and Education. Lecture SPPC Annual Conference 2017: Making the Best of Hard Times. 2017.
5. Bollig G, Mainzer K, Fiedler H, et al. A new Last Aid Course for kids from 8-14 years - a pilot-test. 16th World Congress of the European Association for Palliative Care. 2019.
6. Bollig G. Palliative Care für alte und demente Menschen lernen und lehren. (Learning and Teaching Palliative Care for Old and Demented People. ) LIT-Verlag: Berlin, Germany, 2010.
7. Martins Pereira S, Araújo J,  Hernández-Marrero P. Towards a public health approach for palliative care: an action-research study focused on engaging a local community and educating teenagers. BMC Palliative Care. 2018;17(1):89.
8. Singer PA, Wolfson M. The best places to die. BMJ. 2003;327(408):173–174.
9. Hudson P,  Quinn K,  Kristjanson L, et al. Evaluation of a psycho-educational group programme for family caregivers in home-based palliative care. Palliat Med. 2008;22(3):270–280.
10. Hudson P, Thomas T, Quinn K, et al. Teaching family carers about home-based palliative care: final results from a group education program. J Pain Symptom Manage. 2009;38(2):299–308.
11. http://deathcafe.com
12. https://www.hospizmachtschule.de
13. Martins Pereira S, Araújo J, Hernández-Marrero P. Towards a public health approach for palliative care: an action-research study focused on engaging a local community and educating teenagers. BMC Palliative Care. 2018;17:89.