Table 3.

Highest Ranked PAL-LIFE Group Recommendations to Stakeholders for the Promotion of Palliative Care and Suggestions for Implementation

Position	Stakeholder and suggestions
1.	Policy makers: Policy makers must recognize the societal and ethical value of palliative care and modify the existing healthcare structures, policies, and outcome measures to ensure universal access to palliative care for all patients in need. They must also take the steps to ensure an integrated health system, to allow a smooth flow of patients between the different levels of care, so that patients with complex problems may be referred to secondary and tertiary levels, as needed, and referred back to home care, if possible.
	Suggestions for implementation:
	• Involve national associations to advocate for palliative care
	• Advocate with local policymakers for access to palliative care as a human right
	• Link advocacy to other initiatives such as the movement of whole-person care, preventive medicine, and health promotion
	• Carryout a public awareness campaign focusing on needlessly suffering and the ethical responsibility of the government.
	• Include palliative care as a component of NCD national plans or strategies
2.	Academia (universities and colleges): All academic institutions offering degrees in healthcare-related fields should include mandatory palliative care courses as part of the undergraduate curricula.
	Suggestions for implementation:
	• Approve a national law where palliative care teaching is mandated
	• Develop standard curricula on team-based interdisciplinary palliative care
	• Palliative care curricula must combine theoretical and practical components integrated at the primary care level
	• Teach palliative care by clinically experienced faculties who have academic appointments
	• Funding for education programs should come from governments' healthcare educational budgets.
	• When palliative care is not taught, invite palliative care experts to deliver lectures on palliative care to create the demand
	• Adopt and implement the EAPC recommendations for the inclusion of palliative care in the undergraduate curricula for medical and nursing schools and implement the Initiation for System Transformation project (ITES) for countries throughout
	Latin America
	• Ensure training in the trainer courses, also in primary healthcare teaching.
3.	Healthcare workers: Healthcare professionals working in palliative care should receive appropriate certification while actively participating in continuing education to maintain the adequate competency levels
	Suggestions for implementation:
	• Reach out to the national boards of medicine and nursing and the Ministries of Health and education through National Associations to advocate for the recognition of palliative care as a specialty.
	• Establish a working group among members of the board of medicine and the board of nursing with palliative care experts in the country to determine the minimum level of competencies, knowledge and skills in palliative care, and years of dedication required to be recognized as palliative care professional.
	• Standardize health professional education with basic and specialty certification programs according to each country's process of healthcare professional official certification
4.	Hospitals and healthcare centers: Every hospital and healthcare center should ensure affordable access to palliative care medicines included in the WHO Model List of Essential Medicines, particularly to immediate-release oral morphine. It also should accept palliative care provision as a moral and ethical imperative.
	Suggestions for implementation:
	• Ensure training of all staff in the fundamentals of palliative care
	• Define a palliative care integration strategy for the hospital or Health Center
	• To establish a minimum dataset to monitor the quality of care in advance disease and end of life
5.	Palliative care associations: Representatives of national associations should be effective advocates and work with their governments in the process of implementing international policy framework, including Conventions, Resolutions, and Declarations in their countries (i.e., UNGASS outcome document, Agenda 2030, WHA Resolution).
	Suggestions for implementation:
	• Implement advocacy workshops with representatives of national associations to empower representatives of civil society so that they adopt the skills to do effective advocacy campaigns and strategies.
	• National associations have the power and legitimacy to request and demand from their governments the implementation of the international policies and frameworks which call for the inclusion of palliative care in the national policies and programs, the strengthening of NCD programs, and the adoption of the SDGs in the Agenda 2030.
	• Work to set national standards in palliative care, including primary and specialist palliative education, and training and work with both governmental and nongovernmental stakeholders to develop a national palliative care strategy integrated into universal healthcare.

NCDs, noncommunicable diseases; SDGs, sustainable development goals; WHO, World Health Organization.