Public Palliative Care Education (PPCE) Programmes for Children and Teenagers in Germany—A Narrative Review ()
1. Introduction
Dealing with dying, death and grief is one of the fundamental human experiences everyone has to encounter, many even already in childhood and adolescence. Unfortunately, these topics are often a taboo in the school context (Wegleitner et al., 2014). Public Palliative Care Education (PPCE) aims to empower the general population in dealing with dying, death and grief and to promote death literacy (Bollig & Rosenberg, 2023). Death literacy of the public is needed in order to enable them to engage in a compassionate community approach. For adults, there are different educational formats available including the widespread Last Aid Course (LAC) for adults that has been introduced in 23 countries worldwide (Bollig & Bauer, 2021; Seckin et al., 2025; Mills et al., 2023; Bollig et al., 2026). Internationally, LACs are considered as one example of a standardized and widespread PPCE format that is available in many countries. The longitudinal mixed-methods study by Bollig et al. (2025), showed that LAC not only impacts knowledge, but also can empower participants, reduce their fears of talking about death and dying, promote dialogical learning processes and strengthen their willingness to care for others. These factors are highly relevant for transferring to children’s and teenagers’ education programmes. Today there are mostly small-scale educational efforts for PPCE for children and teenagers introduced by hospice teams or other organisations in Germany. There are some programmes that explicitly integrate palliative care topics into school or other educational settings, including Hospiz macht Schule (Hospice goes to school), Endlich-Projekt (Finally-Project), Letzte Hilfe Kids & Teens (LAC-KT). These programmes build on specialist didactic works on dealing with death and dying by Nolden et al. (2018) and Wegleitner et al. (2014). Interestingly 84% of children and teenagers between 7 and 17 years had already experienced with death and dying before participating in an LAC-KT in a German multicenter study (Bollig et al., 2020a, 2020b, 2024). This indicates a need to talk openly about death, dying and grief with children and teenagers.
Aim of the study
The aim of this narrative review is to identify educational programmes for Public Palliative Care Education (PPCE) of children and teenagers that currently exist in Germany and to provide an overview of the existing literature on the topic. Another aim is to compare the contents of the existing educational programmes and to classify them using the theoretical categories described by Seckin et al. (2025). In addition, strategies for the future dissemination and research of PPCE for this group shall be discussed.
2. Methods
This narrative review is based on a topic-focused approach in order to provide a broad, context-sensitive overview of existing educational programmes on palliative care, dying, death and grief for children and teenagers from 6 to 18 years in Germany. The main focus is on an analytical synthesis of relevant sources that contribute to providing a broad picture on the research topic. Data collection, analysis and reporting are grounded on the recommendations for narrative literature reviews by Green et al. (2001).
The literature search was iterative, broad in scope and topic-driven, as is typical for narrative reviews. It included:
PubMed search with term combinations such as “public palliative care education”, “palliative care education”, “school”, “children”, “adolescents”, “youth”, “Germany”, “Last Aid”
Targeted search for specific programme names (e.g. “Hospiz Goes to School”, “Finally-Project”, “LAC-KT”)
Hand-searching and evaluation of grey literature (project websites, manuals, evaluation reports, publication lists)
Inclusion criteria
Literature, written reports and books on educational Programmes or teaching concepts with explicit reference to dying, death, grief and palliative care were included if:
Exclusion criteria
Analysis
The analysis consisted of a multi-stage process. All authors agreed on an analysis procedure, which was then applied to all included sources. The evaluation was carried out in two steps. The first step included the review of all programmes and descriptions of their contents. All identified programmes were described in terms of target group, context, content, methods and degree of implementation. The second step was a category-guided analysis based on the six main topic categories of PPCE research according to Seckin et al. (2025). Table 1 provides an overview of the main topics.
Table 1. Six main topics for education and training in Palliative Care for citizens and volunteers.
1) Supporting Caregivers & Families 2) End-of-Life Practice 3) Symptom Management & Comfort Care 4) Planning & Preparation for End-of-Life Care 5) Communication & Decision making skills 6) Introductions to palliative Care & End-of-life-Care Philosophies |
3. Results
The results are shown in two parts: This first part presents the main findings from the literature search. The findings are then discussed in the second part with reference to Seckin et al. (2025).
3.1. Main Results
In this study, three specific programmes for children and teenagers could be identified and are described in more detail below: Hospice Goes to School, the Finally-Project, and Last Aid Course for Kids and Teens (LAC-KT).
Hospice Goes to School: One of the best-known and most frequently used programmes for dealing with dying, death, and grief among elementary school children is Hospice Goes to School, described by the Hospice Movement Düren Jülich (2022). It is carried out nationwide by outpatient hospice services in cooperation with elementary schools for children from the 3rd and 4th grade (aged 8 - 10 years). This program was started in 2007. The program comprises a project with five school days with thematic focuses such as life and death, illness, grief, consolation and rituals. The working methods include group discussions, creative methods (painting, crafts, role-playing), conversations and reflections. Facilitators can be hospice employees or volunteers. The objective of the course is defined as follows: To reduce children’s fear of dying, death and grief, to encourage children to engage with this topic and talk open about it. This may contribute to bringing about a change in community with regard to the acceptance of dying and death.
The Finally-Project is a concept for secondary school pupils, aged 15 years and older, in which the topics of dying, death, grief and palliative care are taught in an age-appropriate manner. To implement the Finally-Project, facilitators are trained, who may be teachers, hospice volunteers, or hospice coordinators. A special feature of the Finally-Project is an optional module on the topic of suicide. This topic has been included due to the demand of the participants. The programme uses different methods aimed at encouraging participants to engage in dialogue and to get to know local networks. Another key component is a presentation on palliative and hospice care structures and on the topics of grief and suicide. Creative activities, role-playing, and videos may also be used. The concept is theoretically sound and practice-oriented but has so far only been published in a book (Nolden et al., 2018).
The Last Aid Course-Kids and Teens: (LAC-KT) is an adaptation of the internationally established LAC for adults, adapted and tailored to the needs of children and teenagers. The LAC-KT provides basic knowledge about dying, death, saying goodbye, grief, and ways to support seriously ill people in their environment. The course aims to enable participants to deal with dying and grieving people. The LAC-KT aims to improve the communication skills of children and teenagers and to strengthen their rights as children and teenagers in relation to grief. In addition, breaking the taboo surrounding dying and death and teaching practical skills is of fundamental importance, because many people want to do something. The following methods are used to achieve the above goals: interactive modules, group work, role-playing, groups discussions; practical and creative exercises. The experiences from the first pilot courses starting in Germany in 2018 showed that the LAC-KT was feasible and very much appreciated by the participating children and teenagers (Bollig et al., 2020a, 2020b) The first German multicenter study (Bollig et al., 2024) showed positive effects on knowledge, self-efficacy, and openness in dealing with dying and death.
The promotion of caring communities is of significant relevance for all the programmes. In order to make the three programmes easier comparable the descriptions and main characteristics of the three programmes are presented in Table 2.
Table 2. Descriptions and main characteristics of the education programmes for children and teenagers.
Programme |
Target group |
Location |
Duration |
Methods |
Publication |
Hospice Goes to School |
Children aged 8 - 10 |
school |
5 school days |
group discussions creative methods (painting, crafts,
role-playing) conversations and reflection |
Hospice Movement Düren Jülich (2022) |
Finally-Project |
Teenager aged 15 and older |
school |
2 school days + e.g. 1 extra school day (about suicide) |
group discussions creative methods
(role-playing) conversations and reflection videos presentations dialog |
Nolden et al. (2018) |
LAC-KT |
Children and teenager aged 8 - 18 |
school clubs community centres etc. |
4 teaching-hours (45 minutes each) |
group discussions creative methods (painting, crafts,) conversations and reflection interactive modules practical and creative exercises |
Bollig et al. (2020a, 2020b, 2024) |
3.2. Category-Specific Analysis Based on Seckin et al. (2025)
The analysis of the three main existing programmes in Germany was carried out using the six main topics according to Seckin et al. (2025). An overview is provided in Table 3. Seckin et al. first topic “Introduction to palliative Care & End-of-life Philosophies” includes providing information about hospice and palliative care philosophies to promote understanding of the needs of people who require palliative care and end-of-life care. This includes providing information about hospice and palliative care philosophies to promote understanding of the needs of people who require palliative care and end-of-life care. Seckin et al. (2025) emphasize the importance of understanding the underlying values, knowledge and perspectives in order to give carers and volunteers an understanding of what they can do and where they can find further help to support life-limiting illness. The topic ‘Communication & Decision-Making’ aims to equip the public and volunteers with the skills to conduct sensitive conversations and support informed decision-making. The relevance of effective (verbal and non-verbal) communication is underlined in order to provide comfort for people at the end of life and to understand the needs of those affected. In the topic “Planning and preparation for End-of-life care”, Seckin et al. (2025) discuss the guidance on preparing for end-of-life care and also the importance of advance care planning and the relevance of involving social and community networks. The category “Symptom Management & Comfort Care” covers the teaching of knowledge for recognising and alleviating distressing symptoms, as well as practical guidance on symptom management and maintaining comfort and dignity for patients. According to Seckin et al. the role of touch and connection is important in education for relatives. The topic ‘End-of-life practise’ encompasses cultural and religious aspects as well as an understanding of different practices related to death and dying. Support for patients and their relatives is provided with consideration for cultural rituals and last wishes. Preparing for one’s own death is an essential part of personal and emotional preparation for once own death. It includes guidance on dealing with unfinished business and coping emotionally with the impending loss. For ‘Supporting caregivers and families’ in addition to caring for and recognising the emotional, practical and spiritual needs of carers, promoting self-care and emotional resilience among carers is also relevant. In addition, emotional support and grief counselling for families and friends, understanding grief reactions, and ongoing support during the grieving process are essential. Seckin et al. introduce a further seventh category that maybe applied when comparing different nations. They present the topic “Legal & Ethical Considerations” separately to highlight as a framework for national policies and cultural norms.
The three included programmes correspond to varying degrees to the six topics according to Seckin et al. (2025). The different topics are addressed in varying depth. That has been categorized as included or partially included in the above Table 3. The classification is based on the content, methodology and practical implementation of the topics according to Seckin et al. (2025) in the programmes. The terms “included” and “partially included” have been used to transparently indicate the extent to which each PPCE topic is covered in terms of content, methodology and practical implementation. ‘Included’ means that a topic is covered comprehensively in terms of content, supported by targeted teaching methods and, where appropriate, supplemented by practical components. “Partially included” means that a topic is covered only in reduced depth, with limited methodological support or without practical application. This structured differentiation captures the pedagogical and thematic variability of the programmes and provides a consistent framework for interpreting their coverage of PPCE topics. This differentiated assessment enables a transparent, comprehensible representation of the programmatic differences and reflects the varying priorities of the three programmes. Only the LAC-KT includes all six main topics fully. Table 3 shows that all programmes use the topics “Introduction to palliative Cre & End-of-life Care Philosophies” and “Supporting Caregivers & Families”. The differences can be demonstrated by partially applying the topics “Communication & Decision Making Skills”, “Planning & Preparation for End-of-Life Care” and “Symptommanagement & Comfort Care”. It was found that the programmes differ in terms of teaching practical skills. This topic is according to the existing descriptions in the literature only discussed and taught as part of the LAC-KT course.
Table 3. Analysis of the German PPCE programmes based on the six main topics from Seckin et al. (2025).
PPCE Programme |
Hospice Goes to School |
Finally-Project |
LAC-KT |
Introduction to Palliative Care & End-of -Life Care Philosophies |
included |
included |
included |
Communication & Decision-Making Skills |
partially included |
included |
included |
Planning & Preparation for End-of-Life Care |
partially included |
partially included |
included |
Symptom Management & Com-fort Care |
partially included |
partially included |
included |
End-of-Life Practise |
partially included |
partially included |
included |
Supporting Caregivers & Families |
included |
included |
included |
4. Discussion
The analysis of the literature and other sources that were included in this review shows that the PPCE programmes implemented in Germany all contain elements of the main topics according to Seckin et al. (2025). All programmes take into account the teaching of knowledge in the field of Palliative Care & End-of-Life Care philosophies. Discrepancies can be observed in the methods used depending on the age of the target group. Each of the programmes examined aims to promote communication skills in relation to the topics of dying, death, and grief. A key feature of all programmes is that they aim to support participants tailored with the target group. A key distinguishing feature is that, with regard to planning and preparing for end-of-life care, only the LAC-KT program promotes active engagement with the topic. Differences can also be observed in relation to the seventh topic “ethical decision-making”. Although the Finally-project includes certain elements of this topic, LAC-KT actively encourages engagement with it. There are significant differences between the programs in terms of target groups and implementation in different locations. As part of the Finally-Project and Hospice Goes to School, the measures are implemented in traditional school settings. In contrast, LAC-KT measures are implemented both in schools and in alternative locations, such as community centres, churches and clubs. Reaching children and teenagers in different social contexts is achieved through the use of extracurricular facilities. The various locations serve as gateways to alternative social spaces and generate a new group of participants through new networks. The effects of the courses correspond to the principles of social space orientation. This is consistent with the study by Bollig et al. (2025), which provides important insights into why PPCE formats are effective: course instructors report empowerment effects, a reduction in reservations, the importance of dialogue-oriented learning settings and a strengthening of the willingness to care. LACs thus have an impact on the social environment (Bollig et al., 2025). It can therefore be assumed that this also applies to LAC-KT. International findings suggest that practical caregiving skills and community-based approaches are often underrepresented in PPCE programs (Seckin et al., 2025). The search conducted in PubMed revealed that only a small amount of evidence regarding the programs available in Germany could be found via scientific databases. Only data on LAC-KT are available in a structured form in scientific databases (Bollig et al., 2020a, 2020b). The analysis based on Seckin et al. (2025) topics emphasizes the relevance of reviewing and, if necessary, adapting existing programmes in line with the educational contents that are most relevant for PCCE.
The literature on Last Aid already discusses such network and community effects, but so far mainly in the adult context (Bollig et al., 2025). The findings of our narrative review form an important basis for the further development of German programmes. As agenda for future development of practice and research on the topic we need mixed-methods evaluations on attitudes and knowledge about the topic in general, longitudinal studies on child- and youth-related outcomes and effects, implementation research on curricular anchoring and a greater consideration of community engagement and practical care skills. A consistent transfer to the context of children and teenagers represents a key research desideratum.
Limitations and strengths
This study is designed as a narrative review, with a search strategy that is deliberately topic-focused rather than systematic in the sense of a systematic review. This may potentially lead to an increased risk of selection and publication bias. The PubMed databases and additional grey literature were used for this study. A systematic search of other databases was not carried out. As a result, relevant programmes or studies may have been overlooked.
The search carried out in PubMed revealed a formal evaluation for the LAC-KT programme. In contrast, no published studies could be identified for the Hospice Goes to School and Finally-Project programmes.
Conclusions are therefore based mainly on concept descriptions, practice reports and grey literature and allow only limited conclusions to be drawn regarding effectiveness. The focus on programmes in Germany was chosen because they have been in development for a comparatively longer period of time and therefore the greatest amount of evidence was to be expected. International PPCE programmes for children and young people were deliberately excluded from the analysis. A systematic international comparison of programmes and approaches was neither the aim nor the subject of the review. As LAC-KT is the only programme with existing scientific publications on its evaluation, there is a risk of positive bias in the presentation and interpretation of the results.
No formalised quality assessment of the included studies or materials was carried out, meaning that the significance of the available evidence – particularly regarding the effectiveness of LAC-KT – can only be assessed to a limited extent.
The classification of programmes according to the categories defined by Seckin et al. (2025) is based on content, without a standardised rating procedure, which limits the objectivity of the classifications.
A strength of the paper is, that one of the authors (KG) has practical expertise in all three course formats, while another (SMK) has extensive experience in running Hospice Goes to School and LAC-KT courses. All three authors have extensive knowledge of how to run LAC-KT courses and PPCE for children and teenagers in different settings.
The review identifies and describes three key German programmes (Hospice Goes to School, Finally-Project, LAC-K) and thus offers the first comprehensive overview of PPCE programmes for 6 - 18-year-olds. The differentiated presentation of the target groups, settings, methods and objectives of the programmes provides a practical picture of the current landscape that can be used by schools, hospice organisations and policymakers.
5. Conclusion
With Hospice Goes to School, Finally-Project and LAC-KT, Germany has a relevant core of PPCE programmes for children and teenagers. These programmes are well established in practice, but there is a lack of systematic scientific evaluation that would allow reliable statements to be made about their effectiveness and sustainability.
The study by Bollig et al. (2025) highlights the potential of PPCE formats for strengthening death literacy, willingness to care and social support. Future research is needed on mixed-methods evaluations on attitudes and knowledge about the topic in general, longitudinal studies on child- and youth-related outcomes and effects, implementation research on curricular anchoring and a greater consideration of community engagement and practical care skills. Including the research perspective is crucial for strengthening the implementation of PPCE programmes for children and teenagers, their sustainability and further expanding their role in a hospice and palliative care education culture.