Findings are presented in two sections

status and content of online courses in palliative care, and participant evaluation. The first section consists of a presentation and description of the online courses, including a presentation of participants. The second section presents the findings from one online course (course i) that continuously evaluated the participants’ perceptions of the course.

Status and content of online courses in palliative care

Nine online courses in palliative care were identified, developed, and operated by five different organisations, i.e., palliative centres, regions, and/or foundations, all free of charge for participants and either government funded or funded by a non-profit organisation. Six courses focused on general palliative care (courses a, b, c, d, g, i – see Table 1), and three on specific aspects of palliative care, e.g., existential issues (e), pain relief (f), nutrition (h), of which one focused on specialised palliative care (f).

Access to all the online courses was free of charge, Table 1, but for some, the participants needed to create an account to gain eligibility, and one of the courses (b) targeted only healthcare professionals in a specific region. Depending on the professional’s employment, they were either given access to the course via a learning platform or received an invitation link from their manager requiring login and a specific password.

The estimated time needed to complete the courses varied from 40 to 270 min, Table 1. The target groups for the courses were defined as either all healthcare professionals caring for patients with palliative care needs, nurses and physicians in specialised palliative care, or professionals in nursing homes or home care. However, the courses were also described as being useful for other professionals in the palliative care team, e.g., physiotherapists. Knowledge tests after completing the courses were common, comprising from 10 to 20 questions with a variation in degree of difficulty. Passing and obtaining a certificate required the participant to give correct answers to 80% of the questions. In some tests, the same questions were repeated, while others used randomly selected questions from a question bank and the tests could be performed several times.

All the courses had been checked by interprofessional groups, including physicians, RNs, assistant nurses and/or social workers. Two providers stated that they made revisions to their courses on an ongoing basis. There were differences with regard to whether a course was evaluated by the user after completion and the data that was collected. Some did not collect any data, some collected statistics concerning the number of people who had completed the course, while others collected and evaluated information concerning the profession of the participant, and the numbers who started and completed the course, Table 2. Available data showed that RNs and assistant nurses were in the clear majority (74–87%). About half of the online education providers reported that, in the last two years, they had reduced and finally closed their course since resources for continuous updates were lacking or not prioritised.

One online education provider highlighted the need for a national consensus concerning the content and structure of palliative care education. Available online courses were described as “creating a scattered education catalogue across the country, where providers have different views about the content and the recipients have no idea which course meets their needs”. A single national education package in general palliative care was seen to have the potential to reduce the risk of conceptual confusion, knowledge variations, and to reflect local or regional variations due to structures and organisation controlling the content. Through this, the education could cover palliative care independent of geography, age, gender, and diagnosis.

One provider stated that they continuously used surveys for evaluation of the course, both at the start and after completion of the course. Two other education providers reported that they had evaluated their course irregularly or during specific time periods.

Participant evaluation

Analysis from the single education provider (i) that continuously collected evaluation data is presented below. The findings build on evaluations made between 2018 and 2021. In total, 23 063 persons completed the course, of whom 155 (0.67%) had answered the evaluation survey.

Quantitative evaluation

Eleven different professions had answered the survey with more than half of participants being assistant nurses, followed by registered nurses, occupational therapists, and physicians. Most participants worked in nursing homes, municipal home care, or home care. Over three quarters of the participants had previous experience in palliative care. The characteristics of the participants are presented in Table 3. Most participants had perceived the course as being easy to navigate, using an understandable language, being at the right level and relevant, Table 4.

Qualitative evaluation

Analysis of free text responses exhibited four themes: The set-up; Comprehending; Relevance; and Utilising.

The Set-up

includes participants’ perceptions of the content and structure of the online course. The form and structure, with self-study throughout, were perceived as suitable formats for learning. The time allowed to complete the course was considered too short by some who had spent more than the estimated time needed. Participants perceived that the online technique worked well overall, although some complications and technical problems were experienced, such as audio problems, navigation features not working, and problems with saving and returning to the right section. The flexibility, with options to choose how and where to attend the course, was appreciated. However, perceptions of being isolated in relation to the emotional impact of the subjects were described, and a need for discussion and reflection with others was mentioned.

It was good but I don’t think it’s a course that’s suitable for self-study. I wanted contact with others for conversations during the course, I was emotionally affected and thought a lot about private things. (no. 94)

Theoretical content in the course was perceived to be adequate and instructive, while the cases presented, and the palliative process were perceived as making it more understandable. Gender perspectives, age and religion were perceived to be reflected in the cases, but stereotypical gender roles existed where, for example, nurses were viewed as women and physicians as men. In addition, even though cultural aspects were acknowledged, an enhanced multicultural approach in the course material was requested.

Comprehending

consists of understanding the course, including the perceived level of the course, as well as aspects related to knowledge acquisition. In the comments on the level of the course, some described it as being at an appropriate level, others at a too advanced level, and some expressed a need for more in-depth knowledge. The provision of links and sources to more in-depth material was perceived as beneficial. The knowledge gained was seen as valuable for understanding one’s own abilities and to strengthen trust in one’s professional competence, even by those who had worked in palliative care for years.

I have worked for many years in palliative care, but for me it was a good repetition and proof that I think in the right way. (no. 95)

Participants’ perceptions of how easy it was to understand the content of the courses varied, with some experiencing it as being easy to understand while others expressed difficulties. Language barriers, such as not mastering the Swedish language fully in combination with some complex wording, were expressed. Presentations by different professionals in palliative care teams about their roles were perceived as supporting better comprehension of one’s own role, the roles and tasks of other professionals, as well as the relationships between different professional’s roles. This resulted in recognition of the value of the unique competence within healthcare teams. Taken together, participants expressed some variation in being able to comprehend and understand the content of the online course, including level, ease of use, and profession-specific values.

Relevance

includes the perceived relevance of the course concerning different professions, teamwork, and various healthcare settings. The importance of being relevant to different healthcare professionals and linking this to multi- and interprofessional teamwork was described. Perceptions regarding relevance, and the extent to which the professionals and contexts were depicted in relation to their own views, varied among participants.

The course was described overall as being applicable to multiple professionals and that “everyone involved in some kind of human care profession should complete it”. However, different healthcare professionals described not recognising their own professional role in palliative care. As one occupational therapist stated:

I didn’t recognise myself at all in the depiction of what an occupational therapist does. // If one wants everyone in the team to attend the course and feel involved, it is important to highlight everyone and everyone’s work! (no. 157)

The context (i.e., healthcare settings) included in the cases was described as too narrow and too in-patient focused. More variation regarding care environments and patient groups was requested. Having a team-based focus was perceived as ensuring the relevance of each professional’s importance in the team and the strength of teamwork in palliative care. Nevertheless, the perceptions of the amount of attention given to teamwork ranged from being sufficient to needing more clarity about how different professionals contribute to the team.

Utilising

includes participants’ perceived value of, and learning from, the online course. The focus was on knowledge gained and how to use it practically.

I have updated my knowledge, helping me do an even better job in the future. (no. 5)

The possibility for repetition and being able to go back, both during and after finishing the course, was described as supporting continuous professional development. Participants described a need for further knowledge about the palliative care approach and how to transform theoretical knowledge into practical skills through testing and practice. The course was described as reinforcing the importance of palliative care and that palliative care actions really matter.