Doctors, nurses, and medical students in the Netherlands feel uncertain about providing palliative care and say their training falls short, a new survey shows, raising concerns that patients may not always receive appropriate care in their final phase of life, Trouw reported.

The survey of 450 health care providers and medical students, conducted by foundation Carend and publisher Compendium Geneeskunde, found that more than half of respondents gave the education on end-of-life care a failing grade. Among professionals who had provided palliative care, 79 percent said they felt uncertain while doing so.

Pulmonologist Sander de Hosson, who founded Carend several years ago to improve knowledge of palliative care, called the findings familiar. “I see many medical students who say, ‘Palliative care? We had nothing about that.’ It is a substantial part of my work as a pulmonologist. It is almost half of my profession, I would say.”

De Hosson said current training focuses mainly on medical procedures. “It’s about morphine, pain control, and euthanasia. But palliative care is also about discussing with the patient in time what he or she finds important.”

The Dutch Health Care Authority recently reached a similar conclusion, noting that care in the final phase of life is not always appropriate. Patients sometimes receive treatments that do more harm than good and ultimately die in the emergency department rather than peacefully at home. Discussing wishes and needs early can help prevent that, the authority said.

Survey respondents identified communication as the hardest part of palliative care. “Communication was often mentioned,” De Hosson said. “How do I talk to a dying patient and with the family? Those are often intensely emotional situations that require more than medical knowledge.”

Such conversations frequently involve whether to stop treatment — a difficult decision for doctors, De Hosson said. “We all need to pay more attention to that, although it is, of course, terribly difficult to determine that moment. Maybe we can still try that chemo, is often the thought, because that might still yield quality or extension of life.”

Patients in their final months, weeks, or days also wrestle with questions of meaning that caregivers sometimes struggle to address, De Hosson added. In his practice, the issue often comes down to one question: how to still give color to life at the end.

“It literally concerns the meaning of life; people can get stuck there. They start re-evaluating, looking back: Did I do it right? Was I a good person? If you run past that and only give painkillers, then that is not complete care.”

De Hosson noted that the Netherlands performs relatively well in end-of-life care compared with other countries. “But I certainly think it can be better,” he said. “The deeper layer underneath is that medicine—the word says it all—is completely focused on curing. While much of what we do is actually about alleviating suffering.”