Author: Rachel Neufeld, NP(F), CHPCN, MN Canuck Place Children’s Hospice, Two Worlds Cancer Collaboration and Dr Md Shaidur Rahman, Pediatrician and Pediatric Palliative Physician from Dhaka Medical College Hospital, Dhaka, Bangladesh
Background
Globally, 98% of children requiring palliative care reside in low- and middle-income countries, where access to services and resources is severely limited. The World Health Organization (WHO, 2025) estimates that 56.8 million people, including 25.7 million in their final year of life, need palliative care annually, yet only 14% receive it. At least 7% of these individuals are children (Global Atlas, 2020). In Bangladesh, approximately 220,000 children require pediatric palliative care (PPC) each year, but only around 4,000 access it (Smith S et al., 2022). With an estimated 110,000 annual deaths among children under 15, the need for PPC is critical.
While Bangladesh has an established adult palliative care system based in Dhaka, PPC remains an emerging specialty requiring support, development, and greater awareness. To address this gap, a four-day train-the-trainer workshop was conducted in Dhaka through collaboration with regional champions, local experts trained through Two Worlds Cancer Collaboration (TWCC) fellowships, and Dhaka Medical College Hospital (DMCH).
Workshop Objectives
The workshop aimed to train multidisciplinary healthcare providers from diverse regions of Bangladesh who are interested in or currently integrating PPC into their practice. Participants were equipped with essential PPC principles and effective teaching methods to facilitate program development in their local institutions. The long-term goal is to establish DMCH as a center of excellence (hub) for PPC, with trained providers creating shared-care centers (spokes) to expand knowledge and practice across the country.
Participant Selection
A multidisciplinary cohort of 33 healthcare providers, including physicians, nurses, and allied health professionals, was recruited from various care centers across Bangladesh. Participants were selected based on their prior experience and interest in PPC, as well as their leadership potential to drive implementation in their institutions. Pre-workshop surveys assessed baseline knowledge and awareness to tailor the training effectively.
Faculty Engagement
The workshop was facilitated by two faculty members from TWCC (Canada and Nepal) and local experts from DMCH and Bangladesh Medical University. Emphasis was placed on local leadership, with Bangladeshi faculty playing a central role in program delivery. A dedicated team provided administrative and logistical support to ensure smooth execution.
Workshop Agenda
The program commenced on April 19, 2025, with an inaugural ceremony attended by distinguished professors from DMCH, underscoring the importance of advancing PPC in Bangladesh. The four-day workshop combined didactic lectures, interactive demonstrations, panel discussions, small-group activities, role-playing exercises, case studies, and participant-driven projects.
Day 1
- Introduction to PPC: Communicating its significance to families and colleagues
- Holistic assessment using the PESST model
- Managing symptom burden
- Respiratory symptom management
- Panel discussion: Challenges and opportunities in PPC program development
Day 2
- Pain assessment and management, including procedural pain
- Gastrointestinal symptoms and treatment approaches
- Essential communication techniques
Day 3
- Breaking bad news: Applying the SPIKES model
- Neurological symptom management
- Communicating with children: Understanding illness through play therapy
- Psychosocial support for families coping with illness
- Discharge planning for home care transitions
Day 4
- End-of-life care: Best practices and management strategies
- Interactive teaching methodologies
- Next steps: Using effort matrices to guide future PPC expansion
Post-Workshop Assessment and Follow-Up
Participants completed post-workshop surveys to evaluate knowledge gains and received certificates of completion. To foster ongoing collaboration and mentorship, a WhatsApp group was established, enabling continuous learning, discussion, and resource sharing among participants.
Outcomes and Feedback
Feedback from participants highlighted actionable short- and long-term strategies for applying their learnings. Many expressed enthusiasms for educating their local teams, advocating for expanded PPC services, and addressing gaps in care delivery. The workshop successfully fostered a committed network of professionals poised to drive PPC progress across Bangladesh.
Conclusion
The train-the-trainer workshop, the result of months of preparation, including curriculum design, participant selection, logistical organization, and faculty coordination, marks a significant milestone in strengthening PPC in Bangladesh. By equipping a diverse cohort of healthcare providers with clinical and teaching skills, the initiative lays the foundation for a sustainable, scalable PPC network. Continued investment in training, resources, and advocacy will be essential to bridge the gap between the 220,000 children needing PPC and the 4,000 currently receiving it, ultimately improving the quality of life for Bangladesh’s most vulnerable patients.
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