Author: Dr. S.A.S.S.Dilankani, National Cancer Institute , Sri Lanka
Pediatric palliative care (PPC) is an emerging yet critical component of child health in Sri Lanka. Despite notable achievements in reducing child mortality, recorded at 6.8 per 1,000 live births in 2024, many children with cancer, congenital conditions, and neurological disorders still face preventable suffering. It is estimated that nearly 34,000 children across the country require some form of palliative care each year, but fewer than 1% currently access these essential services.
In this context, a landmark workshop titled “Spreading Awareness for Holistic Palliative Care” was held on 9 June 2025 at the National Cancer Institute, Sri Lanka (NCISL). Organized in collaboration with the Sri Lanka College of Oncologists and the Sri Lanka College of Paediatricians, the workshop aimed to empower frontline professionals in pediatric oncology and palliative care. The event featured global PPC experts Dr. Megan Doherty, Program Director of Pediatric Palliative Care at Two Worlds Cancer Collaboration and Children’s Hospital of Eastern Ontario, and Assistant Professor at the University of Ottawa, Canada; and Dr. Gayatri Palat, Professor and Head of the Department of Pain and Palliative Medicine at MNJ Institute of Oncology, Hyderabad, and Consultant at Two Worlds Cancer Collaboration. Their insights and mentorship helped catalyze a broader vision for palliative care integration in the country.
At NCISL the nation’s only specialized center for pediatric oncology approximately 1,200 new pediatric cancer patients are registered annually. However, despite the evident need for supportive and palliative care, fewer than 5% of these children are currently referred to palliative care services. This significant gap is largely due to limited awareness and the lack of formal pediatric palliative care (PPC) pathways. As a result, many children experience unnecessary suffering, while families are left emotionally burdened and unsupported during the most challenging phases of illness.
While recent advancements such as the establishment of Suwa Arana, Sri Lanka’s first dedicated pediatric palliative care (PPC) hospice represent important progress, the national PPC landscape remains highly centralized and insufficiently resourced. Access to specialized pediatric services is largely limited to urban centers, leaving many children in outlying regions without appropriate care. Additionally, current education and training frameworks are predominantly oriented toward adult palliative care, with a notable absence of pediatric-specific modules in both undergraduate and postgraduate curricula. This highlights an urgent need for comprehensive capacity building, the development of pediatric-focused training programs, and sustained efforts to raise awareness among healthcare professionals, policymakers, and the public about the unique needs of children requiring palliative care.
A total of 97 doctors and nurses involved in pediatric oncology services at NCISL participated in the workshop. This included four Consultant Pediatric Oncologists, 36% postgraduate
trainee doctors (MD Oncology and Diploma in Palliative Medicine), 26% Medical Officers working in pediatric oncology wards, and 34% nurses involved in pediatric oncology and pain management.
The workshop was carefully designed to enrich both the clinical skills and emotional resilience of participants. The goals included equipping healthcare professionals with the ability to explain the value of PPC to families and colleagues, identify appropriate timings for initiation or referral of palliative care, breaking serious news compassionately, manage pain and breathlessness effectively, recognize imminent death, and implement suitable end-of-life care. Emphasis was also placed on building self-awareness, resilience, and the prevention of burnout among providers.
The program featured a dynamic blend of lectures, case-based panel discussions, role plays and interactive activities. Dr. Megan Doherty and Dr. Gayatri Palat led foundational sessions on early PPC integration and holistic assessment. Live role plays demonstrated sensitive communication techniques, supported by the local NCISL palliative care team.
Real-life case scenarios discussed during the panel sessions covered pain management, breathlessness, and end-of-life care. These practical sessions emphasized how to identify futile, high-intensity interventions and replace them with more compassionate, goal-aligned care strategies. The inclusion of group activities such as the “tear water lily” and self-care planning further allowed participants to reflect on their own emotional needs and stress management strategies.
To evaluate the effectiveness of the workshop, pre- and post-assessment surveys were conducted. These assessed both knowledge and attitudinal shifts.
The findings demonstrated a clear improvement in knowledge, with mean scores increasing from 6.18 to 7.31. While the attitudinal items also show statistically significant change, positive shifts were noted in participants’ confidence in starting morphine, communicating prognosis, and caring for children at end-of-life. This explains the potential of such workshops to initiate meaningful change, even as longer-term interventions and mentorship are needed to sustain progress.
The involvement of international experts provided not only academic enrichment but also inspiration and validation for local practitioners. The cultural and clinical similarities between India and Sri Lanka made the lessons from Dr. Palat and Dr. Doherty especially relevant. Their mentorship, humility, and accessibility left a strong impression on participants, many of whom expressed a renewed commitment to improving pediatric palliative care in their practice settings.
This workshop represented a significant milestone in Sri Lanka’s progress toward establishing comprehensive pediatric palliative care (PPC). To build on this momentum, several strategic actions are essential. These include the formulation of a national PPC policy, the integration of PPC into existing healthcare frameworks, the development of specialized pediatric training modules for all levels of healthcare providers, and the establishment of multidisciplinary palliative care teams within both tertiary and secondary care institutions. These measures are critical to ensuring equitable, high-quality palliative care for all children in need across the country.
The Pediatric Palliative Care Workshop held on 9 June 2025 was a truly transformative event seamlessly combining clinical learning with emotional insight and a shared vision for the future. It demonstrated the profound potential of compassion, commitment, and cross-border collaboration in shaping better care for children.
With this strong foundation now in place, the time has come to nurture and expand pediatric palliative care in Sri Lanka ensuring that every child facing serious illness receives the dignity, comfort, and support they deserve.
Together, let us work toward a future where no child suffers in silence, and every healthcare provider is equipped and empowered to deliver compassionate, holistic care.
Excellent article on a very important workshop. Wish pediatric palliative care I’m my country will improve much with the knowledge and skills gained in the workshop.