Trends in Palliative Care Research 2024; Issue #04

Commentary By:

Joanna Humphreys – The Quality of Life and Advanced Care Team at McMaster Children’s Hospital, McMaster University, Ontario, Canada – I am a pediatric palliative care physician with a clinical and research interest in children’s grief.

Feature Article

Bollig, G., Gräf, K., Gruna, H., Drexler, D., & Pothmann, R. (2024). “We Want to Talk about Death, Dying and Grief and to Learn about End-of-Life Care”-Lessons Learned from a Multi-Center Mixed-Methods Study on Last Aid Courses for Kids and Teens. Children, 11(2).


Dr. Georg Bollig’s article on Last Aid education for Kids and Teens stood out to me as I am currently analyzing a research study on children’s grief and I am passionate about involving youth in important conversations about death, dying and grief. The article pulled me in as it described an effective intervention to support death literacy for youth in our society.
This is Bollig and colleagues second paper on Last Aid for Kids and Teen (LAC-KT), after publishing their pilot study in 2020[1]. This paper describes the intervention and results of the youth’s experience of the course. Bollig published his original work on Last Aid Course (LAC) in 2019 [2] after the course was established in 2015. LAC for adults is currently taught in 21 countries across the world with the goal of increasing death literacy and creating compassionate communities where the skills of caring for people at end of life are valued.
LAC-KT was developed with an international working group based on the adult LAC. They studied almost 3000 youth aged 8 to 17 who participated in LAC-KT across Germany. The 4-hour course was delivered in person by two trained facilitators in different community organizations including schools, churches and community centers. The course is taught in four modules 1) Dying as a normal part of life 2) Planning ahead 3) Relieving suffering and 4) Practical goodbyes. LAC-KT employs a variety of tools, including videos and interactive activities, to facilitate discussions surrounding common issues and symptoms encountered at the end of life. It aims to provide guidance on caring for individuals in their final stages and encourages reflection on emotions and the grieving process.
They used a mixed method approach to evaluate the program. The youth were asked to fill in a questionnaire while the instructors views were investigated through focus groups. The team analyzed 2534 questionnaires and 22 instructors participated in focus groups.
84% of the youth responded that they had lost someone important in their life. This statistic alone highlights the importance of grief and death literacy in childhood. 91% of participants thought the course was helpful for everyone and 93% learned something new.
The instructors reported that kids and teens appreciated being able to talk about death, dying and grief. The activities and playful tools were thought to be a highlight of the program. For example, painting a rock as a ritual after death, highlighted the importance of the creative examination of death and dying. The instructors reported that parents and teachers questioned the appropriateness of talking to children about death, dying and grief, while the youth questionnaire results suggest otherwise. Unfortunately, there is no assessment of the effects of LAC-KT beyond intervention, but I hope the research team can learn more as the program expands.
This is the first multi center study showing education on death and dying in feasible, acceptable and that children find it helpful. The results highlight that is does not make sense not to talk to youth about death and dying to try to protect them.
I see this form of protection in my work, life and in society. When I engage with patients, siblings and children outside of work, I find they are open to talking about death, dying and illness and have interesting perspectives. Unfortunately, many have misconceptions, especially when death and illness are not discussed in their homes and communities. I worry that death phobia and avoidance of talking about serious illness in society is growing and is having an impact on youth. I hope death literacy can be enveloped into our current push for mental health support for youth. If 84% of children have experienced the death of someone in their lives, we need to worry about its impact on their mental health.

One group of youth that stands out to me when I think of this intervention is children who have a sibling, parent or close relative with a serious illness. I wonder if arming this group of youth with theoretical knowledge about death and dying and the ability to learn skills to help a person with a serious illness will aid their grief journey. Such preparation may also foster greater engagement and processing of the illness journey. The impact of the intervention on the child’s journey through their person’s illness and death, could be further investigated and shed light onto the benefits of LAC-KT beyond the initial intervention.
LAC-KT seems like an ideal public health intervention to increase death literacy and start conversations with kids and teen about death, dying and illness. If you are as interested as I was after reading this article, visit to learn more.

  1. Bollig, G.; Mainzer, K.; Fiedler, H.; Pothmann, R. The last aid course for kids and teens from 8–14 years: -preliminary results from the first pilot test. Hosp. Palliat. Med. Int. J. 2020, 4, 1–3.
  2. Bollig, G.; Brandt, F.; Ciurlionis, M.; Knopf, B. Last Aid Course. An Education For All Citizens and an Ingredient of Compassionate Communities. Healthcare 2019, 7, 19.

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