JOURNAL OF PALLIATIVE MEDICINE

Volume 0, Number 0, 2023 Original Article

ª Mary Ann Liebert, Inc.
DOI: 10.1089/jpm.2023.0399

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Core Palliative Care Research Competencies

Framework for Palliative Care Clinicians

Daniela Mosoiu, MD, PhD,1,2 Sheila Payne, PhD,3 Oana Predoiu, MS,2 Maria Arantzamendi, PhD,4,5
Julie Ling, PhD,6 Aliki Tserkezoglou, MD, PhD,7 Nicoleta Mitrea, APRN, MS, PhD, FAAN,1,2
Mary Dionisi, MS,7 Marina Martı́nez, PhD,5,8 Stephen Mason, PhD,9
Camelia Ancuta, APRN, MS, PhD’s,2 and Carlos Centeno, MD, PhD4,5

Abstract
Background: Understanding the principles and practice of research by health care professionals helps to
improve the evidence base for palliative care practice and service delivery. Research is a core competency
in palliative care that enables the identification and addressing of problems for patients and their families,
establishes best practice and improves ways to manage pain, other symptoms, and concerns. This work was
undertaken in the research for all palliative care clinicians (RESPACC) Erasmus+ project.
Aim: To identify and develop a set of core research competencies within a structured framework for all
members of the multidisciplinary palliative team.
Design: A multi-method approach was used including rapid review of literature, Nominal Group Technique,
and expert consultation. A quiz to self-assess research competencies outlined within the Framework was
produced.
Results: The Framework includes 17 competencies organized in 7 domains: The clinical context, Scientific
thinking and research design, Ethics and regulatory framework for research, Study and site management, Data
management and informatics, Communication and relationships, and Research leadership. In the consultation
process 6 of the 17 competencies were considered as required by each individual team member, and 3 to be
present within the palliative care team.
Conclusion: Using a multi-method approach, the first Palliative Care Research Framework identifying core
research competencies for palliative care clinicians has been developed. The aim of the framework was not to
transform palliative care clinicians into researchers, but to ensure that clinicians understand the important role
of research and its integration into clinical practice.

Keywords: competency; EAPC; framework; palliative care; research

1
Faculty of Medicine, Transilvania University, Brasov, Romania.
2
HOSPICE Casa Sperantei, Education and National Development Department, Brasov, Romania.
3
International Observatory on End-of-Life Care, Faculty of Health and Medicine, Lancaster University, Lancaster, United Kingdom.
4
Institute for Culture and Society, ATLANTES Global Observatory of Palliative Care, University of Navarra, Pamplona (Navarra),
Spain.
5
Navarra Medical Research Institute (IdiSNA).
6
European Association for Palliative, Head Office team Department, Vilvoorde, Belgium.
7
‘‘Galilee’’ Palliative Care Unit, Senior Management Team, Athens, Greece.
8
Clinica Universidad de Navarra, Department of Palliative Medicine, Pamplona (Navarra), Spain.
9
Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom.
Accepted October 30, 2023.

1
2 MOSOIU ET AL.
What Is Already Known About the Topic?
There are existing frameworks describing research com-
petences for dedicated research staff but none specifically for
clinicians working in palliative care.
There are no defined core research competencies for cli-
nicians in the palliative care multidisciplinary team that
would enable them to conduct small scale research studies
and integrate the results in their daily practice.
What This Paper Adds
This is the first purposefully developed framework with
core research competencies for palliative care clinicians.
We identified 17 core competencies organized within 7
domains.
A practical self-assessment quiz has been developed to
enable clinicians to identify their current level of competence
and their learning needs.
Implications for Practice, Theory, or Policy
The Framework can be used by clinicians working in
palliative care settings to improve their understanding of
research.
Further study is needed to understand how the Framework
can increase research knowledge and skills in clinicians.
Introduction
H ealth research has made a fundamental contribution
to health and wellbeing over the past 50 years. Well-
directed, high-quality research can answer important ques-
tions and provide evidence to inform decisions in clinical
practice and policy development. Despite this, clinical
decision-making remains insufficiently informed by reliable
evidence, and often the available research evidence is not
methodologically robust. Despite many clinicians recogniz-
ing the importance of implementing research findings into
clinical practice, a systematic review conducted in 20161
indicated that many nurses reported feeling unable to effec-
tively read and understand research findings. This led to a
lower engagement with research. A reluctance to utilize and
implement research findings can lead to an over-reliance on
other informal sources of information such as colleagues.2,3
Despite these issues, a better basic understanding of research
by health care professionals may help to improve the
evidence-base for palliative care practice and enhance ser-
vice delivery.
Palliative care, best provided by a multidisciplinary team,
involves the collaboration of a range of different health and
social care professionals. Each professional group has ex-
plicitly advanced competencies and can make specific con-
tributions; however, a multidisciplinary approach provides
the opportunity to offer care with commonly shared values,
processes, and practice.
Even in countries where palliative care is well established,
for example, the United Kingdom, palliative care research
receives <0.3% of funds compared with funding for cancer or
noncancer diseases and research capacity is low.4 Further-
more, research is a core competency because palliative care
aims to alleviate or reduce human suffering at end of life both
for patients and their families. To achieve this, sound re-
search is needed to answer numerous questions in clinical,
educational, and policy fields (such as what interventions
work best in all four domains of total pain? how do we in-
tegrate both patients and family voices in care and how do we
respond to their needs?).
The following working definition for research competence
for clinicians was agreed by the authors: Research compe-
tence is the ability to demonstrate the application of knowl-
edge, understanding, and practical and thinking skills to
achieve effective performance in clinical research, as a cli-
nician and not as a professional researcher.5 Through the lens
of this definition, palliative care clinicians need to acquire
competencies related to both research literacy and also de-
velop skills in conceptualizing and running small-scale re-
search projects (research skills). These skills are needed as
they have to implement research results not generated in their
own culture, which is recognized as a challenge for culturally
appropriate provision of palliative.6 PC clinicians need also
to critically assess how specific interventions work in their
own setting, generate their own research questions, and in
maybe test them in small pilot projects.
Research for all palliative care clinicians project
The project Research for all palliative care clinicians
(RESPACC) (Ref. no. 2020-1-RO01-KA202-080128) is a
2-year Erasmus + international project bringing together
clinicians, educators, and researchers from the European
Association for Palliative Care (EAPC) Belgium, University
of Navarra Spain, Galilee Palliative Care Unit Greece,
Transilvania University and HOSPICE Casa Sperantei Ro-
mania. Throughout the article we will call them ‘‘RESPACC
experts.’’
The aim of the project was to foster inclusion of research as
part of the clinical practice of palliative care professionals by
defining core research competencies for palliative care cli-
nicians. This involved the development of self-assessment
tool for clinician’s research knowledge and skills, production
of a curriculum for basic training in research, and production
of educational materials for training in basic research meth-
odology. In addition, support materials for development of
research projects in the format of videos, webinars, ‘‘how
to..’’ manual, flowcharts, and templates were developed.
This white paper reports on the process of defining core
research competencies for palliative care clinicians and
presents the newly developed framework.
Aim of the White Paper
The aim of the white paper was to identify a set of core
research competencies required to carry out a research study
that should be understood and may be utilized by members of
the multidisciplinary specialized palliative care team.
Methodology and Methods
A multi-method approach to the development of the Pal-
liative Care Research Framework (throughout the article
called Framework) was adopted, which included several
phases.
1. Review of literature to identify existing frameworks
that could inform the new research competency
framework for palliative care clinicians.
EAPC WHITE PAPER
2. Nominal Group Technique (NGT) study with pallia-
tive care clinicians to explore and rank priorities for
research competencies.
3. Development of the core competency framework for
the multidisciplinary palliative care team by experts
within the RESPACC project consortium.
4. Refining the Framework through a European expert
consultation.
5. Development of a quiz to self-assess research com-
petencies by clinicians as stated in the Framework.
Ethical approval for the research was obtained by the
University of Navarra and from the ethics committee of
Hospice Casa Sperantei as project lead (NR 05/27.05.2021)
A rapid literature review
It was performed to provide timely information to RE-
SPACC experts.7 The literature review consisted of a com-
parative analysis of clinical research frameworks available in
full text in both published scientific and gray literature. This
review identified the processes and main characteristics of
published research frameworks. Searches were conducted
through PubMed Database with keywords ‘‘clinical,’’ ‘‘re-
search,’’ ‘‘competence,’’ and ‘‘framework.’’ The search
was combined with a gray literature search using Google
and Google Academic to obtain the full text of frameworks
and to gain a better understanding of usability and appli-
cability. Relevant documents were selected by title and full
text copies were read. A data extraction template was de-
veloped. It included the following elements: document title
and year, link to the full text, organization that developed
the framework, country of origin, group or population under
study, structure, domains, infographic presentations, and
further comments. This facilitated the process of assessing
similarities and differences and identifying key aspects of
the framework.
Nominal Group Technique
NGT was selected as a structured cross-sectional method
to elicit expert opinion and rank priorities, not seek con-
sensus.8 The aim was to identify what palliative care pro-
fessionals understood about research and priorities for
conducting research in Romania, Greece, and Spain. Open
research questions were prepared (e.g., ‘‘What does clinical
research mean for you?’’). The questions were piloted
during online workshop where NGT experts provided
training to the RESPACC team who conducted the NGT
meetings in local languages. Participants per country were
sampled purposefully from palliative care clinicians, re-
presenting different disciplines in the multidisciplinary
team. All participants were asked to complete a brief so-
ciodemographic questionnaire before the meeting. As
meetings took place during the pandemic, all three nominal
groups sessions were conducted online.9 With participants
permission, all were video recorded. Preliminary analysis of
data was undertaken in local languages. Core categories/
themes were translated into English to enable sharing of
data. A cross-country comparison of research knowledge
was followed by ranking of and priorities for clinical
research.
3
Development of the core competency framework
by RESPACC experts
A comparative analysis between competencies identified
during NGT study and those from the research frameworks
was made by RESPACC experts. A list of competencies
adapted to the specific context of palliative care research
was produced. A competency description, with subsections
was developed as model for the development of all the
competencies. The competencies from the list were allo-
cated to RESPACC experts who developed them according
to a model (including competency description, examples of
how these can be demonstrated in practice). Although it is
desirable that all palliative care clinicians possess core re-
search skills, the RESPACC experts reached consensus that
it was acceptable that not all palliative care clinicians would
possess all the research competencies as defined by the
new Framework, but that it was important for them all to
be available within the specialized palliative care team as
a whole.
European experts group consultation
To establish the relevance of the competencies and their
applicability throughout Europe, an expert consultation pro-
cess was undertaken. The competencies were transferred into
an English language online survey in Survey monkey. The
survey comprised 38 questions concerning the 19 compe-
tencies. To capture the diversity of roles of different pallia-
tive care teams in various settings, information about
participants roles in education, advocacy, leadership, re-
search was collected in the survey. The estimated time re-
quired to complete the survey was 45 minutes.
The survey was piloted and underwent minor changes in
format (examples were added to competencies). The survey
link was distributed to European experts by the EAPC and
Hospice Casa Sperantei. Two follow-up e-mail reminders
were sent to all participants.
The target population for the final RESPACC competen-
cies is the multidisciplinary palliative care team. For the
purposes of this project, experts were considered members of
the palliative care multidisciplinary team with clinical ex-
pertise in palliative care and who possessed one of the fol-
lowing qualifications: physician, nurse, social worker,
psychologist, spiritual counselor/priest. The participants for
the survey were selected through clinical associations, uni-
versities, and collaborations, using the following criteria:
member of multidisciplinary team, involvement in clinical
work, interest in research, providing education, optional
publications.
The initial list of potential expert participants was devel-
oped by the EAPC. To ensure a diverse range of European
countries were included, HOSPICE Casa Sperantei as a
Palliative Care Education Centre for Eastern and Central
Europe and member of the European Palliative Care Acad-
emy, added experts from their database.
Once selected, experts were asked to assess each compe-
tency and to give their view on whether it was a core com-
petency. Experts were also asked to identify if the
competency was required by each individual team member or
within the multidisciplinary team. Experts had the opportu-
nity to make comments and suggestions concerning the
wording of competencies.
4 MOSOIU ET AL.

Table 1. Relevance of Previous Research Frameworks for the Palliative Care Research Framework
Reference framework Characteristics of the framework Applicability for the framework
Tropical Diseases Global Applicable to the entire research team. First line reference framework due to:
Competency Framework Combines different frameworks (integrates Simple classifications of domains
for Clinical Research 28 frameworks and 116 job descriptions Applicable to various research designs
(2016)13 obtained from partners in clinical trial It is thought for Low Middle Income
units worldwide and from the web). Countries
Relevant for those in low middle income With low levels of research development
countries. Examples for the set of competencies
Applicable to studies that may differ in Some core competences and the real-life
design, geographical location, disease, examples can be chosen for the
etc., and can be adapted to the particular Framework
needs of specific projects or roles.
Contains, as a tool for evaluation, a grading
system with a template for grading the
individual’s level of expertise for each
area of competency on a (0–5) point as
scale. Grades can be represented
pictorially through the use of a radar
diagram.
Has 5 domains: Scientific thinking, Ethics,
Quality and risk management, Study and
site(s) management-Research operations-
Professional skills.
Joint Task Force Core Too focused on full-time research More complex than other frameworks and
Clinical Trial Competency professionals. PC clinicians may not share very complete, could make it useful as a
Framework (2020) 14 this profile. second line reference framework for
Aimed to define individual roles and comparative proposal
performance evaluations Organized in 3 levels, the first level can be
Aims to prepare workforces for clinical trials used to compare with core competences
on new medications and does not reflect for palliative care professionals and inspire
the richer diversity of palliative care the wording for the Framework.
research. The design as a ring of competences, with
Very complex structure with 51 core active links in the web version, is very
competencies structured in eight domains: attractive and can be used as model.
(1) Scientific Concepts and Research
Design; (2) Ethical and Participant Safety
Considerations; (3) Medicines
Development and Regulation; (4) Clinical
Trials Operations (GCPs); (5) Study and
Site Management; (6) Data Management
and Informatics; (7) Leadership and
Professionalism; and (8) Communication
and Teamwork.
NHS Core Competency Competency framework for clinical research The structure is very complete, proposed to
Framework for Clinical staff be used as a third line reference
Research staff (2019)7 Useful for all kinds of clinical research, not framework.
only clinical trials or medications studies. Considers soft skills that could be of
Organized in 4 themes and 13 competence particular interest in the palliative care
domains and competence statement population (vulnerable patients) and for
Takes in consideration soft skills that would teams where professionals have less
be required in certain areas of clinical medical or nursing training.
research Examples in band 4 and 5 are core ones and
could be useful to choose examples.

Data were analyzed using descriptive and analytical sta-
tistics. Question responses were on a five-point Likert scale
from strongly agree to strongly disagree. A weighted average
was calculated for each competency using the following scores:
10 = strongly agree, 5 = somewhat agree, 0 = neither agree or
disagree, -5 = somewhat disagree and -10 = strongly disagree.
A threshold of 7 for the weighted average was used to accept
the competency. For the second question, if the competency
was a team versus an individual one, Z test was used, where a
Z value over 1.96 and p < 0.05 were considered significant.
Results
Literature review
The literature review identified eight competency frame-
works available in full text. All have been analyzed in detail
EAPC WHITE PAPER 5

Table 2. Participants in the Nominal Group laborative group. Three of them were chosen as the foun-
Technique Meetings dation for developing our new Research Framework for
palliative care teams. The selection was not based on pre-
Greece (G) Romania (R) Spain (S) determined criteria, but on the evident relevance to the
Physicians 2 6 4 palliative care clinicians of the cooperative group. The
Nurses 7 2 3 other five, according to our clinicians, were deemed less
Social worker 1 relevant for the project’s purpose. The WHO developed a
Psychologist 1 2 2 Tropical Diseases Global Competency Framework for
Physiotherapist 1 Clinical Research16 that was considered to be the most
Total 12 10 9 relevant. The Joint Task Force Core Clinical Trial Com-
petency Framework17 was also utilized, as was the Core
Competency Framework for Clinical Research staff,10
(Annex 1). The frameworks were produced between 2007 which is specifically aimed at researchers who do not de-
and 2020. Six frameworks were from the U.K. organiza- liver clinical care.
tions10–15 one from the World Health Organization (WHO), The relevant characteristics of the three frameworks con-
Geneva,16 and one from Harvard (United States).17 The sidered as the top choices and the applicability for the new
analysis of the eight frameworks was presented to the col- Framework are given in Table 1.

Table 3. Domains, Themes and Subthemes Generated in the Nominal Group Technique Meetings
Domain Description
Familiarity with the Awareness of the particularities of the PC research (G/S/R)
clinical palliative Know bias and confounders specifics for PC (R)
care context Theoretical and practical knowledge about Palliative Care and basic areas of the subject under
research (G/S)
Scientific thinking and Knowledge about research methodologies (G/R/S)
research design Ability to accurately formulate and comprehend a research question (G/S/R)
Literature search (S/G/R)
Knowledge of basic research principles/terms (G/S)
Critical and Analytical thinking
Ethics and regulatory Basic Knowledge about bioethics (S/G/R)
framework for Knowledge about ethical aspects of research in PC
research Ethical approvals (S/G)
Authorizations for conducting research (S/G)
Knowledge and skills about the introduction of a research protocol to a target population (R)
Study and site Finding and managing resources and funds for financing the research (G/R/S)
management Knowledge about available resources for research (material, human) (R)
Identify resources to support dissemination (S)
How to write project proposals for research (S)
Data management and Basic knowledge and skills of statistics (G/R/S)
interpretation Basic knowledge and skills in computer and software use (G/S)
Communications and Skills and knowledge of how to present results (S)
relationships Congress presentations (S)
Interviewing and good communication skills with involved parts (patient, family and colleagues)
(R/G)
Linguistic skills: English and other languages (G/R/S)
Leadership Leader characteristics
Organizational skills and planning ability (S/G)
Communication skills (S)
Delegation skills (S)
Time management and scheduling skills (S/G)
Invigorating (Dynamization) skills (S)
Knowledge about how to choose the research focus (S)
Intuition or vision on the research phenomenon (R)
Educational skills (G)
Problem solving (G)
Good Negotiator (R)
Team working Skills
Teamwork skill to do multidisciplinary and networking research (R/S)
Knowing the role and expertise of each team member
Others Researchers qualitative characteristics
Patience, love, enthusiasm, inquisitiveness, ethos (G)
Attitude (R)
G/R/S, = Greece/Romania/Spain.
6 MOSOIU ET AL.

Table 4. Example of Description of Competency for the Framework

Domain 1. The Clinical Context
Competence 1.1 Awareness of specific aspects of doing research in palliative care contexts
Concept Understands the principles of palliative care and has the ability to apply them during the research
process, according to the specific needs of the population. For example, assessing clinical
history in a multidimensional way, using only relevant measures and samples, and providing
appropriate safe care and treatment.
Demonstration an understanding of the principles of palliative care and takes them into account
to describe the objective and scientific techniques used to design studies.
Is aware that palliative care populations might be vulnerable in different ways, especially those
who have advanced disease or are experiencing distress.
Examples of how – Ensures that research aims are relevant to palliative care
this competence
is demonstrated
– Takes into account the potential vulnerability of patients and families
– Understands the specific barriers affecting recruitment and retention of patients in palliative
care studies.
– Understands psychological and physical impact of research in palliative care
– Manages, always according to one’s expertise, medical or psychosocial issues that arise during
a study
– Ensures that data collection is suitable for palliative care (short and clinically applicable)

Nominal group technique
A total of 31 attendees from 3 countries (Greece, Romania,
and Spain) participated in the NGT meetings. The profes-
sional disciplines of participants are given in Table 2.
Using thematic analysis, themes were generated and con-
densed into 19 core competencies. These competences do not
imply consensus but reflect diversity of relevant topics. These
were organized into seven domains given in Table 3.
These first phases of the study were concluded with an
initial draft structure of the framework with seven domains
that was adopted for the next phases.
Draft palliative care research framework
The 19 competencies identified during NGT meetings
were compared with relevant frameworks in the literature and
were adapted to the context of palliative care research. An
example of the description for the first domain is given in
Table 4.
Based on the model described previously, RESPACC
experts developed all the competencies and produced a first
draft of the framework (Fig. 1) that was transferred into a
survey for European Consultation on Survey Monkey
platform.
European consultation
The survey was piloted with 10 participants, with minor
changes in format (examples were added to the survey). The
survey was sent to 120 identified participants, 59 responded,
and 53 fully completed the survey (17 males:36 females)
(response rate 44%, even considered low, as other studies
show,18 is complying with the average online survey re-
sponse rate of 44.1%). Respondents were from 17 countries,
10 from Central–South–Eastern Europe, 7 from Western–
North Europe.
All respondents had experience in palliative care, with
62% having over 10 years’ experience in palliative care.
Participants were from a range of professional backgrounds,
the majority were physicians (52.5%), followed by nurses
(27.1%), psychologists and social workers (each with 5%),
spiritual counselor and physiotherapist (each 1.7%). All
participants were part of a multidisciplinary team and most
worked either in inpatient units (40%) or in community-based
teams (31%). Most participants (64.4%) had experience in
organizational development; 89.8% in palliative care edu-
cation and 62.7% had experience in palliative care research.
Impact on the framework. Calculating the weighted
averages for the competencies (Table 5) according to the
responses of the experts,’ two competencies did not reach the
threshold of seven ‘‘4.2 Ability to attract funding and man-
aging resources’’ and ‘‘6.3. Mastery/Possession of linguistic
skills: use of international languages.’’ They were excluded
from the framework; however, mastery in use of an interna-
tional language was kept as a recommendation reflecting the
need to read articles and research often published in English
only. Using Z test for nine competencies, there was a statis-
tically significant allocation as individual competence (for
six of them) and for three as competencies allocated to the
whole team (Table 5). For the other 10, there was no clear
agreement between the experts regarding the applicability of
the core competencies and their applicability to the individual
or the team as a whole.
The final Framework with the competency’s definitions,
concept, and examples is given in Annex 2. The framework
includes 17 competencies organized in 7 domains: The
clinical context, Scientific thinking and research design,
Ethics and regulatory framework for research, Study and site
management, Data management and informatics, Commu-
nication and relationships, and Research leadership.
Self-assessment quiz
Alongside the Framework, a self-assessment quiz was
developed.19 The quiz enables clinicians to assess and score
their competencies in the seven domains of the framework. If
scores were suboptimal, participants were directed to the
FIG. 1. Draft Palliative Care Research Framework produced by RESPACC experts based on NGT and rapid literature
review. NGT, Nominal Group Technique; RESPACC, research for all palliative care clinicians.

7
8 MOSOIU ET AL.

Table 5. Individual Versus Team Competencies—Results from the European Survey

Core competency Individual vs. team competency
Competence Weighted average Individual competency Team competency
1.1. Awareness of specific aspects of doing 8.3 Not decided Not decided
research in palliative care contexts
2.1. Knowledge of basic research principles/terms 8.11- Not decided Not decided
2.2. Ability to accurately formulate and understand 8.21 Yes
a research question Z = 2.84 p = 0.004
2.3. Knowledge about research methodologies 8.77 Yes
Z = 2.44 p = 0.014
2.4. Ability to read and undertake a basic literature 8.58 Yes
review Z = 1.96 p = 0.048
2.5. Uses critical and analytical thinking 7.83 Yes
Z = 3.16 p = 0.001
3.1. Incorporates and considers the care, safety, and 8.77 Yes
protection of persons in the conduct of clinical Z = -2.57, p = 0.01
research
3.2. Understands the role and remits of research 8.3 Not decided Not decided
ethics committees in clinical research
4.1. Considers the feasibility of a potential project 8.21 Yes
in own working setting Z = -4.13, p < 0.00001
4.2. Ability to attract funding and managing 6.13 Yes
resources Z = -4.89, p < 0.00001
4.3. Coordinates/conducts the study based on the 8.49 Not decided Not decided
research protocol
4.4. Documents all the activities in a research study 8.87 Not decided Not decided
5.1. Basic knowledge and skills of qualitative data 8.4 Yes
analysis, statistics and informatics Z = 2.25 p = 0.02
5.2. Basic knowledge and skills of data 7.74 Not decided Not decided
management (collection, management, analysis)
(n = 53)
6.1. Ability to effectively communicate the content 8.87 Not decided Not decided
and relevance of clinical research findings for
various audiences
6.2. Possession of interviewing and good 8.58 Not decided Not decided
communication skills
6.3. Mastery/possession of linguistic skills: use of 6.98 Yes Z = 2.44 p = 0.014
international languages
7.1. Incorporates and promotes team working skills 8.68 Not decided Not decided
in the conduct of clinical research
7.2. Develops and applies the principles and 7.92 Not decided Not decided
practices of leadership and mentorship in clinical
research

relevant educational materials such as the Framework func-
tions as an educational tool.
Discussion
This white paper presents the first framework of core re-
search competencies for clinicians working in palliative care
contexts.
Defining these research core competencies for clinicians is
essential as palliative care evolves globally. Demonstrating a
close link between clinical practice education and research
will enable the further development of palliative care.20 The
Framework fits with general definitions of ‘‘research com-
petence’’ and is coherent with the clinical reality of teamwork
and the contribution of a range of professional team mem-
bers. Where research and evidence are not integrated into
clinical practice, issues can arise: research generating results
that are not relevant to clinical practice and important key
issues encountered in practice not being studied.21 Further-
more, there may be issues with research methodology not
being adapted to this relatively new field of medicine.22,23
In palliative care, a range of research methodologies need
to be utilized to incorporate and reflect the challenges expe-
rienced by the people receiving palliative care (clinical care
including symptom management) and their families and for
those providing the care. Research is needed not only to re-
flect this, but also needs to address areas such as ethical
challenges, education and e-health. If research results are not
translated into practice, this impacts on both patients (who
may receive suboptimal care) and on the members of the
multidisciplinary team, providers of the care.
The need to fit the palliative care research agenda with the
perspective of those who deliver palliative care has been al-
ready highlighted.24–27 To address this issue, a range of solu-
tions have been suggested including the research-to-practice
consensus workshop model26; community-based participatory
EAPC WHITE PAPER
research whereby researchers and community members work
together as partners in the research process.28,29
The new Framework is specifically designed to enable
clinicians in palliative care to participate as research con-
sumers (research literacy) and as research participants (re-
search skills/knowledge). It will also support research
capacity building in palliative care. By integrating core re-
search competencies into specialist training of palliative care
clinicians, the fundamental aim is to create a common lan-
guage and stronger links between research and clinical
practice as this would benefit both. It is recognized that
‘‘.integrating the needs of palliative care practitioners with
scientific expertise is likely to generate proposals for inno-
vative studies that will ultimately improve practice.’’1,7 Al-
though it is desirable that all palliative care clinicians possess
core research skills, the RESPACC consortium reached a
consensus that it was acceptable if all the research compe-
tencies as defined by the new Framework are available within
the multidisciplinary team as a whole.
Strengths
This work addresses an existing gap where there is no
definition of basic research competencies for those working in
clinical palliative care. A comprehensive process was under-
taken to develop the Framework. This included a rapid review
of the scientific literature, consultation with clinicians working
in the palliative care field through utilization of the NGT, and a
European experts’ survey. The work was conducted using an
international collaborative effort including perspectives from
countries with variable research capacity. An important step in
the project was to clearly define the terms utilized. The project
working group members were from diverse cultural back-
grounds with English not being the native language for most of
the RESPACC experts.
Limitations
The Framework was not subject to a full Delphi consensus
process owing to a limited project timeframe; however, an
international expert consultation was undertaken. Further re-
fining and developing of the framework are warranted.
A challenge of the process was to identify and select Euro-
pean experts, as the Framework is intended for clinicians
wishing to develop basic research competencies for palliative
care. This was explored in the survey and as 63% of respondents
also had expertise in research, this confirmed their selection.
Conclusion
Using a multi-method research project, the first framework
of core research competencies for palliative care clinicians
has been developed. Including detailed description of each
competency, accompanied by examples, ensures that this is a
practical and valuable tool. The Framework can be utilized
by all members of the multidisciplinary team in the devel-
opment of research projects by palliative care clinicians. It
also highlights the opportunities for implementing research
into clinical practice and is a valuable educational tool. The
final aim of the framework and of all the RESPACC addi-
tional materials is not to transform palliative care clinicians
into researchers, but to make research an integral part of their
day-to-day clinical practice.
9
Acknowledgments
The authors thank everyone who participated in the RE-
SPACC project including those who contributed or gave feed-
back on the development of the framework: Alexandra Simion,
Anca Opris (HOSPICE Casa Sperantei Foundation, Brasov,
Romania), Mirabela Mihailescu (Transilvania University, Bra-
sov, Romania), the Board of Directors (2019–2023) of the EAPC
listed here: Prof. Christoph Ostgathe (Germany), Dr. Jeroen
Hasselaar (the Netherlands), Dr. Sebastien Moine (France), Prof.
Catherine Walshe (United Kingdom), Dr. Gert Huysmans
(Belgium), Dr. Karl Bitschnau(Austria), Dr. Martin Loucka
(Czech Republic), Prof. Sonja McIlfatrick (Northern Ireland),
Prof. Josep Porta Sales (Spain), Dr. Danila Valenti (Italy).
Authors’ Contributions
D.M.: conceptualization (lead), methodology (equal),
writing—original draft (lead). S.P.: writing—review and
editing (equal), visualization (equal), supervision (lead).
O.P.: project administration (lead), writing—review and
editing (equal), visualization (supporting), data curation
(equal). M.A.S.: conceptualization (lead), methodology
(lead), writing—review and editing (equal), visualization
(supporting), data curation (supporting). J.L.: writing—
original draft (supporting), writing—review and editing
(equal). A.T.: writing—original draft (equal), conceptuali-
zation (equal), methodology (equal). N.M.: writing—review
and editing (supporting), visualization (supporting). M.D.:
writing—review and editing (equal), visualization (support-
ing). M.M.G.: conceptualization (equal), methodology
(equal), resources (equal), data curation (supporting). S.M.:
conceptualization (equal), methodology (equal), writing—
review and editing (equal), visualization (equal), data
curation (supporting). C.A.: writing—review and editing
(supporting), visualization (supporting). C.C.: conceptuali-
zation (lead), methodology (lead), resources (lead), data
curation (supporting), writing—original draft (supporting).
Ethical Approval and Consent to Participate
Ethical approval for the research was obtained by the
University of Navarra and from the ethics committee of
Hospice Casa Sperantei as project lead (NR 05/27.05.2021).
Consent for Publication
Participants provided consent for data to publish for sci-
entific purpose.
All data are available on RESPACC Project page Studii
Paliative—Research RESPACC or at request from the pro-
ject coordinator, Oana Predoiu, oana.predoiu@hospice.ro.
Data Availability
All data are available on RESPACC Project page Studii
Paliative—Research RESPACC or at request from the pro-
ject coordinator, Oana Predoiu, oana.predoiu@hospice.ro.
Funding Information
This work was supported by the European Erasmus project
under grant agreement (RESPACC) 2020-1-KA202-080128.
The funders had no role in study design, collection, analysis,
10
or interpretation of the data, nor in the writing and the deci-
sion to submit this article for publication.
Author Disclosure Statement
No competing financial interests exist.
Supplementary Material
Annex 1
Annex 2
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Address correspondence to:
Oana Predoiu, MS
HOSPICE Casa Sperantei
Education and National Development Department
17A Sitei Street
Brasov 500074
Romania
E-mail: oana.predoiu@hospice.ro