How to spread the word on the importance of palliative care: experiences from the ATLANTES program

A few years ago, Pau Donés, a well-known Spanish musician publicly shared the last stage of his life as he faced terminal illness. In a televised documentary filmed shortly before his death, he appeared with a calm gaze and a quiet voice, offering a final message of gratitude to his family, his medical team, and life itself. His last song, composed and performed during this time, was a simple but powerful declaration of thanks: “For what you give me; I give you back.” He did not speak explicitly about palliative care, but his attitude, the tone of his farewell, and the presence of a supportive team around him reflected many of its essential values: dignity, serenity, and human connection (1).

This public appearance was not part of any institutional campaign or strategic communication effort, yet it achieved extraordinary resonance. ATLANTES Global Observatory [an interdisciplinary research program at the University of Navarra in Spain and a World Health Organization (WHO) Collaborating Centre] we identified this moment as one of the most socially impactful milestones for palliative car in recent Spanish history. While this editorial draws on the specific experience and strategies of the ATLANTES Program, we believe the principles and lessons outlined here may inspire and inform similar initiatives in other regions, institutions, or cultural contexts. Our program is dedicated to advancing palliative care through three complementary strategies, all aimed at answering a central question: how can society come to understand and embrace the value of palliative care? These are: (I) analyzing and communicating its meaning through public message analysis and university education (Care & Society); (II) documenting its global status and visibility through monitoring and mapping (Global Development and Monitoring); and (III) deepening its ethical, spiritual, and anthropological foundations (Intangible Values of Palliative Care) (Figure 1). The resonance of this public moment brings us back to a fundamental question: how can society come to understand the importance of palliative care?

Figure 1 ATLANTES Global Observatory: a multidimensional program for the advancement of palliative care. WHO, World Health Organization.

In this editorial, we outline four complementary strategies that the ATLANTES program has developed to address this question: reframing the public narrative of palliative care; integrating it meaningfully into university education; making its development visible through global mapping; and exploring its ethical and anthropological foundations. Each strategy reflects our conviction that palliative care must not only be practiced well, it must also be explained well.

Although the examples and data presented in this editorial are drawn from the Spanish context, similar patterns in public perception have been observed internationally. Studies from diverse regions—including North America, Europe, and Asia—have consistently reported widespread misconceptions about palliative care, often associating it exclusively with end-of-life care or euthanasia, and overlooking its holistic, multidimensional approach to alleviating suffering (2,3). This confirms that communication challenges are not unique to a single culture or healthcare system, and that the strategies proposed here may be applicable across borders

Reframing the message: what palliative care really means

The case of Pau Donés is not an exception. We have systematically studied how the message of palliative care circulates in the public sphere (4,5). With input from professionals in law, communication, medicine, sociology, and the humanities, we analysed key media moments in recent Spanish history, those that reached large audiences and triggered widespread conversation. We examined discourse patterns, distortions, and even search trends in Google, identifying which terms provoked greater interest or confusion. The findings confirmed that, although palliative care is often portrayed positively, there is still significant ambiguity. It remains frequently associated with “the last resort” or death itself.

The problem, we realized, is not only terminological, it is narrative. There is a lack of a shared and accessible story that conveys what palliative care truly offers: a distinct way of caring, even when a cure is no longer possible. Technical language, euphemisms, lack of relatable figures, and overlap with topics like euthanasia all contribute to a blurred or distorted message. Against this backdrop, we propose reclaiming a narrative grounded in care, dignity, and presence. One that does not deny the gravity of illness, but affirms that there is still much to live and share, much to alleviate, and much to be grateful for.

This work has guided ATLANTES for years. From an interdisciplinary foundation blending science, humanities, and communication, we have explored the public perception of palliative care, not only as a research topic but as a strategic priority. We have produced doctoral theses, scientific publications, educational programs, and outreach materials all aligned toward this goal. Communicating palliative care effectively is not a complement to the field—it is a structural element of its development, essential to reaching more patients and families who need it.

One of our priorities has been understanding how young people perceive the field. In a qualitative study with university students from diverse disciplines and regions of Spain, we found that palliative care was virtually absent from their awareness and day-to-day perspectives. It was almost exclusively linked to death, provoking disinterest or avoidance. However, when invited into dialogue through real stories and shared reflection, students dismantled their own stigma. They discovered the value of accompaniment, dignity, and peace. Many expressed a desire to know more and to see these themes included in school and university curricula. This experience confirmed what we suspected: young people can be powerful allies in building a more accurate and hopeful social narrative around palliative care (6).

Despite the linguistic and cultural barriers, we identified, our work suggests that society is more receptive than expected—if we find the right way to speak. That requires creativity, interdisciplinary collaboration, and sustained effort. We have begun to explore this through a series of narrative experiments aimed at young, diverse, and non-specialist audiences.

The first was a theatrical performance, Cicely & David, inspired by the origins of the modern hospice movement. Staged in several cities across Spain and Colombia, the play enabled audiences to connect with the foundational values of palliative care through a compelling and accessible story. The enthusiastic reception affirmed that theatre can be a powerful medium for emotional and intellectual engagement (7).

The second initiative was a university-based “Death Café” with students in medicine, nursing, psychology, and communication. Around tables with coffee and cake, without script or hierarchy, students spoke about death in ways they never had before. Their reflections highlighted themes such as serenity, meaning, spirituality, and professional commitment. All participants rated the experience positively, and many expressed a wish to replicate it for their future patients (8).

The third was the “Stay Room”, an immersive educational installation inspired by the format of escape rooms, but with the opposite aim: not to escape, but to remain. Designed to encourage introspection and contemplation of care, vulnerability, and time, it turned a university setting into a space for quiet thought and collective reflection. Participants described it as thought-provoking and emotionally significant, with several expressing interest in repeating the experience (9).

These initiatives confirm a core intuition in our work: that the message of palliative care requires new forms—sensitive, participatory, and human-centred. Society is capable of understanding, appreciating, and embracing palliative care—if we meet it with the right language and imagination.

Educating for transformation

At ATLANTES, we view undergraduate palliative care education not only as knowledge transmission but as a tool for cultural transformation. We have developed multiple teaching initiatives to ensure students—future health and non-health professionals—understand and embrace its core values.

We began with the core subject “Palliative Medicine” for medical students, focused on the human and existential aspects of care (10). Soon after, we introduced experiential workshops at the University Museum (11), using art and storytelling to explore the ethical and aesthetic dimensions of care. These were later extended to nursing and psychology students. Recently, we have developed two interdisciplinary subjects: “Care and Society” for non-health students, and “End-of-Life Accompaniment” within the Faculty of Theology.

These experiences invite students to reflect and discover the human depth of care. Our research shows they foster motivation, ethical sensitivity, and a renewed sense of purpose.

Education is also a research focus. We have studied the impact of our programs, developed value-based tools, and explored how students integrate vulnerability and compassion into their professional identity (12,13).

In parallel, we have participated in European education projects which seek to harmonize and advance palliative care education and research across the continent. We have developed open-access teaching materials, supported doctoral research on palliative care pedagogy, and contributed to international conversations about educational innovation in health humanities (14,15).

The university, in this vision, is not only a training ground—it is a privileged space for shaping the future of healthcare. Educating in palliative care is about preparing future leaders to recognize, value, and defend a more human medicine.

In that sense, undergraduate and professional education becomes not just a vehicle for knowledge, but a strategic tool for diffusion and development. A student who has truly grasped the meaning of care will carry that understanding into every decision they make—whether in the clinic, the courtroom, the newsroom, or the Ministry of Health. The impact of education may not be immediate, but it is structural, sustained, and essential for embedding palliative care into the core of healthcare systems.

Making the invisible visible: mapping palliative care development

Another of ATLANTES’ most effective strategies for spreading the importance of palliative care has been to show where it is absent—and to document where it is taking root. Through mapping exercises such as the Atlases of Palliative Care, we have created visual and analytical tools that reveal, with clarity and precision, the status of palliative care development in countries, regions, and territories across the globe (Figure 2).

Figure 2 Infographics from regional and national palliative care atlases. WHO, World Health Organization.

What is not named does not exist. What is not seen is rarely addressed. These maps counter invisibility with evidence and bring palliative care to the attention of policymakers, academic institutions, and civil society. In 2025, we are publishing five new Regional Atlases—covering Asia-Pacific, Europe, the Eastern Mediterranean, Africa, and the Americas—each presenting updated data from nearly 200 countries. These data are illustrated with comparative maps, infographics, and concise explanatory narratives. All materials are freely available through the website of the ATLANTES Global Observatory, which acts as a WHO Collaborating Centre (16).

The mapping work is not limited to geographical visualization. It has been deepened by the development of a conceptual framework: the Palliative Care House, a comprehensive model to assess national palliative care development. Designed and coordinated by ATLANTES through a global consensus process led by WHO, this framework is structured around six essential dimensions: (I) service provision; (II) access to essential medicines; (III) palliative care education and training; (IV) policy and governance; (V) social and community engagement; and (VI) research and evidence production (17).

Mapping, in this sense, is not about colouring territories—it is about evaluating the strength of foundational systems. The House allows us to detect gaps, highlight progress, and communicate clearly what is needed to sustain growth. It is also a means of translating abstract indicators into actionable insights.

Over time, these tools have been widely used: as a presentation card in ministries, as visual aids in international conferences, and as a basis for peer-reviewed publications. They have also enabled secondary analyses that uncover disparities, success stories, and opportunities for intervention. More importantly, they provide a powerful visual narrative. More importantly, they offer a compelling visual narrative: making the need for development visible, capturing policy attention, and stimulating systemic change.

Key informants have confirmed the relevance of the Atlases, describing them as valuable tools to communicate with decision-makers and advocate for national strategies. Beyond technical utility, the Atlases offer visibility and legitimacy—helping position palliative care as a measurable and politically relevant component of healthcare systems (18).

Grounding the message: exploring the ethical and existential foundations

Spreading the importance of palliative care is not only about increasing visibility or telling powerful stories. It also requires preserving and transmitting its deeper meaning. At the research programme, we are convinced that sustainable advocacy must be rooted in a clear understanding of what palliative care represents. What does it mean to care until the end? What image of the human being is conveyed when a team sits beside someone who suffers, without the possibility of cure? What values are at stake? What does it say about a society—its priorities and fears—when it decides how to treat its vulnerable?

These are not rhetorical questions. They are deeply political, cultural, and social. For that reason, ATLANTES has launched a long-term line of research on the ethical, anthropological, and spiritual foundations of care—what we call the intangibles. In collaboration with philosophers, theologians, ethicists, and scholars in the humanities, we have explored concepts such as compassion, gratitude, dignity or coping. These are less visible than services or policies, but they are no less essential. If the roots are neglected, the message weakens. When they are cultivated, everything else gains coherence.

Within this broader framework, we have developed a specific project on expressions of gratitude in palliative care. By collecting testimonies from patients and families, we have observed how gratitude becomes a form of social validation. Good care leaves a mark—and that mark is remembered and shared. Gratitude, in this sense, becomes not only a personal response, but a societal signal of recognition and impact (19).

We have also studied the relationship between perceived dignity and the wish to die, drawing inspiration from Chochinov’s dignity therapy model. In analysing patient narratives, we found that many expressions of a desire to hasten death were not primarily about physical symptoms. Rather, they reflected experiences of threatened dignity: due to unrelieved suffering, loss of meaning, perceived burden, or identity erosion. This insight reinforces a key message: palliative care is not only about symptom control. It is about preserving the core of personhood in the face of decline. And this, too, must be communicated to society (20).

Moreover, we have investigated how palliative care professionals develop emotional resilience across their careers. This work revealed a five-stage model of coping, built on interviews with physicians and nurses in Spain and Portugal. The journey begins with idealism and emotional intensity, then transitions into a critical phase of recognizing vulnerability and the need for boundaries. Over time, professionals learn to manage emotions proactively (supported by team dynamics) and to adopt a more integrated perspective on care, one that accepts limitations without losing meaning. Eventually, the process is grounded in inner balance, often sustained by a transcendent view of their work (21).

This model shows that palliative care, far from leading to burnout or emotional depletion, can nurture growth. When adequately supported, professionals not only endure—they mature, deepen, and thrive. This challenges prevailing narratives that associate end-of-life care exclusively with burden or despair. It also offers a new story to tell: one of professional development, inner transformation, and purpose-driven care.

This area of work represents a longer-term strategy. It does not generate immediate metrics or headlines. But it is essential. The field cannot grow if it forgets its roots—just like a tree cannot reach upward and outward unless its roots are strong and deep. True growth in palliative care depends on staying grounded in its core values: care, dignity, and the human connection. A message only resonates when it stays true to its roots. Spreading the word on palliative care means expressing through language, evidence and symbols that caring well at the end of life is a radical act of humanity.

Toward a culture that recognizes and communicates care

ATLANTES is not simply a research group: it is a structured program working from multiple angles to strengthen palliative care. While our strategies have emerged from a particular academic and cultural context, we believe their core principles (interdisciplinary collaboration, value-based messaging, and evidence-informed advocacy) can be adapted and implemented across diverse healthcare systems worldwide. Through initiatives in public messaging, undergraduate education, narrative experimentation, global mapping, and foundational inquiry, we have articulated the four complementary strategies mentioned above—each seeking to answer a common question: how can society come to understand and embrace the value of palliative care?

Underlying all these efforts is the conviction that communication is not secondary to the development of a field—it is its scaffolding. When a discipline explains itself well, it earns legitimacy, sustainability, and a future. Our experience shows that it is possible to communicate the meaning and benefits of palliative care with rigor, creativity, and strategic vision.

The ATLANTES program demonstrates that combining science, the humanities, and effective communication can foster a true culture of care. These strategies may serve as a model or inspiration for similar efforts worldwide. As a field capable of alleviating, accompanying, and dignifying, palliative care must also learn to speak, be seen, and secure its place on both public and professional agendas.

In summary, to spread the word on palliative care is not just to inform, but to transform society’s relationship with serious illness, suffering, and end-of-life care. It’s about access. The more people understand what palliative care truly is, the more likely they are to benefit from it. We encourage institutions, professionals, and advocates around the world to adapt, expand, and innovate communication efforts so that the essential message of care reaches every context. Because when palliative care is understood, its demand and its impact grow. Only then will we truly build a more humane and hopeful approach to care at the end of life. In this way, programs like ATLANTES contribute to the international agenda for palliative care set forth by the WHO and World Health Assembly (WHA) Resolution 67.19, helping to advance its integration into health systems worldwide.

Acknowledgments

The authors wish to acknowledge that this work is inspired by the original ideas and multidisciplinary research of all members of the ATLANTES research team, and in a way it is presented here on their behalf.

Footnote

Provenance and Peer Review: This article was commissioned by the Guest Editors (Eva Oldenburger and Johan Menten) for the series “Multidisciplinary and Holistic Palliative Care”, published in Annals of Palliative Medicine. The article has undergone external peer review.

Peer Review File: Available at https://apm.amegroups.com/article/view/10.21037/apm-25-79/prf

Funding: The ICS–ATLANTES Global Observatory received funding from several philanthropic and scientific organizations, including Fundación “la Caixa”, Fundación Científica Ramón Areces, Fundación Lontano, Fundación Colibrí, and The True Colours Trust and privated donnors.

Conflicts of Interest: Both authors have completed the ICMJE uniform disclosure form (available at https://apm.amegroups.com/article/view/10.21037/apm-25-79/coif). The series “Multidisciplinary and Holistic Palliative Care” was commissioned by the editorial office without any funding sponsorship. C.C. and M.A. report receiving funding from Fundacion Cientifica Ramon Areces, Fundacion La Caixa, True Color Trust, L’Ontano Foundation, Baker Family, Ordoñana Family, Erasmus+ Education Projects Program (EU), and Horizon Research Program (EU). The authors have no other conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

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