Norway takes a realistic view of population aging: it has recognized the challenge for two decades, and one of the answers is systematic palliative care. An interview with an expert outlined a model of regional centers, education, and workforce limits similar across Europe. His experience suggests that success will come from a combination of political decisions and strengthening competencies on the ground.
Norwegian model: competence centers and a network of services
According to the Norwegian experience, population aging is around the European average, but the challenges are shared everywhere. The issue has been discussed for 20–25 years, and countries are gradually preparing for it. One of the key steps is to ensure the availability of palliative care for all patients – not as the only answer, but as an important part of the system.
Norway has built a competence center in each health region linked to a university hospital. These centers teach medical students and nurses in undergraduate and postgraduate education and also provide methodological support to both primary and hospital care in the implementation and optimization of the structures and content of palliative care. They also provide clinical care: an inpatient ward, an outpatient clinic, and a mobile team for home-based care. This is a basic model that is considered good practice abroad as well.
Human resources: enough money, too few people
The biggest obstacle is access to healthcare workers. Norway acknowledges that even though there is enough money, there are not enough people – especially outside major cities. Oslo handles the situation better, but the north, the west, and sparsely populated regions struggle with a shortage of doctors and nurses.
The response is systematic education: palliative care is a mandatory component of undergraduate programs in medicine and nursing, which requires no new funding, only state regulation. A subspecialty has also been created for physicians, which is currently in high demand – with capacity limits, about half of applicants are admitted. The goal, however, is not just more people, but more people with the right competencies and better task distribution across professions. Similar trends can be seen in the USA, where palliative medicine is among the fastest-growing specialties.
Implementation in practice and obstacles
Field work varies according to distances and case complexity. If the nurse knows the patient, a home visit can take 30–45 minutes; the rest of the day is dictated by travel. On an eight-hour shift, a mobile hospice team can thus visit approximately 4 to 8 patients per day. Logistics therefore significantly affect the efficiency of services, especially in sparsely populated areas.
When introducing palliative care into oncology, the system also encounters cultural barriers: clinicians' attention is absorbed by new drugs, imaging, and radiotherapy. Nevertheless, the evidence of the benefits of palliative care is strong, and political leadership must help by requiring its integration. The recommendation is to combine a top-down and bottom-up approach: build regional centers while strengthening competencies in primary care. And finally, the goal should be clear – to enable people to die with dignity as their fundamental right.
