Background: In 2009, the EAPC published recommendations on standards and norms for palliative care in Europe, and a decade later,
wished to update them to reflect contemporary practice.
Aim: To elicit consensus on standards and norms for palliative care in Europe, taking account of developments since 2009.
Design: A Delphi technique used three sequential online survey rounds, and a final expert consultation (EAPC Board). The original
2009 questionnaire with 134 statements was updated with 13 new concepts and practices following a scoping of the literature
between 2009 and 2020 (total: 147 statements).
Setting/participants: One contact of Boards of 52 national European organisations affiliated to the EAPC were invited to participate,
with subsequent rounds sent to respondees. The EAPC Board (n = 13) approved final recommendations.
Results: In Round 1: 30 organisations (14 organisations × two people, 16 organisations × one person, total n = 44) in 27 countries
responded (response rate 58% organisations, 82% countries), Round 2 (n = 40), Round 3 (n = 38). 119 statements reached consensus
in Round 1, 9 in Round 2, 7 in Round 3. In total 135/145 statements in five domains (terminology, philosophy, levels, delivery, services) reached consensus (defined as >75% agreement), (122) were original EAPC recommendations with 13 new recommendations
included emerging specialisms: neonatal, geriatric and dementia care, and better care practices. Seven statements failed to reach
consensus and four were removed as irrelevant or repetition.
Conclusions: Most recommendations on standards and norms for palliative care in Europe remain unchanged since 2009. Evolving
concepts in palliative care can be used to support advocacy.