In Italy, the regulation of palliative care was first introduced with Law 38/2010, which defines it as a set of interventions for a person suffering from a disease with an unfavourable prognosis and no longer responding to specific treatments. The law guarantees access to palliative care and pain therapy to all citizens. Palliative care can be provided in inpatient, outpatient or home settings (Ministero della Salute, 2021j).
In 1999, national legislation introduced a new type of residential facility, called a “hospice”, which is an alternative to, or complementary to, home care and dedicated to terminally ill (mainly oncological) patients and their families (Ministero della Salute, 2017b). There are about 240 hospices in Italy, with a total of 2777 beds and over 42 000 admissions per year. Among the regions, Lombardy has the highest number of hospice beds per 100 000 inhabitants (8.3), followed by Lazio (6.9) and Emilia-Romagna (6.5) (VIDAS, 2017). Admission is planned by health care professionals in agreement with patients and their families. Around 5000 volunteers work in hospices every year. They belong to different voluntary organizations coordinated by the Palliative Care Federation (Federazione Cure Palliative, FCP). Volunteers follow specific training, defined by FCP in the volume “Training courses and core curriculum for volunteers in palliative care”. The document distinguishes two types of volunteering: “one dedicated to organizational support, fundraising, awareness raising and dissemination activities”, and the other closer to the patient and the family, which requires careful selection, training and support from psychologists. The training follows three phases: basic training, internships of a minimum of 20 hours and continuous training. An FCP survey (2015) showed that volunteers are mainly women (76%), over 50 (63%) and with at least a high school diploma in 54% of cases.
In very recent years, Italy reached two milestones in the area of palliative care. The first was the approval of the “End of Life” law (Law 219/2017), also known as “living will” law, which came into force in January 2018. The law has introduced the “advance treatment statement” (known as the DAT, in Italian), which is a document in which a person specifies what future medical treatments they would like if they were no longer able to make such decisions themselves due to illness or incapacity. They can also state certain treatments they do not want (e.g. artificial feeding and hydration). The second was the introduction of the School of Specialization in Medicine and Palliative Care and of a compulsory course in palliative care at the School of Specialization in Paediatrics for the first time in the Italian university system.