Primary-level palliative care national capacity: Pallium Canada

Abstract

The need to improve access to palliative care across many settings of care for patients with cancer and non-cancer illnesses is recognised. This requires primary-level palliative care capacity, but many healthcare professionals lack core competencies in this area. Pallium Canada, a non-profit organisation, has been building primary-level palliative care at a national level since 2000, largely through its Learning Essential Approaches to Palliative Care (LEAP) education programme and its compassionate communities efforts. From 2015 to 2019, 1603 LEAP course sessions were delivered across Canada, reaching 28 123 learners from different professions, including nurses, physicians, social workers and pharmacists. This paper describes the factors that have accelerated and impeded spread and scale-up of these programmes. The need for partnerships with local, provincial and federal governments and organisations is highlighted. A social enterprise model, that involves diversifying sources of revenue to augment government funding, enhances long-term sustainability. Barriers have included Canada’s geopolitical realities, including large geographical area and thirteen different healthcare systems. Some of the lessons learned and strategies that have evolved are potentially transferrable to other jurisdictions.

Do learners implement what they learn? Commitment-to-change following an interprofessional palliative care course

“…In-depth descriptions of the course’s goals and learning objectives, design, and curriculum development have been published previously. 4 , 37 , 38 …”

“…In-depth descriptions of the course's goals and learning objectives, design, and curriculum development have been published previously. 4,37,38 Learners are asked at the end of the last session of the course to identify three to four things that they will do differently because of participating in the course. These are referred to as the post-course commitment statements.…”

“…Palliative care education remains a key strategy to address the needs of patients with palliative care needs. 1 , 2 – 4 Curriculum gaps and learning needs related to palliative care have been identified across the learning cycle of health care professionals, from undergraduate and postgraduate training to continuing education for clinicians in practice. 5 – 7 There is emerging evidence that courses of varying length do address some of these gaps.…”

“…Pallium Canada, a non-profit organization that builds primary-level palliative care capacity through interprofessional education courseware called Learning Essential Approaches to Palliative Care (LEAP), has been using the commitment-to-change approach for over a decade. 4 The LEAP program consists of a suite of interprofessional courses, each one targeting a different care setting or disease group. The main goal of the LEAP courses is to provide health care providers with the core competencies to provide a palliative care approach.…”

Outcome measures in palliative care training interventions: a systematic review of trial-based studies

“…There is growing consensus among health care clinicians and researchers that palliative care should be integrated earlier in the serious illness trajectory (1)(2)(3) and that this can be facilitated by generalist clinicians providing primary palliative care to their patients (4,5). Many local and national training programs have been initiated to help develop these skills among primary care physicians, nurses, and non-palliative care specialists (6)(7)(8)(9)(10). A systematic review by Brighton et al in 2017 which evaluated studies of end-of-life care communication skills training, found 153 unique training interventions (11).…”