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Discussion 5.1: Training and Supports

2 months ago
CLOSED: This discussion has concluded.

A 2014 Ipsos Reid Survey commissioned by the Canadian Hospice Palliative Care Association (CHPCA) of general practitioners, family physicians and nurses in primary care found that 20-25% of practicing physicians are not very comfortable or not comfortable at all, 50% are only somewhat comfortable and only 25-30% of practicing physicians felt very comfortable providing palliative or end of life care.

"An appropriately trained workforce is required to improve access, quality and consistency of palliative care in Canada. This applies to all health care professions providing a palliative approach in all settings of care, including but not limited to: physicians, nurses, nurse practitioners, pharmacists, social workers, psychosocial spiritual care practitioners, rehabilitation professionals, respiratory therapists, recreation therapists, music therapists, psychologists, and volunteers.” https://www.cspcp.ca/wp-content/uploads/2018/02/Palliative-Care-Medical-Education-Feb-2018.pdf

As a health care provider, what do you consider appropriate training to provide a palliative approach to care?  Do you feel you have the support you need to provide a palliative approach to care?

This consultation is now closed.


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  • palliumcanada about 1 year ago
    There is a strong and ever-growing body of evidence that shows palliative care, particularly when integrated earlier in the illness, improves patients’ quality of life and reduces health care costs without reducing their life expectancy. If more care providers were trained in palliative care, they would be better prepared to provide care throughout the course of life-threatening illness, and those in their care would be more likely to receive care in their setting of choice.Since its inception in 2000, Pallium Canada has developed a large experience and empiric-base in this area and has completed extensive research on the quality, relevance, need, and impact of its LEAP courses. This research demonstrates very high levels of learner satisfaction, across courses and across professions. Over 90% of respondents indicated that the courses were relevant (“Strongly Agree” to “Agree”) with a similar percentage indicating that they would recommend the course to their colleagues. Furthermore, the largely similar levels of satisfaction across professions, indicates that the interprofessional approach of LEAP programs is effective. Learners have highlighted how important this work is and how the programs and products, like the Pallium Pocketbook, support them in this area. Importantly, our research also provides evidence that, across a number of professions that include physicians, nurses, pharmacists and social workers, the interprofessional Pallium LEAP courses are significantly improving knowledge, attitudes and comfort levels related to providing a palliative care approach. Finally, our research provides important emerging evidence, through the commitment to change statements and reflections, that learners are implementing what they learn into their everyday clinical work with patients and families and alongside colleagues. The majority of commitments reported at 4-months post course were implemented into practice, with physicians and nurses reporting the highest rate of implementation (73%). The commitments to change themes identified include earlier initiation of palliative care; better use of opioids and medications to manage pain; increased patient advocacy; increased screening and use of tools; better grief and bereavement care; and better advance care planning. These themes represent “low-hanging fruit” in terms of focusing curriculum attention on to have greater impact in practice and developing quality improvement tools to accelerate spread in practice. Pallium is also gathering evidence from this research on the barriers that prevent health care workers from implementing their commitments to change, which will facilitate the development of future supports for learners and health care providers.There is strong evidence that Pallium Canada’s curriculum development and knowledge translation and diffusion models provide an effective approach with which to further spread and scale-up of the palliative care approach across Canada and provide health care providers with the educational and training supports that they need.
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    • Visionary2018 about 1 year ago
      Agree that palliative care needs to be integrated at the point of diagnosis of a life-threatening illness, and that all staff working with affected patients need training. I agree that Pallium and the LEAP courses have been instrumental in training; however, the cost of these programs, the lack of education hours to attend and the lack of upfront secured funding makes such education prohibitive for many staff. Re: hospital staff because that's where I work... I believe that Canadian hospitals need to develop standard curriculum (iLearn modules) or collaborate with existing palliative care educators to educate existing and new staff about palliative care.
  • Pallfan2018 about 1 year ago
    Busy clinicians just want available education, yet we know that passive education is not sufficient to train providers in what they need to do to be proficient. I am not even remotely surprised by the survey results. Case-based, hands on approaches work best in my opinion, but would need to be supported as accredited activities for greatest uptake. This could be done as a workshop. Personally, I feel comfortable providing palliative care considering a palliative approach (I am not a palliative care specialist) and much of the comfort and skill has come from "real world" experience but supported by colleagues. Having access to more specific end of life care has also been helpful as I know when patients are getting to that point, there is a resource available beyond my capabilities. The latter gives me confidence in what needs to be done ahead of that point as I also know I can seek advice from the same end of life providers (who are palliative care trained) if I am running in to difficulties.
  • CFHI_FCASS about 1 year ago
    Access to education is only one aspect of creating the conditions for practice change. Quality improvement science and CFHI’s experience demonstrate that it is vital to support practice change through collaboratives or other approaches that combine education and training in best practices with core improvement competencies. Clinicians also need opportunities to use their skills, and to access advice and mentorship. Information and advice needs to be timely, specific and relevant. Models such as connected medicine (including solutions like phone and eConsult), shared care and mentorship are being successfully used to improve access to information and advice for clinicians. Deliberate training and system planning strategies are required to ensure that non-specialist palliative care providers have access to education and support and that sufficient specialist providers and mentors are available to support them. One promising example is the work being undertaken through Connected Medicine: Enhancing Primary Care to Specialist Consult collaborative (https://www.cfhi-fcass.ca/WhatWeDo/connected-medicine) offered by CFHI, Canada Health Infoway, the College of Family Physicians of Canada and the Royal College of Physicians and Surgeons of Canada. Two of the teams in that collaborative – from Newfoundland and Saskatchewan – have included palliative as one of the specialty services offered via remote consult to primary care providers, building on the work of Champlain BASE™, which also offers access to palliative specialists through eConsult.
  • HospicePC about 1 year ago
    I think mentorship and role modeling are a big part of learning skills in palliative care. With the discomfort a lot of people (patients, families and hcp alike) feel with death and dying/end of life/ palliative care, I think learning about this topic needs to go beyond more traditional forms of education. There are many skills, including communications skills in palliative care that you learn best by doing. Mentorship and role modeling can be a big part of this. It would be great if these were more readily built into palliative care related training initiatives.
  • CanadianVirtualHospice about 1 year ago
    Health care providers (hcps) are often motivated by the desire to provide care and support for patients and families. Assisting hcps to do the best job possible needs to be a priority for health care in Canada. Formal training and supports for hcps in delivering a palliative approach to care needs to be supported by providing access to reliable resources and information. Access to reliable resources and information is vital to the delivery of proficient and effective end-of-life care. Unfortunately, as stated above, many hcps often feel unprepared to address the needs of palliative patients and their families. Canadian Virtual Hospice (http://virtualhospice.ca) offers accessible, evidence-based, online resources at no cost, to support a palliative approach to care and the ongoing professional development of hcps. Our Tools for Practice section features over 800 categorized listings including resources about communication, advance care planning, grief and bereavement, self-care, symptoms and more. Tools are added on an ongoing basis and all are reviewed by our clinical team. Our Clinical Team Lead Dr. Mike Harlos’ article “Sit Down, Lean in” talks about the importance of engaging the person (not the patient) in order to address suffering. Jim Mulcahy’s video, “A Story About Care” shares an excellent example of how interactions with hcps can profoundly change a patient’s health care experience. Our Gallery features hundreds of videos for professionals on various topics including videos on how to have difficult conversations, redefining hope, ways to support family caregivers, barriers to palliative care delivery and more. http://LivingMyCulture.ca is a useful tool for hcps wishing to improve care outcomes by enhancing their knowledge and skills in providing care for a person from a different culture. Over 600 video clips are found on this website by individuals from various cultural background sharing their stories and perspectives. Our Quick Consult feature identifies challenging clinical situations and provides guidance by our clinical team. http://Methadone4Pain.ca is a free, accredited online training course on methadone for analgesia in palliative care that enhances hcps understanding of this unique medication and supports their ability to better address questions or misconceptions about methadone. Hcps often use http://MyGrief.ca and http://KidsGrief.ca to enhance their understanding and support for those who are grieving. All the resources mentioned above can be accessed free of charge through For Professionals: http://www.virtualhospice.ca/en_US/Main+Site+Navigation/Home/For+Professionals/For+Professionals.aspx
  • yinyang about 1 year ago
    La complexité des besoins en matière de soins palliatifs exige que les intervenants possèdent les compétences de base requises pour donner des SPFV. Ces compétences sont nécessaires pour prévenir et apaiser la souffrance globale de la personne qui a reçu un pronostic réservé qu'importe l'âge, la pathologie ou le milieu de vie et ainsi assurer la meilleur qualité de vie à cette personne et à ses proches. Ce postulat fait l'objet d'un consensus tout comme la prémisse à savoir que la formation de base en SPFV, tout comme la formation continue, sont nécessaires dans tous les milieux et concernent tous les types de profils d'intervenants. Afin de donner des repères aux établissements du réseau et à soutenir ceux-ci dans le déploiement des activités de formation à l'intention de l'ensemble des intervenants et des bénévoles, un cadre de référence pour le développement des compétences en SPFV a été élaboré dans une perspective de 5 ans. Il prévoit la formation générale selon les approches collaborative et réflexive et la formation par type de profil d'intervenants selon l'approche du mentorat.
  • YYCdoctor about 1 year ago
    We also need to develop a greater number of researchers in medicine, nursing, social work, spiritual care, sociology, health economics and heath services research and other disciplines who can progress palliative care research. Research is a driving factor for improved education and practice of palliative care. We have a shortage of funding for palliative care researchers in Canada and the infrastructure to sustain research collaboration across professions and geographically and the educational opportunities to acquire research skills.
  • Kathryn about 1 year ago
    As a speech-language pathologist, I never received training in palliative care. We had mock discussions regarding diagnoses and treatment options for children, but these mock discussions never had a palliative context. I now work in long-term care and am involved in many palliative discussions due to concerns regarding dysphagia, and I wish I had received more training in this area.
  • afoxrob about 1 year ago
    Intensive care physicians have training in goals of care and end of life discussions. We teach how to provide good end of life care for our ICU patients and are sometimes asked to provide this support as part of our critical care response teams. We are fortunate to have some physicians who have been trained in both palliative care and critical care who have been leaders and contributed to guidelines
  • PallRNKaren about 1 year ago
    The nurses who work on the palliative teams I manage are expected to have the Fundamentals of Palliative Care as they begin working with us, then to take the CAPCE or LEAP program. Unfortunately the courses do not run frequently, the nurses are so busy working that they do not have the free time to take courses and cost.
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    • Visionary2018 about 1 year ago
      Agree. Think we need to combine resources together to create a course to teach new hospital staff about the fundamentals of palliative care (pain and symptoms) including common medications. We asked a local LHIN pain manager to teach a course in the hospial in an effort of collaboration. It still cost staff personal funds and time. In a period of fiscal restraints, we need to figure appropriate education out in an expeditious manner. Why not use existing in hospital resources and have NPs and experienced nurses provide the education? The 1.5 day initial LEAP course was only intended as a review for experienced palliative care professionals though some employers are using it as a quick and inexpensive fix for educating in palliative care. I do believe palliative care is a specialty and therefore, requires educated and skilled professionals. Patients are still suffering in pain and dying without comfort due to lack of knowledge and skill.
  • melmay about 1 year ago
    Everyone caring for palliative patients should have at least basic palliative care training. Pallium, Leap offers a variety of courses across a variety of care settings. Excellent for physicians, NP's, nurses; all members of the care team. We have trained facilitators in our area but the challenge is manpower. This education we give is voluntary, on top of our already very busy schedules
  • JenniferM about 1 year ago
    i think all Doctors, Social Workers, care aides, nurses etc.. should be receiving end of life care education in their training. Along with learning how to have serious conversations with patients and families.
  • livermore about 1 year ago
    Include home care workers, where appropriate
  • Ebaker about 1 year ago
    I think that all health care practitioners entry to practice must include the basics of a palliative approach to care which includes how to do advance care planning, how to have basic goals of care discussions that relate to the care you are providing (benefits v burdens) and symptom management as well as a basic understanding of the differing trajectories of dying and what "triggers" indicate a patient might be changing and require the next ACP or GOC discussion.
  • kott about 1 year ago
    I think we are extreamly resource rich but poorly trained for this service. There has to be one national level training course which should be offered to each providers. I have no palliative care training but asked to take care of patients. we need training in the areas such as mental health, cultural difference and end of life, pharmacology especially pain management and symptoms management in palliative care. I think there should be a group of doctors, pharmacist, nurse and nurse practitioner should develop this course and deliver all across Canada via online and in person . there is no need for every province and health authority to invent their own courses which is time consuming and waste of money
  • jcruikshank about 1 year ago
    CHPCA does not provide healthcare services first-hand, but rather develop, provide and advocate for the resources required for healthcare professionals to deliver palliative care services. This includes a robust network of online resources available through both chpca.net and advancecareplanning.ca, and advocating for more funding and resources for palliative care at alllevels of government. The CHPCA aims to establish national benchmarks for palliative care education for all health care providers at all stages of their professional education, and to establish palliative care competencies for all health care providers and set a consistentminimum standard. This includes requiring that all health care providers and allied health professionals be trained in the basic principles and practices of palliative care; requiring that additional skills training be provided for those who frequently care for adults and children with advanced conditions; and requiring and providing expert training for all hospice palliative care specialists and educators. As well, the CHPCA mandates support and training for hospice palliative care volunteers across all sectors. The CHPCA also publishes a monthly eblast with resources and updates, which reaches approximately 8,000 subscribers.
  • Robin about 1 year ago
    I think all health professional entry-to-practice programs should offer mandatory palliative care education and that accreditation be contingent on evidence that this education has been integrated into curricula. I believe there should be interprofessional options for education, especially when content relates to competencies that are shared across disciplines. Interprofessional palliative care education programs/modules should be developed by an interprofessional team of educators and could also be made accessible (online modules) to practicing healthcare providers.
  • alliedhealthworker about 1 year ago
    As an allied health provider, I never received palliative care training during my formal education. My learning has been a combination of self-study and learning from my palliative care colleagues, as well as taking the initiative myself to take a Fundamentals of Hospice Palliative Care course. I think more consistent incorporation of palliative care into the curriculum of healthcare practitioners would be helpful, but also opportunities to learn as interprofessional teams.
  • NurseDar about 1 year ago
    As much paid Palliative care education should be offered as possible. CHPCN (C) should be offered for those RNs willing to take the certification and be reimbursed for it. I had to pay for my own certification (around $750) because I wish to provide the best care I can. There is little incentive for nurses to certify if they have to make time and spend their own money to do so. I personally feel I do have enough appropriate training to provide excellent palliative care but it is only because I have made personal efforts beyond what the organization offers or had to volunteer my time in order to participate in learning opportunities and give back as a train the trainer. Many of my colleagues do not have adequate training as they have not beeb offered it and do not have the time or resources to seek it on their own. Yet, the health authority prides itself on providing excellent palliative care...who without proper training and support can do this?
  • applebee1 about 1 year ago
    CHPCN for palliative RNs.CAPCE for palliative RPNs.Fundamentals of Palliative Care Training - PSWs and volunteers.GPA and PAC training - all clinical staff and volunteers.Palliative Medicine training for physicians.
  • PalliativeMD about 1 year ago
    Most physicians in practice today never received formal training in palliative medicine.While palliative medicine is a mandatory rotation for most Family Medicine programs now, it is at best an elective for specialists (who make up 50-60% of all new graduating physicians) who should receive at least basic training in palliative medicine.All medical schools should have a department of Palliative Medicine that can provide training for all physicians in palliative medicine. This would provide an academic home for research, training and advocacy.Appropriate training would cover both undergraduate and postgraduate training. It would be both longitudinal throughout the curriculum as well as discrete rotations and blocks of training.My discussions with nurses echo this reality. For most nurses, palliative care training seems to be elective or optional, and often is displaced by other elements of the curriculum. One way to address this would be to integrate the various disciplines (MD, RN, SW, etc) during appropriate sessions for joint teaching opportunities.
  • Fitchix00 about 1 year ago
    As a RN, I feel we don't have enough education around palliative care. I find some of my co-workers are so uncomfortable around death and dying, and yet it is a normal part of the life cycle. If we could make that person and their family more at ease with this transition, wouldn't that be a better experience for all? I've been a part of some beautiful end-of -life experiences with my patient and their loved ones, and them some very sad and scary transitions.for the family and for the patient due to lack of training or education around palliative care. I found some family members thought that the term "palliative care" meant no care, when really we can show them that their loved one can receive more " fined-tune" care, depending on their wishes.