Empowering healthcare professionals to provide high quality palliative care

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By Jiahui Wong and Deyan Kostovski

In Canada, cancer and heart disease remained the leading causes of death and were responsible for nearly half of all deaths.  With an aging population more Canadians are receiving these diagnoses and the majority of them are preferring to die at home.  To meet this growing demand, health care providers need educational support to recognize when palliative care services are appropriate and demonstrate the confidence, competency and compassion in the provision of these services.

Palliative services have been made available across Canada but the access and the quality of care varies.  Many patients with terminal illness still die in acute care settings and receive few palliative care services.

In order to provide evidence-based palliative care to patients, healthcare providers across all disciplines need to recognize when and how to apply the comprehensive palliative care approaches.  Now more than ever healthcare professionals require support; the federal government’s passing of the assisted dying bill in June will amplify the need for these specific skill sets.

A key factor hindering quality palliative care is the lack of systematic standardized training in palliative and end-of-life care. With the exception of palliative care specialists, healthcare providers across the broad spectrum of care receive no comprehensive palliative care specialty training in their professional degree programs.  Evidence suggests that optimal outcomes occur when care is provided earlier on by competent interprofessional teams who are equipped to manage the range of care required, particularly, the ability to carry out sensitive discussions, address pervasive symptoms, minimize suffering and conserve dignity at end of life.

Since 2008, de Souza Institute at the University Health Network has been funded by the Ontario Government to provide evidence based continuing education to healthcare providers in cancer and palliative care.  Over the past eight years, using online learning modules, workshops, and competency measures, the institute has reached more than 8,000 healthcare professionals and has become a go-to-place for healthcare professionals seeking additional cancer care or palliative care training.

Our online learning platform has been enthusiastically welcomed for its flexibility to address learning needs. Individuals can complete varying levels of training that match their needs at any time, from any setting. This flexibility is important; it is dynamic in responding to the training needs of busy clinicians where time is at a premium.  Learners can start and return to the system as needed, the curriculum provides immediate feedback to learners on their state of knowledge, documents learning hours and provides guidance towards new areas for development.

Specialized training is important, but we cannot overstate the importance of having high quality training that encompasses the entire disease trajectory, that starts with the diagnosis and includes a broad range of settings from home care and long term care to community care.

Using a well-known course, Education for Palliative and End of Life Care – Oncology (EPECTM-O) as an example: originally developed by a team in the US and offered exclusively through workshops, it was adapted by the Canadian Partnership Against Cancer in 2011. To increase accessibility and enhance the uptake, de Souza Institute is developing a new online version, iEPEC-O.  This online course includes the core competencies in palliative symptom management, and places an emphasis on comprehensive team-based care, cultural sensitivities and a person-centred approach.   This self-directed eLearning course has been designed to maximize the learning experience using interactive case studies, including those outside of cancer,  allowing direct point of care clinicians to apply evidence-based knowledge, tools and interventions immediately in day to day practice.

The task at hand is significant, but we can deliver high quality palliative care with a highly skilled workforce supported by an accessible, standardized, clinically-relevant and evidence-based continuing education program. Furthermore, it ensures that patients living in rural and remote areas receive the same high quality care aligned with their disease trajectory and wishes.

Jiahui Wong is Manager and Deyan Kostovski is Communication Lead, de Souza Institute, University Health Network.