Education BMJ Support Palliat Care: first published as 10.1136/bmjspcare-2021-003036 on 27 July 2021. Downloaded from Primary- level palliative care national capacity: Pallium Canada Jose Pereira ,1,2 Srini Chary,2,3 Jonathan Faulkner,2 Bonnie Tompkins,2 Jeffrey B Moat2 ► Additional supplemental ABSTRACT Key messages material is published online The need to improve access to palliative care only. To view, please visit the journal online (http:// dx. doi. across many settings of care for patients with What was already known? org/ 10. 1136/ bmjspcare- 2021- cancer and non-cancer illnesses is recognised. ► Primary- level and specialist- level palliative 003036). This requires primary- level palliative care capacity, care services are needed to meet the but many healthcare professionals lack core 1Family Medicine, McMaster palliative care needs of a population, but University Faculty of Health competencies in this area. Pallium Canada, professionals across many settings of care Sciences, Hamilton, Ontario, a non- profit organisation, has been building lack core palliative care skills. Canada primary-level palliative care at a national level ► Pallium Canada, a non- profit organisation 2Pallium Canada, Ottawa, since 2000, largely through its Learning Essential founded in 2000, builds primary palliative Ontario, Canada care capacity through education and 3Division of Palliative Medicine, Approaches to Palliative Care (LEAP) education compassionate communities. Foothills Hospital, Calgary, programme and its compassionate communities Alberta Health Services, efforts. From 2015 to 2019, 1603 LEAP course What are the new findings? Edmonton, Alberta, Canada sessions were delivered across Canada, reaching ► The programme has spread across Correspondence to 28 123 learners from different professions, Canada; from 2015 to 2019 alone, 1603 Dr Jose Pereira, Family Medicine, including nurses, physicians, social workers and courses were delivered and over 28 000 McMaster University Faculty of pharmacists. This paper describes the factors professionals trained. Health Sciences, Hamilton, ON ► Several factors have helped or impeded that have accelerated and impeded spread and copyright. L8P 1H6, Canada; spread and scale- up; drivers include jpereira@ mcmaster. ca scale-up of these programmes. The need for strategic partnerships and a social partnerships with local, provincial and federal J Pereira. (Plenary). Building enterprise model. Primary-Level Palliative Care governments and organisations is highlighted. A Capacity Through Education social enterprise model, that involves diversifying What is their significance? across Canada: The Pallium sources of revenue to augment government ► The lessons learned offer insights into Canada Experience. 15th World large- scale, national- level deployment of funding, enhances long-term sustainability. Congress of the European palliative care continuing professional Palliative Care Association. Barriers have included Canada’s geopolitical programmes. Madrid, Spain, 18 May 2017. realities, including large geographical area and ► Large- scale interprofessional continuing thirteen different healthcare systems. Some of http://spcare.bmj.com/ Received 9 March 2021 professional development is viable and Accepted 11 July 2021 the lessons learned and strategies that have impactful. evolved are potentially transferrable to other jurisdictions. across many care settings and specialty areas can provide what is referred to as INTRODUCTION the palliative care approach.9 10 However, Palliative care is needed across many many healthcare professionals lack the on September 28, 2021 by guest. Protected settings of care and for patients with cancer competencies and confidence to provide and non- cancer illnesses.1–4 This includes this approach.11–13 This calls for palliative © Author(s) (or their initiating a palliative care approach earlier care education, including undergraduate employer(s)) 2021. Re- use permitted under CC BY- NC. No in the illness trajectory and integrating it in and postgraduate training, and continuing 5 6 commercial re- use. See rights chronic disease management. Achieving professional development (CPD) for those and permissions. Published by universal access requires a multipronged already in practice. BMJ. approach that incorporates appropriate Achieving widespread uptake of a To cite: Pereira J, Chary S, policies, services, funding and education.7 palliative care education programme Faulkner J, et al. BMJ All the palliative care needs of a popu- involves ‘spread’ (replicating an initiative Supportive & Palliative lation cannot be met by palliative care elsewhere) and ‘scale-up’. 14 The latter Care Epub ahead of 8 print: [please include Day specialists alone. If equipped with core requires infrastructures, processes and Month Year]. doi:10.1136/ palliative care skills and supported by policies to support full-scale, system- wide bmjspcare-2021-003036 specialist palliative care teams, providers implementation and sustainability. Pereira J, et al. BMJ Supportive & Palliative Care 2021;0:1–9. doi:10.1136/bmjspcare-2021-003036 1 Education BMJ Support Palliat Care: first published as 10.1136/bmjspcare-2021-003036 on 27 July 2021. Downloaded from Pallium Canada (Pallium) is a non-profit organisa- professionals via its interprofessional Learning Essen- tion founded in 2000 to build primary palliative care tial Approaches to Palliative Care (LEAP) courses and capacity nationally across Canada. This paper discusses complementary materials.17 The LEAP courses address Pallium’s evolution and the national spread and core palliative care competencies. While most are scale-up of its education and compassionate commu- 1- day to 2- day classroom events with a maximum of nities programmes and the factors that have facilitated 30 learners, flipped, hybrid and entirely online virtual and impeded their spread and scale-up. versions are also available. Pallium draws on Rogers’ diffusion of innovations PALLIUM CANADA’S GEOPOLITICAL CONTEXT, model.18 Rogers posits that once a critical mass of inno- APPROACH AND EVOLUTION vators and early adopters—about 16% of the target Canada has a diverse and multicultural population of audience—adopt a new approach, a tipping point is 37.2 million and an area that equals Europe. Most of reached after which wider adoption accelerates.19 the population lives in urban areas close to its southern Pallium has evolved in phases.20 Activities and learn- border, but up to 16% of the population lives in rural ings from each phase have informed subsequent phases. and remote communities. Canada is a confederation of The six phases from 2000 to date are summarised in thirteen provinces and territories, each with responsi- online supplemental appendix A. bility over its own publicly funded healthcare system. This creates 13 different healthcare systems, with vari- ability in terms of funding and the delivery of palliative SPREAD OF PALLIUM CANADA’S PROGRAMMES care. AND ACTIVITIES Pallium’s approach is guided by several tenets. First, The growth in number of LEAP course sessions deliv- patients with palliative care needs and their families ered from 2001 to 2019 is shown in figure 1. In phase are found across many care settings. Second, care is 1 (2001–2003), 17 LEAP courses were delivered, provided across these settings by providers from various compared with 537 in 2019. The number of course professions and specialty areas. Third, palliative care sessions delivered from 2006 to 2014 was not tracked requires an interprofessional and multidisciplinary because of a decentralised distribution model with no approach that is promoted through interprofessional course registration mechanism. 14 education. Lastly, palliative care requires a public Prior to 2013, there was only one type (version) of copyright. health approach that includes engaging communi- the LEAP course, an interprofessional 2- day workshop ties.7 15 for community- based primary care professionals. Since Pallium positions itself as a Knowledge- to- Action 2014, 1- day or 2- day versions have evolved or are broker and a health system change agent.16 It brings being developed to target different settings and disease together palliative care subject matter experts from groups.17 These include versions for different settings across the country to identify best practices and (community, hospitals and long-term care (LTC)), evidence and synthesise and spread them to health services (paramedic services, emergency departments, http://spcare.bmj.com/ on September 28, 2021 by guest. Protected Figure 1 Number of Learning Essential Approaches to Palliative Care (LEAP) course sessions delivered across Canada from 2001 to 2019. 2 Pereira J, et al. BMJ Supportive & Palliative Care 2021;0:1–9. doi:10.1136/bmjspcare-2021-003036 Education BMJ Support Palliat Care: first published as 10.1136/bmjspcare-2021-003036 on 27 July 2021. Downloaded from Figure 2 Learning Essential Approaches to Palliative Care (LEAP) course sessions delivered by course type from 2015 to 2019. ED, emergency department; LTC, long- term care; Onco, Oncology; Peds, paediatrics. paediatrics and healthcare leaders) and specific disease participated. The latter includes physiotherapists, groups (cancer, renal, lung, heart and liver diseases). counsellors, dietitians, and clinical managers. The From 2015 to 2019, 1603 course sessions were largest growth in terms of course participation has delivered across Canada (figure 2). The course version been with nurses (figure 3). Physician