When it comes to delivering care on the ground, Nova Scotia’s palliative care specialist teams are stretched thin. They can’t support every patient that needs palliative care, and they shouldn’t have to.
“All health care providers should have basic skills in palliative care, and they should know where—and how—to access specialist care when needed,” says Cheryl Tschupruk, Director of Palliative Care Integration at the Nova Scotia Health Authority (NSHA). “If you’re a patient, you shouldn’t have to rely on luck to find a palliative care practitioner.”
The NSHA works closely with palliative care providers and stakeholders to implement the province’s palliative care strategy. It has a guiding framework to help improve the quality of care that patients and their families receive—no matter where they are in the system. To improve quality of care, part of the NHSA’s focus is on building the knowledge, skills and confidence of primary health care providers including physicians, nurse practitioners, paramedics, home care nurses and hospital staff.
In the past, the NHSA offered at least three formal palliative education programs to build health care providers’ confidence and competency but had limited capacity to support all of them. Each program had its own infrastructure in terms of data collection, curriculum updating and embedding clinical guidelines. They decided to choose one education program to deliver across the province, which would allow the NHSA team to better focus their efforts, investment, resources and support.
The team developed a palliative care competency framework and mapped all the training programs they offered—including Pallium’s LEAP™ Core training—to identify which programs ensured participants would acquire the skills and competencies that are best aligned with the NHSA priorities.
The results of the mapping exercise showed that LEAP™ Core met the NHSA criteria, an outcome supported by the organization’s capacity building working group who recommended moving forward with the program.
“By offering LEAP™ Core training, we’re creating a pool of providers who have the essential skills our province needs,” says Tschupruk. “It allows us to be more efficient with resources because we’re sharing responsibility while increasing access to palliative care.”
The LEAP Core training fits well into the Nova Scotia Department of Health and Wellness’ integrated palliative care strategy, which was released in 2014. One of the pillars focuses on building capacity and practice change. The aim of this pillar is to identify a provincial education strategy and program, which the NHSA accomplished by undertaking this comparative analysis and ultimately choosing LEAP™ Core. The entire strategy is centred around integrated service delivery; with LEAP™ Core training, the NHSA can offer practical education to promote that integration.
Since narrowing their focus to LEAP™, the NHSA has trained over 1,200 health care providers on LEAP™ Core and LEAP™ Long-Term Care, as well as over 1,000 first responders in LEAP™ Paramedic. In the years to come, they are setting targets to train between 400 and 500 health care providers every year.
What do participants think of LEAP™ Core? “Close to 100 percent of people who take the training have positive feedback,” says Tschupruk. “We usually have waitlists for these classes, which is always a good sign.” Sometimes the NHSA receives feedback that the training felt rushed or the setting wasn’t ideal; they take every suggestion seriously so they can continuously improve the offering.
Tschupruk likes LEAP™ Core because the in-class dynamic helps build relationships between health care providers across the province. “It’s not just about what you learn,” says Tschupruk. “Bringing people together from different roles and disciplines builds trust, which is essential in health care.”
Moving forward, the NHSA has learned that it is important to develop annual training schedules. Currently, the facilitator team sets training dates on an ad hoc basis; they promote a session, fill it with participants, deliver the training and then start planning the next session. Tschupruk would like to take a more coordinated approach so health care providers can plan ahead and be mindful about deciding when to attend.
Since narrowing the province’s training focus to LEAP™ Core, Tschupruk has noticed a deliberate shift in mindset among primary health care professionals with increased awareness that palliative care is a shared responsibility—everybody has a role to play. Today, Nova Scotia has a growing pool of skilled palliative care providers, which allows the province to be more efficient with its resources, while improving access to palliative care for the patients that could benefit from it.
Tschupruk encourages other health authorities to take a thoughtful and careful approach to offering effective palliative care training to health care providers in their province. She recommends that provinces identify the competencies they expect health care providers to have and determine which training solution will do the best job at building those core skills. For Nova Scotia, Pallium’s LEAP™ courseware continues to meet their needs.
The Learning Essential Approaches to Palliative Care (LEAP™) Core training is a two-day course for health care professionals who care for patients with life-limiting illnesses, but whose primary focus is not palliative care. Certified by the College of Family Physicians of Canada for up to 28 Mainpro+ credits, LEAP™ Core was developed and peer-reviewed by a volunteer, pan-Canadian team of subject matter experts who are committed to promoting the palliative care approach. Participants learn the essential skills and competencies of the palliative care approach while building strong teams and fostering collaboration among providers in different agencies who work together.
 https://novascotia.ca/dhw/palliativecare/documents/Pallative-Care-Progress-Report.pdf (page 8)