When it comes to delivering care on the ground, Nova Scotia’s palliative care specialist teams, as in most areas, are stretched thin. They can’t support every patient who needs palliative care, and they shouldn’t have to. Palliative Care is everyone’s responsibility.
“All health care providers should have basic skills and provide primary 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). The roles of the specialist palliative care teams are to provide support and education to other health care providers, provide intermittent or extended shared care to patients and families along with their primary care providers, and to participate in research to advance palliative care in Canada.
NSHA works closely with palliative care providers and stakeholders to implement the Nova Scotia Department of Health and Wellness’ integrated palliative care strategy, 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 NHSA’s focus is on building the knowledge, skills and confidence of primary palliative care providers including physicians, nurse practitioners, paramedics, home care nurses and hospital staff.
In the past, NHSA offered at least three formal palliative education programs but had limited capacity to support the spread of all of them. Each program had its own infrastructure in terms of data collection, curriculum updating and embedding clinical guidelines.
One of the pillars of the Palliative Care Strategy was Capacity Building and Practice Change and one of its aims was to identify a standardized education program. A working group was formed and over a two-year period developed the Nova Scotia Palliative Care Competency Framework. Competencies were mapped to a number of commonly available palliative care education programs, including Pallium’s Learning Essential Approaches to Palliative Care (LEAP) Core, to identify programs that allowed participants to learn about the identified competencies.
The committee chose LEAP CORE as the education program that would be delivered across the province, which would allow the NHSA team to better focus their efforts, investment, resources and support. The provincial strategy is centred around integrated service delivery. With LEAP Core training, NHSA can offer practical education to promote that integration.
“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 the 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 its focus to LEAP, NHSA has trained more than 1,200 health care providers using LEAP Core and LEAP Long-Term Care, and more than 1,000 first responders in LEAP Paramedic. In the years to come, it is 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 sessions, which is always a good sign.” Several experienced health care professionals have commented that it was the “best practical education they had ever received.” NSHA uses participant feedback, such as the “session felt rushed” or the “setting wasn’t ideal” to continuously improve the training.
Tschupruk feels the in-person teaching method 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, NHSA aims 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 that health care providers can plan which session they’d like to attend ahead of time. This also provides clinical managers a chance to build schedules with staff attendance in mind.
Since enhancing the province’s focus on palliative care training, Tschupruk has noticed increased attendance among primary health care professionals and a noticeable culture shift that palliative care is a shared responsibility.
Tschupruk encourages other health authorities to take a coordinated 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(s) 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.