Integrating palliative care into health professionals’ education

As a result of the COVID-19 pandemic, many changes have been made to British Columbia’s health care system, including an evolution of the way undergraduate and postgraduate medical education is conducted through online lectures. Modules focused on equity-based approaches to palliative care should be integrated into this educational framework.[1] An equity-based approach to palliative care considers the needs of Indigenous people, immigrants, and people of all social and cultural backgrounds.

The National Institute of Nursing Research defines palliative care as, “the treatment of the discomfort, symptoms, and stress of serious illness.”[2] Palliative care has advanced in providing comfort to patients experiencing chronic or life-threatening diseases. The related field of education must also evolve to meet the learning needs of health care professionals interested in integrating equity-based palliative care approaches into their practice. During the COVID-19 pandemic, we have seen a rise in disparities in access to physical and mental health interventions by equity-seeking populations,[3] those who are marginalized due to historical, social, or environmental barriers based on age, ethnicity, disability, economic status, nationality, or race.[4]

A study of medical residents by Sanchez-Reilly and colleagues evaluated four domains, including reaction to palliative care education, learning from education, changes in professional behavior, and clinical practice changes resulting from palliative care education.[5] Residents applied patient-centred care approaches to their clinical palliative care practice;[5] however, it is not clear whether online palliative care education programs have equity-informed palliative care education. There is a need to embed equity-informed palliative care education approaches in health professions’ training.

Physicians who have expertise in palliative care can make referrals to other specialists, provide patient and family-centred care, and train and mentor the next generation of professionals. Organizations such as Pallium Canada, the Canadian Medical Association, the College of Family Physicians of Canada, and local universities and colleges offer training programs to medical learners at all career levels,[6] but it is unclear whether these programs have an equity focus.[7,8]

Medical schools have a responsibility to encourage learners to explore palliative care. Online education programs that are available to doctors, nurses, and other health care providers can help to train a health care workforce in palliative care clinical practice.[9,10] Many clinical scholars and educators have also identified the lack of training in palliative care.[11,12] The time has come to provide a creative solution: innovative, virtual education aligned with CME requirements to teach undergraduate and postgraduate medical trainees the equity-oriented foundational skills of palliative care[13] that could be applied to clinical practice for a positive impact on the health care system.
—Vidhi Thakkar, PhD
University of Victoria, Institute of Aging, Faculty of Nursing
—Jake Colautti
BHSc student, McMaster University, Faculty of Health Sciences
—Shaina Raza, PhD
University of Toronto, Dalla Lana School of Public Health
—Kelli Stajduhar, RN, PhD, FCAHS, FCAN
University of Victoria, Institute of Aging, Faculty of Nursing

Acknowledgment
This research and content is part of Vidhi Thakkar’s CIHR Health Systems Impact Fellowship.

References
1.   Stajduhar K. Equity in palliative care. Accessed 21 December 2021. equityinpalliativecare.com.
2.   National Institute of Nursing Research. What is palliative care? Accessed 21 December 2021. www.ninr.nih.gov/newsandinformation/what-is-palliative-care.
3.   Davison, KM, Thakkar V, Lin SL, et al. Interventions to support mental health among those with health conditions that present risk for severe infection from coronavirus disease 2019 (COVID-19): A scoping review of English and Chinese-language literature. Int J Environ Res Pub Health 2021:18:7265.
4.   Canadian Council for the Arts. Equity-seeking groups. Accessed 21 December 2022. https://canadacouncil.ca/glossary/equity-seeking-groups.
5.   Sanchez-Reilly S, Ross JS. Hospice and palliative medicine: Curriculum evaluation and learner assessment in medical education. J Palliat Med 2012;15:116-122.
6.   Canadian Medical Association. National call to action for physicians on palliative care. Accessed 21 December 2021. www.cma.ca/national-call-action-physicians-palliative-care.
7.   University of British Columbia. Faculty of Medicine, Palliative Care, Department of Medicine. CFPC enhanced skills palliative medicine residency programs. Accessed 21 December 2021. https://palliativecare.med.ubc.ca/education/postgrad/cfpc-enhanced-skill....
8.   Canadian Home Care Association. Home and community-based palliative care: Shaping the future from lessons learned during the COVID-19 pandemic. Accessed 21 December 2021. https://cdnhomecare.ca/wp-content/uploads/2021/06/Home-and-Community-bas....
9.   Rosa WE, de Campos AP, Abedini NC, et al. Optimizing the global nursing workforce to ensure universal palliative care access and alleviate serious health-related suffering worldwide. J Pain Symptom Manage 2021;S0885-3924(21)00470-X. Online ahead of print.
10.   Ray RA, Fried O, Lindsay D. Palliative care professional education via video conference builds confidence to deliver palliative care in rural and remote locations. BMC Health Services Res 2014;14:1-8.
11.   Macdonald CJ, Stodel EJ, Hall P, Weaver L. The impact of an online learning resource designed to enhance interprofessional collaborative practice in palliative care: Findings from the caring together pilot project. J Res Interprofessional Practice Educ 2009;1. doi: 10.22230/jripe.2009v1n1a6.
12.   Pelayo-Alvarez M, Perez-Hoyos S, Agra-Varela Y. Clinical effectiveness of online training in palliative care of primary care physicians. J Palliat Med 2013;16:1188-1196.
13.   Partridge AH, Seah DS, King T, et al. Developing a service model that integrates palliative care throughout cancer care: The time is now. J Clin Oncol 2014;32:3330-3336.