Pallium Canada: Interview with Kathryn Downer

Categories: Education.

Could you give me a brief background of Pallium Canada (I’m very interested in the concept of a community of practice)?

Pallium Canada is a national palliative education Community of Practice (CoP) comprised of academic, health care providers, and government and NGO leaders. Pallium’s CoP has grown over the years due to the members’ common interest in improving the quality of hospice/palliative care services in Canada. It is through the process of sharing information and experiences within the group that members learn from each other.

Pallium began in 2001 as ‘the Pallium Project’ with an initial focus on palliative care delivery in rural settings. In 2003 Pallium received funding to broaden its reach across the country and to develop a range of sub-projects in a number of areas; from courses for primary healthcare professionals and education programs for chaplains, to clinical decision support resources such as the Pallium Palliative Pocketbook (referenced and extensively peer reviewed) and the 99 questions for nurses on Palliative Care, to community support services such as telephone lines for British Columbia, Alberta, Saskatchewan and Manitoba. An online commons for resources was also developed and existing programs such as a grief and bereavement program for children in was enhanced. Moreover, the CoP greatly expanded through monthly teleconference dialogues. We now have a large suite of podcasts, videos and instructional material available for free through a Creative Commons Licence on our iTunes and YouTube.

In 2012 Pallium relocated from Western Canada (Edmonton, Alberta) to Canada’s capital city in Ottawa, Ontario. This relocation has improved collaboration with partners such as the Canadian Hospice Palliative Care Association. Family physicians in Canada are required to complete a certain number of training “credits” each year to maintain their professional licenses. The Learning Essential Approaches to Palliative and End-of-Life Care (LEAP) course qualifies for those training credits. 

Could you tell me about the education initiatives of Pallium Canada and how these link up with the rest of the work that you do?

Pallium’s focus is on creating educational resources that can be used to improve all aspects of hospice palliative care. This includes targeting the entire interprofessional community involved in providing hospice palliative care; from physicians, to nurses, to social workers, to spiritual care providers and caregivers. For Pallium, these professionals work together to provide the best possible palliative care.

Our most popular course: LEAP, is now delivered in universities, hospitals and community based healthcare settings across the country. LEAP is a Main Pro-C accredited educational program through the College of Family Physicians Canada.

LEAP has been informed by an on-going dialogic collaboration among academic health and community-practice leaders. The course integrates current evidence with analyses of quality, competent practice in Canadian community settings at the primary care and the regional resource leader levels. LEAP learning modules include; Creating Context, Gastro-Intestinal Problems in Palliative Care, Pain Management, Respiratory Problems, Communication, Depression, Anxiety & Suffering, Grief & Bereavement, Delirium, Palliative Sedation, Last Days & Hours, and Working as a Team. Pallium is currently working on an updated version of LEAP that will tailor to medical specialities such as; long-term care, emergency departments, oncology, etc.

Another one of our most popular tools is the Pallium Palliative Pocketbook. The Pocketbook was designed to support those involved in palliative interventions as a first source of information, enabling regional coordinators and consultants to more effectively, responsively, and efficiently support primary-care colleagues engaging in local planning and management of palliative services.

The Pocketbook is fully-referenced and peer reviewed, and is used all over Canada in educational and health care settings; to train undergraduates, medical residents and for on-the-job referencing. The Pocketbook is designed to be an accompaniment to the LEAP course.

Pallium Canada offers online learning. What, in your experience is the advantages of this learning format?

Healthcare providers are generally very busy individuals who have difficulty making the time in their schedule for a week-long, or even 2-day course. E-learning provides an opportunity for learners to access course material any place, at any time, and to work at their own pace.

Carefully prepared courses, created by subject matter experts (SMEs), writers, and technical professionals ensure learners are provided with standardized, up-to-date, relevant training material. E-learning material is scalable with little resources, as the material has been prepared, and delivery is only dependent on access to the internet. The Dual-Coding theory hypothesized that visual and auditory information are coded in two distinct areas of the brain. When learners use both channels to code information, information recall is more successful.

Pallium is currently in the process of developing a Learning Management System (LMS) where learners can interact with e-learning content. An LMS holds and displays multimedia content including: video, audio clips, interactive multimedia, ebooks, as well as functioning to interact with other learners and course facilitators.

Pallium Canada addresses disparities in access to education opportunities that exist between urban centres and more remote areas in Canada. Do you think that the Pallium experience can be drawn on to inform palliative care education globally?

Good palliative care services have actually been shown to reduce the overall costs to the healthcare system and reduce visits to the emergency department. Palliative care can also be delivered in the home, which is the way Canada is moving to modernize its public healthcare system. The “home first” philosophy is very important to rural regions that may not have close proximity to hospitals or hospices. By receiving palliative care services at home, the patient experiences an improved quality of life by being close to family; in a setting they are familiar and comfortable with. There is also less of a financial burden to public costs. However, it is important that this approach be interprofessional – from doctors, nurses, social workers, personal support workers, spiritual support and more – all of these pieces must work together to provide the patient with the best possible quality of life.

While certain regions of Canada have built this integrated palliative care system into their overall health strategy, many areas are still lacking. However, the positive results from these integrated palliative care systems has been catching on nationally, with support now coming from the federal government.

I believe other countries could learn from our example while we continue to strengthen our own health care system. E-Learning is an especially important aspect in providing access to education in more rural and remote areas of the country. 

Is there anything that we haven’t spoken about that you would like to add?

The work is moving forward from a more formalised packet of courseware, to develop these learning apps and just-in-time solutions to meet the needs of busy practitioners. The idea of palliative care being interprofessional is key to good care and moving beyond healthcare to compassionate communities and the impact of so many areas of support for families and those who care for loved ones beyond straight clinical care is where I see the future of the broader application of palliative principles.

Pallium Canada is launching new website. Look out for the announcement in the next couple of weeks on ehospice.  For more information please contact Pallium Canada’s national director, Dr Kathryn Downer, at or at +613 562-6262 ext. 1230.

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