Lessons learnt from education in paediatric palliative care - the QuoCCA project
A blog post written by Dr Anthony Herbert, Director, Paediatric Palliative Care Service, Division Medicine, Queensland Children's Hospital
“Education is the most powerful weapon which you can use to change the world.” – Nelson Mandela
The Quality of Care Collaborative Australia (QuoCCA) delivers education in paediatric palliative care and has been operating since 2015, and is funded by the Department of Health. In that time significant education has been delivered to health professionals of all disciplines and levels of experience. Education has been both scheduled and “pop-up” and has been delivered by inter-professional teams to inter-professional audiences (ie health professionals from a variety of disciplines). “Pop-up” education is a form of education where a small team will travel to a regional or rural centre to provide education around the care of a specific patient. There is a timely response to the patient’s needs (be it related to setting up palliative care supports, managing difficult symptoms or end of life care). Increasingly, such education has also revolved around bereavement support visits, including aspects of quality improvement, such as death reviews.
In our early evaluation of education provided by the QuoCCA project, a number of interesting observations were made.  The education was both accessible and effective. We learnt we were able to reach a very large number of health professionals (more than 10,000) in every state and territory of Australia during the first 2 cycles of the project (each cycle lasting approx. 3 years). The reach of the education also included aboriginal health workers, community developmental workers, pastoral carers, teachers, administration staff and funeral directors. There was improvement between pre- and post- education evaluations for both experienced and less experienced practitioners. It appeared health professionals started at a different point on the knowledge or confidence curve and were nudged further up the curve by educational interventions. Another interesting finding was that there appeared to be a “dose-response” relationship in terms of the duration of education that was delivered. A full day course having more impact than a half day or shorter session. This justifies our efforts to organise full day workshops where we can. This usually requires forward planning – so health professionals can arrange appropriate leave and back-fill, and also before rosters have been created.
However, at the same time, we also saw the need to factor in smaller bite size educational encounters for the busy clinician (even as small as 30 minutes duration). This may be “on the run” or linked to another clinical session such as a clinical handover meeting, hospital morbidity and mortality round or even over lunch. This type of “incidental” education can allow integration of the principles of paediatric palliative care into tertiary children’s hospitals and other health care settings. “Pop-up” education related to the care of a specific patient is sometimes delivered within this timeframe, and we are currently grappling with the best way to evaluate such education. Further, we are also interested in the long-term outcomes of our education and what impact this may have on clinical decision making and the care provided.
As we engaged with smaller communities located throughout our respective states, the compassionate capacity of these communities became very apparent. The importance of local neighbours, faith communities, funeral companies, schools, non-government organisations and the local ambulance service in the care and support of those in need in their community is significant and acknowledged. This was reflected in the significant “other” who attended our educational sessions. How to capture and evaluate this social networking and in community capacity remains a challenge.
It is not surprising that as our project has evolved over the past 4 years, we have seen the emergence of a network of clinicians, educators and health professionals caring for children with life limiting conditions and their families throughout Australia. Through “Discovery Interviews” with both our educators and health professionals we were able to identify themes that had emerged within this network of care providers.  Our educators have both significant clinical experience, but also a willingness to become better teachers. We observed a distinct benefit of having dedicated educators within services, who were not also balancing a busy clinical load. There was benefit in having a national project facilitating collaboration between nurse educators and allied health staff in different states. This allowed harmonisation, synergy and innovation in both the content and processes of the education. Our collaborative also quickly learnt that education was much more than delivering a PowerPoint presentation. Some of our innovative learnings in education delivery have been described elsewhere. 
We developed a number of different ways of delivering education including case based, interactive styles, role play and simulation. “I think early only when we were finding our feet it was very much didactic because we had to learn it ourselves … you can become a little more engaging once you’re comfortable.”  Educators also learnt that the participants in the education program brought with them a wealth of knowledge and expertise.
We have also examined how the complex care needs of the child and their family require a diverse network of health and social care professionals. Families need to navigate a complex web of formal and informal care providers. Communication pathways were also forged between the specialist paediatric palliative care services and regional services, resulting in earlier referrals and development of care teams for each specific patient and family. As the project has evolved, mentoring type relationships also developed with ongoing collegial support and guidance provided to the recipients of the education.
“It’s highly valuable work … it’s important that we get it right because parents and families, the kids that grow up and have their generational bereavement … they look back to this time and they never forget a good memory of staff being supportive and helpful. That’s my whole aim and the reason why I’m so passionate about … getting it right for these parents and families.” 
We would like to thank the children and families who allow us the privilege of caring for them. We learn a lot from caring for our families. We also need to explore their perspectives on the care they receive. Further, we need to better understand the demographics of the patients we care for. Perhaps this is a topic for a future blog!
- Slater PJ, Herbert AR, Baggio SJ, Donovan LA, McLarty AM, Duffield JA, et al. Evaluating the impact of national education in pediatric palliative care: the Quality of Care Collaborative Australia. Adv Med Educ Pract. 2018 Dec 14;9:927-941. doi: 10.2147/AMEP.S180526. eCollection 2018.
- Donovan LA, Slater PJ, Baggio SJ, McLarty AM, Herbert AR. Perspectives Of Health Professionals And Educators On the Outcomes Of A National Education Project In Pediatric Palliative Care: The Quality of Care Collaborative Australia. Adv Med Educ Pract. 2019 Nov 7;10:949-958. doi.org/10.2147/AMEP.S219721
- Palliative Care Australia. 2017 National Palliative Care Awards catchup: QuoCCA [Internet]. Canberra (ACT): Palliative Care Australia; 2017 [updated 2019 Sept 11; cited 2019 Dec 2].
Dr Anthony Herbert, Director, Paediatric Palliative Care Service, Division Medicine, Queensland Children's Hospital