QuoCCA paediatric palliative care education evaluation findings

An article written by Penny Slater and Anthony Herbert

The Quality of Care Collaborative Australia (QuoCCA) project was formed in 2014, and now includes representatives from specialist Paediatric Palliative Care (PPC) teams in seven tertiary children’s hospitals around Australia. A multidisciplinary team of educators were recruited to develop and deliver an education program throughout Australia. The aim was to achieve service quality improvement in national PPC through education, research, and evaluation within a quality framework.

Strategies included education to enhance the knowledge, skills, and confidence in the principles of PPC (Baggio et al, 2017). Participants engaged in either a scheduled general education session, ‘pop up’ education focused on a specific patient and family’s needs in regional areas (Mherekumombe 2016), or incidental education through conferences, meetings, ward rounds, and handovers.

Evaluation of this national project was governed through a Project Logic, which drove analysis on the level of outputs, impacts, and outcomes.

Outputs

QuoCCA education has now been provided to over 20,000 health and human service professionals throughout Australia via the three funded QuoCCA projects from 2015 to February 2023. This was delivered through 1178 education sessions over 2425 hours in every state and territory in Australia. There were 607 scheduled, 434 pop up and 137 incidental sessions. Medical Officers comprised 12% of participants, nurses 52%, allied health 10% and the rest were other health and human services employees or not specified.  The provision of education is spread across all areas of remoteness – for QuoCCA 3 to date there has been 1.4 QuoCCA sessions provided per 100,000 population in major cities, 1.8 in inner regional, 1.4 in outer regional, 3.4 in remote and 2.6 in very remote areas. Please refer to the infographic attached below.

Having supported generalist health and human service professionals to provide PPC (particularly in regional and community services close to families’ homes), QuoCCA also sought to maintain the sustainability of tertiary specialist PPC services. Medical Fellows and Nurse Practitioner candidates were recruited from 2015 at Queensland Children’s Hospital, Brisbane; Sydney Children’s Hospital, Randwick; and John Hunter Children’s Hospital, Newcastle. QuoCCA has rotated 31 Medical Fellows and five Nurse Practitioner candidates through the services to June 2022.

Impacts

Evaluation findings showed a significant increase in knowledge and confidence for all measures following education, increasing with greater dosages of education (both in length and repetition of exposure to education sessions) (Slater et al, 2018). More effective education was tailored to the needs of the audience, was interactive and included story-telling, case studies and parent experiences.

Outcomes

Families expressed their appreciation for the umbrella of support provided through pop up education, building partnerships, providing a network of care for their ongoing support, and responding to the needs of the whole family (Donovan et al 2022). 

Health and human professionals who experienced education found value in building capability through effective and accessible education, developing inter-professional partnerships, sustaining wellbeing, and learning from children and families (Donovan et al, 2019). QuoCCA provided ongoing collegial support and guidance to regional staff.

An evaluation of educational outcomes more than 6 months following QuoCCA education showed that its impact was sustained in the long term, with improvements to clinical practice and care of patients (Slater, Osborne & Herbert, 2021). QuoCCA education had improved knowledge, skills and confidence, raised awareness of local and statewide services and resources, improved collaboration, early referral and communication, and enabled better symptom management and care planning.

QuoCCA Medical Fellows and Nurse Practitioner candidates found that the education and mentoring framework supported their professional development and wellbeing outcomes (Slater & Herbert, 2023a). Participants reported various levels and modes of education and mentoring, including individual, team leader, PPC team, and external learning, supported by the collaborative team and service leadership. The positions not only improved the trainee’s general clinical practice, including communication, empathy, and holistic care, it also developed their specialised clinical skills and wellbeing (Slater & Herbert, 2023b).

References and links

• Baggio, Sarah, Herbert, Anthony, Delaney, Angela, McLarty, Alison, Slater, Penny, Donovan, Leigh, Pedersen, Lee-Anne, and Johnson, Susan (2017). A national quality of care collaboration to improve paediatric palliative care outcomes. National Rural Health Conference, Cairns, Australia, 26 - 29 April 2017. Canberra, ACT, Australia: National Rural Health Alliance.
• Mherekumombe MF, Frost J, Hanson S, Shepherd E and Collins J. Pop Up: A new model of paediatric palliative care. J Paediatr Child H. 2016;52:979-982.
• Slater PJ, Herbert AR, Baggio SJ, Donovan LA, McLarty AM, Duffield JA, Pedersen LC, Duc JK, Delaney AM, Johnson SA, Heywood MG and Burr CA. Evaluating the impact of national education in pediatric palliative care: the Quality of Care Collaborative Australia. Advances in Medical Education and Practice 2018;9:927-941. DOI https://doi.org/10.2147/AMEP.S180526
• Donovan LA, Slater PJ, Delaney AM, Baggio SJ, Herbert AR. Building capability in paediatric palliative care and enhancing education through the voice of parents: the Quality of Care Collaborative Australia. Palliative Care and Social Practice. 2022 10.1177/26323524221128835. https://doi.org/10.1177/26323524221128835
• Donovan LA, Slater PJ, Baggio SJ, McLarty AM, Herbert AR. Quality of Care Collaborative Australia. Perspectives of health professionals and educators on the outcomes of a national education project in pediatric palliative care: the Quality of Care Collaborative Australia. Advances in Medical Education and Practice 2019;10:949-958. DOI https://doi.org/10.2147/AMEP.S219721
• Slater PJ, Osborne CJ, Herbert AR. Ongoing Value and Practice Improvement Outcomes from Pediatric Palliative Care Education: The Quality of Care Collaborative Australia. Advances in Medical Education and Practice 2021;12:1189-1198.DOI https://doi.org/10.2147/AMEP.S334872
• Slater PJ, Herbert AR. Education and mentoring of the trainee specialist pediatric palliative care medical and nursing workforce: the Quality of Care Collaborative Australia. Advances in Medical Education and Practice, 2023;14:43-60. DOI https://doi.org/10.2147/AMEP.S393051
• Slater PJ, Herbert AR. Supporting the wellbeing of specialist pediatric palliative care medical and nursing trainees: the Quality of Care Collaborative Australia. Advances in Medical Education and Practice, 2023, in press.

Penny Slater
Program Manager
Oncology Services Group
Queensland Children’s Hospital

Dr. Anthony Herbert
Director
Paediatric Palliative Care Service 
Queensland Children’s Hospital