Program background

The goal of palliative cancer care is to improve the quality of life of people with cancer and their families. Unfortunately, despite advances in anticancer treatment over the past decades, half of Canadians with cancer still eventually die of it. The need for excellent palliative care is clear, and its lack across Canada has been recognized most recently in a Senate committee report (Quality End-of-Life Care: The Right of Every Canadian, 2000), and the Kirby and Romanow reports on health care in Canada (2002). Given the burden of suffering that palliative care addresses, there has been relatively little research carried out in Canada and internationally. There is a great and pressing need for evidence as to the most effective and efficient interventions and health services, and how these might differ based on social and cultural differences.

Three national groups have been convened since 1999 to determine priorities for Palliative Care research. The similarities in recommendations are striking: all 3 groups decided that the first priority for advancing Palliative Care research in Canada is to increase the number of investigators able and willing to carry it out. There is a lack of specialized programs for palliative care research training worldwide. To our knowledge, nowhere in the world is there a program specifically designed to train palliative care investigators at the PhD level. In addition, there are a few Master's programs for clinicians that provide some training focused on palliative care research but, except for one, these are discipline-specific. CIHR and the National Cancer Institute of Canada have funded this program to address this critical gap. The Strategic Training Program in Palliative Care research is unique worldwide in its interdisciplinary nature, critical mass of trainees and mentors with a palliative care focus, mix of excellent academic and clinical palliative care research mentors, inclusion of doctoral students, and support in developing a network of investigators able to communicate in both official languages of Canada.

Program objectives

1. Develop an exemplary nationally and internationally recognized program to support and train people from a wide spectrum of relevant disciplines to produce excellent interdisciplinary, innovative, and relevant palliative care research.
2. Trainees and mentors combine and develop creative Palliative Care research methodologies from different fields, disciplines, and research laboratories.
3. Trainees and mentors learn to conduct and disseminate research that will be used by health care providers and policymakers to optimize the quality of life of palliative care patients and their families.
4. Create a network among an interdisciplinary group of Palliative Care investigators that results in future collaboration between and amongst mentors and trainees and connect them to the broader palliative care research community.

Program description

Palliative care is by nature interdisciplinary as the person rather than the disease must be treated, in an integrated manner, as bodily symptoms cannot be separated from psychological, social, and spiritual well-being. This innovative program has been designed to allow trainees in 3 cities to obtain graduate degrees and post-doctoral training in various disciplines while adding interdisciplinary training and exposure to palliative care specific research challenges in both English and French, as well as connection to a network of palliative care researchers. In addition, this program will provide friendly review of proposals of new palliative care investigators other than trainees in the program.

This interdisciplinary training program will be grafted onto established research programs that are already strongly interdisciplinary in nature. Palliative Care research involves special challenges and creative solutions. Many of the investigators in this program have developed methodologies required to face these challenges. They study a variety of populations (patients; family caregivers; physicians; nurses) with different methodologies (e.g. quantitative and qualitative; self-report and clinician-report; database linkage). They address various issues such as pain, stress, delirium, existential well-being, ethical dilemmas, and rehabilitation in the wide variety of settings in which palliative care clinical research must take place (homes; hospices; outpatient clinics; oncology inpatient units; palliative care inpatient units).

Program requirements

Trainees obtaining a Master's, Ph.D. or ubdertaking post doctoral training will be accepted to and obtain degrees from their supervisor's department by meeting specific departmental requirements. In addition, they must meet the following requirements:

1. The trainee's research/thesis will be focused in the field of palliative care.
2. In addition to their supervisor, each trainee will be assigned a second mentor selected from the 12 investigators participating in the Program with expertise in another discipline.
3. Prior to admission, one of the investigators must have agreed to supervise the candidate upon acceptance in the program.
4. All trainees will be expected to apply for available external funding at the national, provincial, and local levels.
5. Trainees must be registered full-time in their program while holding the fellowship.
6. Trainees must spend at least 75% of their work-time conducting their studies/research.
7. The trainee must complete all courses, seminars and activities as outlined in the program content.
8. Mentors will participate in course organization, seminars and activities as outlined in the program content.
9. In addition to presenting their research to the members of the program, trainees must disseminate their knowledge by presenting their research at a national or international conference. They must also submit at least one paper for publication. They must present their findings to both a scientific and a clinical or policymaker audience.

Program content

The Strategic Training Program in Palliative Care Research content will be delivered in a mixture of French and english. All course and seminar material will be made available in both French and English, although lectures will be carried out in one language. All mentors are bilingual and are available to help all trainees. During the workshops, small groups will be conducted in both languages. Trainees will be free to choose the language in which they wish to participate. Students who enter the program with a minimal understanding of either official language will be encouraged to take one of the intensive language immersion courses offered at each university during the summer.

The Strategic Training Program in Palliative Care Research content was designed to provide synergy with departmental programs and to fit the normal flow of the academic year. The content includes:

• One graduate level course in research methodology to be taken during first year in the Program.
• One graduate level course in statistics.
• One graduate level course in qualitative methods.
• Palliative Care Research Seminars organized for all trainees will be conducted via videoconference from all 3 universities. Trainees will make presentation in the area of their research thesis in the official language of their choice, either French or English. Guest speakers or mentors may also be present. There will be 2 seminars per semester.
• Proposal Writing Interactive Course on Palliative Care Research. This five day course is offered in May after winter classes end. Trainees in the first year in the program will learn to articulate a research question and to write a proposal to address that question. In addition, trainees will receive didactic lectures and written material while learning to write their research proposal section by section followed by group discussion. Mentors of all first year trainees will attend the workshop while other mentors may join. Trainees in second and subsequent years of the program will be required to help run and participate in the interactive small groups, thus acquiring more training and mentoring experience. Participants are expected to travel to one city and participate in person.
• Palliative Care Research Proposal Review. This review process is a follow-up to the Palliative Care Proposal Writing Course and takes place approximately 4 weeks later in June. Trainees in all years of the program will be asked to review two proposals using CIHR criteria and rating scales. This will be a 1-2 day workshop involving presentation of reviews by trainees and discussion of the reviews and proposals by all trainees and all mentors. Ethical concerns about the proposals will be noted and discussed during the Ethics Course.
• Ethical Challenges in Palliative Care Research Course. Following presentation of core concepts in research ethics, questions raised by trainees and mentors will be discussed. All trainees and mentors of first year trainees will attend this 1-day course.
• Annual Scientific Meeting. This will be held together with the two courses listed above. Ongoing research will be presented and discussed in a collegial atmosphere. Attendance is required of all trainees and mentors. It is anticipated that all first year master and doctoral trainees will have a proposal suitable for submission to their department and ethics committee within 1 year of entering the program.
• Examples of learning opportunities open to trainees accepted in the program (Subject to change).

McGill University

• Palliative Care McGill Rounds (monthly)
• Dept.Oncology Interdisciplinary Journal Club(monthly)
• Dept. Oncology Grand Rounds (monthly)
• Visiting Professor in Oncology Program, 3 focused on palliative care per year (in conjunction with Université de Montréal). Experts give several talks and meet informally with trainees and clinical staff
• McGill University Health Centre Palliative Care Service Journal Club (weekly)
• Qualitative Research Forum (4-6 times per year)
• Annual McGill Pain Day
• School of Nursing Research Colloquia (approximately 12 per year)
• Joint lab meeting of Nancy Mayo, Sharon Wood-Dauphinee, and Robin Cohen
• McGill University Health Centre Symptom Control Rounds (weekly)
• Dept. Oncology Research Retreat (twice annually)
• McGill University Health Centre Dept. Medicine Grand Rounds (weekly)
• McGill University Health Centre Oncology Rounds (weekly)

Université Laval

• La Maison Michel Sarrazin : Rencontres des chercheurs en soins palliatifs et psycho-oncologie (environ 6 par année)
• Faculté des Sciences Infirmières: Midis de la recherche
• CHUQ, Hôtel Dieu de Québec: Conférences hebdomadaires du centre de recherche
• CHUQ: Conférences hebdomadaires en oncologie
• CHUQ : Conférences hebdomadaires en médecine interne
• CHUQ : Conférences hebdomadaires en psychiatrie
• CHUQ : Conférences en soins palliatifs (environ 8 par année)
• Université Laval (au Centre Hospitalier L`Hôtel Dieu de Québec) : Programme de cours du programme de résidence en oncologie (conjoint avec le programme de résidence en radio-oncologie) - hebdomadaire
• Centre de recherche Université Laval Robert-Giffard : conférences de recherche en psychiatrie (mensuelles)

University of Ottawa

• Institute of Palliative Care: Palliative Care Rounds (monthly)
• School of Nursing: Thesis in Progress Seminars