title: Protocol: Evaluating the impact of a nation-wide train-the-trainer educational initiative to enhance the quality of palliative care for children with cancer.
abstract: BACKGROUND
  There are identified gaps in the care provided to children with cancer based on the self-identified lack of education for health care professionals in pediatric palliative care and in the perceptions of bereaved parents who describe suboptimal care. In order to address these gaps, we will implement and evaluate a national roll-out of Education in Palliative and End-of-Life Care for Pediatrics (EPEC®-Pediatrics), using a 'Train-the-Trainer' model.
  
  
  METHODS
  In this study we are using a pre- post-test design and an integrated knowledge translation approach to assess the impact of the educational roll-out in four areas: 1) self-assessed knowledge of health professionals; 2) knowledge dissemination outcomes; 3) practice change outcomes; and 4) quality of palliative care. The quality of palliative care will be assessed using data from three sources: a) parent and child surveys about symptoms, quality of life and care provided; b) health record reviews of deceased patients; and c) bereaved parent surveys about end-of-life and bereavement care. After being trained in EPEC®-Pediatrics, 'Master Facilitators' will train 'Regional Teams' affiliated with 16 pediatric oncology programs in Canada. Each team will consist of three to five health professionals representing oncology, palliative care, and the community. Each team member will complete online modules and attend one of two face-to-face conferences, where they will receive training and materials to teach the EPEC®-Pediatrics curriculum to 'End-Users' in their region. Regional Teams will also choose a Tailored Implementation of Practice Standards (TIPS) Kit to guide implementation of a quality improvement project in their region; support will be provided via quarterly meetings with Co-Leads and via a listserv and webinars with other teams.
  
  
  CONCLUSIONS
  Through this study we aim to raise the level of pediatric palliative care education amongst health care professionals in Canada. Our study will be a significant step forward in evaluation of the impact of EPEC®-Pediatrics both on dissemination outcomes and on care quality at a national level. Based on the anticipated success of our project we hope to expand the EPEC®-Pediatrics roll-out to health professionals who care for children with non-oncological life-threatening conditions.
authors.affiliation: Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 130-155 College Street, Toronto, ON, M5T 1P8, Canada. kim.widger@utoronto.ca.|Pediatric Advanced Care Team, Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada. kim.widger@utoronto.ca.
authors.forename: Kimberley
authors.initials: K
authors.lastname: Widger
authors.affiliation: Department of Pain Medicine, Palliative Care & Integrative Medicine, Children's Hospitals and Clinics of Minnesota, 2525 Chicago Avenue South, Minneapolis, MN, 55404, USA. Stefan.Friedrichsdorf@childrensMN.org.
authors.forename: Stefan
authors.initials: S
authors.lastname: Friedrichsdorf
authors.affiliation: Pediatric Palliative Care Service, Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA. joanne_wolfe@dfci.harvard.edu.
authors.forename: Joanne
authors.initials: J
authors.lastname: Wolfe
authors.affiliation: Pediatric Palliative Care Program, The Montreal Children's Hospital, 2300 Rue Tupper, Montréal, QC, H3H 1P3, Canada. stephenliben@gmail.com.
authors.forename: Stephen
authors.initials: S
authors.lastname: Liben
authors.affiliation: Pediatric Oncology Group of Ontario, 480 University Avenue, Suite 1014, Toronto, ON, M5G 1 V2, Canada. jpole@pogo.ca.
authors.forename: Jason D
authors.initials: JD
authors.lastname: Pole
authors.affiliation: Brain Tumor Program, Division of Hematology/Oncology, Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada. eric.bouffet@sickkids.ca.
authors.forename: Eric
authors.initials: E
authors.lastname: Bouffet
authors.affiliation: Policy and Clinical Affairs, Pediatric Oncology Group of Ontario, 480 University Avenue, Suite 1014, Toronto, ON, M5G 1 V2, Canada. mgreenberg@pogo.ca.
authors.forename: Mark
authors.initials: M
authors.lastname: Greenberg
authors.affiliation: Department of Family and Community Medicine, University of Toronto, Temmy Latner Centre for Palliative Care, Mount Sinai Hospital, 60 Murray Street, 4th Floor, Toronto, ON, M5T 3 L9, Canada. amna.husain@tlcpc.org.
authors.forename: Amna
authors.initials: A
authors.lastname: Husain
authors.affiliation: Canuck Place Children's Hospice, Clinical Professor, Department of Pediatrics, University of British Columbia, 1690 Matthews Avenue, Vancouver, BC, V6J 2 T2, Canada. hsiden@cw.bc.ca.
authors.forename: Harold
authors.initials: H
authors.lastname: Siden
authors.affiliation: Department of Hematology/Oncology, Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada. jim.whitlock@sickkids.ca.
authors.forename: James A
authors.initials: JA
authors.lastname: Whitlock
authors.affiliation: Pediatric Advanced Care Team, Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada. adam.rapoport@sickkids.ca.
authors.forename: Adam
authors.initials: A
authors.lastname: Rapoport
mesh_terms: D000293:Adolescent; D002170:Canada; D002648:Child; D002675:Child, Preschool; D003479:Curriculum / Q000592:standards; D006282:Health Personnel / Q000193:education*; D006801:Humans; D009369:Neoplasms / Q000628:therapy*; D010166:Palliative Care / Q000379:methods* / Q000592:standards*; D010372:Pediatrics / Q000379:methods; D015397:Program Evaluation; D011788:Quality of Life / Q000523:psychology; D013663:Teaching / Q000592:standards*
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