Table 2.

Reflections from the first cycle of the CTC Program

Organizational Barriers
Lack of buy-in from administrators and decision-makers	• A more rigorous process of sample selection through interviews and personal judgement • Identifying senior clinical and non-clinical leaders within organizations and engaging them
Workforce shortage to initiate PC service	• A 2-day on-site structured mentor visit where mentors addressed site-specific issues with administrators/decision-makers • Sensitization and training programs by experts on palliative care
Lack of resources – space, funding, time
Lack of awareness about PC among other healthcare providers
Hierarchical structure in the healthcare system that impedes communication and collaboration	• Group brainstorming with the team on how to enhance team collaboration and communication • Team building activities during the mentor visit and refresher course
Individual Barriers:
Lack of motivation towards PC	• Improving selection of change champions by interviews and personal judgment • Selecting those with some awareness, understanding and commitment towards palliative care • Identifying those who have had short-term training in palliative care in the cancer treatment institutes and involving them in the program
• Deficits in PC skills and knowledge • Lack of leadership skills	• Structured training program that included a 3-day centralized refresher training which focused on: • Problem-based learning and peer learning techniques to foster a culture of continuous self-directed learning • Microlearning to reinforce previously acquired knowledge and skills, address gaps in knowledge and help in retention
Competing interests of the healthcare provider	• Appropriate selection of candidates who would be able to devote exclusive time to PC • Organizational buy-in from administrators ensured to smoothen this transition
Barriers for drug availability
Opioid access and use	• Liaising with opinion leaders, administrators, local change champions, and governmental agencies for better opioid access • Training for healthcare staff on safe use of opioids