{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T05:07:37Z","timestamp":1787807257290,"version":"build-2784847793"},"reference-count":56,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T00:00:00Z","timestamp":1751328000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"},{"start":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T00:00:00Z","timestamp":1751328000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"funder":[{"name":"Dr. Joshua Shadd Pallium Canada Research Hub"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Palliat Care"],"DOI":"10.1186\/s12904-025-01804-4","type":"journal-article","created":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T10:10:33Z","timestamp":1751364633000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Spread, participant experience, and implementation of Pallium Canada\u2019s Palliative Care ECHO project: a mixed methods study"],"prefix":"10.1186","volume":"24","author":[{"given":"Jos\u00e9","family":"Pereira","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lynn M.","family":"Meadows","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashwak","family":"Rhayel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-3412-1179","authenticated-orcid":false,"given":"Ashlinder","family":"Gill","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dragan","family":"Kljujic","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Panza","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Faulkner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey Moat","family":"CM","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,7,1]]},"reference":[{"key":"1804_CR1","unstructured":"World Health Assembly. WHA67.19. Strengthening of palliative care as a component of comprehensive care throughout the life course. World Health Organ. 2014;(May)."},{"key":"1804_CR2","doi-asserted-by":"crossref","unstructured":"McCallum M, Carver J, Dupere D, Ganong S, Henderson JD, McKim A et al. Developing a palliative care competency framework for health professionals and volunteers: the Nova Scotian experience. J Palliat Med. 2018;21(7).","DOI":"10.1089\/jpm.2017.0655"},{"key":"1804_CR3","unstructured":"Shadd JD, Burge F, Stajduhar KI, Cohen SR, Kelley M, Lou. Pesut B. Defining and measuring a palliative approach in primary care. 59, Can Fam Physician. 2013."},{"key":"1804_CR4","doi-asserted-by":"crossref","unstructured":"Boddaert MS, Douma J, Dijxhoorn AFQ, H\u00e9man RACL, van der Rijt CCD, Teunissen SSCM et al. Development of a National quality framework for palliative care in a mixed generalist and specialist care model: A whole-sector approach and a modified Delphi technique. PLoS ONE. 2022;17(3 March).","DOI":"10.1371\/journal.pone.0265726"},{"key":"1804_CR5","doi-asserted-by":"crossref","unstructured":"Periyakoil VS, Von Gunten CF, Fischer S, Pantilat S, Quill T. Generalist versus specialist palliative medicine. 25, J Palliat Med. 2022.","DOI":"10.1089\/jpm.2021.0644"},{"key":"1804_CR6","doi-asserted-by":"crossref","unstructured":"Lupu D, Quigley L, Mehfoud N, Salsberg ES. The growing demand for hospice and palliative medicine physicians: will the supply keep up?? J Pain Symptom Manage. 2018;55(4).","DOI":"10.1016\/j.jpainsymman.2018.01.011"},{"key":"1804_CR7","doi-asserted-by":"crossref","unstructured":"Shamon S, Gill A, Meadows L, Kruizinga J, Kaasalainen S, Pereira J. Providing palliative and end-of-life care in long-term care during the COVID-19 pandemic: a qualitative study of clinicians\u2019 lived experiences. CMAJ Open. 2023;11(4).","DOI":"10.9778\/cmajo.20220238"},{"key":"1804_CR8","doi-asserted-by":"crossref","unstructured":"Carter AJE, Arab M, Harrison M, Goldstein J, Stewart B, Lecours M et al. Paramedics providing palliative care at home: A mixed-methods exploration of patient and family satisfaction and paramedic comfort and confidence. Can J Emerg Med. 2019;21(4).","DOI":"10.1017\/cem.2018.497"},{"key":"1804_CR9","doi-asserted-by":"crossref","unstructured":"Pereira J, Meadows L, Kljujic D, Strudsholm T. Do learners implement what they learn? Commitment-to-change following an interprofessional palliative care course. Palliat Med. 2022;36(5).","DOI":"10.1177\/02692163221081329"},{"key":"1804_CR10","doi-asserted-by":"crossref","unstructured":"Gill A, Meadows L, Ashbourne J, Kaasalainen S, Shamon S, Pereira J. \u2018Confidence and fulfillment\u2019: a qualitative descriptive study exploring the impact of palliative care training for long-term care physicians and nurses. Palliat Care Soc Pract. 2024;18.","DOI":"10.1177\/26323524241235180"},{"key":"1804_CR11","doi-asserted-by":"crossref","unstructured":"Evans JM, Mackinnon M, Pereira J, Earle CC, Gagnon B, Arthurs E et al. Building capacity for palliative care delivery in primary care settings Mixed-methods evaluation of the INTEGRATE project. Can Fam Physician. 2021;67(4).","DOI":"10.46747\/cfp.6704270"},{"key":"1804_CR12","doi-asserted-by":"publisher","first-page":"e1","DOI":"10.1136\/bmjspcare-2021-003036","volume":"14","author":"J Pereira","year":"2024","unstructured":"Pereira J, Chary S, Faulkner J, Tompkins B, Moat JB. Primary-level palliative care National capacity: pallium Canada. BMJ Support Palliat Care. 2024;14:e1.","journal-title":"BMJ Support Palliat Care"},{"key":"1804_CR13","doi-asserted-by":"crossref","unstructured":"Postier AC, Wolfe J, Hauser J, Remke SS, Baker JN, Kolste A et al. Education in palliative and End-of-Life Care-Pediatrics: curriculum use and dissemination. J Pain Symptom Manage. 2022;63(3).","DOI":"10.1016\/j.jpainsymman.2021.11.017"},{"key":"1804_CR14","unstructured":"Munday D, Pastrana T, Murray A. Defining and developing primary palliative care as an essential element of primary health care. Palliat Med. 2004."},{"key":"1804_CR15","doi-asserted-by":"crossref","unstructured":"Arora S, Thornton K, Jenkusky SM, Parish B, Scaletti JV, Project ECHO. Linking university specialists with rural and prison-based clinicians to improve care for people with chronic hepatitis C in new Mexico. 122, Public Health Rep. 2007.","DOI":"10.1177\/00333549071220S214"},{"key":"1804_CR16","doi-asserted-by":"crossref","unstructured":"Arora S, Kalishman S, Thornton K, Dion D, Murata G, Deming P et al. Expanding access to hepatitis C virus treatment - Extension for Community Healthcare Outcomes (ECHO) project: Disruptive innovation in specialty care. Vol. 52, Hepatology. 2010.","DOI":"10.1002\/hep.23802"},{"key":"1804_CR17","doi-asserted-by":"crossref","unstructured":"Zhou C, Crawford A, Serhal E, Kurdyak P, Sockalingam S. The impact of project ECHO on participant and patient outcomes: A systematic review. Vol. 91, Academic Medicine. 2016.","DOI":"10.1097\/ACM.0000000000001328"},{"key":"1804_CR18","doi-asserted-by":"crossref","unstructured":"Arora S, Kalishman SG, Thornton KA, Komaromy MS, Katzman JG, Struminger BB et al. Project ECHO: A telementoring network model for continuing professional development. J Contin Educ Health Prof. 2017;37(4).","DOI":"10.1097\/CEH.0000000000000172"},{"key":"1804_CR19","unstructured":"Project ECHO. Publications Dashboard. Project ECHO."},{"key":"1804_CR20","doi-asserted-by":"crossref","unstructured":"Thomas A, Menon A, Boruff J, Rodriguez AM, Ahmed S. Applications of social constructivist learning theories in knowledge translation for healthcare professionals: A scoping review. Implement Sci. 2014;9(1).","DOI":"10.1186\/1748-5908-9-54"},{"key":"1804_CR21","doi-asserted-by":"crossref","unstructured":"Mohsen W, Chan P, Whelan M, Glass A, Mouton M, Young E et al. Hepatitis C treatment for difficult to access populations: can telementoring (as distinct from telemedicine) help? Intern Med J. 2019;49(3).","DOI":"10.1111\/imj.14072"},{"key":"1804_CR22","doi-asserted-by":"crossref","unstructured":"Soller B, Myers O, Sood A. Transfer of knowledge on pneumoconiosis care among Rural-Based members of a digital community of practice: Cross-Sectional study. JMIR Form Res. 2024;8(1).","DOI":"10.2196\/52414"},{"key":"1804_CR23","first-page":"s1","volume":"4","author":"E Francis","year":"2020","unstructured":"Francis E, Kraschnewski J, Hogentogler R, Buckner K, Sabol J, Bowers K. 4060 A telehealth approach to improving healthcare to rural and underserved populations. J Clin Transl Sci. 2020;4:s1.","journal-title":"J Clin Transl Sci"},{"key":"1804_CR24","doi-asserted-by":"crossref","unstructured":"Wilson CG, Alexander S, Hitch WJ, Lorenz-Miller L, Matheson E, Blake Fagan E. Project ECHO\u00ae in Primary Care: Informing Providers about COVID-19 and Its Impact on Health Care Delivery. N C Med J. 2022;83(2).","DOI":"10.18043\/ncm.83.2.130"},{"key":"1804_CR25","doi-asserted-by":"crossref","unstructured":"Katzman JG, Tomedi LE, Everly G, Greenwood-Ericksen M, Romero E, Rosenbaum N et al. First responder resiliency echo: innovative telementoring during the covid-19 pandemic. Int J Environ Res Public Health. 2021;18(9).","DOI":"10.3390\/ijerph18094900"},{"key":"1804_CR26","doi-asserted-by":"crossref","unstructured":"Zhang E, Bellinger S, Swails L, Punt S, Tepper K, Nelson EL. Connecting behavioral health specialists with schools: adapting a telementoring series during COVID-19. Rural Special Educ Q. 2023;42(2).","DOI":"10.1177\/87568705231152619"},{"key":"1804_CR27","doi-asserted-by":"crossref","unstructured":"Hunt RC, Struminger BB, Redd JT, Herrmann J, Jolly BT, Arora S, et al. Virtual Peer-to-Peer learning to enhance and accelerate the health system response to COVID-19: the HHS ASPR project ECHO COVID-19 clinical rounds initiative. Volume 78. Annals of Emergency Medicine; 2021.","DOI":"10.1016\/j.annemergmed.2021.03.035"},{"key":"1804_CR28","unstructured":"Watson M. At the hub of things. 24, Eur J Palliat Care. 2017."},{"key":"1804_CR29","doi-asserted-by":"crossref","unstructured":"Alvarez GP. Technology for improving accessibility of end-of-life care: Extension for Community Healthcare Outcomes Project. Vol. 12, Current Opinion in Supportive and Palliative Care. 2018.","DOI":"10.1097\/SPC.0000000000000390"},{"key":"1804_CR30","doi-asserted-by":"crossref","unstructured":"Arora S, Brakey HR, Jones JL, Hood N, Fuentes JE, Cirolia L. Project ECHO for Cancer care: a scoping review of provider outcome evaluations. J Cancer Educ. 2023;38(5).","DOI":"10.1007\/s13187-023-02292-x"},{"key":"1804_CR31","first-page":"5","volume":"2019","author":"S Yennurajalingam","year":"2019","unstructured":"Yennurajalingam S, Amos CE, Weru J, Addo Opare-Lokko EBVND, Arthur JA, Nguyen K, et al. Extension for community healthcare outcomes-palliative care in Africa program: improving access to quality palliative care. J Glob Oncol. 2019;2019:5.","journal-title":"J Glob Oncol"},{"key":"1804_CR32","doi-asserted-by":"crossref","unstructured":"Pereira J, Giddings G, Sauls R, Harle I, Antifeau E, Faulkner J. Navigating design options for large-scale interprofessional continuing palliative care education: pallium canada\u2019s experience. Palliat Med Rep. 2021;2(1).","DOI":"10.1089\/pmr.2021.0023"},{"key":"1804_CR33","doi-asserted-by":"crossref","unstructured":"De Witt Jansen B, Brazil K, Passmore P, Buchanan H, Maxwell D, McIlfatrick SJ et al. Evaluation of the impact of telementoring using ECHO\u00a9 technology on healthcare professionals\u2019 knowledge and self-efficacy in assessing and managing pain for people with advanced dementia nearing the end of life. BMC Health Serv Res. 2018;18(1).","DOI":"10.1186\/s12913-018-3032-y"},{"key":"1804_CR34","unstructured":"Reichheld FF. The one number you need to grow. 81, Harvard Business Rev. 2003."},{"key":"1804_CR35","doi-asserted-by":"crossref","unstructured":"Vaismoradi M, Turunen H, Bondas T. Content analysis and thematic analysis: Implications for conducting a qualitative descriptive study. Vol. 15, Nursing and Health Sciences. 2013.","DOI":"10.1111\/nhs.12048"},{"key":"1804_CR36","doi-asserted-by":"crossref","unstructured":"Thurston WE, Cove L, Meadows LM. Methodological congruence in complex and collaborative mixed method studies. Int J Mult Res Approaches. 2008;2(1).","DOI":"10.5172\/mra.455.2.1.2"},{"key":"1804_CR37","unstructured":"Institute for Healthcare Improvement [Internet]. 2022. How to Improve: Model for Improvement."},{"key":"1804_CR38","unstructured":"Arora S, Smith T, Snead J, Zalud-Cerrato S, Marr L, Watson M et al. Project ECHO: an effective means of increasing palliative care capacity. Am J Manag Care. 2017;23(7)."},{"key":"1804_CR39","unstructured":"Piromalli C. Global palliative care ECHO parntership: year in review and vision for the future. The ECHO Institute, University of New Mexico."},{"key":"1804_CR40","doi-asserted-by":"crossref","unstructured":"Osei-Twum JA, Wiles B, Killackey T, Mahood Q, Lalloo C, Stinson JN. Impact of project ECHO on patient and community health outcomes: A scoping review. Volume 97. Academic Medicine; 2022.","DOI":"10.1097\/ACM.0000000000004749"},{"key":"1804_CR41","doi-asserted-by":"crossref","unstructured":"Moss P, Hartley N, Newcomb D, Russell T. Measuring the success of a project ECHO implementation: results from an international e-Delphi study. Global Implement Res Appl. 2022;2(3).","DOI":"10.1007\/s43477-022-00050-7"},{"key":"1804_CR42","doi-asserted-by":"publisher","unstructured":"Aurora S. Project ECHO: the evidence is catching up with the enthusiasm. Health Affairs Blog. January 2017;13. https:\/\/doi.org\/10.1377\/hblog20170113.058331.","DOI":"10.1377\/hblog20170113.058331"},{"key":"1804_CR43","doi-asserted-by":"crossref","unstructured":"Stajduhar KI, Mollison A, Giesbrecht M, McNeil R, Pauly B, Reimer-Kirkham S et al. Just too busy living in the moment and surviving: barriers to accessing health care for structurally vulnerable populations at end-of-life 16 studies in human society 1608 sociology. BMC Palliat Care. 2019;18(1).","DOI":"10.1186\/s12904-019-0396-7"},{"key":"1804_CR44","doi-asserted-by":"crossref","unstructured":"Shahid S, Taylor EV, Cheetham S, Woods JA, Aoun SM, Thompson SC. Key features of palliative care service delivery to Indigenous peoples in australia, new zealand, Canada and the united states: A comprehensive review. BMC Palliat Care. 2018;17(1).","DOI":"10.1186\/s12904-018-0325-1"},{"key":"1804_CR45","doi-asserted-by":"crossref","unstructured":"Schill K, Caxaj S. Cultural safety strategies for rural Indigenous palliative care: A scoping review. 18, BMC Palliat Care. 2019.","DOI":"10.1186\/s12904-019-0404-y"},{"key":"1804_CR46","doi-asserted-by":"crossref","unstructured":"Razai MS, Kooner P, Majeed A. Strategies and interventions to improve healthcare professionals\u2019 Well-Being and reduce burnout. 14, J Prim Care Community Health. 2023.","DOI":"10.1177\/21501319231178641"},{"key":"1804_CR47","doi-asserted-by":"crossref","unstructured":"Koffman J, Shapiro GK, Schulz-Quach C. Enhancing equity and diversity in palliative care clinical practice, research and education. 22, BMC Palliat Care. 2023.","DOI":"10.1186\/s12904-023-01185-6"},{"key":"1804_CR48","doi-asserted-by":"crossref","unstructured":"Lalloo C, Osei-Twum JA, Rapoport A, Vadeboncoeur C, Weingarten K, Van Veldhuijzen S et al. Pediatric Project ECHO\u00ae: A Virtual Community of Practice to Improve Palliative Care Knowledge and Self-Efficacy among Interprofessional Health Care Providers. J Palliat Med. 2021;24(7).","DOI":"10.1089\/jpm.2020.0496"},{"key":"1804_CR49","doi-asserted-by":"crossref","unstructured":"Doherty M, Modanloo S, Evans E, Rowe J, Newhook D, Palat G et al. Exploring health professionals\u2019 experiences with a virtual learning and mentoring program (Project ECHO) on pediatric palliative care in South Asia. Glob Pediatr Health. 2021;8.","DOI":"10.1177\/2333794X211043061"},{"key":"1804_CR50","doi-asserted-by":"crossref","unstructured":"McBain RK, Sousa JL, Rose AJ, Baxi SM, Faherty LJ, Taplin C et al. Impact of project ECHO models of medical Tele-Education: a systematic review. 34, J Gen Intern Med. 2019.","DOI":"10.1007\/s11606-019-05291-1"},{"key":"1804_CR51","doi-asserted-by":"crossref","unstructured":"Sockalingam S, Arena A, Serhal E, Mohri L, Alloo J, Crawford A. Building provincial mental health capacity in primary care: an evaluation of a project ECHO mental health program. Acad Psychiatry. 2018;42(4).","DOI":"10.1007\/s40596-017-0735-z"},{"key":"1804_CR52","doi-asserted-by":"crossref","unstructured":"Agley J, Delong J, Janota A, Carson A, Roberts J, Maupome G. Reflections on project ECHO: qualitative findings from five different ECHO programs. Med Educ Online. 2021;26(1).","DOI":"10.1080\/10872981.2021.1936435"},{"key":"1804_CR53","doi-asserted-by":"crossref","unstructured":"Pereira J, Meadows L, Kljujic D, Strudsholm T, Parsons H, Riordan B et al. Learner experiences matter in interprofessional palliative care education: A mixed methods study. J Pain Symptom Manage. 2022;63(5).","DOI":"10.1016\/j.jpainsymman.2021.12.034"},{"key":"1804_CR54","doi-asserted-by":"crossref","unstructured":"Ranmuthugala G, Plumb JJ, Cunningham FC, Georgiou A, Westbrook JI, Braithwaite J. How and why are communities of practice established in the healthcare sector? A systematic review of the literature. BMC Health Serv Res. 2011;11.","DOI":"10.1186\/1472-6963-11-273"},{"key":"1804_CR55","doi-asserted-by":"crossref","unstructured":"McKellar KA, Pitzul KB, Yi JY, Cole DC. Evaluating communities of practice and knowledge networks: A systematic scoping review of evaluation frameworks. Vol. 11, EcoHealth. 2014.","DOI":"10.1007\/s10393-014-0958-3"},{"key":"1804_CR56","volume-title":"Cultivating communities of practice","author":"W E","year":"2002","unstructured":"E W. R M, W S. Cultivating communities of practice. London, United Kingdom: Harvard Business Review; 2002."}],"container-title":["BMC Palliative Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12904-025-01804-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12904-025-01804-4\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12904-025-01804-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T10:10:45Z","timestamp":1751364645000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcpalliatcare.biomedcentral.com\/articles\/10.1186\/s12904-025-01804-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,1]]},"references-count":56,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["1804"],"URL":"https:\/\/doi.org\/10.1186\/s12904-025-01804-4","relation":{},"ISSN":["1472-684X"],"issn-type":[{"value":"1472-684X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,1]]},"assertion":[{"value":"7 February 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"5 June 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"1 July 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable. No identifying information and details have been included in this publication that may compromise anonymity.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"Conflicts of Interest JP: Has received stipends from Pallium Canada as Scientific Officer of Pallium and more recently as Scientific Advisor. JM: Is paid by Pallium Canada as its Chief Executive Officer. JF: Is paid by Pallium Canada as Vice President of Operations.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"PC ECHO participants complete consent prior to ECHO session participation for the inclusion of their feedback for evaluation purposes. Interview participants provided informed consent prior to interview participation, to be audio recorded, and for anonymized, deidentified data to be included for analysis and dissemination.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}},{"value":"Hamilton Integrated Research Ethics Board granted this investigation as quality improvement ethics exemption, citing item TCPS2 [2022] Article 2.5. No reference number was provided, as an email verification was provided for full board ethics exemption for program evaluation and local program development.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}}],"article-number":"176"}}