Proven approach to palliative care sparks important conversations about living well

Nov 01, 2019
Members from the Wing Kei team

Members from the Wing Kei team
Back row: Peggy Tan, Sandra Sliz and Emily Dymchuk
Front row: Cecilia Cao and Grace Hung

Staff at healthcare organizations across five provinces and one territory are implementing a proven innovation that is supporting them to have earlier conversations with residents about their wishes and goals for their care.

The organizations are participated in the Canadian Foundation for Healthcare Improvement’s Embedding Palliative Approaches to Care (EPAC) collaborative.  EPAC is a proven innovation developed by VancouverCoastal Health and implemented in 48 of their long term care homes, resulting in a 56 percent decrease in emergency department transfers, and a 45 percent decrease in the number of days patients spent in acute care at the end of their lives.

The Institute for Continuing Care Education and Research (ICCER) in Alberta is one participant in the EPAC collaborative. Four of its member organizations in Edmonton and Calgary responded to the call to take part.

“Our sites have told us staff tend to avoid conversations about dying. This has meant patients end up in emergency situations and die in places they don’t want,” said Emily Dymchuk, Program Coordinator at ICCER. “We see EPAC as an opportunity to fill gaps in continuing care for our members who don’t have the resources and staff to develop palliative care initiatives.”

By participating in CFHI’s collaborative, ICCER members have learned to:

  • identify residents who would benefit from a palliative approach to care
  • discuss goals for care with the resident or the resident’s decision maker
  • develop and implement a comprehensive care plan that reflects the unique wishes of each resident.

People admitted to long term care stay for an average of two years, and most remain there until the end of their life. Among residents who died in long term care in 2016/17, 24 percent were identified as having less than six months to live; and six percent of all residents — and 22 percent of those identified as having less than 6 months to live — were recorded as having received palliative care in the last year of life.

Only partway through their implementation, ICCER members say their staff, patients and families are already more comfortable having the tough conversations. And many participants have made their own innovations to spread palliative approaches.

Tatsiana Haidukevich is a registered nurse and case manager with Edmonton’s St. Michael’s Long Term Care Centre. She said her organization has benefitted from CFHI’s EPAC workshops, desktop resources, webinars and coaching calls.

“The opportunity to network and share experiences has been a real support,” said Haidukevich. Using EPAC as a model, St. Michael’s has educated its staff on the value of palliative approaches, how to have conversations with a resident, and how to make the resident’s wishes understood by recording the results. “Staff were reluctant about having nurses and others – as opposed to doctors or families – start conversations about dying. But we are becoming more comfortable. Now we find that most people want to talk about dying but don’t know how to start.”

Bethany, an ICCER organization providing housing and support for seniors and adults with disabilities in six Alberta cities, has educated 90 percent of its staff using EPAC principles. Plans are in place to provide training to nurses, care services managers, chaplains and social workers about how to talk to residents and their families about serious illnesses and do advanced care planning. Among many other innovations, Bethany has created a palliative/end-of-life care pamphlet for residents and families when they get an admission tour.

Wing Kei is a not-for-profit organization in Calgary providing culturally appropriate care to seniors. (Wing Kei means “glorify God” in Chinese.) Peggy Tan, Wing Kei’s Lead for Person and Family Centred Care, has surveyed staff and family members about the principles of EPAC and is currently tabulating the results. Tan has at least one physician on board to help educate staff and families about palliative approaches to care and has started formal planning to begin an education process.

“The palliative/end-of-life approach is not new to Wing Kei, but EPAC has helped our team and organization put this forward as a culture shift,” said Tan. “Our goal is to educate staff in engaging families with advanced care planning and to be more comfortable in initiating serious illness conversations.”

Lifestyle Options Retirement Communities, which operates six sites in Alberta, is committed to a long-term, sustainable approach to introducing palliative care. The organization is using Prosci's ADKAR (awareness, desire, knowledge, ability, reinforcement) approach to support planning and implementation. At present, Lifestyle Options is spreading awareness and getting desire from its stakeholders so they will understand, sponsor and support the project.

“We still are having to remove the stigma attached to the word ‘palliative’ so that people do not always think of death when these conversations happen,” said Cherryll de la Cruz-Cabalo, Quality and Risk Manager/Clinical Lead with Lifestyle Options. “Palliative care should be not only about dying, but also living.”