Embedding Palliative Approaches to Care Spread Collaborative 

  • Forming Teams
  • Planning Initiative
  • Launch
  • Changes Tested
  • Some Improvement
  • Improvement
  • Significant Improvement
  • Sustainable Improvement

Only 15 percent of Canadians have early access to palliative home care, including in long term care homes. Sixty-two percent of Canadians who receive palliative care do so in an acute care hospital – most likely in the last month of their life.1

People approaching their end-of-life should have the opportunity to make informed decisions about their care and treatment, in partnership with their families and caregivers, as well as healthcare professionals. Good communication between people at the frontline or care, people approaching their end of life and their loved ones is essential and should be sensitive to personal preferences. Early identification of care requirements plays a critical role in triggering other components of high-quality palliative care.

Embedding Palliative Approaches to Care (EPAC) is a proven innovation that helps staff in long-term care homes identify residents who could benefit from a palliative approach to care. Through EPAC, staff have conversations with residents, their families and caregivers regarding palliative care preferences, to establish and implement comprehensive, resident-centred care plans that honour the resident’s wishes, values and choices.

Offering a common, consistent approach to supporting residents who are near their end-of-life creates opportunities – and provides permission – for death and dying to be openly discussed, normalized and supported.

EPAC originated with the Canadian Foundation for Healthcare Improvement’s (CFHI’s) open call for innovations in 2017 as The Daisy Project: embedding a palliative approach in residential settings. Jane Webley (Regional Lead, End-of-Life, Vancouver Coastal Health team) demonstrated the success of this innovation by enabling residents to receive improved end-of life care at long-term care homes – avoiding unnecessary hospital transfers and supporting family, caregivers and providers throughout their experience.

In 2018, CFHI, working closely with Jane Webley, launched a collaborative to spread EPAC. Seven teams from five provinces and one territory participated in the collaborative until November 2019, implementing EPAC through a train-the-trainer approach in 22 long term care homes.

Subscribe to our newsletter to see the results of the EPAC collaborative when they are available in 2020.

How EPAC contributes to better healthcare in Canada

EPAC is part of CFHI’s ongoing efforts to spread and scale proven innovations that deliver high quality care that is closer to home and the community.

Of Canadians who have a preference, 75 percent would prefer to die in their home 2. For residents of long-term care homes, these residences are their homes. By spreading EPAC, CFHI aimed to increase capacity and capability in the delivery of end-of-life care at home, as well as avoid unnecessary emergency department visits and hospital admissions.

EPAC has also shown to be instrumental in successfully shifting the culture and normalizing conversations about end-of-life and living goals. EPAC improves the end-of-life care experiences for dying residents, their families and loved ones, as well as their healthcare providers.

Participating EPAC teams have tracked metrics including the number of documented goals and care discussions, number of emergency department transfers, as well as resident, family and loved ones experiences. Teams are working with CFHI evaluators to produce quantitative and qualitative results from the collaborative which will be available in 2020.

The Approach 

CFHI provided teams with support and access to a range of resources to help spread and embed EPAC in their long-term care homes through a train-the-trainer approach.

The pillars of the EPAC model are flexible, enabling individual homes to adopt and adapt them to their unique local needs and strengths.

EPAC house infographic, descriptive text follows

This is the EPAC house which starts with Identify, discuss, plan (IDP) at least 8 weeks prior to end of life. There are four pillars that sit underneath this. 1. Increase capacity and confidence: education, tools, resources. 2. Increase knowledge of residents and families: palliative care, disease trajectory, goals of care/serious illness conversation. 3. Psychosocial care for residents and families: impact of loss on survivors, tools, resources. 4. Psychosocial care for healthcare team: tools, resources. Underneath this sits the foundation layer referred to as metrics and reporting.

  • EPAC Teams

Earlier conversations about things that matter provide permission for collaborative planning and saying goodbye in a meaningful way, creating lasting memories. I call this the ‘Gift of Time’ that we, as healthcare providers, can offer residents and the people that are important to them.

-Jane Webley,
Regional Leader, End of Life, Vancouver Coastal Health (2018)

Tool / Resource

Engagement Guiding Principles
Read more >

Improvement Conversation

Proven approach to palliative care sparks important conversations about living well
Read more >

What We Do

Better Care Closer to Home and the Community
Read More > 

1 Canadian Institute for Health Information. Access to Palliative Care in Canada. Ottawa, ON: CIHI; 2018.

2 CIHI, Access to Palliative Care in Canada, 2018. Available via: https://www.cihi.ca/en/access-data-and-reports/access-to-palliative-care-in-canada