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 people in Canada have early access to palliative care at home, including residents living in long-term care homes. Sixty-two percent of people in Canada who receive palliative care receive it in an acute care hospital – most likely in the last month of their life.[1]

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, team members have conversations with residents, their families and care partners about their preferences for palliative care. Together they create comprehensive, resident-centred care plans that honour the resident’s wishes, values and choices.

Early identification of care requirements plays a critical role in triggering other components of high-quality palliative care. Offering a common, consistent approach to supporting residents who are near the end-of-life creates opportunities – and provides permission – for death and dying to be openly discussed, normalized and supported.

EPAC originated from Vancouver Coastal Health’s The Daisy Project: embedding a palliative approach in residential settings, part of Canadian Foundation for Healthcare Improvement’s open call for innovations in 2017. The following year, CFHI worked closely with Jane Webley from Vancouver Coastal Health to launch 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. 

How EPAC contributes to better healthcare in Canada

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

Of people in Canada who have a preference, 75 percent would prefer to die in their home[2] – including long-term care 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 been instrumental in successfully shifting the culture and normalizing conversations about end-of-life and living goals. It improves end-of-life care experiences for dying residents, their families and loved ones, as well as their healthcare providers.

Read the summary results of the collaborative

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.

Short modules can help long-term care providers get started in delivering palliative and end-of-life care through EPAC.

An interactive, four-part module Giving the Gift of Time: Embedding Palliative Approaches to Care, walks long-term care teams through the journey of a real resident, offering ways to improve end-of-life care.


This is the EPAC house which starts with identify, discuss, plan (IDP) at least 6 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

Embedding Palliative Approaches to Care (EPAC) Learning Modules
Read more >

Improvement Conversation

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

Tool / Resource

Giving the Gift of Time: Embedding Palliative Approaches to Care
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