11. Strengthening our long-term care together: Embedding palliative approaches to care spread collaborative (Panel)
Learning objectives: Embedding Palliative Approaches to Care (EPAC) is a model that helps staff in long-term care identify, discuss and plan the goals of care of residents at least 8 weeks before end-of-life. The Canadian Foundation for Healthcare Improvement (CFHI) supported and evaluated the implementation of EPAC in 7 teams across Canada in 2018-2019.
The objective of the panel session is to learn strategies for integrating palliative care in long-term care from the perspective of CFHI, EPAC innovator, and one of the EPAC teams. This includes interactive audience participation (Poll Everywhere) to assess knowledge on palliative care.
Methods: Teams were trained on the four components of EPAC: 1-increasing confidence of staff, 2-increasing knowledge of residents and families, 3-providing psychosocial support to residents and families, and 4-providing psychosocial support to staff.
Training methods included a combination of face-to-face (workshops) and online learning (webinars, coaching calls and online platform). Each team adapted EPAC based on their organizational context and jurisdictional requirements for advance care planning. Teams shared their implementation strategies including successes, barriers and lessons learned at mid-point and end of the collaborative.
Teams tracked their progress by collecting monthly data on the number of residents who died in their home, including the date of their most recent goals of care conversation, and number of emergency department and hospital transfers in the last three months of life.
Outcomes/Results: EPAC helped teams improve the way palliative care is delivered in their home by increasing the comfort level of staff members, encouraging earlier goals of care conversations with residents and their families, and documenting their preferences. Teams reported improvements in the quality of care provided to residents, including more control over decisions made about their care. There was a gradual improvement in the timing of the goals of care conversations based on reported resident death data during the collaborative.
Conclusion: EPAC teams are continuing their efforts to improve the quality of care provided to residents and families at end-of-life. CFHI is developing a knowledge translation strategy to support EPAC sustainability and share the implementation experiences and outcomes with stakeholders.
Leadership Lessons Learned: Successful implementation of EPAC depends on a shift in culture, a change in the beliefs and behaviors of staff to focus on the needs of residents. This requires leadership support and dedicated time for learning and improvement to change how palliative care is perceived in long-term care. This includes acknowledging that death is a normal part of life, working as a team to provide palliative care, having goals of care conversations as part of the admission process, and reviewing and respecting the wishes of the residents.
System Changes: Teams reported improvements in the quality of care provided to residents and their families however more time is needed to evaluate the impact of EPAC based on resident death data, including number of emergency department/hospital transfers in the last three months of life. The premise of EPAC is that palliative care conversations happen early, as part of the admission process. The average length of stay of residents was four years based on reported resident death data.
Emily Dymchuk – Institute for Continuing Care Education and Research
Diana Sarakbi – Canadian Foundation for Healthcare Improvement
Jane Webley – Vancouver Coastal Health Authority
Elan Graves – Canadian Foundation for Healthcare Improvement