Regional Palliative Approach to Care Education (RPACE)
Regional Palliative Approach to Care Education (RPACE) supports all communities of care and programs across VCH in engaging in an early palliative approach to care.
About RPACE
Our services
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Education for all staff, either in-person or online. Education is offered to all disciplines around defining a palliative approach, identifying patients who would benefit, and having goals of care conversations.
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Coaching and mentorship with goals of care conversations
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Support with implementing a palliative approach to care within your work setting
Our story
- 2015-2017 | EPAIRS: Embedding a Palliative Approach in Residential Settings (also known as Daisy)
- 2017-2019 | iPACE: Integrating a Palliative Approach to Care Early
- 2019 - now | RPACE: Regional Palliative Approach To Care Education
Our vision
We are shifting the culture across VCH to support the practice of an early palliative approach to care.
We strive to achieve the benefits of communicating and respecting a patient’s goals, values and beliefs in all care decisions so that early conversations lead from foundational to exceptional care.
Frequently Asked Questions
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What is palliative approach to care?
A palliative approach to care is focused on the relief of suffering, while integrating psychosocial and spiritual aspects of care important to the patient/family. It does not link the provision of care with prognosis, but instead focuses on conversations with people about their needs, values and wishes. Based on the patient's wishes, the palliative care philosophy is applicable at any time of the illness journey, in conjunction with other therapies intended to prolong life, and includes investigations needed to better understand and manage distressing clinical complications. It neither hastens nor postpones death but sets out to preserve the best possible quality of life to support a natural death.
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When is an individual referred for a palliative approach to care?
All health care providers, regardless of care setting can start integrating a palliative approach to care into their routine care. This does not require a separate referral but simply involves the clinician initiating a conversation about what matters to the patient and about their wishes for care. This website contains several conversation frameworks designed to support this conversation.
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Can every discipline use a palliative approach to care and have Serious Illness Conversations?
Yes, every discipline can identify indicators of health change and have a Serious Illness Conversation as taught in education.
*Framing of concerns/prognosis should be expressed within a clinician's scope of practice.
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I have goals of care conversations on a regular basis. How does the Serious Illness Conversation differ?
Many health care providers understand goals of care conversations to be about an individual's wishes around specific medical decisions and interventions (e.g. preference for the location of care, Cardiopulmonary Resuscitation, medications for relief of suffering). The Serious Illness Conversation Guide is a validated tool and guiding framework to assist clinicians in having more comprehensive goals of care conversations.
The Serious Illness Conversation explores what matters most to patients and allows clinicians to learn more about a patient's goals and values so that recommendations for care can be made based on what matters to the patient. (E.g. I've heard you say that you are worried about experiencing a lot of pain at the end of life. Keeping that in mind and with what we know about your illness, I recommend that we discuss options for pain management, including medication and non-medication supports).
Resources
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Identification
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Conversation
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Documentation
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Resources
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Education
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Translations
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Contact RPACE
Hours of operation are Monday to Friday 8:00 a.m. to 4:00 p.m. For more information, contact rpace@vch.ca.
Newsletter
If you're looking for a dose of inspiration, look no further! Here is the latest edition of the RPACE newsletter.
Previous editions (Network access required)
We would love to hear from you! Submit your reflections, stories and ideas by email to rpace@vch.ca. Please email us to subscribe or unsubscribe to the newsletter.
Glossary
Advance care planning
Advance Care Planning is planning as early as possible for any individual, healthy or not. It is stating one’s wishes and preferences for future care in the event of an acute medical crisis or sudden health deterioration. An advance care plan may be used to guide the substitute decision maker and the healthcare team when contemplating what an individual would want or not want if they were unable to speak for themselves.
Goals of care discussion
Discussions around goals of care can relate both to the overall intent of medical treatment (along a spectrum from cure at all costs through life prolongation to a focus on maximizing comfort) and to more specific goals as defined by a person's values and priorities at a given point in time (e.g. improving mobility, spending time with family). Goals of care guide specific medical decisions. A person's goals of care can change over time. An Advance Care Plan (ACP) can inform the goals of care and similarly, a conversation about goals of care can lead to updates in a person's ACP. (Example of a person's goals of care: "I'm willing to have fluid drained from my abdomen to help improve my breathing, but I would like to have it done without being admitted to hospital.").
Illness
Illness is defined as an absence of wellness due to disease, other conditions, or ageing. It includes acute, chronic, advanced, life-limiting or life-threatening illnesses. An acute illness is one that is recent in onset and likely to be time-limited. If severe, it could be life-threatening. A chronic illness is likely to persist for months to years. If it progresses, it may become life-threatening. An advanced illness is likely to be progressive and life-threatening. A life-limiting illness is one that affects health and quality of life and can lead to death in the near future. A life-threatening illness is one that is likely to cause death in the immediate future.
Framing prognosis
Framing our concerns about where this illness is likely to lead at some point in the near or more distant future. This can be done by "planting seeds" about what to expect as a person's disease progresses to assist individuals in making the most informed decisions possible.
Palliative approach to care
A palliative approach to care is a philosophy of care that is focused on the relief of suffering, including psychosocial and spiritual aspects of care that are important to the individual/family. It does not link the provision of care with prognosis, but instead focuses on conversations with people about their needs, values and wishes. Based on the person’s wishes, a palliative approach is applicable at any time of the illness journey, and can be integrated in conjunction with other therapies intended to prolong life. This includes investigations needed to better understand and manage distressing clinical complications. It neither hastens nor postpones death but sets out to preserve the best possible quality of life to support a natural death.
Serious illness conversation guide
The Serious Illness Conversation Guide is a conversation framework that supports a conversation with a person who has a serious illness or life-limiting condition. It explores their values, wishes, and beliefs. This framework is based upon two key principles: personhood and dignity, and is focused on learning who the person is and what matters most to them, while sharing the team's insight as to how the person's condition may progress. Information from this conversation can be used to determine goals of care and treatment options that align with a patient's unique needs and wishes. (Examples: "I want to spend more time at home with my family as my illness progresses." And "I am most worried about how my husband will manage as a single parent.")
Substitute decision maker
A substitute decision maker (SDM) makes health care decisions for a patient when the patient is incapable of making these decisions on their own. A patient can appoint a SDM in advance of a severe illness or injury and may need to complete a Representation Agreement in order to legally do so. In BC, if no one has been legally appointed to make health care decisions, a temporary SDM is usually chosen according to a defined order set out by the Ministry of Health.