Increasing palliative care capacity in primary care: study protocol of a cluster randomized controlled trial of the CAPACITI training program

Abstract

Background Primary care providers play a critical role in providing early palliative care to their patients. Despite the availability of clinical education on best practices in palliative care, primary care providers often lack practical guidance to help them operationalize this approach in practice. CAPACITI is a virtual training program aimed at providing practical tips, strategies, and action plans to provide an early palliative approach to care. The entire program consists of 12 sessions (1 h each), divided evenly across three modules: (1) Identify and Assess; (2) Enhance Communication Skills; (3) Coordinate for Ongoing Care. We report the protocol for our planned evaluation of CAPACITI on its effectiveness in helping primary care providers increase their identification of patients requiring a palliative approach to care and to strengthen other core competencies. Methods A cluster randomized controlled trial evaluating two modes of CAPACITI program delivery: 1) self-directed learning, consisting of online access to program materials; and 2) facilitated learning, which also includes live webinars where the online materials are presented and discussed. The primary outcomes are 1) percent of patients identified as requiring palliative care (PC), 2) timing of first initiation of PC, and self-reported PC competency (EPCS tool). Secondary outcomes include self-reported confidence in PC, practice change, and team collaboration (AITCS-II tool), as well as qualitative interviews. Covariates that will be examined are readiness for change (ORCA tool), learning preference, and team size. Primary care teams representing interdisciplinary providers, including physicians, nurse practitioners, registered nurses, care coordinators, and allied health professionals will be recruited from across Canada. The completion of all three modules is expected to take participating teams a total of six months. Discussion CAPACITI is a national trial aimed at behavior change in primary care providers. This research will help inform future palliative care educational initiatives for generalist health care providers. Specifically, our findings will examine the effectiveness of the two models of education delivery and the participant experience associated with each modality. Trial registration ClinicalTrials.gov NCT05120154.

Implementing palliative care education into primary care practice: A qualitative case study of the CAPACITI pilot program

“…The ndings from this pilot study will be applied to the development of a national randomized controlled trial to compare the effectiveness of self-directed education alone versus education with facilitation, in the delivery of a three-part, revised version of CAPACITI. 44 A key limitation of this study is that not all teams participated in a focus group interview. Although we collected qualitative data from all teams, it is likely that those willing to participate in a focus group were more engaged in the CAPACITI program than those that did not, which may have biased our ndings.…”

Patient and Provider Attitudes and Preferences Regarding Early Palliative Care Delivery for Patients with Advanced Gastrointestinal Cancers: A Prospective Survey

“…Prior research found that patients may become disconnected from primary care upon entering the cancer system [ 32 , 33 , 34 , 35 ]; the patients in our study may have not yet re-engaged with their family physician. FDs have a key role in the initiation of EIPC, given the long-standing and integral care relationship they often have with their patients [ 36 , 37 ]. Moreover, collaborative care between FDs and oncology specialists has the potential to improve patient experience [ 38 ].…”

Implementing palliative care education into primary care practice: a qualitative case study of the CAPACITI pilot program

“…We implemented the modules leaving one-month in between to allow teams time to apply the teachings in practice. However, some found this time lengthy, making it difficult to maintain momentum, while others needed more time to complete the activities [ 62 ]. To shorten the length of CAPACITI while preserving the content and maintaining a stepwise implementation plan, we would divide the 10 session pilot program into three shorter modules that would each take 3 months to complete and could be taken solely or in succession.…”

“…There was an acceleration in the advent of self-directed online education with highly contextualized content as a result of the pandemic [ 63 – 65 A purely self-directed format may prove to be a cost-effective alternative to the live facilitated sessions we offered in CAPACITI and potentially preferred by participants as being more convenient. The findings from this pilot study will be applied to the development of a national randomized controlled trial to compare the effectiveness of self-directed education alone versus education with facilitation, in the delivery of a three-part, revised version of CAPACITI [ 62 ].…”