Does Facilitated Palliative Care Education Improve Patient Identification? A Cluster Randomized Controlled Trial of...

Background: Primary care providers (PCPs) play a critical role in initiating palliative care but are often unsure how to identify patients for this approach. Community Access to PAlliative Care via Interprofessional Teams Improvement program (CAPACITI) is a virtual education program that provides practical tools and strategies for PCPs to help them operationalize palliative care, complementing clinical skills training. Objectives: To assess the impact of facilitated versus self-directed versions of CAPACITI, in assisting PCPs to better incorporate an early palliative approach to care in practice. Design: A cluster randomized controlled trial (cRCT). Setting/Subjects: PCP teams across Canada that enrolled in CAPACITI were randomized and stratified by team size and geography. The control group (self-directed) received access to the CAPACITI online session materials (e.g., slide decks, tools, summary sheets, assignments). In addition to this, the intervention group (facilitated) was also invited to participate in facilitated biweekly, virtual webinars. Measurements: Difference between the two groups in self-reported identification of patients requiring a palliative approach to care following the intervention (calculated as percentage of caseload in past three months). Results: A total of 185 teams, representing 566 individuals, enrolled in CAPACITI and completed baseline measures. In total, 295 participants reported providing direct patient care; 166 of these participants (33.9%) were lost to follow-up. Prior to CAPACITI, providers in both groups reported identifying a median of 20.0% of their patients as requiring a palliative approach to care. Post-intervention, these median percentages increased for both groups to 33.3% for the facilitated group, and 40.0% for the self-directed group (p < 0.001 overall), with no significant difference between groups (p = 0.3, mean effect estimate = -0.04, 95% CI: [-0.12, 0.04]). Conclusions: We found that CAPACITI improved palliative care identification, regardless of whether the online content was facilitated via webinars or self-directed. Further research is required to examine optimal uses of facilitation for skill development.