Grant: Project Grant

Palliative care is care that emphasizes quality-of-life rather than curative treatment for patients with advanced illness. Particularly home-based palliative care is important because 80% of patients want to die at home, yet 65% die in hospital. Strong evidence shows home-based palliative care-delivered by physicians working in primary care teams-reduces pain and symptoms, improves quality-of-life, and reduces health care costs. Yet <10% of patients get access to home-based palliative care by family physicians in the last year of life. Improving access to home-based palliative care can improve patient and system outcomes. However, we lack interventions that build capacity among primary care teams to deliver home-base palliative care. To address this, we propose an intervention called CAPACITI (Community Access to PAlliative Care via Interprofessional Teams Intervention). CAPACITI is a 1-year palliative care training and coaching program for primary care teams. Over monthly sessions and bi-weekly calls, it integrates 4 components: clinical education for early identification and communication; evidence-based tools for symptom management and care pathways; practice supports for team collaboration and system coordination; and high-facilitation and expert coaching for adaptation to local context. Our study will evaluate outcomes in 53 primary care teams in Ontario before vs. after implementation of CAPACITI, using a phased approach that compares intervention teams to control teams who have yet to start CAPACITI. The outcomes are access to home-based palliative care, team knowledge and collaboration, and patient-caregiver satisfaction. Our team has tested, evaluated and refined elements of CAPACITI, demonstrating its effectiveness on small numbers of primary care teams. We are ready to test CAPACITI on a provincial scale. Ultimately this study's results will strengthen the primary care system and increase access to home-based palliative care for patients across Canada.