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

Hsien Seow; Daryl Bainbridge; Samantha Winemaker; Kelli Stajduhar; Gregory Pond; Kathy Kortes-Miller; Denise Marshall; Frances Kilbertus; Jeff Myers; Leah Steinberg; Nadia Incardona; Oren Levine; Jose Pereira

doi:10.1186/s12904-022-01124-x

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

BMC Palliat Care. 2023 Jan 5;22(1):2. doi: 10.1186/s12904-022-01124-x.

Authors

Affiliations

¹ Department of Oncology, McMaster University, Hamilton, ON, Canada. seowh@mcmaster.ca.
² Department of Oncology, McMaster University, Hamilton, ON, Canada.
³ School of Nursing, University of Victoria, Victoria, BC, Canada.
⁴ Department of Social Work, Lakehead University, Thunder Bay, ON, Canada.
⁵ Department of Family Medicine, McMaster University, Hamilton, ON, Canada.
⁶ Northern Ontario School of Medicine University, Thunder Bay, ON, Canada.
⁷ Division of Palliative Care, University of Toronto, Toronto, ON, Canada.
⁸ Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.

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.

Keywords: Cluster Randomized Controlled Trial; Education; Health Personnel; Palliative Care; Professional Competence; Training Programs.

Publication types

Clinical Trial Protocol

MeSH terms

Health Personnel / education
Humans
Learning
Palliative Care* / methods
Physicians*
Primary Health Care
Randomized Controlled Trials as Topic

Associated data

ClinicalTrials.gov/NCT05120154

Grants and funding

408099/CAPMC/ CIHR/Canada