Improving Palliative Care in the Home and Community: the CAPACITY trial

Improving palliative care is a critical national issue. Providing palliative care in the home is important because hospital resources are increasingly limited and 80% of people prefer to die at home. Yet over 60% of Canadians die in the hospital, mostly because there is a lack of capacity for primary care providers to deliver palliative care for patients in the home. Research shows that home-based interprofessional palliative care teams can improve patient and family experiences and reduce unnecessary hospital care; yet they are not widely available to patients. We have validated a 6-part, facilitator-led intervention that builds primary care capacity for interprofessional team-based palliative care. However, we lack evidence about whether this intervention can be spread on a large scale across diverse geographies and provinces to improve outcomes. Our study team proposes the CAPACITY trial: Community Access to PAlliative Care via Interprofessional Teams. Its goal is to improve the care of dying Canadians by implementing the intervention, which builds capacity for interprofessional teams to deliver palliative care in the home, in three provinces of Ontario, Nova Scotia and British Columbia. This research program will be evaluated using a cluster randomized controlled trial. Across three provinces, we have identified 67 diverse community teams of interprofessional palliative care providers who want to participate. The trial will randomly assign half the community teams to receive the intervention; the other half will receive print materials only. We will compare intervention and control teams on four outcomes: hospital use and costs, patient and caregiver experience, team capacity for palliative care, and effectiveness across diverse geographies. Ultimately, the intervention's results will help all communities across Canada to better support very sick patients who want to die at home and their families with cost-efficient, patient-centered, and high-quality care.