Building Palliative Care Capacity for Generalist Providers in the Community: Results From the Capaciti Pilot Education Program

Abstract

Objective: Primary care providers play an important role in providing early palliative care, however they often lack practical supports to operationalize this approach in practice. CAPACITI is a virtual training program aimed at providing practical tips, strategies, and action plans to help primary care providers offer an early palliative approach to care. The CAPACITI pilot program consisted of 10 facilitated, monthly training sessions, covering identification and assessment, communication, and engaging caregivers and specialists. We present the findings of an evaluation of the pilot program. Method: We conducted a single cohort study of primary care providers who participated in CAPACITI. Study outcomes were the change in the percentage of caseload reported as requiring palliative care and improved confidence in competencies measured on a 20-item, study-created survey. Pre and post survey data were analyzed using paired t-tests. Results: Twenty-two teams representing 127 care providers (including 36 physicians and 28 Nurse Practitioners) completed CAPACITI. Paired comparisons showed a moderate improvement in confidence across the competencies covered (.6 to 1.3 mean improvement across items using seven-point scales, all P < .05). Pre-CAPACITI, clinician prescribers ( N = 32) identified a mean of 1.2% of their caseload requiring a palliative approach to care, which increased to 1.6% post-program ( P = .02). Said differently, the total group of paired clinician prescribers identified 338 patients as requiring palliative care in their caseloads at baseline vs 482 patients following the intervention, for an overall increase of 144 patients in their collective caseloads. Conclusion: CAPACITI improved self-assessed palliative care identification and provider confidence in core competencies. The program demonstrated potential for building palliative care capacity in primary care teams.

Facilitators and barriers to implementation of a patient and staff reported measure for screening of palliative concerns of patients with heart failure: a qualitative analysis using the Consolidated Framework for Implementation Research

“…Further studies on how to build up palliative care capacity for generalists could also be explored. 41 …”

“…There is a strong need to determine which patients would benefit most from specialist palliative care versus those who could receive support from healthcare staff with generalist palliative care skills, such as cardiologists. 16 , 41 …”

“…There is a strong need to determine which patients would benefit most from specialist palliative care versus those who could receive support from healthcare staff with generalist palliative care skills, such as cardiologists. 16,41 A minor limitation of this study was that the IPOS was only validated in English, due to funding constraints on the part of the study team. Therefore, we were unable to recruit Chinese speaking participants in the current study.…”

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

“…The development of CAPACITI was previously described in detail. 17 All sessions included 1) educational support for clinical practice through the provision of expert advice, 2) evidence-based tools (such as the Prognostic Indicator Guidance [PIG] which supports early identi cation of patients who may require a palliative approach to care), 26 and 3) coaching and facilitation to support practitioners to tailor knowledge, skills, and tools to their regional contexts. Each session began with an hour-long virtual webinar, comprised of an instructional segment followed by an interactive session with a palliative care expert who was able to answer questions, offer advice, and share their personal experiences (Fig.…”

“…In our prior studies, CAPACITI participants reported signi cant increases in their identi cation of patients requiring palliative care, competency in providing care, and team collaboration following the intervention. 17,18 While studies of other palliative care training interventions have demonstrated a positive in uence on provider-reported outcomes, 13,19,20 it remains less clear how and to what extent the elements of these programs are effectively integrated into primary care team practice.…”