RPD301 - A feasibility study of hospital-wide CAPC training for primary palliative care

Key Message : Systematic and widespread promotion of primary palliative care training for generalist clinicians is needed to improve access to high-quality serious illness care. The multi-faceted, low-cost strategies used to promote a curated CAPC training curriculum in this feasibility study led to high clinician adherence and are reproducible at scale.

Abstract:

Background: Due to the limited specialty palliative care workforce and the growing population of adults living (longer) with serious illness in the U.S.,1,2 there is an urgent need for widespread training among generalist clinicians to improve access to high-quality primary palliative care. In preparation for a pragmatic trial testing a non-inferiority hypothesis of the overall effectiveness of trained generalist vs. specialist palliative care among more than 40,000 adults with high risk of one-year mortality in 49 U.S. hospitals across 2 health systems, we undertook a feasibility study of a Center to Advance Palliative Care (CAPC) training curriculum at two of the study hospitals.

Objective: Determine how to optimally engage busy clinicians to achieve high training adherence of the CAPC training curriculum.

Methods: The CAPC curriculum included 4 CEU-eligible courses covering broad topic areas (basics of palliative care, symptom management, and communication). Eligible clinicians were invited via email to complete training within 4-6 weeks. We employed multiple strategies to promote course completion, including identifying site champions, emails and texts to remind non-responders, and announcements at departmental meetings.

Results: Of 158 eligible clinicians, 100% completed the CAPC curriculum at Trinity (n=56/56) and 92% at KPSC (n=94/102) over approximately three months. Clinicians’ post-course evaluations (97% response rate) demonstrated high scores for new knowledge and relevance to practice across all 4 courses: 74% reported substantial or greater topic knowledge and there was a mean 12% increase in the proportion of clinicians rating their post-course knowledge as “very substantial” compared to pre-course.

Conclusion: CAPC provides an expert-developed and self-directed training platform with a full slate of courses that can be selected to meet specific leadership priorities. The strategies used to promote the training curriculum in this feasibility study led to high clinician adherence and are reproducible at scale for the planned large pragmatic trial.

References: 1. Bynum J, Meara E, Chang C-H, Rhoads JM. Our Parents, Ourselves: Health Care for an Aging Population: A Report of the Dartmouth Atlas Project. Feb 17, 2016.
2. Dall TM, Gallo PD, Chakrabarti R, et al. An aging population and growing disease burden will require a large and specialized health care workforce by 2025. Health Aff (Millwood). Nov 2013;32(11):2013-20. doi:10.1377/hlthaff.2013.0714