Comparative Trial of Home-Based Palliative Care

Background: To effectively alleviate suffering and improve quality of life for patients with
serious illness and their caregivers, palliative care (PC) services must be offered across
multiple settings. Research is needed to determine how best to optimize home-based palliative
care (HBPC) services to meet the needs of individuals with high symptom burden and functional
limitations.

Aim: The investigators will compare a standard HBPC model that includes routine home visits
by a nurse and provider with a more efficient tech-supported HBPC model that promotes timely
inter-professional team coordination via synchronous video consultation with the provider
while the nurse is in the patient's home. The investigators hypothesize that tech-supported
HBPC will be as effective as standard HBPC.

Design: Cluster randomized trial. Registered nurses (n~130) will be randomly assigned to the
tech-supported or standard HBPC model so that half of the patient-caregiver dyads will
receive one of the two models.

Setting/Participants: Kaiser Permanente (15 Southern California and Oregon sites). Patients
(n=10,000) with any serious illness and a prognosis of 1-2 years and their caregivers
(n=4,800)

Methods: Patients and caregivers will receive standard PC services: comprehensive needs
assessment and care planning, pain and symptom management, education/skills training,
medication management, emotional/spiritual support; care coordination, referral to other
services, and 24/7 phone assistance.

Results: Primary patient outcomes: symptom improvement at 1 month and days spent at home in
the last six months of life; caregiver outcome: perception of preparedness for caregiving.

Conclusion: Should the more efficient tech-supported HBPC model achieves comparable
improvements in outcomes that matter most to patients and caregivers, this would have a
lasting impact on PC practice and policy.