Palliative care (PC), a patient-centered approach that provides pain and symptom management and psychosocial and spiritual support, has strong evidence of improved outcomes for patients who are seriously ill. In 2017, we received funding from PCORI to conduct a randomized controlled trial (RCT) to test the effectiveness of an evidence-based model of home-based PC (HBPC) for patient and caregiver outcomes. This HBPC was provided by community HBPC agencies selected by the accountable care organizations (ACOs) and paid for by our insurance partner. We had aimed to randomly assign 1155 patients who were seriously ill (and approximately 884 of their caregivers) and receiving care from 10 ACOs in California to 1 of 2 trial groups: HBPC or enhanced usual care. For the latter, usual primary care would be enhanced through additional training in PC principles. After 3 trial modifications and 20 months of attempting to engage primary care physicians (PCPs) and patients in the trial, we closed the RCT in April 2019 because of insufficient enrollment. Instead, we applied for and received permission to change our scope of work with the aim of exploring challenges and facilitators to engaging a range of stakeholders in both research and HBPC.
