Enhancing Palliative Care Integration in Home Healthcare: Assessing Readiness, Identifying Needs, and Overcoming Challenges (EPIC-HHC)

About This Grant

Specialized home-based palliative care offers cost-effective, patient-centered care, enhancing satisfaction and quality of life for individuals with serious illnesses. Home healthcare (HHC) patients, predominantly seriously ill older individuals with multiple chronic conditions, could greatly benefit from such care. However, only 7% of home-based palliative care programs are operated by HHC agencies. Addressing this gap, the National Association of Home Care and Hospice (NAHC) has advocated for Medicare payment model revisions. The “Expanding Access to Palliative Care Act” bill proposes a broader HHC palliative care approach. Nevertheless, a wider integration of palliative care into HHC depends on clinician readiness, patient and caregiver receptivity, and a robust screening tool for the timely identification of palliative care beneficiaries. Currently, no HHC-specific screening tool exists. The 2018 National Consensus Project (NCP) Clinical Practice Guidelines for Quality Palliative Care outlines eight domains for comprehensive palliative care. However, existing assessments often overlook crucial contextual or social factors, important for patients with complex care needs. Variations in palliative care access and utilization exist, and factors affecting public perception of palliative care are multifaceted. Our team, guided by the 2018 NCP guidelines, developed two HHC-specific questionnaires to measure Palliative Care-related Knowledge, Attitudes, and Confidence: one for HHC clinicians (PC-KAC- Clinician), and another for HHC patients and caregivers (PC-KAC-Patient/Caregiver). Using the unique HHC setting-specific PC-KAC questionnaires, this project seeks to assess readiness for palliative care integration in HHC, explore variation in readiness and receptivity, and devise a screening tool for identifying HHC patients benefiting from palliative care. We will 1) develop a consensus and evidence-based screening tool to identify HHC patients who can most benefit from palliative care and assess the feasibility and acceptability of the screener; 2) assess the preparedness of HHC clinicians to deliver palliative care; 3) evaluate the knowledge and receptiveness of palliative care among HHC patients and caregivers and identify differences in knowledge and receptivity; and 4) explore the barriers and facilitators related to the integration of palliative care services into HHC practice. Screening tool development will be through systematic review, expert input, validation and pilot testing with HHC clinicians. Questionnaires will be conducted among HHC clinicians (n=480), and patients/caregivers (total n=480) to understand their palliative care-related knowledge, attitudes, and confidence. Qualitative interviews will be conducted with key stakeholders to explore how best to incorporate palliative care into HHC practice. Alignment with PAR-22-092, this project aims to advance a new care model, integrating palliative care within HHC, catering to patients with multiple chronic conditions, especially those with multiple chronic conditions and complex social and care needs.