• Jenna M Evans, Marnie Mackinnon, José Pereira, Craig C Earle, Bruno Gagnon, Erin Arthurs, Sharon Gradin, Tara Walton, Frances Wright, and Sandy Buchman.
• Scientist at Cancer Care Ontario in Toronto and Assistant Professor (status) at the Institute of Health Policy, Management, and Evaluation at the University of Toronto.
• Can Fam Physician. 2021 Apr 1; 67 (4): 270-278.

ObjectiveTo evaluate an intervention aimed at building capacity to deliver palliative care in primary care settings.DesignThe INTEGRATE Project was a 3-year pilot project involving interprofessional palliative care education and an integrated care model to promote early identification and support of patients with palliative care needs. A concurrent mixed-methods evaluation was conducted using descriptive data, provider surveys before and after implementation, and interviews with providers and managers.SettingFour primary care practices in Ontario.ParticipantsAll providers in each practice were invited to participate. Providers used the "surprise question" as a prompt to determine patient eligibility for inclusion.Main Outcome MeasuresProvider attitudes toward and confidence in providing palliative care, use of palliative care tools, delivery of palliative care, and perceived barriers to delivering palliative care.ResultsA total of 294 patients were identified for early initiation of palliative care, most of whom had multiple comorbid conditions. Results demonstrated improvement in provider confidence to deliver palliative care (30% mean increase, P < .05) and self-reported use of palliative care tools and services (25% mean increase, P < .05). There was substantial variation across practices regarding the percentage of patients identified using the surprise question (0.2% to 1.5%), the number of advance care planning conversations initiated (50% to 90%), and mean time to conversation (13 to 76 days). This variation is attributable, in part, to contextual differences across practices.ConclusionA standardized model for the early introduction of palliative care to patients can be integrated into the routine practice of primary care practitioners with appropriate training and support. Additional research is needed to understand the practice factors that contribute to the success of palliative care interventions in primary care and to examine patient outcomes.Copyright© 2021 the College of Family Physicians of Canada.

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