RT Journal Article SR Electronic T1 Findings and lessons learnt from early termination of a pragmatic comparative effectiveness trial of video consultations in home-based palliative care JF BMJ Supportive & Palliative Care JO BMJ Support Palliat Care FD British Medical Journal Publishing Group SP bmjspcare-2020-002553 DO 10.1136/bmjspcare-2020-002553 A1 Huong Q. Nguyen A1 Carmit McMullen A1 Eric C Haupt A1 Susan E Wang A1 Henry Werch A1 Paula E Edwards A1 Gina M Andres A1 Lynn Reinke A1 Brian S Mittman A1 Ernest Shen A1 Richard A Mularski YR 2020 UL http://spcare.bmj.com/content/early/2020/10/13/bmjspcare-2020-002553.abstract AB Background Health systems need evidence about how best to deliver home-based palliative care (HBPC) to meet the growing needs of seriously ill patients. We hypothesised that a tech-supported model that aimed to promote timely inter-professional team coordination using video consultation with a remote physician while a nurse is in the patient’s home would be non-inferior compared with a standard model that includes routine home visits by nurses and physicians.Methods We conducted a pragmatic, cluster randomised non-inferiority trial across 14 sites (HomePal Study). Registered nurses (n=111) were randomised to the two models so that approximately half of the patients with any serious illness admitted to HBPC and their caregivers were enrolled in each study arm. Process measures (video and home visits and satisfaction) were tracked. The primary outcomes for patients and caregivers were symptom burden and caregiving preparedness at 1–2 months.Results The study was stopped early after 12 months of enrolment (patients=3533; caregivers=463) due to a combination of low video visit uptake (31%), limited substitution of video for home visits, and the health system’s decision to expand telehealth use in response to changes in telehealth payment policies, the latter of which was incompatible with the randomised design. Implementation barriers included persistent workforce shortages and inadequate systems that contributed to scheduling and coordination challenges and unreliable technology and connectivity.Conclusions We encountered multiple challenges to feasibility, relevance and value of conducting large, multiyear pragmatic randomised trials with seriously ill patients in the real-world settings where care delivery, regulatory and payment policies are constantly shifting.