Applying the Multiphase Optimization Strategy for the Development of Optimized Interventions in Palliative Care
Open accessAbstract
Recent systematic reviews and meta-analyses have reported positive benefit of multicomponent "bundled" palliative care interventions for patients and family caregivers while highlighting limitations in determining key elements and mechanisms of improvement. Traditional research approaches, such as the randomized controlled trial (RCT), typically treat interventions as "bundled" treatment packages, making it difficult to assess definitively which aspects of an intervention can be reduced or replaced or whether there are synergistic or antagonistic interactions between intervention components. Progressing toward palliative care interventions that are effective, efficient, and scalable will require new strategies and novel approaches. One such approach is the Multiphase Optimization Strategy (MOST), a framework informed by engineering principles, that uses a systematic process to empirically identify an intervention comprised of components that positively contribute to desired outcomes under real-life constraints. This article provides a brief overview and application of MOST and factorial trial design in palliative care research, including our insights from conducting a pilot factorial trial of an early palliative care intervention to enhance the decision support skills of advanced cancer family caregivers (Project CASCADE).
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The minimally distressed sample contrasts with other caregiving trials that had better outcomes with a more distressed sample; for example, the Forst et al. trial had mean baseline HADS anxiety scores above 11 and used GAD-7 ≥5 as eligibility.
“Our minimally distressed sample contrasts with other caregiving trials that had better outcomes with a more distressed sample; for example, a recent trial by Forst and colleagues35 of an effective behavioral health specialist–led telehealth intervention for caregivers of patients with primary malignant brain tumors consisted of a sample where the mean baseline HADS anxiety scores in both groups”
From Palliative Care Coaching for Family Caregivers of Patients With Advanced Cancer (2026) · cites this paper as [35]
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- Authors
- Wells, R. D., Guastaferro, K., Azuero, A., Rini, C., Hendricks, B. A., Dosse, C., Taylor, R., Williams, G. R., Engler, S., Smith, C., Sudore, R., Rosenberg, A. R., Bakitas, M. A., & Dionne-Odom, J. N.
- Affiliations
- University of Alabama at Birmingham (US)
- Pennsylvania State University (US)
- Northwestern University (US)
- University of California, San Francisco (US)
- University of Washington (US)
- Corresponding author
- Wells, Rachel D.
- ORCID
- Venue
- Journal of Pain and Symptom Management
- Publisher
- Elsevier BV
- Published
- 2021-07
- Volume
- 62
- Issue
- 1
- Pages
- 174-182
- ISSN
- 0885-3924 (ISSN-L)
- PMC
- PMC8274323
- OpenAlex
- W3107432668
- Cited by
- 28
- References
- 46
- Citations by year
- 2026: 3 · 2025: 7 · 2024: 7 · 2023: 3 · 2022: 1 · 2021: 7
- FWCI
- 0.46
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of Pain and Symptom Management (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- National Palliative Care Research Center
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative and Oncologic Care
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Keywords
- multiphase optimization strategy, palliative care interventions, factorial design, early palliative care, advanced cancer, family caregivers
- MeSH terms
- Humans, Palliative Care, Research Design, Randomized Controlled Trials as Topic, Caregivers, Hospice and Palliative Care Nursing
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