Skip to content


Palliative care is medical care that seeks to relieve the burdens of serious illness. Most palliative care in the U.S. is provided in hospitals, either by an interdisciplinary team of specialty-trained clinicians (specialist) or by any individual clinician (e.g., physician, nurse, advanced practice provider, social worker) as part of their routine care of patients with serious illness (generalist). Systematic reviews of randomized trials suggest that both generalist and specialist palliative care improve outcomes for seriously ill hospitalized patients, but evidence is lacking regarding the comparative effectiveness of these approaches among all hospitalized patients who may benefit. We will conduct a pragmatic hybrid effectiveness-implementation parallel-cluster randomized trial among approximately 43,000 seriously ill patients admitted over 30 months to 48 hospitals across 17 states in two of the largest U.S. health systems. Hospitals will be randomly assigned to one of three study arms: (1) standardized usual care, (2) trained generalist palliative care, or (3) specialist palliative care. Our primary hypotheses are that systematically triggering generalist palliative care will be non-inferior to systematically triggering specialist palliative care on the primary outcome of hospital-free days through 6 months and the key secondary outcome of patient-reported quality of life, and that both interventions will be superior to usual care. This trial will guide health systems and other key stakeholders on how best to improve care for the nation’s sickest patients and their care partners. Further, this trial will reveal how these three approaches compare in terms of the equity of palliative care delivery and improvements in patient-centered outcomes among specific patient subgroups. Finally, this study will identify the most promising ways to tailor implementation strategies to promote reach and maintenance of each intervention within different types of hospitals.

Partnering Health Systems

Trinity Health

Kaiser Permanente Southern California (KPSC)

Other research partners:
Duke Clinical Research Institute (DCRI)
Center to Advance Palliative Care (CAPC)
National Patient Advocate Foundation (NPAF)


Patient-Centered Outcomes Research Institute (PCORI)