Applying the Multiphase Optimization Strategy for the Development of Optimized Interventions in Palliative Care

Rachel D. Wells, Kate Guastaferro, Andres Azuero, Christine Rini, Bailey A. Hendricks, Chinara Dosse, Richard Taylor, Grant R. Williams, Sally Engler, Charis Smith, Rebecca Sudore, Abby R. Rosenberg, Marie A. Bakitas, J. Nicholas Dionne-Odom

Research output: Contribution to journalReview articlepeer-review


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).

Original languageEnglish (US)
Pages (from-to)174-182
Number of pages9
JournalJournal of Pain and Symptom Management
Issue number1
StatePublished - Jul 2021


  • Multiphase Optimization Strategy
  • clinical trials
  • factorial experiment
  • intervention development

ASJC Scopus subject areas

  • General Nursing
  • Clinical Neurology
  • Anesthesiology and Pain Medicine


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