Barriers and facilitators to implementing a pragmatic trial to improve advance care planning in the nursing home setting
Abstract Background The PRagmatic trial Of Video Education in Nursing homes (PROVEN) aims to test the effectiveness of an advance care planning (ACP) video intervention. Relatively little is known about the challenges associated with implementing ACP interventions in the nursing home (NH) setting, e...
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| Format: | Article |
| Language: | English |
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BMC
2019-07-01
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| Series: | BMC Health Services Research |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12913-019-4309-5 |
| _version_ | 1818917206903226368 |
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| author | Jennifer A. Palmer Victoria A. Parker Vincent Mor Angelo E. Volandes Lacey R. Barre Emmanuelle Belanger Phoebe Carter Lacey Loomer Ellen McCreedy Susan L. Mitchell |
| author_facet | Jennifer A. Palmer Victoria A. Parker Vincent Mor Angelo E. Volandes Lacey R. Barre Emmanuelle Belanger Phoebe Carter Lacey Loomer Ellen McCreedy Susan L. Mitchell |
| author_sort | Jennifer A. Palmer |
| collection | DOAJ |
| description | Abstract Background The PRagmatic trial Of Video Education in Nursing homes (PROVEN) aims to test the effectiveness of an advance care planning (ACP) video intervention. Relatively little is known about the challenges associated with implementing ACP interventions in the nursing home (NH) setting, especially within a pragmatic trial. To address this research gap, this report sought to identify facilitators of and barriers to implementing PROVEN from the perspective of the Champions charged with introducing the ACP video program delivery to patients and families. Methods In semi-structured telephone interviews at 4 and 15 months of the 18-month implementation period, ACP Champions at all PROVEN intervention facilities (N = 119) were asked about their perceptions of program implementation. Forty interviews were purposively sampled, transcribed, and analyzed using a hybrid deductive/inductive approach to thematic analysis incorporating the Consolidated Framework for Implementation Research’s domains: Intervention Characteristics (IC), Inner Setting (IS), Characteristics of Individuals (CI), Outer Setting (OS), and Process (P). Results Implementation facilitators identified by Champions included: the intervention’s adaptable mode of presentation and minimal time burden (IC) as well as the program’s customizable delivery to patients and families and opportunity for group reflection on implementation among ACP Champions (P). Barriers included mandated protocol-driven aspects of the program (OS), limited time to deliver the intervention (IS), and lack of perceived relevance and emotional readiness for ACP amongst stakeholders (CI). Conclusions Despite the promise of PROVEN’s intervention for improving ACP in nursing homes, unchangeable setting and characteristics of Champions, patients, and family members presented implementation barriers. Researchers need to engage all program participants (i.e., facility staff, patients, and families), in addition to corporate-level stakeholders, in early pragmatic trial design to minimize such obstacles. Further, despite the facilitating nature of PROVEN’s implementation processes, the study encountered tension between scientific rigor and real-world demands. Researchers need to optimize the real-world authenticity of pragmatic trial design while avoiding excessive implementation protocol deviations. Trial registration ClinicalTrials.gov Identifier: NCT02612688. Registered 19 November 2015. |
| first_indexed | 2024-12-20T00:30:23Z |
| format | Article |
| id | doaj.art-091cec2144884e1b80bf9d0a3ac04afa |
| institution | Directory Open Access Journal |
| issn | 1472-6963 |
| language | English |
| last_indexed | 2024-12-20T00:30:23Z |
| publishDate | 2019-07-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj.art-091cec2144884e1b80bf9d0a3ac04afa2022-12-21T19:59:56ZengBMCBMC Health Services Research1472-69632019-07-0119111210.1186/s12913-019-4309-5Barriers and facilitators to implementing a pragmatic trial to improve advance care planning in the nursing home settingJennifer A. Palmer0Victoria A. Parker1Vincent Mor2Angelo E. Volandes3Lacey R. Barre4Emmanuelle Belanger5Phoebe Carter6Lacey Loomer7Ellen McCreedy8Susan L. Mitchell9Harvard Medical SchoolPeter T. Paul College of Business and Economics, University of New HampshireCenter for Gerontology and Healthcare Research, School of Public Health, Brown UniversityHarvard Medical SchoolDepartment of Health Services, Policy, and Practice, School of Public Health, Brown UniversityCenter for Gerontology and Healthcare Research, School of Public Health, Brown UniversityHebrew SeniorLife, Hinda & Arthur Marcus Institute for Aging ResearchDepartment of Health Services, Policy, and Practice, School of Public Health, Brown UniversityCenter for Gerontology and Healthcare Research, School of Public Health, Brown UniversityHarvard Medical SchoolAbstract Background The PRagmatic trial Of Video Education in Nursing homes (PROVEN) aims to test the effectiveness of an advance care planning (ACP) video intervention. Relatively little is known about the challenges associated with implementing ACP interventions in the nursing home (NH) setting, especially within a pragmatic trial. To address this research gap, this report sought to identify facilitators of and barriers to implementing PROVEN from the perspective of the Champions charged with introducing the ACP video program delivery to patients and families. Methods In semi-structured telephone interviews at 4 and 15 months of the 18-month implementation period, ACP Champions at all PROVEN intervention facilities (N = 119) were asked about their perceptions of program implementation. Forty interviews were purposively sampled, transcribed, and analyzed using a hybrid deductive/inductive approach to thematic analysis incorporating the Consolidated Framework for Implementation Research’s domains: Intervention Characteristics (IC), Inner Setting (IS), Characteristics of Individuals (CI), Outer Setting (OS), and Process (P). Results Implementation facilitators identified by Champions included: the intervention’s adaptable mode of presentation and minimal time burden (IC) as well as the program’s customizable delivery to patients and families and opportunity for group reflection on implementation among ACP Champions (P). Barriers included mandated protocol-driven aspects of the program (OS), limited time to deliver the intervention (IS), and lack of perceived relevance and emotional readiness for ACP amongst stakeholders (CI). Conclusions Despite the promise of PROVEN’s intervention for improving ACP in nursing homes, unchangeable setting and characteristics of Champions, patients, and family members presented implementation barriers. Researchers need to engage all program participants (i.e., facility staff, patients, and families), in addition to corporate-level stakeholders, in early pragmatic trial design to minimize such obstacles. Further, despite the facilitating nature of PROVEN’s implementation processes, the study encountered tension between scientific rigor and real-world demands. Researchers need to optimize the real-world authenticity of pragmatic trial design while avoiding excessive implementation protocol deviations. Trial registration ClinicalTrials.gov Identifier: NCT02612688. Registered 19 November 2015.http://link.springer.com/article/10.1186/s12913-019-4309-5Pragmatic trialImplementationNursing homes |
| spellingShingle | Jennifer A. Palmer Victoria A. Parker Vincent Mor Angelo E. Volandes Lacey R. Barre Emmanuelle Belanger Phoebe Carter Lacey Loomer Ellen McCreedy Susan L. Mitchell Barriers and facilitators to implementing a pragmatic trial to improve advance care planning in the nursing home setting BMC Health Services Research Pragmatic trial Implementation Nursing homes |
| title | Barriers and facilitators to implementing a pragmatic trial to improve advance care planning in the nursing home setting |
| title_full | Barriers and facilitators to implementing a pragmatic trial to improve advance care planning in the nursing home setting |
| title_fullStr | Barriers and facilitators to implementing a pragmatic trial to improve advance care planning in the nursing home setting |
| title_full_unstemmed | Barriers and facilitators to implementing a pragmatic trial to improve advance care planning in the nursing home setting |
| title_short | Barriers and facilitators to implementing a pragmatic trial to improve advance care planning in the nursing home setting |
| title_sort | barriers and facilitators to implementing a pragmatic trial to improve advance care planning in the nursing home setting |
| topic | Pragmatic trial Implementation Nursing homes |
| url | http://link.springer.com/article/10.1186/s12913-019-4309-5 |
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