Implementation of a palliative care intervention for patients with COPD – a mixed methods process evaluation of the COMPASSION study
Abstract Objectives Little direction exists on how to effectively implement palliative care for patients with COPD. In the COMPASSION study, we developed, executed, and evaluated a multifaceted implementation strategy to improve the uptake of region-tailored palliative care intervention components i...
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| Format: | Article |
| Language: | English |
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BMC
2022-12-01
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| Series: | BMC Palliative Care |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12904-022-01110-3 |
| _version_ | 1828091228998074368 |
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| author | Johanna M. C. Broese Rianne M. J. J. van der Kleij Els M. L. Verschuur Huib A. M. Kerstjens Yvonne Engels Niels H. Chavannes |
| author_facet | Johanna M. C. Broese Rianne M. J. J. van der Kleij Els M. L. Verschuur Huib A. M. Kerstjens Yvonne Engels Niels H. Chavannes |
| author_sort | Johanna M. C. Broese |
| collection | DOAJ |
| description | Abstract Objectives Little direction exists on how to effectively implement palliative care for patients with COPD. In the COMPASSION study, we developed, executed, and evaluated a multifaceted implementation strategy to improve the uptake of region-tailored palliative care intervention components into routine COPD care. We evaluated the implementation strategy and assessed the implementation process, barriers, and facilitators. Methods A mixed methods process evaluation was performed. Primary and secondary healthcare providers in four hospital regions in the Netherlands were trained. Patients identified during hospitalisation for an acute exacerbation received palliative care and were followed for a year. Various sources were used: process data, questionnaires including the End-of-life Professional Caregiver Survey (EPCS), medical records, monitoring meetings, and interviews. The Consolidated Framework of Implementation Research (CFIR) was used to categorize implementation determinants. Results The training sessions with roleplay were positively evaluated and increased professionals’ self-efficacy in providing palliative care statistically significantly. Of 98 patients identified, 44 (44.9%) received one or more palliative care conversations at the outpatient clinic. Having those conversations was highly valued by healthcare providers because it led to clarity and peace of mind for the patient and higher job satisfaction. Coordination and continuity remained suboptimal. Most important barriers to implementation were time constraints, the COVID-19 pandemic, and barriers related to transmural and interdisciplinary collaboration. Facilitators were the systematic screening of patients for palliative care needs, adapting to the patient’s readiness, conducting palliative care conversations with a pulmonologist and a COPD nurse together, and meeting regularly with a small team led by a dedicated implementation leader. Conclusions Providing integrated palliative care for patients with COPD is highly valued by healthcare providers but remains challenging. Our findings will guide future implementation efforts. Future research should focus on how to optimize transmural and interdisciplinary collaboration. Trial registration The COMPASSION study is registered in the Netherlands Trial Register (NTR): NL7644. Registration date: 07/04/2019. |
| first_indexed | 2024-04-11T06:10:05Z |
| format | Article |
| id | doaj.art-bc0514a9b82b47ccbd34948fc85ef4fd |
| institution | Directory Open Access Journal |
| issn | 1472-684X |
| language | English |
| last_indexed | 2024-04-11T06:10:05Z |
| publishDate | 2022-12-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Palliative Care |
| spelling | doaj.art-bc0514a9b82b47ccbd34948fc85ef4fd2022-12-22T04:41:22ZengBMCBMC Palliative Care1472-684X2022-12-0121111210.1186/s12904-022-01110-3Implementation of a palliative care intervention for patients with COPD – a mixed methods process evaluation of the COMPASSION studyJohanna M. C. Broese0Rianne M. J. J. van der Kleij1Els M. L. Verschuur2Huib A. M. Kerstjens3Yvonne Engels4Niels H. Chavannes5Public Health & Primary care, Leiden University Medical CentrePublic Health & Primary care, Leiden University Medical CentreLung Alliance NetherlandsRespiratory Medicine & Tuberculosis, University Medical Centre GroningenAnaesthesiology, Pain & Palliative medicine, Radboud University Medical CentrePublic Health & Primary care, Leiden University Medical CentreAbstract Objectives Little direction exists on how to effectively implement palliative care for patients with COPD. In the COMPASSION study, we developed, executed, and evaluated a multifaceted implementation strategy to improve the uptake of region-tailored palliative care intervention components into routine COPD care. We evaluated the implementation strategy and assessed the implementation process, barriers, and facilitators. Methods A mixed methods process evaluation was performed. Primary and secondary healthcare providers in four hospital regions in the Netherlands were trained. Patients identified during hospitalisation for an acute exacerbation received palliative care and were followed for a year. Various sources were used: process data, questionnaires including the End-of-life Professional Caregiver Survey (EPCS), medical records, monitoring meetings, and interviews. The Consolidated Framework of Implementation Research (CFIR) was used to categorize implementation determinants. Results The training sessions with roleplay were positively evaluated and increased professionals’ self-efficacy in providing palliative care statistically significantly. Of 98 patients identified, 44 (44.9%) received one or more palliative care conversations at the outpatient clinic. Having those conversations was highly valued by healthcare providers because it led to clarity and peace of mind for the patient and higher job satisfaction. Coordination and continuity remained suboptimal. Most important barriers to implementation were time constraints, the COVID-19 pandemic, and barriers related to transmural and interdisciplinary collaboration. Facilitators were the systematic screening of patients for palliative care needs, adapting to the patient’s readiness, conducting palliative care conversations with a pulmonologist and a COPD nurse together, and meeting regularly with a small team led by a dedicated implementation leader. Conclusions Providing integrated palliative care for patients with COPD is highly valued by healthcare providers but remains challenging. Our findings will guide future implementation efforts. Future research should focus on how to optimize transmural and interdisciplinary collaboration. Trial registration The COMPASSION study is registered in the Netherlands Trial Register (NTR): NL7644. Registration date: 07/04/2019.https://doi.org/10.1186/s12904-022-01110-3Chronic obstructive pulmonary diseasePalliative careImplementationEvaluation studies |
| spellingShingle | Johanna M. C. Broese Rianne M. J. J. van der Kleij Els M. L. Verschuur Huib A. M. Kerstjens Yvonne Engels Niels H. Chavannes Implementation of a palliative care intervention for patients with COPD – a mixed methods process evaluation of the COMPASSION study BMC Palliative Care Chronic obstructive pulmonary disease Palliative care Implementation Evaluation studies |
| title | Implementation of a palliative care intervention for patients with COPD – a mixed methods process evaluation of the COMPASSION study |
| title_full | Implementation of a palliative care intervention for patients with COPD – a mixed methods process evaluation of the COMPASSION study |
| title_fullStr | Implementation of a palliative care intervention for patients with COPD – a mixed methods process evaluation of the COMPASSION study |
| title_full_unstemmed | Implementation of a palliative care intervention for patients with COPD – a mixed methods process evaluation of the COMPASSION study |
| title_short | Implementation of a palliative care intervention for patients with COPD – a mixed methods process evaluation of the COMPASSION study |
| title_sort | implementation of a palliative care intervention for patients with copd a mixed methods process evaluation of the compassion study |
| topic | Chronic obstructive pulmonary disease Palliative care Implementation Evaluation studies |
| url | https://doi.org/10.1186/s12904-022-01110-3 |
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