Hostname: page-component-745bb68f8f-5r2nc Total loading time: 0 Render date: 2025-01-09T15:30:34.607Z Has data issue: false hasContentIssue false
  • English
  • Français

Implementation of the integrated palliative care outcome scale in acute care settings – a feasibility study

Published online by Cambridge University Press:  21 January 2018

Susanne Lind ,
J. Sandberg ,
T. Brytting ,
C.J. Fürst  and
L. Wallin
Susanne Lind*
Affiliation:
Department of Neurobiology, Care Sciences and Society, Division of nursing, Karolinska Institutet, Flemingsberg, Sweden Department of Health Care Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden
J. Sandberg
Affiliation:
Department of Nursing Science, School of Health and Welfare, Jönköping University, Sweden
T. Brytting
Affiliation:
The Institute of Organisation and Worklife Ethics, Ersta Sköndal Bräcke University College, Stockholm, Sweden
C.J. Fürst
Affiliation:
Institute for Palliative Care, Lund University and Region Skåne, Sweden Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Oncology, Lund, Sweden
L. Wallin
Affiliation:
Department of Neurobiology, Care Sciences and Society, Division of nursing, Karolinska Institutet, Flemingsberg, Sweden School of Education, Health and Social Science, Dalarna University, Sweden Department of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
*
Author for correspondence: Susanne Lind, Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, SE-141 52 Huddinge, Sweden E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective

Although hospitals have been described as inadequate place for end-of-life care, many deaths still occur in hospital settings. Although patient-reported outcome measures have shown positive effects for patients in need of palliative care, little is known about how to implement them. We aimed to explore the feasibility of a pilot version of an implementation strategy for the Integrated Palliative care Outcome Scale (IPOS) in acute care settings.

Method

A strategy, including information, training, and facilitation to support the use of IPOS, was developed and carried out at three acute care units. For an even broader understanding of the strategy, it was also tested at a palliative care unit. A process evaluation was conducted including collecting quantitative data and performing interviews with healthcare professionals.

Result

Factors related to the design and performance of the strategy and the context contributed to the results. The prevalence of completed IPOS in the patient's records varied from 6% to 44% in the acute care settings. At the palliative care unit, the prevalence in the inpatient unit was 53% and the specialized home care team 35%. The qualitative results showed opposing perspectives concerning the training provided: Related to everyday work at the acute care units and Nothing in it for us at the palliative care unit. In the acute care settings, A need for an improved culture regarding palliative care was identified. A context characterized by A constantly increasing workload, a feeling of Constantly on-going changes, and a feeling of Change fatigue were found at all units. Furthermore, the internal facilitators and the nurse managers’ involvement in the implementation differed between the units.

Significance of the results

The feasibility of the strategy in our study is considered to be questionable and the components need to be further explored to enhance the impact of the strategy and thereby improve the use of IPOS.

Keywords

Implementationpalliative careintegrated palliative care outcome scaleacute care settingsfacilitation
Type
Original Article
Information
Palliative & Supportive Care , Volume 16 , Issue 6 , December 2018 , pp. 698 - 705
Copyright
Copyright © Cambridge University Press 2018 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Antunes, B, Harding, R, Higginson, IJ, and Euroimpact (2014) Implementing patient-reported outcome measures in palliative care clinical practice: a systematic review of facilitators and barriers. Palliative Medicine 28(2), 158–175.Google Scholar
Baker, R, Camosso-Stefinovic, J, Gillies, C, et al. (2015) Tailored interventions to address determinants of practice. Cochrane Database Syst Rev (4), CD005470.Google Scholar
Bausewein, C, Daveson, BA, Currow, DC, et al. (2015) EAPC White Paper on outcome measurement in palliative care: Improving practice, attaining outcomes and delivering quality services - recommendations from the European Association for Palliative Care (EAPC) Task Force on Outcome Measurement. Palliative Medicine 30(1), 6–22.Google Scholar
Bausewein, C, Simon, ST, Benalia, H, et al. (2011) Implementing patient reported outcome measures (PROMs) in palliative care - users’ cry for help. Health and Quality of Life Outcomes, 9, 27.Google Scholar
Beck, I, Olsson Möller, U, Malmström, M, et al. (2017) Translation and cultural adaptation of the Integrated Palliative care Outcome Scale including cognitive interviewing with patients and staff. BMC Palliative Care 16(1), 49.Google Scholar
Bloomer, MJ, Endacott, R, O'Connor, M, and Cross, W (2013). The ‘dis-ease’ of dying: challenges in nursing care of the dying in the acute hospital setting. A qualitative observational study. Palliative Medicine 27(8), 757–764.Google Scholar
Boyce, MB, Browne, JP, and Greenhalgh, J (2014) The experiences of professionals with using information from patient-reported outcome measures to improve the quality of healthcare: a systematic review of qualitative research. BMJ Quality & Safety 23(6), 508–518.Google Scholar
Bloomer, M, Moss, C, and Cross, W (2011) End-of-life care in acute hospitals: an intergrative literature review. Journal of Nursing and Healthcare of Chronic Illness 3, 165–173.Google Scholar
Catania, G, Costantini, M, Beccaro, M, et al. (2013) Does quality of life assessment in palliative care look like a complex screening program? Health and Quality of Life Outcomes 11, 7.Google Scholar
Dawson, J, Doll, H, Fitzpatrick, R, et al. (2010) The routine use of patient reported outcome measures in healthcare settings. BMJ 340, c186.Google Scholar
Elo, S, and Kyngäs, H (2008) The qualitative content analysis process. Journal of Advanced Nursing 62(1), 107–115.Google Scholar
Etkind, SN, Daveson, BA, Kwok, W, et al. (2015) Capture, transfer, and feedback of patient-centered outcomes data in palliative care populations: does it make a difference? A systematic review. Journal of Pain Symptom Management 49(3), 611–624.Google Scholar
Frey, R, Gott, M, Raphael, D, et al. (2014) Clinical staff perceptions of palliative care-related quality of care, service access, education and training needs and delivery confidence in an acute hospital setting. BMJ Support and Palliative Care 4(4), 381–389.Google Scholar
Friedrichsen, M, Heedman, PA, Astradsson, E, et al. (2013) Does a half-day course about palliative care matter? A quantitative and qualitative evaluation among health care practitioners. Journal of Palliative Medicine 16(5), 496–501.Google Scholar
Gifford, W, Davies, B, Edwards, N, et al. (2007) Managerial leadership for nurses’ use of research evidence: an integrative review of the literature. Worldviews on Evidence-Based Nursing 4(3), 126–145.Google Scholar
Grimshaw, JM, Eccles, MP, Lavis, JN, et al. (2012) Knowledge translation of research findings. Implementation Science 7, 50.Google Scholar
Greenhalgh, J, Long, AF, and Flynn, R (2005) The use of patient reported outcome measures in routine clinical practice: lack of impact or lack of theory? Social Science & Medicine 60(4), 833–843.Google Scholar
Harvey, G and Kitson, A (2015) Translating evidence into healthcare policy and practice: Single versus multi-faceted implementation strategies - is there a simple answer to a complex question? International Journal of Health Policy Management 4(3), 123–126.Google Scholar
Harvey, G and Kitson, A (2016) PARIHS revisited: from heuristic to integrated framework for the successful implementation of knowledge into practice. Implement Science 11, 33.Google Scholar
Harvey, G, Loftus-Hills, A, Rycroft-Malone, J, et al. (2002) Getting evidence into practice: the role and function of facilitation. Journal of Advanced Nursing 37(6), 577–588.Google Scholar
Harvey, G and Kitson, A (2015) Implementing evidence-based practice in healthcare: a facilitation guide. London: Routledge/Taylor & Francis Group.Google Scholar
Hsieh, HF and Shannon, SE (2005) Three approaches to qualitative content analysis. Qualitative Health Research 15(9), 1277–1288.Google Scholar
Håkanson, C, Öhlén, J, Morin, L, and Cohen, J (2015) A population-level study of place of death and associated factors in Sweden. Scandinavian Journal of Public Health 43(7), 744–751.Google Scholar
Lind, S, Wallin, L, Brytting, T, et al. (2017) Implementation of national palliative care guidelines in Swedish acute care hospitals: a qualitative content analysis of stakeholders’ perceptions. Health Policy 121(11), 1194–1201.Google Scholar
McCormack, B, Kitson, A, Harvey, G, et al. (2002) Getting evidence into practice: the meaning of ‘context’. Journal of Advanced Nursing 38(1), 94–104.Google Scholar
McKinsey & Company (2016). Digitizing healthcare in Sweden. (In Swedish). Available from: https://www.mckinsey.com/industries/healthcare-systems-and-services/our-insights/digitizing-healthcare-in-sweden.Google Scholar
Moore, GF, Audrey, S, Barker, M, et al. (2015) Process evaluation of complex interventions: Medical Research Council guidance. BMJ 350, h1258.Google Scholar
National Board of Health and Welfare) (2013) A national knowledge-based guidance for End-of-life palliative care. (In Swedish) Stockholm: National Board of Health and Welfare (Socialstyrelsen).Google Scholar
National Board of Health and Welfare (2016) Palliative care in end of life: Summary with improvements areas: evaluation of national guidance. (In Swedish) Stockholm: National Board of Health and Welfare (Socialstyrelsen).Google Scholar
Pivodic, L, Pardon, K, Morin, L, et al. (2016) Place of death in the population dying from diseases indicative of palliative care need: a cross-national population-level study in 14 countries. Journal of Epidemiological Community Health 70(1), 17–24.Google Scholar
Radbruch, L and Payne, S (2009). White Paper on standards and norms for hospice and palliative care in Europe: part 1 recommendations from the European Association for Palliative Care. European Journal of Palliative Care 16(6), 278–289.Google Scholar
Regional Cancer Center in Cooperation (Regionala cancercentrum i samverkan) (2012) National clinical practice guidelines for palliative care 2012–2014 (Nationellt vårdprogram för palliativ vård 2012–2014). Västerås: Edita Ed.Google Scholar
Reid, C, Gibbins, J, Bloor, S, et al. (2015) Healthcare professionals’ perspectives on delivering end-of-life care within acute hospital trusts: a qualitative study. BMJ Supportive & Palliative Care 5(5), 490–495.Google Scholar
Reyniers, T, Houttekier, D, Cohen, J, et al. (2014) The acute hospital setting as a place of death and final care: a qualitative study on perspectives of family physicians, nurses and family carers. Health Place 27, 77–83.Google Scholar
Rycroft-Malone, J (2004) The PARIHS framework--a framework for guiding the implementation of evidence-based practice. Journal of Nursing Care Quality 19(4), 297–304.Google Scholar
Schildmann, EK, Groeneveld, EI, Denzel, J, et al. (2016) Discovering the hidden benefits of cognitive interviewing in two languages: the first phase of a validation study of the Integrated Palliative care Outcome Scale. Palliative Medicine 30(6), 599–610.Google Scholar
Squires, JE, Sullivan, K, Eccles, MP, et al. (2014) Are multifaceted interventions more effective than single-component interventions in changing health-care professionals’ behaviours? An overview of systematic reviews. Implementation Science 9, 152.Google Scholar
Stetler, C, Legro, M, Rycroft-Malone, J, et al. (2006) Role of “external facilitation” in implementation of research findings: a qualitative evaluation of facilitation experiences in the Veterans Health Administration. Implementation Science 1(1), 23.Google Scholar
The Government Official Reports (Statens Offentliga Utredningar) (2016) Effective care: final report (Effektiv vård : slutbetänkande) (Vol. SOU 2016:2). Stockholm: Wolters Kluwer.Google Scholar
The Swedish Agency for Health and Care Services Analysis (Myndigheten för vård- och omsorgsanalys) (2016) Managers' view of the improvement in health care: a discussion paper (Chefers syn på förbättringsarbete i hälso- och sjukvården: ett diskussionsunderlag) (Vol. PM 2016:3). Stockholm: Vårdanalys.Google Scholar
Wallin, L (2009) Knowledge translation and implementation research in nursing. International Journal of Nursing Studies 46(4), 576–587.Google Scholar
van Riet Paap, J, Vernooij-Dassen, M, Sommerbakk, R, et al. (2015) Implementation of improvement strategies in palliative care: an integrative review. Implementation Science 10(1), 103.Google Scholar
Yukl, GA (2013) Leadership in organizations. Boston: Pearson.Google Scholar
Supplementary material: File

Lind et al. supplementary material

Lind et al. supplementary material 1

Download Lind et al. supplementary material(File)
File 74.1 KB