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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]
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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 

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