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Implementation of the integrated palliative care outcome scale in acute care settings: a feasibility study.
Karolinska institutet.
Jönköping university.
Ersta Sköndal Bräcke University College, The Institute for Organisational and Worklife Ethics.ORCID iD: 0000-0002-6800-3449
Lunds universitet.
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2018 (English)In: Palliative & Supportive Care, ISSN 1478-9515, E-ISSN 1478-9523, Vol. 16, no 6, p. 698-705Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
2018. Vol. 16, no 6, p. 698-705
Keywords [en]
Implementation, Acute care settings, Facilitation, Integrated palliative care outcome scale, Palliative care
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:esh:diva-6633DOI: 10.1017/S1478951517001158PubMedID: 29352836OAI: oai:DiVA.org:esh-6633DiVA, id: diva2:1183059
Available from: 2018-02-15 Created: 2018-02-15 Last updated: 2019-04-16Bibliographically approved
In thesis
1. Implementation of knowledge-based palliative care in acute care settings: obstacles, opportunities and experiences
Open this publication in new window or tab >>Implementation of knowledge-based palliative care in acute care settings: obstacles, opportunities and experiences
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background and aim: Quality improvement is continuously ongoing at different levels in our healthcare system. In Sweden, as in other countries, guidelines are important for quality improvement in healthcare, since they summarize the best available evidence. Improved living conditions and enhanced treatments for a variety of diseases have resulted in increased longevity and the need for palliative care has therefore also increased. A high proportion of deaths occur in acute care settings, where the care has been described as inadequate for dying patients. In 2013, the National Board of Health and Welfare published A National knowledgebased guidance for good palliative care in end-of-life care and just prior to this in 2012, the Regional Cancer Centre published the National clinical practice guideline for palliative care. The overarching aim of this thesis was to study implementation of knowledge-based palliative care in acute care settings.

Methods and results of the studies: The first and second studies covered aspects that were to be taken into account for the implementation of the documents described above. In study I, national policy documents in Sweden were reviewed for quality indicators relevant to palliative care and end-of-life care. In study II, perceptions regarding national palliative care guidelines were investigated and obstacles to and opportunities for implementing these guidelines in acute care hospitals were identified through interviews with local politicians, chief medical officers and healthcare professionals. The results showed scarce knowledge of the two documents at all levels of the healthcare organisation. Palliative care was primarily described as end-of- life care. The environment and culture in hospitals, with heavy workload, poor communication and poor teamwork, were described as obstacles for implementation. However, staff emphasised a need for training and support in palliative care through theoretical knowledge and mentoring to develop clinical skills. An implementation strategy for the use of the Integrated Palliative care Outcome Scale (IPOS) was developed. The strategy included information, training and facilitation to support the use of the scale. The implementation was performed at three acute care settings and, to gain a broader understanding of the strategy, it was also tested at a palliative care unit. The evaluation of the strategy, presented in study III and IV, was conducted through multiple methods. The findings showed varying prevalence of completed IPOS, indicating shortcomings in implementation.

Conclusion: The awareness of the two documents on palliative care varied at all levels in the healthcare organisation, being predominantly low among healthcare professionals in acute care settings. The feasibility of the performed implementation strategy was considered questionable and the components need to be further explored to enhance the impact of implementation and thereby improve the use of IPOS in acute care settings.

Place, publisher, year, edition, pages
Stockholm: Karolinska institutet, 2018. p. 65
National Category
Nursing
Identifiers
urn:nbn:se:esh:diva-7397 (URN)978-91-7676-918-8 (ISBN)
Public defence
2018-01-24, Bringsalen, Ersta Konferens och hotel, , Stockholm, Erstagatan 1, Stockholm, 00:00 (Swedish)
Supervisors
Available from: 2019-04-16 Created: 2019-04-16 Last updated: 2019-04-16Bibliographically approved

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