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The integrated palliative care outcome scale for patients with palliative care needs: Factors related to and experiences of the use in acute care settings.
Ersta Sköndal Bräcke University College, Department of Health Care Sciences, Palliative Research Centre, PRC.
Karolinska institutet.
Lunds universitet, Region Skåne.
Lunds universitet, Region Skåne.
2019 (English)In: Palliative & Supportive Care, ISSN 1478-9515, E-ISSN 1478-9523, p. 1-8Article in journal (Refereed) Epub ahead of print
Abstract [en]

OBJECTIVE: Implementation of patient-reported outcome measures for patients with palliative care needs is characterized by both enablers and barriers. The ways in which healthcare professionals experience the use of assessment tools is important. Our aims were to explore factors contributing to or hindering patients with palliative care needs in assessing their symptoms with the Integrated Palliative Care Outcome Scale (IPOS) and to explore healthcare professionals' experiences of the use of IPOS in acute care settings.

METHOD: Data were collected as a part of the evaluation of the feasibility of an implementation strategy for introducing IPOS. Data from three participating acute care units were included. We used descriptive and analytical statistics; a qualitative content analysis was also performed.ResultA total of 309 patients were eligible to be offered assessment of symptoms with IPOS. Of these 69 (22%) had completed IPOS. A significant positive association was found between healthcare professionals' participation in training sessions and completed IPOS. The experiences of IPOS were split into two categories: "IPOS acting as a facilitator" and "barriers to the use of IPOS." The use of IPOS was described as contributing to person-centered care of patients with palliative care needs and inspiration to improved routines. Healthcare professionals' feelings of uncertainty about how to approach severely ill patients and their family members appear to have hindered their use of IPOS.Significance of resultsWe found an association between healthcare professionals' participation in training sessions and patients who completed IPOS, indicating the need for a high degree of attendance at the training to achieve successful implementation. The healthcare professionals expressed feelings of insecurity concerning the use of IPOS indicating a need for further education and clinical support in its use of IPOS. Nevertheless, use of IPOS was considered to contribute to improved care of patients with palliative care needs.

Place, publisher, year, edition, pages
2019. p. 1-8
Keywords [en]
Acute care settings, Implementation, Integrated palliative care, Mixed-method, Outcome scale, Palliative care
National Category
Nursing
Identifiers
URN: urn:nbn:se:esh:diva-7396DOI: 10.1017/S1478951518001104PubMedID: 30841947OAI: oai:DiVA.org:esh-7396DiVA, id: diva2:1305310
Available from: 2019-04-16 Created: 2019-04-16 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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Citation style
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