Integrating early palliative care: Qualitative results from a multi-site implementation trial.

BACKGROUND

While evidence demonstrates benefits of early palliative care, translation into practice remains inconsistent. Effective implementation strategies are required to advance the field.

AIM: To understand implementation strategies perceived as effective in delivering early palliative care for people with cancer.

DESIGN

Multi-site stepped-wedge implementation trial of an early palliative care model for people with cancer, 'Care Plus', with qualitative outcome data focused upon perceptions of implementation strategies. Designed to target barriers to palliative care, Care Plus intervention involved: introduction of palliative care at designated cancer specific illness points; outpatient delivery of minimum three palliative care consultations alongside usual cancer care; and primary care case conferences. Interviews to understand perceptions of implementation strategies were audio-recorded, transcribed and analysed using a combined thematic inductive and theoretical deductive approach. This enabled identification of emerging ideas as well as categorisation based upon the RE-AIM implementation framework domains (Reach, Effectiveness, Adoption, Implementation and Maintenance).

SETTING/

PARTICIPANTS

Four Australian hospitals, involving patients, carers and healthcare providers purposively sampled across representative tumour streams.

RESULTS

Fifty-one interviews: patients (n = 11), caregivers (n = 2) and healthcare providers (physicians n = 19, nurse consultants/practitioners n = 16, other n = 3), with, in total, 232 patients receiving Care Plus. Participants highlighted effective implementation strategies as: clinician-endorsed 'transition' points to prompt referral; systematic identification of patients; patient referral embedded into workflows; branding 'Care Plus', key phrases and mentored training to support referring clinicians; regular feedback to clinicians; and co-locating palliative care and cancer clinics.

CONCLUSION

These effective strategies are available for the field to replicate supporting broader palliative care implementation.

TRIAL REGISTRATION: ACTRN12619001703190, [https://www.anzctr.org.au/].