Implementing the Empowering Better End of life Dementia Care (EMBED-Care) Framework to improve palliative dementia care in care homes: A feasibility evaluation.

OBJECTIVE

Care homes are the main provider of palliative care for people living with dementia. In the UK around 70% of care homes are residential, with no onsite medical or nursing staff to manage residents' complex needs. eHealth interventions can support holistic care delivery in this context; however, adoption in care homes has been limited. Innovative approaches grounded in implementation science are required to encourage uptake. This study aimed to assess the feasibility of a theoretically informed implementation plan for the EMBED-Care Framework, an eHealth intervention delivered via a mobile app to support holistic assessment and decision-making for people living with dementia in care homes.

METHODS

An embedded mixed-methods feasibility study was conducted in two residential homes. Qualitative data included non-participant observations, focus groups and semi-structured interviews with staff, analysed using codebook thematic analysis informed by Normalisation Process Theory. Quantitative data comprised app-usage metrics, analysed descriptively. Patient and public involvement informed the study design and conduct.

RESULTS

Twenty staff across two care homes used the intervention with 26 residents. Although some uptake was observed, usage data indicated that the Framework was largely not used as intended. Whilst care staff acknowledged its potential benefit, they faced substantial practical challenges to its use related to workload and a sense it was duplicating existing care processes. These issues led to negative appraisals of its impact and compromised staff engagement.

CONCLUSION

Feasibility evaluation enabled rapid identification of barriers and refinement of implementation strategies. Iterative revisions to strategies related to providing further staff support, including a more tailored approach to training, and additional reminders to use the Framework. The Framework itself also requires adaptation to improve 'fit' in the care home context. Further collaboration on the revised strategies with people living with dementia and their family carers is required.