Implementation of tools for identifying palliative care needs and supporting advance care planning: A scoping review of barriers and facilitators in hospital settings.

BACKGROUND

Implementing tools to identify and support palliative care needs remains challenging in hospitals, requiring a clear understanding of implementation determinants. This study defines tools as clinical resources for palliative care identification, needs assessment, and advance care planning support.

AIM: This scoping review aimed to identify and categorise the barriers and facilitators influencing the implementation of tools in hospital settings.

DESIGN

Following the Arksey and O'Malley framework with PRISMA-ScR reporting, we employed a hybrid analysis combining inductive thematic coding with deductive mapping onto the Consolidated Framework for Implementation Research. Studies in English, Danish, Norwegian, or Swedish were considered eligible for inclusion.

DATA SOURCES: In May 2024, the databases MEDLINE, Embase, Scopus, CINAHL, SocINDEX, and PsycINFO were searched for studies focusing on tool implementation by healthcare professionals in hospital settings.

RESULTS

From 4032 records screened, 25 studies were included. Determinants were identified across all five Consolidated Framework for Implementation Research domains, though primarily concentrated within the Inner Setting and Individuals. Key barriers included time constraints, lack of training, and fragmented communication. Facilitators comprised strong leadership support, clinical champions, multidisciplinary collaboration, and a supportive organisational culture.

CONCLUSION

This scoping review identifies determinants that can inform the selection of implementation strategies for tools in hospitals. Our findings suggest that tool implementation likely requires multi-faceted strategies capable of addressing barriers across multiple levels, from individual training to organisational leadership and culture. Future research should focus on evaluating tailored strategies that account for the unique complexities of different hospital contexts to ensure sustainable adoption.