Implementation of a palliative care intervention for patients with COPD – a mixed methods process evaluation of the COMPASSION study

BMC Palliative Care

Research

Yvonne Engels¹  Els M. L. Verschuur²  Niels H. Chavannes³  Rianne M. J. J. van der Kleij³  Johanna M. C. Broese⁴  Huib A. M. Kerstjens⁵ 

[1]Anaesthesiology, Pain & Palliative medicine, Radboud University Medical Centre, Nijmegen, The Netherlands

[2]Lung Alliance Netherlands, Amersfoort, The Netherlands

[3]Public Health & Primary care, Leiden University Medical Centre, Leiden, The Netherlands

[4]Public Health & Primary care, Leiden University Medical Centre, Leiden, The Netherlands

[5]Lung Alliance Netherlands, Amersfoort, The Netherlands

[6]Respiratory Medicine & Tuberculosis, University Medical Centre Groningen, Groningen, The Netherlands

关键词: Chronic obstructive pulmonary disease;    Palliative care;    Implementation;    Evaluation studies;   

DOI  :  10.1186/s12904-022-01110-3

 received in 2022-09-01, accepted in 2022-11-22,  发布年份 2022

来源: Springer

【 摘 要 】

ObjectivesLittle direction exists on how to effectively implement palliative care for patients with COPD. In the COMPASSION study, we developed, executed, and evaluated a multifaceted implementation strategy to improve the uptake of region-tailored palliative care intervention components into routine COPD care. We evaluated the implementation strategy and assessed the implementation process, barriers, and facilitators.MethodsA mixed methods process evaluation was performed. Primary and secondary healthcare providers in four hospital regions in the Netherlands were trained. Patients identified during hospitalisation for an acute exacerbation received palliative care and were followed for a year. Various sources were used: process data, questionnaires including the End-of-life Professional Caregiver Survey (EPCS), medical records, monitoring meetings, and interviews. The Consolidated Framework of Implementation Research (CFIR) was used to categorize implementation determinants.ResultsThe training sessions with roleplay were positively evaluated and increased professionals’ self-efficacy in providing palliative care statistically significantly. Of 98 patients identified, 44 (44.9%) received one or more palliative care conversations at the outpatient clinic. Having those conversations was highly valued by healthcare providers because it led to clarity and peace of mind for the patient and higher job satisfaction. Coordination and continuity remained suboptimal. Most important barriers to implementation were time constraints, the COVID-19 pandemic, and barriers related to transmural and interdisciplinary collaboration. Facilitators were the systematic screening of patients for palliative care needs, adapting to the patient’s readiness, conducting palliative care conversations with a pulmonologist and a COPD nurse together, and meeting regularly with a small team led by a dedicated implementation leader.ConclusionsProviding integrated palliative care for patients with COPD is highly valued by healthcare providers but remains challenging. Our findings will guide future implementation efforts. Future research should focus on how to optimize transmural and interdisciplinary collaboration.Trial registrationThe COMPASSION study is registered in the Netherlands Trial Register (NTR): NL7644. Registration date: 07/04/2019.

【 授权许可】

CC BY   
© The Author(s) 2022

【 图 表 】

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