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Bradshaw A, Birtwistle J, Evans CJ, Sleeman KE, Richards S, Foy R, Millares Martin P, Carder P, Allsop MJ, Twiddy M. Factors Influencing the Implementation of Digital Advance Care Planning: Qualitative Interview Study. J Med Internet Res 2024; 26:e50217. [PMID: 39151167 DOI: 10.2196/50217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 10/18/2023] [Accepted: 05/30/2024] [Indexed: 08/18/2024] Open
Abstract
BACKGROUND Palliative care aims to improve the quality of life for people with life-limiting illnesses. Advance care planning conversations that establish a patient's wishes and preferences for care are part of a person-centered approach. Internationally, electronic health record systems are digital interventions used to record and share patients' advance care plans across health care services and settings. They aim to provide tools that support electronic information sharing and care coordination. Within the United Kingdom, Electronic Palliative Care Coordination Systems (EPaCCS) are an example of this. Despite over a decade of policy promoting EPaCCS nationally, there has been limited implementation and consistently low levels of use by health professionals. OBJECTIVE The aim of this study is to explore the factors that influence the implementation of EPaCCS into routine clinical practice across different care services and settings in 2 major regions of England. METHODS A qualitative interview study design was used, guided by Normalization Process Theory (NPT). NPT explores factors affecting the implementation of complex interventions and consists of 4 primary components (coherence, cognitive participation, collective action, and reflexive monitoring). Health care and social care practitioners were purposively sampled based on their professional role and work setting. Individual web-based semistructured interviews were conducted. Data were analyzed using thematic framework analysis to explore issues which affected the implementation of EPaCCS across different settings at individual, team, organizational, and technical levels. RESULTS Participants (N=52) representing a range of professional roles were recruited across 6 care settings (hospice, primary care, care home, hospital, ambulatory, and community). In total, 6 themes were developed which mapped onto the 4 primary components of NPT and represented the multilevel influences affecting implementation. At an individual level, these included (1) EPaCCS providing a clear and distinct way of working and (2) collective contributions and buy-in. At a team and organizational level, these included (3) embedding EPaCCS into everyday practice and (4) championing driving implementation. At a technical level, these included (5) electronic functionality, interoperability, and access. Breakdowns in implementation at different levels led to variations in (6) confidence and trust in EPaCCS in terms of record accuracy and availability of access. CONCLUSIONS EPaCCS implementation is influenced by individual, organizational, and technical factors. Key challenges include problems with access alongside inconsistent use and engagement across care settings. EPaCCS, in their current format as digital advance care planning systems are not consistently facilitating electronic information sharing and care coordination. A redesign of EPaCCS is likely to be necessary to determine configurations for their optimal implementation across different settings and locations. This includes supporting health care practitioners to document, access, use, and share information across multiple care settings. Lessons learned are relevant to other forms of digital advance care planning approaches being developed internationally.
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Affiliation(s)
- Andy Bradshaw
- Cicely Saunders Institute, Kings College London, London, United Kingdom
| | | | - Catherine J Evans
- Cicely Saunders Institute, Kings College London, London, United Kingdom
- Sussex Community NHS Foundation Trust, Brighton, United Kingdom
| | | | - Suzanne Richards
- Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | - Robbie Foy
- Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | | | - Paul Carder
- NHS West Yorkshire Integrated Care Board, White Rose House, Wakefield, United Kingdom
| | - Matthew J Allsop
- Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | - Maureen Twiddy
- Hull York Medical School, Institute of Clinical and Applied Health Research, Allam Medical Building, University of Hull, Hull, United Kingdom
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de Bell S, Zhelev Z, Bethel A, Coon JT, Anderson R. Factors influencing effective data sharing between health care and social care regarding the care of older people: a qualitative evidence synthesis. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2024; 12:1-87. [PMID: 38778710 DOI: 10.3310/ttwg4738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
Background Sharing data about patients between health and social care organisations and professionals, such as details of their medication, is essential to provide co-ordinated and person-centred care. While professionals can share data in a number of ways - for example, through shared electronic record systems or multidisciplinary team meetings - there are many factors that make sharing data across the health and social care boundary difficult. These include professional hierarchies, inaccessible electronic systems and concerns around confidentiality. Data-sharing is particularly important for the care of older people, as they are more likely to have multiple or long-term conditions; understanding is needed on how to enable effective data-sharing. Objectives To identify factors perceived as influencing effective data-sharing, including the successful adoption of interventions to improve data-sharing, between healthcare and social care organisations and professionals regarding the care of older people. Methods MEDLINE and seven further databases were searched (in March 2023) for qualitative and mixed-methods studies. Relevant websites were searched and citation-chasing completed on included studies. Studies were included if they focused on older people, as defined by the study, and data-sharing, defined as the transfer of information between healthcare and social care organisations, or care professionals, regarding a patient, and were conducted in the United Kingdom. Purposive sampling was used to obtain a final set of studies which were analysed using framework synthesis. Quality appraisal was conducted using the Wallace checklist. Stakeholder and public and patient involvement groups were consulted throughout the project. Results Twenty-four studies were included; most scored highly on the quality appraisal checklist. Four main themes were identified. Within Goals, we found five purposes of data-sharing: joint (health and social care) assessment, integrated case management, transitions from hospital to home, for residents of care homes, and for palliative care. In Relationships, building interprofessional relationships, and therefore trust and respect, between professionals supported data-sharing, while the presence of professional prejudices and mistrust hindered it. Interorganisational Processes and procedures, such as a shared vision of care and operationalisation of formal agreements, for example data governance, supported data-sharing. Within Technology and infrastructure, the use of technology as a tool supported data-sharing, as did professionals' awareness of the wider care system. There were also specific factors influencing data-sharing related to its purpose; for example, there was a lack of legal frameworks in the area of palliative care. Limitations Data-sharing was usually discussed in the context of wider initiatives, for example integrated care, which meant the information provided was often limited. The COVID-19 pandemic has had significant impacts on ways of working; none of our included studies were conducted during or since the pandemic. Conclusions Our findings indicate the importance of building interprofessional relationships and ensuring that professionals are able to share data in multiple ways. Future work Exploration of the impact of new technologies and ways of working adopted as a result of the COVID-19 pandemic on data-sharing is needed. Additionally, research should explore patient experience and the prevention of digital exclusion among health and social care professionals. Study registration The protocol was registered on PROSPERO CRD42023416621. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR135660), as part of a series of evidence syntheses under award NIHR130538, and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 12. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Siân de Bell
- Exeter HS&DR Evidence Synthesis Centre, Department of Health and Community Sciences, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Zhivko Zhelev
- Exeter HS&DR Evidence Synthesis Centre, Department of Health and Community Sciences, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Alison Bethel
- Exeter HS&DR Evidence Synthesis Centre, Department of Health and Community Sciences, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Jo Thompson Coon
- Exeter HS&DR Evidence Synthesis Centre, Department of Health and Community Sciences, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Rob Anderson
- Exeter HS&DR Evidence Synthesis Centre, Department of Health and Community Sciences, University of Exeter Medical School, University of Exeter, Exeter, UK
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Bock MA, Macchi ZA, Harrison KL, Katz M, Dini M, Jones J, Ayele R, Kutner JS, Pantilat SZ, Martin C, Sillau S, Kluger B. Does a novel community-based outpatient palliative care intervention for Parkinson's disease and related disorders improve care? Qualitative results from patients and care partners. Palliat Med 2024; 38:240-250. [PMID: 38267836 PMCID: PMC10865748 DOI: 10.1177/02692163231219923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
BACKGROUND Palliative care has the potential to address significant unmet needs in people with Parkinson's disease and related disorders, but models that rely on in-person specialty palliative care teams have limited scalability. AIM To describe patient and care partner experiences with a novel, community-based palliative care intervention for Parkinson's disease. DESIGN Qualitative study embedded in a randomized clinical trial to document participant experiences with a novel palliative care intervention (community neurologist training and remote team-based specialist palliative care). Transcripts were coded and thematically analyzed through a combination of team-based inductive and deductive coding. SETTING/PARTICIPANTS Twenty-eight patients and 33 care partners purposively sampled from participants in a randomized clinical trial of a palliative care intervention for Parkinson's disease and related disorders conducted at nine sites. RESULTS Benefits of the intervention included management of a wider range of non-motor symptoms, facilitation of conversations about the future, greater engagement with the health care team, and increased referrals to resources. Participants identified areas of improvement, including uptake of palliative care training by community neurologists, additional prognostic counseling, and clarity and timeliness of communication with the multidisciplinary team. CONCLUSIONS Clinicians caring for people with Parkinson's disease and related disorders should screen for non-motor symptoms, provide regular prognostic counseling, and refer to specialty palliative care services earlier in the course of illness. Future interventions should be designed to promote uptake of palliative care training by community neurologists and further optimize referral to and coordination with in-person or remote specialty palliative teams.
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Affiliation(s)
- Meredith A Bock
- Department of Neurology at University of California, San Francisco, CA, USA
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Zachary A Macchi
- Departments of Neurology and Medicine at University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA
| | - Krista L Harrison
- Department of Medicine, Division of Geriatrics at University of California, San Francisco, CA, USA
| | - Maya Katz
- Department of Neurology at Stanford University, Stanford, CA, USA
| | - Megan Dini
- Parkinson’s Foundation, New York, NY, USA
| | - Jacqueline Jones
- College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Roman Ayele
- Departments of Neurology and Medicine at University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA
| | - Jean S Kutner
- Department of Medicine, Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Steven Z Pantilat
- Department of Medicine, Division of Palliative Medicine at University of California, San Francisco, CA, USA
| | - Christine Martin
- Center for Health and Technology, University of Rochester, Rochester, NY, USA
| | - Stefan Sillau
- Departments of Neurology and Medicine at University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA
| | - Benzi Kluger
- Departments of Neurology and Medicine, Division of Palliative Care, University of Rochester, Rochester, NY, USA
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Ramirez-Valdez EA, Leong C, Wu F, Ball S, Maistrello G, Martin G, Fritz Z. Towards cataloguing and characterising advance care planning and end-of-life care resources. BMC Palliat Care 2022; 21:211. [PMID: 36447187 PMCID: PMC9706845 DOI: 10.1186/s12904-022-01102-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 11/11/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Resources for healthcare professionals, patients and those important to them relating to planning and coordinating treatment and care at the end of life are abundant, and can be difficult to navigate. However, they have not been systematically collated or catalogued in terms of their purpose, scope or intended audience. AIM To collate, categorise and characterise advance care planning and end-of-life treatment and care (EoLT + C) resources directed towards healthcare professionals, patients and their families. METHODS Rapid review and thematic synthesis of resources available in the United Kingdom. Google searches and reviews of websites belonging to selected organisations that develop and publish materials relating to EoLT + C, and advance care planning were used. Materials were included if they were intended for those over 18 living in the UK and pertained to five domains of EoLT + C: identifying those approaching end of life; accessing EoLT + C services; conducting important conversations about EoLT + C and preferences; advance care planning, including recording of preferences and plans; and ensuring that plans and preferences are accessed and used by health and social care services. RESULTS 246 resources directed at healthcare professionals, patients and their families were identified, collated, catalogued and made internationally available for clinicians, researchers, patients and the public. 61 were classified as interactive, providing decision support in EoLT + C that went beyond simply providing information. Of these, there was notable content overlap among tools for identifying patients in their last year of life. There was variation in the development of tools across all domains of end-of-life care by geography and patient group. Few interactive resources integrated seamlessly with a digital interface or healthcare provider workflows. Incentives for the adoption of best-practice appeared rare. CONCLUSIONS We present a repeatable and scalable approach to the cataloguing and characterisation of palliative care resources. The identified resources will be of benefit not only to those in the UK but to those in other countries, developing or evaluating their own resources for aiding professionals and patients to plan and deliver excellent treatment and care at the end of life.
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Affiliation(s)
- Edric Aram Ramirez-Valdez
- grid.120073.70000 0004 0622 5016School of Clinical Medicine, University of Cambridge, Addenbrooke’s Hospital, Hills Rd, Cambridge, CB2 0SP UK
| | - Clare Leong
- grid.5335.00000000121885934The Healthcare Improvement Studies Institute, THIS Institute, University of Cambridge, Cambridge Biomedical Campus, Clifford Allbutt Building, Cambridge, CB2 0AH UK
| | - Frances Wu
- grid.5335.00000000121885934The Healthcare Improvement Studies Institute, THIS Institute, University of Cambridge, Cambridge Biomedical Campus, Clifford Allbutt Building, Cambridge, CB2 0AH UK
| | - Sarah Ball
- grid.425785.90000 0004 0623 2013RAND Europe, Cambridge, UK
| | | | - Graham Martin
- grid.5335.00000000121885934The Healthcare Improvement Studies Institute, THIS Institute, University of Cambridge, Cambridge Biomedical Campus, Clifford Allbutt Building, Cambridge, CB2 0AH UK
| | - Zoë Fritz
- grid.5335.00000000121885934The Healthcare Improvement Studies Institute, THIS Institute, University of Cambridge, Cambridge Biomedical Campus, Clifford Allbutt Building, Cambridge, CB2 0AH UK
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Mason B, Carduff E, Laidlaw S, Kendall M, Murray SA, Finucane A, Moine S, Kerssens J, Stoddart A, Tucker S, Haraldsdottir E, Ritchie SL, Fallon M, Keen J, Macpherson S, Moussa L, Boyd K. Integrating lived experiences of out-of-hours health services for people with palliative and end-of-life care needs with national datasets for people dying in Scotland in 2016: A mixed methods, multi-stage design. Palliat Med 2022; 36:478-488. [PMID: 35354412 PMCID: PMC8972951 DOI: 10.1177/02692163211066256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Unscheduled care is used increasingly during the last year of life by people known to have significant palliative care needs. AIM To document the frequency and patterns of use of unscheduled healthcare by people in their last year of life and understand the experiences and perspectives of patients, families and professionals about accessing unscheduled care out-of-hours. DESIGN A mixed methods, multi-stage study integrating a retrospective cohort analysis of unscheduled healthcare service use in the last year of life for all people dying in Scotland in 2016 with qualitative data from three regions involving service users, bereaved carers and general practitioners. SETTING Three contrasting Scottish Health Board regions and national datasets for the whole of Scotland. RESULTS People who died in Scotland in 2016 (n = 56,407) had 472,360 unscheduled contacts with one of five services: telephone advice, primary care, ambulance service, emergency department and emergency hospital admission. These formed 206,841 individual continuous unscheduled care pathways: 65% starting out-of-hours. When accessing healthcare out-of-hours, patients and carers prioritised safety and a timely response. Their choice of which service to contact was informed by perceptions and previous experiences of potential delays and whether the outcome might be hospital admission. Professionals found it difficult to practice palliative care in a crisis unless the patient had previously been identified. CONCLUSION Strengthening unscheduled care in the community, together with patient and public information about how to access these services could prevent hospital admissions of low benefit and enhance community support for people living with advanced illness.
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Affiliation(s)
- Bruce Mason
- Primary Palliative Care Research Group, Usher Institute, The University of Edinburgh, Edinburgh, UK
| | | | | | - Marilyn Kendall
- Primary Palliative Care Research Group, Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Scott A Murray
- Primary Palliative Care Research Group, Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Anne Finucane
- Primary Palliative Care Research Group, Usher Institute, The University of Edinburgh, Edinburgh, UK
- Clinical Psychology, School of Health in Social Science, The University of Edinburgh, Edinburgh, UK
| | - Sebastien Moine
- Primary Palliative Care Research Group, Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Joannes Kerssens
- Electronic Data Research & Innovation Service (eDRIS), Public Health Scotland, Edinburgh, UK
| | - Andrew Stoddart
- Edinburgh Clinical Trials Unit, The University of Edinburgh, Edinburgh, UK
| | | | | | | | | | | | - Stella Macpherson
- Primary Palliative Care Research Group, Usher Institute, The University of Edinburgh, Edinburgh, UK
| | | | - Kirsty Boyd
- Primary Palliative Care Research Group, Usher Institute, The University of Edinburgh, Edinburgh, UK
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