scholarly journals Planning for Implementation Success of an Electronic Cross-Facility Health Record for Pediatric Palliative Care Using the Consolidated Framework for Implementation Research (CFIR)

2022 ◽  
Vol 19 (1) ◽  
pp. 453
Author(s):  
Theresa Sophie Busse ◽  
Sven Kernebeck ◽  
Larissa Alice Dreier ◽  
Dorothee Meyer ◽  
Daniel Zenz ◽  
...  
Keyword(s):  
Palliative Care ◽  
Implementation Research ◽  
Positive Impact ◽  
Pediatric Palliative Care ◽  
Successful Implementation ◽  
Health Record ◽  
Implementation Barriers ◽  
Related Information ◽  
Facilitators And Barriers

Pediatric palliative care (PPC) patients require years of care across professions and sectors. Sharing treatment-related information and communicating among different PPC professionals is critical to ensure good quality of care. In Germany, this communication is mostly paper-based and prone to errors. Therefore, an electronic cross-facility health record (ECHR) was participatorily designed with users, wherein information can be shared and PPC professionals can communicate with each other. As this form of electronic health record differs from existing models in Germany, there is a need for successful implementation to ensure a positive impact. Therefore, the facilitators and barriers to the implementation of ECHR in PPC were examined. Using the consolidated framework for implementation research (CFIR), transcripts of 32 interviews, 3 focus groups, and 20 think-aloud studies with PPC professionals were analyzed. CFIR indicated that the ECHR-design was viewed positively by users and can be a facilitator for implementation. Barriers exist, mainly due to the fact that the implementation is not planned, the use of the ECHR involves effort, costs are not covered, and all users must be motivated to use the ECHR for functionality. CFIR helps uncover the crux of the issues that need to be considered when planning ECHR implementation to improve care in PPC.

scholarly journals Assessing the quality of deliberative stakeholder consultations involving allied health professionals in pediatric palliative care and hematology/oncology in Canada

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Vasiliki Rahimzadeh ◽  
Cristina Longo ◽  
Justin Gagnon ◽  
Conrad Fernandez ◽  
Gillian Bartlett
Keyword(s):  
Palliative Care ◽  
Policy Issue ◽  
Practice Change ◽  
Pediatric Palliative Care ◽  
Perceived Fairness ◽  
Implementation Barriers ◽  
Deliberative Process ◽  
Allied Health Professionals ◽  
Palliative Care Teams

Abstract Background In this paper we assess the quality of six deliberative stakeholder consultations regarding the implementation of a precision diagnostic for life-threatening pediatric brain tumors. Decision makers who base policy recommendations on the outputs of consultative exercises can presuppose that all deliberants are well informed of the policy issue, that participation in the deliberative process was fair, and that overcoming implementation barriers will necessarily result in practice change. Additional evidence is therefore needed to substantiate the informational quality of the deliberation, measure the equality of participation and study the effects on stakeholder reasoning to appropriately guide uptake of proposed recommendation(s). Methods Using the DeVries framework for assessing the deliberative quality, we analyzed data from 44 post-consultation evaluation surveys completed by pediatric oncology and palliative care teams at two tertiary pediatric healthcare centers in Canada. We also conducted turn-taking and word-contribution analyses from the text transcriptions of each deliberation to assess equality of participation using descriptive statistics. Results Deliberants agreed the quality of the deliberative process was fair (median ratings ranging from 9–10 out of 10) and the opportunities to receive expert information and discuss with others about the implementation of a new LDT were helpful (9.5 out of 10). While the session improved understanding of the implementation barriers and opportunities, it had marginal effects on deliberants’ reasoning about whether LDTs would change their own clinical practice (3–10 out of 10). Participation was proportionate in at least four of the six deliberations, where no deliberant took more than 20% of total turns and contributed equal to, or less than 20% of total words. Conclusion The quality assessment we performed demonstrates high informational value and perceived fairness of two deliberative stakeholder consultations involving pediatric palliative care and oncology teams in Canada. Quality assessments can reveal how the process of deliberation unfolds, whether deliberative outputs are the result of equitable participation among deliberants and what, if any, stakeholder voices may be missing. Such assessments should be routinely reported as a condition of methodological rigor and trustworthiness of deliberative stakeholder engagement research.

scholarly journals Participatory Design of an Electronic Cross-Facility Health Record (ECHR) System for Pediatric Palliative Care: A Think-Aloud Study

Children ◽  
2021 ◽  
Vol 8 (10) ◽  
pp. 839
Author(s):  
Theresa Sophie Busse ◽  
Chantal Jux ◽  
Sven Kernebeck ◽  
Larissa Alice Dreier ◽  
Dorothee Meyer ◽  
...  
Keyword(s):  
Palliative Care ◽  
Participatory Design ◽  
Point Of View ◽  
Pediatric Palliative Care ◽  
Health Record ◽  
Think Aloud ◽  
Information Communication ◽  
System A ◽  
Available Information ◽  
Patients Experience

Background: Pediatric palliative care (PPC) patients experience years of multisectoral and professional care. An electronic cross-facility health record (ECHR) system can support the immediate exchange of information among PPC professionals. Based on a needs assessment, a prototype ECHR system was developed. Methods: To evaluate potential users’ perspective regarding the system, a qualitative observational study was conducted consisting of a concurrent think-aloud session and a semi-structured qualitative interview. Results: Twenty PPC professionals (nurses, physicians) from specialized outpatient PPC teams, a PPC unit, and medical offices rated the ECHR system as a helpful tool to improve the exchange and collection of information, communication between PPC professionals, and treatment planning. From the user’s point of view, the basic logic of the ECHR system should be further adapted to improve the interaction of data remirrored from patient records of outpatient and inpatient care with those entered via the system. The users wished for further functions (text search) and content (information on therapies). Some content, such as the treatment process, needs to be further adapted. Conclusion: The developed ECHR system needs to be more specific in some features by offering all available information; while for other features, be less specific to offer a quick overview. The ability to share information promptly and automatically was seen as a tremendous improvement to the quality of care for PPC patients.

scholarly journals Longitudinal Pediatric Palliative Care: Quality of Life & Spiritual Struggle (FACE): Design and methods

2012 ◽  
Vol 33 (5) ◽  
pp. 1033-1043 ◽  
Author(s):  
Ronald H. Dallas ◽  
Megan L. Wilkins ◽  
Jichuan Wang ◽  
Ana Garcia ◽  
Maureen E. Lyon
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Care Quality ◽  
Pediatric Palliative Care ◽  
Spiritual Struggle ◽  
Design And Methods

scholarly journals The Role of Physiotherapy in Pediatric Palliative Care: A Systematic Review

Children ◽  
2021 ◽  
Vol 8 (11) ◽  
pp. 1043
Author(s):  
Silvia Ortiz-Campoy ◽  
Cristina Lirio-Romero ◽  
Helena Romay-Barrero ◽  
David Martín-Caro Álvarez ◽  
Purificación López-Muñoz ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Palliative Care ◽  
Scientific Evidence ◽  
Pediatric Palliative Care ◽  
Cochrane Library ◽  
Her Family ◽  
Life Threatening ◽  
Respiratory Physiotherapy

Pediatric palliative care (PPC) is a set of actions aimed at children who suffer from a severe or life-threatening disease to alleviate the symptoms of the disease and improve the quality of life of both the child and his/her family. One of the tools used to control symptoms is physiotherapy; however, its application in the child population has not been thoroughly studied. The main objective of this study was to gather, analyze, and critically evaluate the available scientific evidence on physiotherapy in children who require palliative care through a systematic review of the studies published in the last 10 years in the following databases: PubMed, Cochrane Library, PEDro, CINAHL, and Scopus. Of a total of 622 studies, the inclusion criteria were only met by seven articles, which were focused on the relationship between physiotherapy and PPC. This study analyzed: (1) the main pathologies treated, with a predominance of cerebral palsy and cancer; (2) the interventions applied, such as respiratory physiotherapy, neurological physiotherapy, therapeutic massage, and virtual reality; (3) the effects achieved in the child and his/her family, highlighting the control of symptoms and the improvement of the quality of life; and (4) the knowledge of the physiotherapists on PPC, observing that most of the professionals had not received training in this scope. The findings of this review indicate a lack of an adequate evidence foundation for physiotherapy in PPC.

scholarly journals Factors Impacting the Implementation of a Psychoeducation Intervention Within the Mental Health System: a Multisite Study Using the Consolidation Framework for Implementation Research

2020 ◽  
Author(s):  
Agnes Higgins ◽  
Rebecca Murphy ◽  
Carmel Downes ◽  
Jennifer Barry ◽  
Mark Monahan ◽  
...  
Keyword(s):  
Mental Health ◽  
Health System ◽  
Implementation Research ◽  
Mental Health System ◽  
Full Range ◽  
National Policy ◽  
Evidence Base ◽  
Successful Implementation ◽  
The Republic

Abstract Background Despite a strong evidence base and policy recommendation supporting the implementation of psychoeducation interventions within the mental health system, equitable access for many service users and family members has not been achieved. To enhance translation, developing an evidence-base around the factors that influence implementation of interventions is critical.Methods The aim of the study was to explore the factors influencing implementation of a group cofacilitated recovery focused psychoeducation intervention. The study design was explorative qualitative descriptive, involving the collection of data through individual and focus group interviews with key stakeholders (n=75) involved with the implementation within 14 mental health sites in the Republic of Ireland. The Consolidation Framework for Implementation Research (CFIR) was used as a conceptual framework to guide data collection and analysis. Results Key enablers and barriers were identified across all CFIR domains of the framework with some factors (depending on context) being both an enabler and a barrier. National policy; structural stability with national systems; leadership at all levels; peer payment system; local champions and support from multidisciplinary team members; evidence strength and quality of the programme design; availability of resources; referral pathways; knowledge, beliefs and self-efficacy of facilitators, as well as local culture influenced implementation. While some were specific to the programme, many barriers reflected systemic and structural challenges within health services more generally. Conclusion: Findings from this study provide an enhanced understanding of the different layers of determinants to implementation of an intervention. Overcoming challenges will involve positive and ongoing engagement and collaboration across the full range of stakeholders that are active within each domain, including policy and operational levels. The quality of leadership at each domain level is of crucial importance to successful implementation.

scholarly journals An Evaluation of Texture Modified Diets Compliant with the International Dysphagia Diet Standardisation Initiative in Aged-Care Facilities Using the Consolidated Framework for Implementation Research

2021 ◽  
Author(s):  
Xiaojing Sharon Wu ◽  
Anna Miles ◽  
Andrea Braakhuis
Keyword(s):  
Quality Of Care ◽  
Implementation Research ◽  
Aged Care ◽  
Successful Implementation ◽  
Site Specific ◽  
Barriers And Enablers ◽  
Care Facilities ◽  
Aged Care Facilities ◽  
Specific Implementation

Abstract Background: Texture modified diets (TMDs) are commonly prescribed for older adults with swallowing difficulties to improve swallowing safety. The International Dysphagia Diet Standardization Initiative (IDDSI) provides a framework for terminology, definitions and testing of TMDs. This observational mixed-method study used the Consolidated Framework for Implementation Research (CFIR) to establish the barriers and enablers to IDDSI adoption in aged-care facilities (ACFs).Methods: Five New Zealand ACFs who had adopted IDDSI >12 months previously were recruited. Evaluation tools were developed based on CFIR constructs, integrating data from i) mealtime observations; ii) manager interviews and iii) staff (nursing, carers and kitchen) self-administrated surveys. Results: All facility and kitchen managers were IDDSI-aware and had access to online resources. Three sites had changed to commercially compliant products post-IDDSI adoption, which had cost implications. Awareness of IDDSI amongst staff ranged from 5-79% and <50% of staff surveyed felt sufficiently trained. Awareness was greater in large sites and where IDDSI was mandated by head office. Managers had not mandated auditing and they felt this had led to reduced perceived importance. Managers felt staff required more training and staff wanted more training, believing it would improve food safety and quality of care. Lack of a dedicated project leader and no speech pathologist onsite were perceived barriers. Collaboration between healthcare assistants, kitchen staff and allied health assisted implementation. Conclusion: ACF staff were aware of IDDSI but staff awareness was low. Using the CFIR, site-specific and generic barriers and enablers were identified to improve future implementation effectiveness. Managers and staff want access to regular training. Multidisciplinary collaboration and improving communication are essential. ACFs should consider TMD auditing regularly. Successful implementation of IDDSI allows improvement of quality of care and patient safety but requires a systematic, site-specific implementation plan.

scholarly journals A conceptual model of barriers and facilitators to primary clinical teams requesting pediatric palliative care consultation based upon a narrative review

2019 ◽  
Vol 18 (1) ◽  
Author(s):  
Jennifer K. Walter ◽  
Douglas L. Hill ◽  
Concetta DiDomenico ◽  
Shefali Parikh ◽  
Chris Feudtner
Keyword(s):  
Palliative Care ◽  
Conceptual Model ◽  
Treatment Plan ◽  
Research Literature ◽  
Pediatric Palliative Care ◽  
Palliative Care Consultation ◽  
Communication Challenges ◽  
Care Consultation ◽  
The Individual

Abstract Background Despite evidence that referral to pediatric palliative care reduces suffering and improves quality of life for patients and families, many clinicians delay referral until the end of life. The purpose of this article is to provide a conceptual model for why clinical teams delay discussing palliative care with parents. Discussion Building on a prior model of parent regoaling and relevant research literature, we argue for a conceptual model of the challenges and facilitators a clinical team might face in shifting from a restorative-focused treatment plan to a plan that includes palliative aspects, resulting in a subspecialty palliative care referral. Like patients and families, clinicians and clinical teams may recognize that a seriously ill patient would benefit from palliative care and shift from a restorative mindset to a palliative approach. We call this transition “clinician regoaling”. Clinicians may experience inhibitors and facilitators to this transition at both the individual and team level which influence the clinicians’ willingness to consult subspecialty palliative care. The 8 inhibitors to team level regoaling include: 1) team challenges due to hierarchy, 2) avoidance of criticizing colleagues, 3) structural communication challenges, 4) group norms in favor of restorative goals, 5) diffusion of responsibility, 6) inhibited expression of sorrow, 7) lack of social support, 8) reinforcement of labeling and conflict. The 6 facilitators of team regoaling include: 1) processes to build a shared mental model, 2) mutual trust to encourage dissent, 3) anticipating conflict and team problem solving, 4) processes for reevaluation of goals, 5) sharing serious news as a team, 6) team flexibility. Conclusions Recognizing potential team level inhibitors to transitioning to palliative care can help clinicians develop strategies for making the transition more effectively when appropriate.

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