Summary:
New knowledge is not necessarily readily applied in medicine, even when there is evidence of its effectiveness.
As a result of the gap between knowing and doing, policy makers, professional care providers, patients and their families have benefited too little from new developments. Implementation research has developed models for stepwise implementation but it is still unclear which strategies are effective for whom and which factors influence the effectiveness of implementation strategies.
From the point of view of implementation sciences changing palliative care is a major challenge, since adequate organization of palliative care requires collaboration between a range of different professionals and healthcare organizations. Besides, as a consequence of the ageing population, the number of people in need for cancer and dementia palliative care will rise. Therefore we will focus on implementation strategies in palliative care.
Aims:
The overall aim of this project is to develop optimal implementation strategies for using quality indicators to improve the organization of palliative cancer and dementia care in Europe and to study factors influencing the effectiveness of the strategies. We will focus on the implementation process and concentrate the Work Packages on: the organization of palliative care, the development of a set of setting-specific implementation strategies including an interactive website and instruction by consultants, the evaluation of the use of selected strategies to improve the organization of palliative care and factors influencing the effectiveness of the implementation strategies.
This information will be used to build a conceptual model that should be applicable across diverse healthcare settings and that allows rigorous assessment of the effectiveness of implementation strategies. Dissemination of the results will be enhanced by involving stakeholders, including two European networks related to the subject of this implementation process study.
Expected results:
It is widely known that even evidence-based interventions do not implement themselves. As a result, there is a know-do gap between clinical research and everyday clinical practice.
Our project will contribute to a better understanding of implementation strategies by systematically studying the process of implementation of quality indicators in a specific field of an urgent societal problem; the organization of palliative care for the rapidly growing group of cancer and dementia patients. We will use the 'case' of palliative care as a model to study the process of implementation in the organization of complex, mulit-professional holistic care. Relevant stakeholders will be involved in all phases of the implementation process.
Methods:
The Work Packages will use a variety of methods to provide the deliverables. We will use literature reviews to get an overview of what is already knows, qualitative methods such as focus groups, interviews and consensus meetings to derive information on barriers and facilitators in the organization of palliative care consensus conferences to reach agreement. We will use content analysis and grounded theory approach to analyse the data (Hsieh 2005). In the ongoing HANDOVER (FP7), it has been proven to be feasible to use a variety of qualitative methods in a multi‐centre European research.
Work package goals:
Work Package 1:
WP 1 concerns the overall co-ordination of the project by the coordinator, who is assisted by a Project Management Office. Together, they take care of the management of contractual, financial, legal, administrative and scientific issues.
- Management of the project consortium
- Management of finances
- Management of legal issues
- Management of project reporting
Work Package 2:
1. To develop and applicate an analytic framework to characterize models of palliative care for both patient groups (patients with severe dementia and patients with progressive cancer) across Europe
2. To describe and model the variation in the European healthcare systems and healthcare delivery patterns considering palliative care for cancer and severe dementia patients with regard to the national context (macro-level), the available workforce (meso-level), and the settings and professional s (micro-level)
3. To compare models of palliative care organization for cancer patients and for dementia to identify disease-specific determinants of ‘good practice’
Work Package 3:
1. Literature study of strategies
2. Choose set of indicators to be used in WP4
3. To describe overall and setting-specific barriers and facilitators to apply quality indicators for the improvement of the organization of palliative cancer and dementia care (M13-16)
4. To describe barriers and facilitators in national policy (policy makers, (results from WP 2) health care insurance, scientific bodies) regarding applying quality indicators for the improvement of the organization of palliative dementia and cancer care (M13-16)
5. To select a set of strategies to implement the use of the indicators, taking the barriers and facilitators into account (M22)
6. To develop a training for consultants who help professionals / teams / organizations to use the quality indicators (M24)
7. To develop a web-based system to collect data on the use of quality indicators and provide feedback (M24)
8. To adapt the set of general and national specific strategies based on the results of the evaluation of the use the recommended strategies (M48)
9. Revision of the set of indicators that has been developed in the EAHC ‘best practices in palliative care in Europe’ project, and which set will be implemented in year 3
Work Package 4:
To evaluate the effectiveness and acceptability of our implementation strategies in the specific settings and across settings.
Work Package 5:
To determine factors influencing implementation of the set of quality indicators for cancer and dementia palliative care.
Work Package 6:
This WP deal with the dissemination of the knowledge, the results and the tools developed within the project. In particular, dissemination activities will include:
1. To support the implementation process in building relationship with target populations and organization
2. Development of dissemination strategies related to specific objectives and audiences
3. Dissemination of tools, methodologies, use and results of the project
For more information download the Project overview or visit the project website: www.impactpalliativecare.eu