Facilitating successful implementation of a person-centred intervention to support family carers within palliative care: a qualitative study of the Carer Support Needs Assessment Tool (CSNAT) intervention

Abstract

BackgroundAn understanding of how to implement person-centred interventions in palliative and end of life care is lacking, particularly for supporting family carers. To address this gap, we investigated components related to successful implementation of the Carer Support Needs Assessment Tool (CSNAT) intervention, a person-centred process of carer assessment and support, using Promoting Action on Research Implementation in Health Services (PARIHS) as a theoretical framework. This study identifies how the PARIHS component of ‘facilitation’ and its interplay with the components of ‘context’ and ‘evidence’ affect implementation success.MethodsMRC Framework Phase IV study to evaluate implementation of the CSNAT intervention at scale, over six months, in 36 UK palliative care services. 38 practitioners acting as internal facilitators in 35/36 services were interviewed. Field notes were collected during teleconference support sessions between the external and internal facilitators.ResultsSuccessful implementation was associated with internal facilitators’ ‘leverage’ including their positioning within services, authority to change practice, and having a team of supportive co-facilitators. Effective facilitation processes included a collaborative approach, ongoing communication, and proactive problem solving to address implementation barriers. Facilitators needed to communicate the evidence and provide legitimacy for changing practice. Contextual constraints on facilitation included having to adjust recording systems to support implementation, organisational changes, a patient-focused culture and lack of managerial support.ConclusionsThe CSNAT intervention requires attention to both facilitation processes and conducive organisational structures for successful implementation. These findings are likely to be applicable to any person-centred process of assessment and support within palliative care.Electronic supplementary materialThe online version of this article (10.1186/s12904-018-0382-5) contains supplementary material, which is available to authorized users.

A drive for structure: A longitudinal qualitative study of the implementation of the Carer Support Needs Assessment Tool (CSNAT) intervention during hospital discharge at end of life

“…We have previously examined factors affecting the implementation of carer assessment and support more broadly within end-of-life care. 23 – 25 To better understand particular challenges encountered in this hospital context, we draw upon relevant aspects of the Nonadoption, Abandonment, Scale-up, Spread and Sustainability (NASSS) framework. 26 This framework suggests that sustaining implementation may be very difficult in contexts in which health conditions are unpredictable, where the intervention does not directly measure changes in health condition, and where the intervention does not readily align with prevailing organisation and system beliefs, including what counts as ‘high-quality’ evidence.…”

Barriers and facilitators to implementing the Carer Support Needs Assessment Tool in a community palliative care setting

“…Having a CSNAT Champion within the team promotes and encourages team members to use the tool. Similarly, Diffin et al (2018b) found successful CSNAT implementation was associated with having internal facilitators within each team.…”

“…They found that services with a higher proportion of internal CSNAT facilitators to staff members were more likely to be high adopters of the CSNAT, thus being more successful at implementing it. Diffin et al (2018b) found that the success of the implementation of the CSNAT was also determined by how the internal facilitator role was enacted within the service. The establishment of a team of internal facilitators, and giving them authority to manage the implementation process both positively influenced the success of CSNAT implementation.…”

Introducing an interactional approach to exploring facilitation as an implementation intervention: examining the utility of Conversation Analysis

“…Another example of research exploring facilitation experiences includes a study in the UK that utilised interviews and field notes to examine the implementation of person-centred assessment and support in palliative care, using a model of internal and external facilitators, where all internal facilitators supported their local sites and the external facilitators provided monthly ‘peer support’ sessions to troubleshoot any barriers [ 11 ]. This study described how facilitation was crucial to motivating and supporting the use of the intervention within the specific context of implementation.…”

“…A final example of previous research exploring facilitation experiences includes a doctoral thesis that explored facilitation within a neonatal intensive care unit [ 11 ]. In this research, facilitation was identified as crucial for bringing people together.…”