Implementation Science: Implications for Intervention Research in Hospice and Palliative Care

Abstract

This article provides a general introduction to implementation science-the discipline that studies the implementation process of research evidence-in the context of hospice and palliative care. By discussing how implementation science principles and frameworks can inform the design and implementation of intervention research, we aim to highlight how this approach can maximize the likelihood for translation and long-term adoption in clinical practice settings. We present 2 ongoing clinical trials in hospice that incorporate considerations for translation in their design and implementation as case studies for the implications of implementation science. This domain helps us better understand why established programs may lose their effectiveness over time or when transferred to other settings, why well-tested programs may exhibit unintended effects when introduced in new settings, or how an intervention can maximize cost-effectiveness with strategies for effective adoption. All these challenges are of significance to hospice and palliative care, where we seek to provide effective and efficient tools to improve care services. The emergence of this discipline calls for researchers and practitioners to carefully examine how to refine current and design new and innovative strategies to improve quality of care.

Barriers and facilitators to implementation of the Liverpool Care Pathway in the Netherlands: a qualitative study

“…Implementation research is important to bridge the gap between research and practice,19 and to maximise the likelihood of successful long-term adoption of quality instruments in clinical practice 20. Numerous theories and models have been developed to understand barriers and facilitators to implementation processes in healthcare 21–23.…”

A Survey to Evaluate Facilitators and Barriers to Quality Measurement and Improvement: Adapting Tools for Implementation Research in Palliative Care Programs

“…41 Using a rigorously-developed survey to measure palliative care team members’ perceptions may be useful for framing how best to implement quality measurement initiatives, interpret results to prioritize quality improvement strategies, and enhance ongoing quality improvement. Further research will evaluate the construct and criterion validity of this survey for this purpose and refine how it should best be implemented.…”

Addressing Methodological Challenges in Large Communication Data Sets: Collecting and Coding Longitudinal Interactions in Home Hospice Cancer Care

“…Because of the huge scope of this project—collecting over 2000 hours of audio recorded data from hospice enrollment to patient death from over 300 families and nurses across the country, consisting of over 3000 individual recordings—as well as the challenge of studying communication longitudinally in a difficult-to-recruit population (Demiris, Oliver, Capurro, & Wittenberg-Lyles, 2014; Kutner et al, 2010; McMillan & Weitzner, 2003), it was important for us to develop a protocol that would address potential challenges, including development of coding systems based on our conceptual framework, data collection, data management and protection, and coding, including ensuring and maintaining reliability.…”