Implementing volunteer-navigation for older persons with advanced chronic illness (Nav-CARE): a knowledge to action study

Abstract

Background Nav-CARE is a volunteer-led intervention designed to build upon strategic directions in palliative care: a palliative approach to care, a public health/compassionate community approach to care, and enhancing the capacity of volunteerism. Nav-CARE uses specially trained volunteers to provide lay navigation for older persons and family living at home with advanced chronic illness. The goal of this study was to better understand the implementation factors that influenced the utilization of Nav-CARE in eight diverse Canadian contexts. Methods This was a Knowledge to Action study using the planned action cycle for Nav-CARE developed through previous studies. Participants were eight community-based hospice societies located in diverse geographic contexts and with diverse capacities. Implementation data was collected at baseline, midpoint, and endpoint using qualitative individual and group interviews. Field notes of all interactions with study sites were also used as part of the data set. Data was analyzed using qualitative descriptive techniques. The study received ethical approval from three university behavioural review boards. All participants provided written consent. Results At baseline, stakeholders perceived Nav-CARE to be a good fit with the strategic directions of their organization by providing early palliative support, by facilitating outreach into the community and by changing the public perception of palliative care. The contextual factors that determined the ease with which Nav-CARE was implemented included the volunteer coordinator champion, organizational capacity and connection, the ability to successfully recruit older persons, and the adequacy of volunteer preparation and mentorship. Conclusions This study highlighted the importance of community-based champions for the success of volunteer-led initiatives and the critical need for support and mentorship for both volunteers and those who lead them. Further, although the underutilization of hospice has been widely recognized, it is vital to recognize the limitations of their capacity. New initiatives such as Nav-CARE, which are designed to enhance their contributions to palliative care, need to be accompanied by adequate resources. Finally, this study illustrated the need to think carefully about the language and role of hospice societies as palliative care moves toward a public health approach to care.

A mixed-method evaluation of a volunteer navigation intervention for older persons living with chronic illness (Nav-CARE): findings from a knowledge translation study

“…The most significant reason for volunteer attrition was failure to recruit older persons in a timely manner [52]. Twenty-three volunteers completed the study (See Fig.…”

“…Six volunteers withdrew from being a Nav-CARE volunteer, and 9 were never assigned to an older person, and hence, were inactive. The most significant reason for volunteer attrition was failure to recruit older persons in a timely manner [ 52 ]. Twenty-three volunteers completed the study (See Fig.…”

“…The difficulties in recruiting older persons were related to a number of factors including public perceptions of hospice, professional gatekeeping, and a concern that recruitment strategies would identify too many older persons and thus overwhelm the capacity of the organization. These factors have been described in detail in another paper [52]. This meant that not all older persons received the full 12-or 18-month intervention.…”

“…This manuscript focuses on objective 2, evaluating the impact of the Nav-CARE program. A related manuscript focuses on objective 1 by describing Nav-CARE implementation and sustainability issues across diverse study sites [52].…”

How do inner and outer settings affect implementation of a community-based innovation for older adults with a serious illness: a qualitative study

“…Evidence from the field of implementation science indicates innovations need to be tailored to the context where they are being implemented [37]. Our study supplemented data from a larger study [38,39] with stakeholder interviews in a single community to explore context-specific factors affecting successful implementation within that community; it focused on the inner and outer setting domains in the CFIR framework. The rationale for focusing on the inner and outer setting domains was an interest in understanding how organizational support for Nav-CARE and links between organizations affected implementation.…”