The Influence of Context and Practitioner Attitudes on Implementation of Person‐Centered Assessment and Support for Family Carers Within Palliative Care

Diffin, Janet; Ewing, Gail; Harvey, Gill; Grande, Gunn

doi:10.1111/wvn.12323

Cited by 13 publications

(18 citation statements)

References 25 publications

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“…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.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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Background: Informal carers are essential in enabling discharge home from hospital at end of life and supporting palliative patients at home, but are often ill-prepared for the role. Carers’ support needs are rarely considered at discharge. If carers are less able to cope with home care, patient care may suffer and readmission may become more likely. Aim: To investigate the implementation of an evidence-based Carer Support Needs Assessment Tool (CSNAT) intervention to support carers during hospital discharge at end of life. Design: Longitudinal qualitative study with thematic analysis. Setting/participants: One National Health Service Trust in England: 12 hospital practitioners, one hospital administrator and four community practitioners. We provided training in CSNAT intervention use and implementation. Practitioners delivered the intervention for 6 months. Data collection was conducted in three phases: (1) pre-implementation interviews exploring understandings, anticipated benefits and challenges of the intervention; (2) observations of team meetings and review of intervention procedures and (3) follow-up interviews exploring experiences of working with the intervention. Results: Despite efforts from practitioners, implementation was challenging. Three main themes captured facilitators and barriers to implementation: (1) structure and focus within carer support; (2) the ‘right’ people to implement the intervention and (3) practical implementation challenges. Conclusions: Structure and focus may facilitate implementation, but the dominance of outcomes measurement and performance metrics in health systems may powerfully frame perceptions of the intervention and implementation decisions. There is uncertainty over who is best-placed or responsible for supporting carers around hospital discharge, and challenges in connecting with carers prior to discharge.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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“…Of these, around 20 used a deductive approach in that they used the elements and sub-elements to structure the analytic process (e.g., [150,170,188,215,242]). About 35 studies applied PARIHS for quantitative analysis, (e.g., [69,168,174,190,211]). In half of these, the Alberta Context Tool (e.g., [155,165,180,195,229]) and the Organizational Readiness to Change Assessment Tool (e.g., [74,159,219,240]) were used; both these tools being derived from PARIHS.…”

Section: The Application Of Parihs In Data Analysismentioning

confidence: 99%

The use of the PARIHS framework in implementation research and practice—a citation analysis of the literature

et al. 2020

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Background: The Promoting Action on Research Implementation in Health Services (PARIHS) framework was developed two decades ago and conceptualizes successful implementation (SI) as a function (f) of the evidence (E) nature and type, context (C) quality, and the facilitation (F), [SI = f (E,C,F)]. Despite a growing number of citations of theoretical frameworks including PARIHS, details of how theoretical frameworks are used remains largely unknown. This review aimed to enhance the understanding of the breadth and depth of the use of the PARIHS framework. Methods: This citation analysis commenced from four core articles representing the key stages of the framework's development. The citation search was performed in Web of Science and Scopus. After exclusion, we undertook an initial assessment aimed to identify articles using PARIHS and not only referencing any of the core articles. To assess this, all articles were read in full. Further data extraction included capturing information about where (country/ countries and setting/s) PARIHS had been used, as well as categorizing how the framework was applied. Also, strengths and weaknesses, as well as efforts to validate the framework, were explored in detail. Results: The citation search yielded 1613 articles. After applying exclusion criteria, 1475 articles were read in full, and the initial assessment yielded a total of 367 articles reported to have used the PARIHS framework. These articles were included for data extraction. The framework had been used in a variety of settings and in both high-, middle-, and low-income countries. With regard to types of use, 32% used PARIHS in planning and delivering an intervention, 50% in data analysis, 55% in the evaluation of study findings, and/or 37% in any other way. Further analysis showed that its actual application was frequently partial and generally not well elaborated. Conclusions: In line with previous citation analysis of the use of theoretical frameworks in implementation science, we also found a rather superficial description of the use of PARIHS. Thus, we propose the development and adoption of reporting guidelines on how framework(s) are used in implementation studies, with the expectation that this will enhance the maturity of implementation science.

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“…There is often a fear that a new tool might replace or negatively impact the relationship between carer and practitioner, so it is important that any tool is seen as being complementary, and enhancing the therapeutic relationship (Antunes et al, 2014). Diffin et al (2018a) explored the influence of practitioner attitudes on the implementation of the CSNAT. 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.…”

Section: Shared Reviewmentioning

confidence: 99%

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

Horseman

Milton

Finucane

2019

Br J Community Nurs

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Family carers play a central role in community-based palliative care. However, caring for a terminally ill person puts the carer at increased risk of physical and mental morbidity. The Carer Support Needs Assessment Tool (CSNAT) enables comprehensive assessment of carer support needs. The present study aimed to identify barriers and facilitators to implementing the CSNAT in a community specialist palliative care service. Semi-structured interviews with 12 palliative care nurse specialists from two community nursing teams in Lothian, Scotland, June 2017. Data was audio-recorded, transcribed and analysed. Palliative care nurse specialists acknowledge the importance of carers in palliative care and encourage carer support practices. Nurses perceived the CSNAT as useful, but used it as an ‘add-on’ to current practice, rather than as a new approach to carer-led assessment. Further training is recommended to ensure community palliative care nurses are familiar with the broader CSNAT approach.

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The Influence of Context and Practitioner Attitudes on Implementation of Person‐Centered Assessment and Support for Family Carers Within Palliative Care

Cited by 13 publications

References 25 publications

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

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

The use of the PARIHS framework in implementation research and practice—a citation analysis of the literature

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

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