Formative Evaluation of a Multi-Component, Education-Based Intervention to Improve Processes of End-of-Life Care

Abstract

A multicomponent, palliative care, education-based intervention was implemented in six Veterans Affairs Medical Centers in the southeast United States. The intervention comprised onsite staff training plus supporting written materials, installation of an electronic order set, and follow-up consultations. Training included large-group didactic presentations, small-group clinical demonstrations, and one-on-one consultations. The intervention strategy was targeted broadly to hundreds of hospital providers, including physician, nursing, and ancillary staff. The purpose was to train staff in identifying actively dying patients and implementing best practices of home-based hospice care. A formative evaluation was conducted utilizing semistructured telephone interviews with key informants from each site. Qualitative data analysis revealed processes that facilitated or impeded uptake of the intervention. Results will be used to inform ongoing and future clinical initiatives and optimize future implementation of education-based interventions to improve adoption of best practices for end-of-life care within acute care settings.

Predictors of Physical Restraint Use in Hospitalized Veterans at End of Life: An Analysis of Data from the BEACON Trial

“…We conducted a secondary analysis of data from the ''Best Practices for End-of-Life Care for Our Nation's Veterans'' (BEACON) trial, which is described elsewhere. 27,28 Briefly, BEACON was a pragmatic, multisite implementation trial to evaluate the impact of an educational intervention on end-oflife care processes in six VA Medical Centers (VAMCs). The intervention included training inpatient staff to identify actively dying patients and to implement home hospice best practices in the acute care setting.…”

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

“…Of the articles reporting type of setting where the implementation project/research took place, a majority were undertaken in hospitals ( n = 126) [ 26 , 27 , 30 , 38 , 39 , 41 , 42 , 45 , 49 , 51 – 55 , 60 , 62 – 64 , 67 , 70 – 72 , 77 , 84 , 85 , 88 , 89 , 95 – 98 , 103 , 106 , 107 , 111 , 115 – 118 , 120 – 122 , 128 , 131 , 132 , 136 , 137 , 139 , 143 , 146 , 149 , 151 , 153 – 155 , 157 , 161 , 165 , 167 – 169 , 172 , 173 , 175 , 180 – 182 , 184 , 186 , 190 – 193 , 205 , 207 , 212 , 215 , 221 , 223 , 227 , 230 , 231 ,…”

“…A total of 102 (28%) articles described testing or validating PARIHS, or provided comments on the validity of the framework [ 3 , 13 , 23 , 24 , 35 , 44 , 46 , 58 , 60 , 62 , 64 , 67 , 71 , 74 , 76 , 78 – 81 , 84 , 85 , 89 , 98 , 105 , 107 , 110 , 113 , 115 , 120 , 121 , 143 , 149 , 150 , 153 , 155 , 157 – 159 , 166 , 168 , 170 , 172 , 180 – 182 , 187 , 188 , 190 , 191 , 195 , 198 , 201 , 203 , 204 , 206 – 209 , 211 , 212 , 214 , 229 , 246 , 249 , 250 , 252 , 253 , 255 , 264 , 267 , 268 , 277 , 278 ...…”

Comparison of Two Methods for Implementing Comfort Care Order Sets in the Inpatient Setting: a Cluster Randomized Trial

“…A formative evaluation was conducted to understand the processes facilitating adoption of best practices and to inform the design of future dissemination. 31 Participant accounts detailed how small group instruction and interactive teaching methods facilitated active learning. They also indicated the need for a train-thechampion model, where training could be ongoing at each site, allowing for a more sustained delivery of training.…”