National Survey Using CFIR to Assess Early Outpatient Specialty Palliative Care Implementation

Rosenblum, Rachel E; Rogal, Shari S.; Park, Elyse R.; Impagliazzo, Carolyn; Abdulhay, Lindsay B.; Grosse, Philip J; Temel, Jennifer S.; Arnold, Robert M.; Schenker, Yael

doi:10.1016/j.jpainsymman.2022.11.019

Cited by 6 publications

(4 citation statements)

References 21 publications

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“…Most experts and clinical guidelines recommend an integrated model of care for patients with advanced cancer that includes early referral to specialised palliative care teams [ 20 , 21 , 22 , 45 ]. Many of these experts and guidelines recommend systematic referral to the EPC of all patients with incurable advanced cancer and limited survival soon after diagnosis and concurrently with cancer treatment.…”

Section: Discussionmentioning

confidence: 99%

“…Based on this consistent scientific evidence, the American Society of Clinical Oncology recommended that all patients with advanced cancer should be managed by multidisciplinary teams specialising in EPC in parallel with cancer treatment [ 20 , 21 , 22 ]. However, a consensus report from the Centre to Advance Palliative Care argued that it was neither desirable nor sustainable for all advanced patients to be cared for by specialised EPC teams, given the real limitations of these resources in daily clinical practice.…”

Section: Introductionmentioning

confidence: 99%

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Validation Study of the PALCOM Scale of Complexity of Palliative Care Needs: A Cohort Study in Advanced Cancer Patients

Viladot,

Gallardo-Martínez,

Hernandez-Rodríguez

et al. 2023

Cancers

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Background: In a patient-centred model of care, referral to early palliative care (EPC) depends on both the prognosis and the complexity of care needs. The PALCOM scale is a 5-domain multidimensional assessment tool developed to identify the level of complexity of palliative care needs of cancer patients. The aim of this study was to validate the PALCOM scale. Patient and methods: We conducted a prospective cohort study of cancer patients to compare the PALCOM scale and expert empirical assessment (EA) of the complexity of palliative care needs. The EA had to categorise patients according to their complexity, considering that medium to high levels required priority attention from specialist EPC teams, while those with low levels could be managed by non-specialist teams. Systematically collected multidimensional variables were recorded in an electronic report form and stratified by level of complexity and rating system (PALCOM scale versus EA). The correlation rank (Kendall’s tau test) and accuracy test (F1-score) between the two rating systems were analysed. ROC curve analysis was used to determine the predictive power of the PALCOM scale. Results: A total of 283 advanced cancer patients were included. There were no significant differences in the frequency of the levels of complexity between the EA and the PALCOM scale (low 22.3–23.7%; medium 57.2–59.0%; high 20.5–17.3%). The prevalence of high symptom burden, severe pain, functional impairment, socio-familial risk, existential/spiritual problems, 6-month mortality and in-hospital death was significantly higher (p < 0.001) at the high complexity levels in both scoring systems. Comparative analysis showed a high correlation rank and accuracy between the two scoring systems (Kendall’s tau test 0.81, F1 score 0.84). The predictive ability of the PALCOM scale was confirmed by an area under the curve in the ROC analysis of 0.907 for high and 0.902 for low complexity. Conclusions: In a patient-centred care model, the identification of complexity is a key point to appropriate referral and management of shared care with EPC teams. The PALCOM scale is a high precision tool for determining the level of complexity of palliative care needs.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Validation Study of the PALCOM Scale of Complexity of Palliative Care Needs: A Cohort Study in Advanced Cancer Patients

Viladot,

Gallardo-Martínez,

Hernandez-Rodríguez

et al. 2023

Cancers

View full text Add to dashboard Cite

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“…The framework is composed of 48 constructs and 19 sub-constructs within ve major domains: intervention characteristics, outer setting, inner setting, characteristics of the individuals involved, and the process of implementation ( 16). Similar research has used the CFIR in cross-sectional survey designs to systematically capture potential facilitators and barriers to implementing evidence-based interventions (17) (18). The Checklist for Reporting Results of Internet E-Surveys (CHERRIES) reporting guideline was used to guide survey development and reporting (19).…”

Section: Study Design and Conceptual Frameworkmentioning

confidence: 99%

“…For the nal survey design, respondents were instructed to rate the degree to which they agreed on the ve-point Likert scale for each statement, with a sixth option of "N/A or Unsure" in the caregiver version and a statement of "I do not have the experience/knowledge to comment" in the OT and healthcare administrator versions. Options of "strongly agree" and "agree" indicated that the construct was a potential facilitator (factors that support or enable the implementation of EIMT therapies) and a response of "strongly disagree" or "disagree" indicated that the construct was a potential barrier (factors that hinder the ability to implement EIMT therapies) (17). The option of "neutral" meant the respondent "neither agreed nor disagreed" with the statement, indicating that the construct was neither a barrier nor a facilitator.…”

Section: Survey Developmentmentioning

confidence: 99%

Facilitators and Barriers to Implementation of Early Intensive Manual Therapies for Young Children with Cerebral Palsy Across Canada

Vurrabindi,

Hilderley,

Kirton

et al. 2024

Preprint

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Background: Cerebral Palsy (CP) is the most common childhood-onset motor disability. Play-based early intensive manual therapies (EIMT) is an evidence-based practice to improve long-term hand function particularly for children with asymmetric hand use due to CP. For children under two years old, this therapy is often delivered by caregivers who are coached by occupational therapists (OTs). However, why only a few Canadian sites implement this therapy is unclear. There is a need to identify strategies to support implementation of EIMT. The primary objective of this study was to identify the facilitators and barriers to EIMT implementation from the perspectives of (1) caregivers of children with CP, (2) OTs and (3) healthcare administrators for paediatric therapy programs. Methods: The Consolidated Framework for Implementation Research (CFIR) was used to guide development of an online 5-point Likert scale survey to identify facilitators (scores of 4 and 5) and barriers (scores of 1 and 2) to implementation of EIMT. Three survey versions were co-designed with knowledge user partners for distribution to caregivers, OTs, and healthcare administrators across Canada. The five most frequently endorsed facilitators and barriers were identified for each respondent group. Results: Fifteen caregivers, 54 OTs, and 11 healthcare administrators from ten Canadian provinces and one territory participated in the survey. The majority of the identified facilitators and barriers were within the ‘Inner Setting’ CFIR domain, with ‘Structural Characteristics’ emerging as the most reported CFIR construct. Based on the categorization of the most frequently endorsed facilitators and barriers within the CFIR domains, the key facilitators to EIMT implementation included the characteristics of the intervention and establishing positive workplace relationships and culture. The key barriers included having workplace restrictions on EIMT delivery models and external influences (e.g., funding) on EIMT uptake. Conclusions: We identified key facilitators and barriers to implementing EIMT from a multi-level Canadian context. These findings will inform the next steps of designing evidence-informed and theory-driven implementation strategies to support increased delivery of EIMT for children under two years old with asymmetric hand use due to CP across Canada.

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American Society of Clinical Oncology guideline update on palliative care for patients with cancer: Addressing the reality gap

Crowley,

Smith,

Arnold

et al. 2024

Cancer

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Plain Language Summary We commend the American Society of Clinical Oncology for their sweeping recommendations and advocacy for integrated palliative care as part of oncologic care. The literature that exists is heterogeneous and at times difficult to interpret, and the panel has clearly described their systemic review process and subsequent rationale for their recommendations. Although we agree with the overall recommendations, there are significant practical limitations to their application that renders them aspirational. We worry that the guidelines may be impossible for most programs to fully achieve due to a variety of factors including specialty palliative care workforce shortages, limited health care system resource allocation to integrate palliative care widely in cancer care, and lack of financial support for the research necessary to better answer outstanding clinical and implementation questions. We outline briefly some practical ways in which these recommendations can be applied by existing cancer centers and health care systems. Ultimately, both financial and quality incentives will be necessary to push forward the expansion and integration of palliative care within our national health care system as a whole.

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National Survey Using CFIR to Assess Early Outpatient Specialty Palliative Care Implementation

Cited by 6 publications

References 21 publications

Validation Study of the PALCOM Scale of Complexity of Palliative Care Needs: A Cohort Study in Advanced Cancer Patients

Validation Study of the PALCOM Scale of Complexity of Palliative Care Needs: A Cohort Study in Advanced Cancer Patients

Facilitators and Barriers to Implementation of Early Intensive Manual Therapies for Young Children with Cerebral Palsy Across Canada

American Society of Clinical Oncology guideline update on palliative care for patients with cancer: Addressing the reality gap

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