Understanding the Role of Clinical Champions and Their Impact on Clinician Behavior Change: The Need for Causal Pathway Mechanisms

Morena, Alexandra L; Gaias, Larissa M.; Larkin, Celine

doi:10.3389/frhs.2022.896885

Cited by 32 publications

(19 citation statements)

References 79 publications

(312 reference statements)

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“…In the EPIC project the practice champions self-identified. The implementation science literature shows that champions can increase the adoption of an innovation at multiple levels, but their success often depends on educating and persuading others through social influence 46. This is confirmed in our study, the most successful EPIC champions were collaborative and had a strong passion for implementing a palliative approach to care in their practice.…”

Section: Discussionsupporting

confidence: 81%

Barriers to and facilitators of successful implementation of a palliative approach to care in primary care practices: a mixed methods study

Langley,

Urquhart,

Tschupruk

et al. 2024

BMJ Open

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ObjectiveIntegrating a palliative approach to care into primary care is an emerging evidence-based practice. Despite the evidence, this type of care has not been widely adopted into primary care settings. The objective of this study was to examine the barriers to and facilitators of successful implementation of a palliative approach to care in primary care practices by applying an implementation science framework.DesignThis convergent mixed methods study analysed semistructured interviews and expression of interest forms to evaluate the implementation of a protocol, linked to implementation strategies, for a palliative approach to care called Early Palliation through Integrated Care (EPIC) in three primary care practices. This study assessed barriers to and facilitators of implementation of EPIC and was guided by the Consolidated Framework for Implementation Research (CFIR). A framework analysis approach was used during the study to determine the applicability of CFIR constructs and domains.SettingPrimary care practices in Canada. Interviews were conducted between September 2020 and November 2021.Participants10 individuals were interviewed, who were involved in implementing EPIC. Three individuals from each practice were reinterviewed to clarify emerging themes.ResultsOverall, there were implementation barriers at multiple levels that caused some practices to struggle. However, barriers were mitigated when practices had the following facilitators: (1) a high level of intra-practice collaboration, (2) established practices with organisational structures that enhanced communications, (3) effective leveraging of EPIC project supports to transition care, (4) perceptions that EPIC was an opportunity to make a long-term change in their approach to care as opposed to a limited term project and (5) strong practice champions.ConclusionsFuture implementation work should consider assessing facilitators identified in our results to better gauge primary care pre-implementation readiness. In addition, providing primary care practices with support to help offset the additional work of implementing innovations and networking opportunities where they can share strategies may improve implementation success.

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Section: Discussionsupporting

confidence: 81%

Barriers to and facilitators of successful implementation of a palliative approach to care in primary care practices: a mixed methods study

Langley,

Urquhart,

Tschupruk

et al. 2024

BMJ Open

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“…The clinical champion approach has been linked to reduction of implementation barriers and can promote behavior change across providers. 18 8: Development of Palliative Occupational Therapy (OT) Liaison Role: A formal job description and role delineation is developed for OTPs on palliative care IDTs. Rationale : OTPs facilitate participation in meaningful activities and enhance quality of life for people nearing end-of-life. 2 Living while dying is an occupation, 19 and fostering independence during this vulnerable time may allow a seriously ill person to maintain a level of autonomy as well as much desired social connections.…”

Section: Resultsmentioning

confidence: 99%

“…The clinical champion approach has been linked to reduction of implementation barriers and can promote behavior change across providers. 18…”

Section: Resultsmentioning

confidence: 99%

Building Bridges in Palliative Rehabilitation: An Evidence-Based Toolkit to Promote Collaboration

Henshaw

Winstead

2023

Am J Hosp Palliat Care

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Background: Palliative care and rehabilitation professionals caring for seriously ill people and their families face barriers to effective, timely collaboration. Barriers such as ineffective communication processes, role misunderstanding across professions, and resource limitations can lead to underutilization of rehabilitation services for this vulnerable population. Objectives: To create practical connections between palliative care and rehabilitation professionals and to provide tools and strategies for teams to develop the core competencies (role clarity, communication, teamwork, and shared values) necessary to provide coordinated, timely, effective care to people living with serious illness. Design: With Interprofessional Education Collaborative (IPEC) Core Competencies1 as a framework for interprofessional collaborative practice, a quality improvement project was conducted at a large academic medical center. The 5-phase project included literature review, expert interviews, identification of barriers and facilitators, development of strategies to mitigate barriers, and pilot testing of select strategies. Results: The PalRehab Toolkit consists of strategies to enhance interprofessional collaborative practice and infuse rehabilitation into palliative care in the acute care setting. Preliminary evaluation of piloted strategies suggests increased communication across professions, improved role clarity, and an increased likelihood of collaboration. Conclusion: Providing educational offerings, establishing efficient communication channels, and infusing rehabilitation concepts into palliative care practices, as outlined in the PalRehab Toolkit, may positively impact interprofessional collaborative practice and improve care delivery for people with serious illness and their families.

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“…Earlier studies have reported that clinical champions are instrumental in the quicker initiation of interventions, assist in overcoming institutional barriers, and can motivate and involve staff in clinical trials. 39,40 We report that every year, a trained EM provider will between ve and 115 seriously ill older adult patients depending on the ED volume, patient mix, and geographic setting, among other factors. This wide range of encounter highlights the diversity in the patient population that visit the ED, and the need for each ED to conduct a needs assessment, create ED-speci c standard operating procedures in engaging qualifying patients in SI conversations, and provide a conducive environment for SI conversations in their respective EDs.…”

Section: Discussionmentioning

confidence: 99%

Serious Illness Communication Skills Training for Emergency Physicians and Advanced Practice Providers: A Multi-Method Assessment of the Reach and Effectiveness of the Intervention

Adeyemi

Ginsburg

Kaur

et al. 2023

Preprint

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Background EM Talk is a communication skills training program designed to improve emergency providers’ serious illness conversational skills. Using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, this study aims to assess the reach of EM Talk and its effectiveness. Methods EM Talk is one of the components of Primary Palliative Care for Emergency Medicine (EM) intervention. It consisted of one 4-hour training session during which professional actors used role-plays and active learning to train providers to deliver serious/bad news, express empathy, explore patients’ goals, and formulate care plans. After the training, emergency providers filled out an optional post-intervention survey, which included course reflections. Using a multi-method analytical approach, we analyzed the reach of the intervention quantitatively and the effectiveness of the intervention qualitatively using conceptual content analysis of open-ended responses. Results A total of 879 out of 1,029 (85%) EM providers across 33 emergency departments completed the EM Talk training, with the training rate ranging from 63–100%. From the 326 reflections, we identified meaning units across the thematic domains of improved knowledge, attitude, and practice. The main subthemes across the three domains were the acquisition of discussion tips and tricks, improved attitude toward engaging qualifying patients in serious illness (SI) conversations, and commitment to using these learned skills in clinical practice. Conclusion Effectively engaging qualifying patients in serious illness conversations requires appropriate communication skills. EM Talk has the potential to improve emergency providers’ knowledge, attitude, and practice of SI communication skills. Trial registration: NCT03424109

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Understanding the Role of Clinical Champions and Their Impact on Clinician Behavior Change: The Need for Causal Pathway Mechanisms

Cited by 32 publications

References 79 publications

Barriers to and facilitators of successful implementation of a palliative approach to care in primary care practices: a mixed methods study

Barriers to and facilitators of successful implementation of a palliative approach to care in primary care practices: a mixed methods study

Building Bridges in Palliative Rehabilitation: An Evidence-Based Toolkit to Promote Collaboration

Serious Illness Communication Skills Training for Emergency Physicians and Advanced Practice Providers: A Multi-Method Assessment of the Reach and Effectiveness of the Intervention

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