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Table 1 Consistencies and differences in the components of three LCP implementation guides

From: Development of the care programme for the last days of life for older patients in acute geriatric hospital wards: a phase 0–1 study according to the Medical Research Council Framework

United kingdom

Italy

The Netherlands

Component 1-Establishing the LCP implementation project and preparing the environment for organizational change

1. Informing all relevant clinical staff1

1. Informing all relevant clinical staff

1. Informing all relevant clinical staff

2. Executive endorsement

2. Executive endorsement

2. Executive endorsement

3. Involvement of specialist palliative care services is recommended

3. Involvement of specialist palliative care services is obvious: Palliative Care Unit (PCU) is responsible for implementation

3. Involvement of specialist palliative care services is recommended

4. LCP facilitators2: members of the ward

4. No LCP facilitators: PCU is responsible for implementation

4. LCP facilitators: members of the ward

5. Steering group3: members of the ward

5. Steering group: PCU with two reference persons as a link between ward and PCU

5. Steering group: members of the ward

6. Intensive training4: of LCP facilitators

6. Intensive training of PCU

6. Intensive training of LCP facilitators

7. Project registration with LCP Central Team (UK), LCP National Centre (Italy), or Comprehensive Cancer Centre of the Netherlands

Component 2-Preparing the documentation

Adapting the LCP document and/or supportive LCP documentation to the ward5

Component 3-Baseline review

Analyzing end-of-life care data and feedback the results to the staff6

Component 4-Training health care staff

1. LCP facilitators and specialist palliative care colleagues train health care staff

1. Health care staff follow a mandatory 12 h training organized by PCU

1. LCP facilitators and specialist palliative care colleagues train health care staff

2. Aim training

2. Aim training

2. Aim training

 ○ To understand and work with LCP

 ○ To understand and work with LCP

 ○ To understand and work with LCP

 ○ document

 ○ document

 ○ document

 ○ An education in LCP related issues7

 ○ An education in LCP related issues

Component 5-LCP use and ongoing support

1. LCP use after sufficient training and education

1. LCP use after sufficient training and education

1. LCP use after sufficient training and education

2. Ongoing support and supervision of LCP facilitators each time the LCP document is used8

2. Intensive support and supervision of PCU through repeated coaching, telephone, and direct guidance, discussion of clinical cases, and clinical audits

2. Ongoing support and supervision of LCP facilitators each time the LCP document is used

Component 6-Reflective practice

1. To engage staff in ongoing and reflective practice9

1. Semi-intensive support and supervision of PCU through repeated coaching, telephone, and direct guidance, discussion of clinical cases, and clinical audits

1. To engage staff in ongoing and reflective practice

2. To develop and deliver ongoing and sustainable education strategies

2. To develop and deliver ongoing and sustainable education strategies

Component 7-Evaluation

1. To organize a formal and quantitative reflection (= audit) 10

1. To organize a qualitative evaluation of implementation11

1. To organize a formal and quantitative reflection (= audit)

2. The audit acknowledges areas where further education or training is needed

2. The qualitative evaluation acknowledges areas where further support, education, or training is needed

2. The audit acknowledges areas where further education or training is needed

Component 8-Continuing development of competencies

To develop knowledge and skills of staff constantly to embed LCP model within the ward12

PCU supports ward staff through repeated coaching, telephone, and direct guidance, discussion of clinical cases, and clinical audits

To develop knowledge and skills of staff constantly to embed LCP model within the ward

Component 9-Ongoing education, training, and support

To create structures and processes to underpin the continuing education, training, and support required

Examples:

❖ To link with local audit departments to encourage ongoing reflection on the quality of care delivery

❖ To keep up to date with developments in end of life care

❖ To encourage ongoing liaison with local specialist palliative care teams

❖ To participate in regional and national audit

  1. 1All clinical staff are to be informed about the project and made aware of the importance to change the care in the last days of life.
  2. 2LCP facilitators are assigned to preside the steering group.
  3. 3A steering group needs to be established to coordinate the project and consists of members of the ward who are motivated for this project or the PCU with two reference persons (Italy).
  4. 4LCP facilitators or PCU (Italy) are intensively trained in order to provide leadership for the project.
  5. 5The ward implementing the LCP can adapt the LCP document and/or supportive LCP documentation to the local health care setting if these adaptations are approved by the LCP Central Team, LCP National Centre, or Comprehensive Cancer Centre of the Netherlands (i.e. adapting prompts of care goals, adding care goals, adapting information leaflets, local design of information leaflets).
  6. 6To highlight and reinforce the need for change within the ward, it is important to retrospectively evaluate the care during the last days of life by reviewing the medical and nursing files and giving feedback about these results to the staff.
  7. 7Training and education is also related to competencies important for good care during the last days of life (i.e. communication, symptom control).
  8. 8Ongoing support and supervision each time the LCP document is used for a dying patient, is necessary to increase staff’s knowledge and confidence in using the LCP and empower them in caring for the dying.
  9. 9Reflections on the LCP document use and the specific elements of care delivery provide an opportunity to acknowledge which competencies need to be maintained and which need to be improved.
  10. 10The first LCP documents are quantitatively evaluated in order to provide feedback, highlight improvements since the implementation and identify areas where further education or training is needed.
  11. 11The PCU qualitatively evaluates and discusses the performance and progress of each of the previous components in order to identify staff’s training needs and barriers for the LCP use and provision of optimum end-of-life care.
  12. 12Solutions for identified training needs and barriers are to be sought and performed in order to embed the LCP programme within the organization.
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BMC Palliative Care

ISSN: 1472-684X

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