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Table 1 Description of the implementation strategy and integrated palliative care intervention of the Compassion study

From: A cluster randomized controlled trial on a multifaceted implementation strategy to promote integrated palliative care in COPD: study protocol of the COMPASSION study

Implementation strategy
Components Content of the component Tools/materials/ underpinning theory
Formation of regional intervention group Multidisciplinary regional team Implementation strategies integrated into multiple settings and directed to multiple professions involved are more effective [17]
Access to online toolbox Website with information and guidance on the core elements of palliative care in COPD, including tools and links for facultative use Quality Framework [7]
Input from experts
Training session 1 (3 h) Introductory information on the project and research n.a.
  Instruction the Propal-COPD tool to identify the palliative phase in patients with COPD Propal-COPD tool [16]
  Multidimensional assessment (physical, psychological, social, spiritual) Adapted version of Problems Square [18]
  Communication training on advance care planning in COPD including roleplay with actors Training in palliative care communication with roleplay supports implementation [19,20,21]
  Non-pharmacological and pharmacological dyspnea management Breathing Thinking Functioning model [22]
Training session 2 (3 h) Discussion current palliative care as organized in region vs. desired palliative care 7-phase model [23]
  Introductory information on implementing care pathway 7-phase model [23]
  Filling in formats A to E (who does what how and when) leading to first draft of regional action plan Flowchart on patient care process (see Fig. 2)
  Assigning local implementation leaders 7-phase model [23]
Completion of regional action plan Agreement on who does what how and when Format regional action plan
Action planning stimulates behavior change [24] and assures the suitability of the intervention to the existing structure of the region
Monitoring Monitoring meetings on site Audit and provide feedback to monitor, evaluate, and modify provider behavior [25]
  Evaluation meetings with local implementation groups Share local knowledge on how implementers and clinicians made something work in their setting and then share it with other sites [25]
Integrated palliative care intervention
Components Content of the component
Identification Calculation of Propal-COPD score
  Planning first consultation with patient and informal caregiver
Multidimensional assessment Assessing palliative care needs on physical, psychological, social and spiritual dimension
Symptom management Non-pharmacological and pharmacological treatment for breathlessness and other physical symptoms, smoking cessation, medication review, anxiety and depression
Advance care planning Education about the illness trajectory and discussions with patient and informal caregiver on goals and preferences for future medical treatment
Coordination & continuity Individual care plan, documentation of advance care directives
Information exchange and cooperation with general practitioners and other involved professionals
Regular multidisciplinary meetings
Dying phase & bereavement care Planning a consultation with informal caregiver to evaluate care in the last phase
Planning an evaluation of the provided palliative care with all involved professionals