Table 1 Description of the implementation strategy and integrated palliative care intervention 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. |
| Â | Instruction the Propal-COPD tool to identify the palliative phase in patients with COPD | Propal-COPD tool [16] |
| Â | Multidimensional assessment (physical, psychological, social, spiritual) | Adapted version of Problems Square [18] |
| Â | Communication training on advance care planning in COPD including roleplay with actors | Training in palliative care communication with roleplay supports implementation [19,20,21] |
| Â | 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] |
| Â | 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) |
| Â | 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] |
| Â | 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 | |
| Â | 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 | ||