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Table 3 Theoretical propositions making up the IPT

From: A realist evaluation of a home-based end of life care service for children and families: what works, for whom, how, in what circumstances and why?

Component of the service

Propositions

1. ANTICIPATORY APPROACH TO CARE PLANNING AND DELIVERY

If the Care 24 Lothian service adopts an anticipatory approach to the care of children and families (Context), then the service is able to plan and deliver the majority of care during regular working hours (08:00–18:00) (Mechanism) thus reducing the need for access to out of hours (OOH) care by families (Outcome).

2. ADVANCE CARE PLANNING

When advance care planning that supports families’ choices and goals for quality palliative and EOL care (Context) underpins the service provided by the Care 24 Lothian team and is prioritised within the care delivered (Mechanism), this can lead to delivery of effective and person-centred EOL care for the child and family (Outcome).

3. SERVICE RESPONSIVENESS AND FLEXIBILITY

Access to care in different settings (home, hospice, hospital) and supporting families to move between settings according to their fluctuating needs at that time (Context), by the service responding in a flexible and need-driven way (Mechanism), will provide families with choice over the preferred place of EOL care and they will be supported to remain there as long as they wish (Outcome).

4. 24/7 NURSE-LED SERVICE WITH 24-HOUR MEDICAL SUPPORT AVAILABLE

Care 24 Lothian is a 24/7 nurse-led service providing home-based EOL care to children and families (Context). It is delivered by nurses with appropriate knowledge and expertise in children’s palliative and EOL care and supported by 24-h access to expert medical care (Mechanism). This approach leads to the provision of consistent, high quality care and support to children and families (Outcome).

5. PARTNERSHIP WORKING

An integrated service where NHS Lothian and CHAS work in partnership to deliver home-based EOL care for children and families (Context) requires effective communication, leadership and adoption of joint policies, procedures and documentation (Mechanism) to ensure the provision of consistent, high quality care and support to families (Outcome) and to enhance team working (Outcome).