Table 7 Overview of all reported facilitators and barriers of the RE-AIM Maintenance dimension

Intervention characteristics

• Refining the intervention regarding availability of consultant, frequent evaluation of intervention activities, and MDMs as standard practice may contribute to sustained use over time (QM1.1)^a

• Ownership of the intervention by organizations in palliative care in order to transfer palliative care knowledge to social service professionals (QM1.2)

• Structural discussion of patients initiated by the palliative care consultant may contribute to sustainable, early, future-focused consultations (QM1.3)

• Unclear mutual responsibilities hamper sustained use over time due to complexity (QM1.4)

• A shift in non-intervention-related tasks of the palliative care consultant could hamper collaboration as this could hamper availability and participation in intervention activities (QM1.5)

• Small-scale and specific consultations may negatively affect maintenance and expansion of the intervention over time (QM1.6)

Outer setting

• A policy of clear incentives and regulations regarding patient indication and associated existing funding help in maintaining the intervention over time (QM1.7)

• Lack of clear policy and regulations regarding proper/structural palliative care indications and funding for care (QM1.8)

Inner setting

• Mental and financial support from manager and colleagues for consultants within the organization helps prioritize intervention for consultants in future (QM1.9)

• Professionals’ openness to teamwork helps use of the intervention over time (QM1.10)• Organizations’ recognition of a need for change contributes to a culture that is more open to change over time (QM1.11)• A mindset within social services that focuses on more domains such as the somatic domain (QM1.12)

• Concrete actions, like sharing information on the intervention activities performed, to prevent loss of consultants’ position, helps embed intervention over time (QM1.13)

• As long as organizations are unfamiliar with death and dying among this population, maintaining the intervention will be hampered by these assumptions. (QM1.14)

• Staff shortages hamper use of the intervention over time (QM1.15)

• Unpaid medical tasks not being taken seriously within organization may hamper the implementation climate in future (QM1.16)

• Different views on ethical issues may hamper future collaboration (QM1.17)

• Many layers of management in an organization mean it takes a long time to arrange financing and hours for consultants; this threatens continuation of the intervention (QM1.18)

• Drop-out and vulnerability of consultants’ position threaten use of the intervention over time (QM1.19)

Process

• Maintenance is highly dependent on local champions, which might threaten future collaborations and maintenance of the intervention over time (QM1.20)