Table 6 Facilitators (F) and barriers (B) that affected the process of implementing palliative care into regular COPD care
Domain | Constructs | F/B | Main findings |
|---|---|---|---|
Intervention characteristics | Relative advantage | F | The intervention was highly valued because it provided clarity, peace of mind, and less anxiety to the patient, improved the relationship with the patient, and increased job satisfaction. |
F | Systematic screening of patients helped HCPs to become aware of palliative care needs. | ||
Perceived difficulties of the intervention | B | Patients responded differently to the intervention. It was relieving for some and it was confronting for others. It was considered essential to adapt to the patient’s level of readiness. | |
B | All HCPs felt that transmural collaboration was still inadequate. Raised issues were: challenge to have phone contact due to busy schedules, lack of an appropriate communication tool, doubt about what and how to communicate, and lack of COPD nurses in primary care. | ||
Inner setting | Tension for change | F | Almost all HCPs believed that (better structured) palliative care for patients with COPD was highly necessary. |
B | Two HCPs found that they already did many things well and that change was not needed. | ||
Available resources | B | Due to busy schedules, it was challenging to schedule palliative care conversations. | |
Networks and communications | B | The division of roles between HCPs of the pulmonary department and the specialist palliative care team was unclear. | |
Relative priority | B | The COVID-19 pandemic caused changed priorities, resulting in the postponement of palliative care conversations. | |
Characteristics of individuals | Knowledge and beliefs about the intervention | F | The observed positive effects on patients motivated to continue with the intervention. |
F | Sharing experiences in implementing and organizing integrated palliative care between regions was considered useful and inspiring to continue the intervention. | ||
Self-efficacy | F | Communication training and being provided with example phrases were perceived as helpful. | |
F | Conducting palliative care conversations (in part) together with a COPD nurse helped the pulmonologist to discuss non-medical topics and it saved time. | ||
Implementation process | Planning | B | HCPs found it challenging to formulate clear implementation goals and to plan actions. |
Reflecting & Evaluating | F | Regular meetings with a small team helped to make implementation agreements. | |
Engaging | B | Implementation was primarily focused on planning palliative care conversations in the outpatient clinical setting. Team members from primary care and palliative care were not actively involved in the implementation process because their potential role was unclear. | |
Implementation leaders | F | A dedicated implementation leader feeling responsible for the implementation was essential. | |
B | Without someone explicitly made responsible, implementation was hampered. |