Table 2 Determinants for implementing the MUTUAL intervention as measured by the Measurement Instrument for Determinants of Innovations (N = 37)

 1

Procedural clarity: the ACP intervention clearly indicates the activities I should perform and in which order

37

4,05

0,57

0,0

13,5

86,5

 2

Correctness: the ACP intervention is based on factually correct knowledge

36

3,94

0,53

0,0

16,7

83,3

 3

Completeness: the ACP intervention provides the information and materials needed to perform the intervention properly

36

4,03

0,70

2,8

13,9

83,3

 4

Complexity: the ACP intervention is easy for me to use

36

4,00

0,63

2,8

11,1

86,1

 5

Compatibility: the ACP intervention is a good match for how I am used to working at the outpatient clinic

36

3,86

0,72

5,6

16,7

77,8

 6

Observability: the outcomes of using the ACP intervention are clearly observable

36

3,53

0,77

8,3

38,9

52,8

 7a

Relevance for patients: the ACP conversations are relevant for my patients

36

4,47

0,56

0,0

2,8

97,2

 7b

Relevance for their proxies: the ACP conversations are relevant for proxies of the patients

37

4,51

0,61

0,0

5,4

94,6

 8a

Personal benefits: the ACP intervention helps me to improve the quality of care

37

4,11

0,57

2,7

2,7

94,6

 8b

Personal benefits: the ACP intervention helps me to understand the wishes of my patient

36

4,11

0,62

2,8

5,6

91,7

 8c

Personal benefits: the ACP intervention improves the connection with my patient

36

3,61

0,73

8,3

27,8

63,9

 8d

Personal benefits: the ACP intervention improves follow-up conversations with my patient

36

3,44

0,77

5,6

47,2

47,2

 8e

Personal benefits: the ACP intervention saves time in the long term

36

3,56

0,81

8,3

38,9

52,8

 8f

Personal benefits: ACP conversations make me feel satisfied

36

3,81

0,71

5,6

19,4

75,0

 8g

Personal benefits: the ACP intervention contributes to my personal development

36

3,61

0,84

11,1

27,8

61,1

 8h

Personal benefits: the ACP intervention helps me to structure the conversation

36

3,78

0,83

8,3

22,2

69,4

 8i

Personal drawback: the ACP intervention is demanding for me

36

3,00

0,76

27,8

44,4

27,8 (barrier)

 8j

Personal drawback: the ACP intervention raises the workload

36

3,19

0,89

27,8

27,8

44,4 (barrier)

 9a

I expect that the ACP intervention enables the patient to define goals and preferences for future medical treatment and care^a

33

4,03

0,47

0,0

9,1

90,9

 9b

I expect that the ACP intervention enables the discussion of goals and preferences with family and healthcare professionals^a

33

4,21

0,42

0,0

0,0

100,0

 9c

I expect that the ACP intervention leads to the documentation of treatment preferences^a

33

4,24

0,50

0,0

3,0

97,0

 10a

Professional obligation: I feel that the ACP conversations are my responsibility as a professional

33

4,21

0,65

3,0

3,0

93,9

 10b

Professional obligation: I feel that the ACP conversations are the responsibility of the hospital

33

3,73

0,76

6,1

27,3

66,7

 10c

Professional obligation: I feel that the ACP intervention should always involve a physician

33

4,06

0,83

6,1

12,1

81,8

 11

Patient satisfaction: patients are generally satisfied with the ACP intervention

33

4,09

0,58

0,0

12,1

87,9

 12

Patient cooperation: patients generally cooperate with the ACP intervention

32

3,66

0,55

3,1

28,1

68,8

 13a

Social support: I can count on adequate assistance from my colleagues with the ACP intervention

33

3,91

0,68

0,0

27,3

72,7

 13b

Social support: I can count on adequate support from management with the ACP intervention

32

3,28

0,81

9,4

56,3

34,4

 14

Descriptive norm: the proportion of colleagues from my specialty who use the ACP intervention^b

33

4,18

1,31

39,4

24,2

36,4

 15a

Normative beliefs: physicians from my specialty expect me to use the ACP intervention^a

33

3,97

0,64

3,0

12,1

84,8

 15b

Normative beliefs: nurses from my specialty expect me to use the ACP intervention^a

32

4,00

0,57

0,0

15,6

84,4

 15c

Normative beliefs: patients expect me to use the ACP intervention^a

32

3,41

0,61

3,1

56,3

40,6

 15d

Normative beliefs: patients’ proxies expect me to use the ACP intervention^a

32

3,34

0,60

3,1

62,5

34,4

 16a

Self-efficacy: Should you wish to do so, do you think you can select and invite patients for the ACP intervention?^a

33

4,15

0,44

0,0

3,0

97,0

 16b

Self-efficacy: Should you wish to do so, do you think you are able to use the ACP intervention?^a

33

4,33

0,54

0,0

3,0

97,0

 16c

Self-efficacy: Should you wish to do so, do you think you are able to document/register the goals and preferences from the ACP intervention?^a

33

4,27

0,63

0,0

9,1

90,9

 17

Knowledge: I know enough to use the ACP intervention correctly

33

3,97

0,47

0,0

12,1

87,9

 19

Formal ratification by management: there are formal arrangements relating to the ACP intervention^c

37

2,35

0,59

5,4

54,1

40,5

 20a

Replacement when staff leave: if employees who are responsible for conducting ACP conversations leave the organisation, they are replaced in a timely manner by colleagues who are prepared to have ACP conversations

35

3,14

0,85

22,9

37,1

40,0

 20b

Replacement when staff leave: if employees that are responsible for planning ACP conversations leave the organisation, they are replaced in a timely manner by colleagues who are prepared to plan ACP conversations

34

3,15

0,74

14,7

52,9

32,4

 21

Staff capacity: there are enough people in our organisation to use the ACP intervention as intended

34

3,18

0,97

26,5

32,4

41,2

 22

Financial resources: there are enough financial resources available to use the intervention as intended^c

35

2,20

0,58

8,6

62,9

28,6

 23a

Time available: there is sufficient time available to introduce and invite patients to the ACP intervention at the outpatient clinic

36

3,28

0,97

25,0

16,7

58,3

 23b

Time available: there is sufficient time available to have the ACP conversations at the outpatient clinic as intended

37

3,41

0,93

18,9

24,3

56,8

 24

Material resources and facilities: our organisation provides me with enough materials and other resources or facilities necessary for using the ACP intervention as intended

36

3,69

0,75

11,1

13,9

75,0

 25

Coordinator: the coordinator of the ACP intervention is accessible

36

3,94

0,67

0,0

25,0

75,0

 26a

Unsettled organisation: the Covid-19 pandemic influences the ACP intervention

37

3,95

0,78

5,4

16,2

78,4 (barrier)

 26b

Unsettled organisation: there are other projects within the hospital that influence the ACP intervention ^d

33

1,27

0,45

27,3 (yes)

72,7 (no)

 27

Information accessible: easy to receive information about the ACP intervention

36

3,75

0,73

8,3

16,7

75,0

 28

Performance feedback: within the hospital feedback is regularly provided about progress with the implementation of the ACP intervention

36

3,78

0,76

5,6

25,0

69,4

 29

Regulations: the ACP intervention fits well with existing legislation and regulations

36

3,75

0,50

0,0

27,8

72,2