Biomaterial Database

Barriers and facilitators to implementing a pragmatic trial to improve advance care planning in the nursing home setting. 2019

Jennifer A Palmer, and Victoria A Parker, and Vincent Mor, and Angelo E Volandes, and Lacey R Barre, and Emmanuelle Belanger, and Phoebe Carter, and Lacey Loomer, and Ellen McCreedy, and Susan L Mitchell

Harvard Medical School, 25 Shattuck Street, Boston, MA, 02215, USA. jennypalmer@hsl.harvard.edu.

BACKGROUND The PRagmatic trial Of Video Education in Nursing homes (PROVEN) aims to test the effectiveness of an advance care planning (ACP) video intervention. Relatively little is known about the challenges associated with implementing ACP interventions in the nursing home (NH) setting, especially within a pragmatic trial. To address this research gap, this report sought to identify facilitators of and barriers to implementing PROVEN from the perspective of the Champions charged with introducing the ACP video program delivery to patients and families. METHODS In semi-structured telephone interviews at 4 and 15 months of the 18-month implementation period, ACP Champions at all PROVEN intervention facilities (N = 119) were asked about their perceptions of program implementation. Forty interviews were purposively sampled, transcribed, and analyzed using a hybrid deductive/inductive approach to thematic analysis incorporating the Consolidated Framework for Implementation Research's domains: Intervention Characteristics (IC), Inner Setting (IS), Characteristics of Individuals (CI), Outer Setting (OS), and Process (P). RESULTS Implementation facilitators identified by Champions included: the intervention's adaptable mode of presentation and minimal time burden (IC) as well as the program's customizable delivery to patients and families and opportunity for group reflection on implementation among ACP Champions (P). Barriers included mandated protocol-driven aspects of the program (OS), limited time to deliver the intervention (IS), and lack of perceived relevance and emotional readiness for ACP amongst stakeholders (CI). CONCLUSIONS Despite the promise of PROVEN's intervention for improving ACP in nursing homes, unchangeable setting and characteristics of Champions, patients, and family members presented implementation barriers. Researchers need to engage all program participants (i.e., facility staff, patients, and families), in addition to corporate-level stakeholders, in early pragmatic trial design to minimize such obstacles. Further, despite the facilitating nature of PROVEN's implementation processes, the study encountered tension between scientific rigor and real-world demands. Researchers need to optimize the real-world authenticity of pragmatic trial design while avoiding excessive implementation protocol deviations. BACKGROUND ClinicalTrials.gov Identifier: NCT02612688. Registered 19 November 2015.

UI	MeSH Term	Description	Entries
D007318	Inservice Training	On the job training programs for personnel carried out within an institution or agency. It includes orientation programs.	Employee Orientation Programs,Orientation Programs, Employee,On-the-Job Training,Training, Inservice,Employee Orientation Program,On the Job Training,Orientation Program, Employee,Program, Employee Orientation,Programs, Employee Orientation,Training, On-the-Job
D007407	Interviews as Topic	Works about conversations with an individual or individuals held in order to obtain information about their background and other personal biographical data, their attitudes and opinions, etc. It includes works about school admission or job interviews.	Group Interviews,Interviewers,Interviews, Telephone,Oral History as Topic,Group Interview,Interview, Group,Interview, Telephone,Interviewer,Interviews, Group,Telephone Interview,Telephone Interviews
D008297	Male		Males
D009735	Nursing Homes	Facilities which provide nursing supervision and limited medical care to persons who do not require hospitalization.	Homes, Nursing,Nursing Home
D010353	Patient Education as Topic	The teaching or training of patients concerning their own health needs.	Education of Patients,Education, Patient,Patient Education
D005260	Female		Females
D006282	Health Personnel	Men and women working in the provision of health services, whether as individual practitioners or employees of health institutions and programs, whether or not professionally trained, and whether or not subject to public regulation. (From A Discursive Dictionary of Health Care, 1976)	Health Care Professionals,Health Care Providers,Healthcare Providers,Healthcare Workers,Health Care Professional,Health Care Provider,Healthcare Provider,Healthcare Worker,Personnel, Health,Professional, Health Care,Provider, Health Care,Provider, Healthcare
D006801	Humans	Members of the species Homo sapiens.	Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000068217	Social Workers	Professionals who work with persons affected by social disadvantages such as POVERTY; mental and physical illness or disability, and social injustice. Their focus is on both the individual and his or her environment, including violations of their civil liberties and human rights.	Social Worker,Worker, Social,Workers, Social
D001291	Attitude of Health Personnel	Attitudes of personnel toward their patients, other professionals, toward the medical care system, etc.	Staff Attitude,Attitude, Staff,Attitudes, Staff,Health Personnel Attitude,Health Personnel Attitudes,Staff Attitudes