Developing archetypes for key roles in a pragmatic trial: implementing human-centered design to promote advance care planning in primary care

Implementation Science Communications, Journal Year: 2025, Volume and Issue: 6(1)

Published: Jan. 6, 2025

Abstract Background Archetypes are representations of a group people with shared behaviors, attitudes, and characteristics. The design use archetypes have potential application to increase partnership support when embedding scaling interventions but methodological approaches not been developed. Objective To describe the methodology designing for in pragmatic trial advance care planning primary context, SHARING Choices ((NCT04819191). We present resulting representing three key roles (primary champion, facilitator, patient) our trial. Methods Our process developing involved 4 steps: 1) Identify archetype development, 2) Shareholders Data Sources Archetype Development, 3) Generate unique their distinguishing traits, 4) Iteratively refine through exposure, scrutiny, shareholder input. also developed map communicate methodology. Results created 6 distinct champion role, 5 facilitator role patient role. For each we described strengths, challenges, prevailing emotions, successful collaboration (e.g., “what works me”). Unique opportunities synergy between (such as champion) challenges suggest ways improve training roles. Discussion creating implementation research was iterative informative discussion shareholders. expect this be useful anticipating analyzing many aspects implementation.

Language: Английский

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Understanding the implementation process of the Adult Day Services Plus program

BMC Geriatrics, Journal Year: 2025, Volume and Issue: 25(1)

Published: Feb. 13, 2025

Abstract Background Among the available evidence-based interventions targeting dementia family caregivers, there is limited evidence on implementation processes that produce desired outcomes (i.e., reductions in depression and burden) for people living with (PLWD), community-based programs themselves. In a national multi-site hybrid effectiveness trial, we investigated success challenges of embedding an intervention (ADS Plus) caregivers whose PLWD was enrolled adult day service (ADS). Methods Informed by Consolidated Framework Implementation Research, conducted directed qualitative content analysis to understand caregiver ( n = 15) staff 14) perceptions facilitators potential barriers ADS Plus nine guide future dissemination efforts. Results demonstrated successful delivery achieved through adaptability, personalization, structure (innovation); responsiveness external changes marketability (outer domain); presence aligned goals familiarity (inner setting); involvement research staff, connections among practitioners, meeting needs (individual understanding caregivers’ addressing capacity take action (implementation process). This adaptability reassures us implement heterogeneous programmatic settings. Conclusion Globally, our results demonstrate offers viable solution supporting high diverse Trial registration ClinicalTrials.gov ID: NCT02927821 (Registration Date 10/7/2016).

Language: Английский

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Pain Management Education for Rural Hospice Family Caregivers: A Pilot Study With Embedded Implementation Evaluation

American Journal of Hospice and Palliative Medicine®, Journal Year: 2023, Volume and Issue: 41(6), P. 619 - 633

Published: July 25, 2023

Background Assessing and managing hospice patients’ pain is a common source of anxiety among family caregivers (HFCGs), especially in rural communities who face special challenges including distance, limited access, concerns about opioid misuse. Objective To pilot test Ready2Care, management education intervention for HFCGs. We sought to determine whether there was signal benefit clinically-relevant outcomes identify contextual factors pertinent conducting future randomized clinical trial Ready2Care. Methods conducted multi-method, single-arm study, enabling completion paired t-tests comparing pre- post-intervention measures caregiver anxiety, self-efficacy, barriers management, reports patient intensity corresponding distress. concurrently an embedded implementation evaluation via calculation descriptive statistics (recruitment retention data) directed content analysis brief interviews. Results Twenty-seven (n = 27) HFCGs participated; 15 completed the study. Among completers, significant improvement observed (average 1.4 points decrease on 0-10 scale) overall experience. No statistically changes were detected or self-efficacy. Facilitators successful conduct included high acceptability driven by its perceived clarity relevance caregivers’ concerns. Barriers lower-than-anticipated accrual attrition rate nearly 44%. Conclusion A multisite Ready2Care warranted; however, success may require more effective recruitment strategies participants.

Language: Английский

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Adapting Dementia Care Management to a Regional German Context: Assessment of Changes in Acceptability, Appropriateness, and Feasibility

Journal of Applied Gerontology, Journal Year: 2024, Volume and Issue: unknown

Published: June 5, 2024

Dementia care management, an evidence-based concept in Germany, optimizes for people with dementia and their caregivers. Implemented by qualified professionals, it comprises intervention modules addressing treatment care, medication caregiver support. Positively evaluated one federal state, it’s recommended nationwide integration into routine care. Since the infrastructure of German healthcare system differs regionally, underwent adaption regional implementation a participatory, iterative process. Five local experts as co-researchers tested adjusted selected components pilot study. This trend analysis aims to assess adapted acceptance, appropriateness, feasibility. A total 89 were over 18 weeks, co-researcher’s assessment was gathered through accompanying online survey. The participatory process itself rated positively overall, but technical problems had negative impact on evaluation concept.

Language: Английский

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Evaluating the use of participatory action research to implement evidence‐based guidance on dementia palliative care in long‐term care settings: A creative hermeneutic analysis

International Journal of Older People Nursing, Journal Year: 2022, Volume and Issue: 17(5)

Published: March 31, 2022

Dementia affects a large proportion of society and places significant burden on older people healthcare systems internationally. Managing symptoms at the end life for with dementia is complex. Participatory action research can offer an approach that helps to encourage implementation evidence-based practices in long-term care settings.Three guidance documents (pain assessment management, medication nutrition hydration management) were introduced three settings people. Data generated from work-based learning groups analysed using critical hermeneutic explore use participatory support these settings.Engagement Facilitation emerged as key factors which both enabled hindered PAR processes each study site.This adds body knowledge emphasises value enabling practice change. It further identifies development approaches are necessary enable occur dementia. The highlights need ensure dedicated attention paid strategies facilitate transformations clinical practice.

Language: Английский

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Using the Consolidated Framework for Implementation Research to Foster the Adoption of a New Dementia Education Game During the COVID-19 Pandemic

The Gerontologist, Journal Year: 2022, Volume and Issue: 63(3), P. 467 - 477

Published: Aug. 31, 2022

The pandemic of coronavirus disease 2019 challenged educators to move staff education online and explore innovative ways motivate learning support dementia care for patients in geriatric settings. This article presents how the Consolidated Framework Implementation Research (CFIR) was used adoption an game Canadian hospitals long-term homes (LTC). codeveloped with local patient partners teach practical person-centered communication techniques. CFIR guided our strategy development overcoming barriers implementation. meetings were conducted practice leaders, frontline health workers, a partner. Our analysis examined 4 interactive domains: intervention, inner context, outer settings, individuals involved implementation process. identified 5 effective strategies: Easy access, Give extrinsic intrinsic rewards, Apply science theory, Multiple tools, Engagement champion. provided systematic process, comprehensive understanding barriers, possible enabling strategies implement gamified education. Interdisciplinary (n = 3,025) 10 LTC played games. evaluation showed positive outcomes knowledge improvement care. Gamified offers social experience component fun promote adoption. In addition, is useful engaging stakeholders conduct project planning team reflection real-time discussion adjustment helped overcome challenges timely meet needs multiple organizations.

Language: Английский

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Nurses Barriers to Evidence-Based Practice in Palliative Care: A Systematic Review

SAGE Open Nursing, Journal Year: 2022, Volume and Issue: 8

Published: Jan. 1, 2022

Research shows low evidence-based practice (EBP) uptake among palliative care nurses, a global concern because the demand for services is rising, raising urgent need to improve healthcare quality. Promoting EBP in can This systematic review investigated nurses' barriers implementation care.PubMed, MEDLINE, CINHAL, and Google Scholar were used identify seven articles. Articles included if they published within past 10 years (English only) care.Four identified: (a) time resource constraints, (b) lack of readiness organizational change, (c) negative attitudes toward care, (d) process-specific difficulties.This review's findings inform policy changes care.

Language: Английский

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Participatory development and implementation of a dementia care pathway with intervention bundles in acute care during the coronavirus pandemic: A process evaluation study

Journal of Clinical Nursing, Journal Year: 2023, Volume and Issue: 32(19-20), P. 7193 - 7208

Published: June 15, 2023

Abstract Aims To explore the implementation of a dementia care pathway in an acute setting. Background Dementia settings is often constrained by contextual factors. We developed evidence‐based with intervention bundles, and implemented it on two trauma units, aim to empower staff improve quality care. Design Process evaluation using quantitative qualitative methods. Methods Pre‐implementation, unit completed survey ( n = 72) assessing family skills level Post‐implementation, champions 7) same survey, additional questions acceptability, appropriateness feasibility, participated focus group interview. Data were analysed descriptive statistics content analysis guided Consolidated Framework for Implementation Research (CFIR). Reporting Guideline Standards Qualitative Checklist. Results staff's perceived moderate overall, high ‘building relationships’ ‘sustaining personhood’. Evidence‐based interventions delivered seldom frequent, ‘individualized care’ scoring lowest ‘assessing cognition’ highest. pathway/intervention bundles was overshadowed pandemic, failed due major organisational‐ process‐related barriers. Acceptability scored highest feasibility lowest, concerns relating complexity compatibility pathways/bundles when introduced into clinical routines. Conclusions Our study implies that organisational process factors are most influential determinants settings. Future efforts should draw evolving evidence within science research ensure effective integration improvement process. Relevance Clinical Practice provides important learning around improving persons their families hospitals. Patient or Public Contribution A caregiver involved development education training programme.

Language: Английский

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Ready or Not: A Conceptual Model of Organizational Readiness for Embedded Pragmatic Dementia Research

Research in Gerontological Nursing, Journal Year: 2024, Volume and Issue: 17(3), P. 149 - 160

Published: April 10, 2024

The National Institute on Aging Alzheimer's Disease/Alzheimer's Disease and Related Dementias Research Implementation Milestones emphasize the need for implementation research that maximizes up-take scale-up of evidence-based dementia care practices across settings, diverse populations, disease trajectories. Organizational readiness is a salient consideration when planning conducting embedded pragmatic trials, in which interventions are implemented by provider staff. current article examines conceptual theoretical underpinnings organizational operationalization this construct. We offer preliminary model explicating measuring describe unique characteristics demands implementing targeting persons with and/or their partners. [

Language: Английский

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Development and validation of clinical implementation methods for patient-reported outcomes in Japanese multi-center palliative care units

Journal of Patient-Reported Outcomes, Journal Year: 2024, Volume and Issue: 8(1)

Published: May 14, 2024

Abstract Background Patient-Reported Outcomes (PROs) are recommended for use in clinical oncology. However, they not routinely used professional palliative care practices Japan. The reasons include both patient and healthcare provider factors the implementation of PROs. This study aimed to develop validate methods PROs Japanese units. Methods Consolidated Framework Implementation Research (CFIR) was conducted with four units six steps: unit assessment, development a PRO plan, post-implementation survey analysis its utilization, review process, creation method unit, verification method. Steps 1–5 were phase, step 6 phase. Results Interviews providers prior implementation. Intervention characteristics, needs related organization identified as barriers. plan developed, core members selected. procedures created above mentioned steps. same true validation Conclusions guided specialized setting. developed validated unit. In it important assess address barriers implementation, reduce burden on providers. Furthermore, had be supported by champion, person responsible

Language: Английский

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