Table 2 Summary of Key findings across InterACT hospitals in relation to CFIR constructs
CFIR Construct | Hospital X | Hospital Y | Hospital Z |
|---|---|---|---|
Intervention | - Longest time intervention period - Visible alert flag - Fit with existing views about non-beneficial treatment, although concerned about additional workload it could create - SPICT screening tool was seen to be too sensitive by certain clinical teams | - Document containing alert was not used by most clinical teams - Limited perceived advantage of InterACT – clinicians felt they were already able to identify end-of-life patients - Mixed views about the strength of evidence underpinning InterACT and relevance of screening tools | - Shortest intervention period - Poor visibility of response/alert - Screening tools were seen to be appropriate - Difficulty engaging clinical teams |
Individuals | Some clinicians: - Believed they were already proficient at identifying individuals at end-of-life - Questioned sensitivity of the screening tools - Expressed a fear of failing patients if treatment ceased | - Mixed views amongst clinicians about the need for change - Difficulty identifying a site champion | - Differences of opinion amongst clinicians about end-of-life care - ‘Death-denying’ views present amongst some - Perceived lack of educational preparation in end-of-life care - Limited dissemination of audit feedback data beyond the senior clinician |
Inner Setting | - Strong support from the Executive Advisory Group | - Initially had strong senior leadership for the project, but change of staff resulted in reduced engagement of Executive Advisory Group - Loss of Advance Care Planning facilitator and lack of clarity about who was responsible for Advance Care Planning | - Strong leadership engagement and support - Organisational culture supportive of research |
Outer Setting | - COVID-19 delays to implementation affected the momentum - Influence of wider policy changes on delivery of palliative care - New quality standards around palliative care | - COVID-19 delays | - COVID-19 delays Enactment of assisted dying legislation increasing awareness of end-of-life issues - Influence of existing policy and legislation |
Implementation Process | - Paper record system meant auditing took longer, however, visibility of auditors on the wards increased awareness of the intervention - Educational preparation from the research team was good, although may have benefited from refresher sessions - Potential benefit of having an on-site project facilitator | - Support from research team was perceived to be good, although opportunities to raise awareness further were identified, - Challenges in the auditing process | - Well prepared and supported by the research team - Auditing process relatively quick and efficient with electronic record system |
Other | - Awareness building - Role of other health professionals - Value of research opportunities - Sustainability and other cohorts | - Value of pre-existing partnerships - Transferability to other cohorts | - Economic research impact - Sustainability |