The implementation of guidelines in palliative care - a scoping review

Area of Science:

• Healthcare Management
• Clinical Practice Guidelines
• Palliative Care Research

Background:

• Healthcare guidelines are crucial for quality care but often face implementation challenges.
• The practical application of palliative care guidelines and associated barriers/facilitators are not well understood.

Purpose of the Study:

• To systematically review global literature on palliative care guideline implementation.
• To identify factors supporting or hindering the implementation of palliative care guidelines worldwide.

Main Methods:

• A comprehensive scoping review was conducted using Arksey and O'Malley's (2005) methodology.
• Searches were performed across CINAHL, LIVIO, PubMed, and Web of Science Core Collection databases.
• Article selection and data categorization were performed independently by two researchers, utilizing Petermann's (2014) taxonomy of implementation outcomes.

Main Results:

• 29 articles were included in the final analysis, identifying six implementation outcomes: acceptability, adoption, appropriateness, feasibility, fidelity/adherence, and penetration.
• Quantitative approaches dominated the studies (n=22), primarily focusing on healthcare professionals' perspectives.
• Facilitators included professional motivation and managerial support; barriers comprised time constraints and limited knowledge. Patient and caregiver perspectives were underrepresented.

Conclusions:

• Palliative care guideline implementation demonstrates significant variability.
• Future research should explore facilitators and barriers using mixed-method approaches and consider diverse implementation outcomes.
• A comprehensive analysis is needed to improve guideline adherence and patient outcomes in palliative care.