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Using an implementation science approach to enhance advance care planning practice: a community case study.

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Developing a national quality practice guideline for advance care planning (ACP) involved engaging stakeholders to address implementation barriers. This iterative process, using the Knowledge-to-Action model, aimed to improve ACP uptake and completion rates.

Keywords:
advance care planningimplementation scienceknowledge to actionknowledge translationquality frameworkstakeholder engagement

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Area of Science:

  • Healthcare quality improvement
  • Implementation science
  • Public health policy

Background:

  • Advance care planning (ACP) is crucial for end-of-life decision-making, but low uptake and completion rates persist.
  • Nationwide studies in Singapore revealed significant gaps and barriers to ACP implementation across practice settings.

Purpose of the Study:

  • To describe the stakeholder engagement and guideline development process for a national quality practice guideline for ACP implementation.
  • To outline a novel approach for formulating national guidelines using a multi-level partnership and the Knowledge-to-Action model.

Main Methods:

  • Convened a knowledge exchange platform with a multi-level partnership to form a workgroup.
  • Engaged key knowledge users (ACP implementers) throughout the Knowledge-to-Action (KTA) cycle, including an e-survey to prioritize barriers.
  • Linked prioritized barriers (mapped to the Theoretical Domains Framework) with intervention functions and implementation strategies, contextualized for local application.
  • Piloted implementation strategies with ACP teams to facilitate quality ACP implementation.

Main Results:

  • A quality practice guideline for ACP implementation was developed through an iterative, multi-level partnership approach.
  • The process successfully translated evidence and addressed identified barriers to ACP.
  • Pilot studies provided insights into facilitating quality ACP implementation.

Conclusions:

  • The Knowledge-to-Action (KTA) model facilitated the iterative development of a national quality practice guideline for ACP.
  • This multi-level partnership approach offers a novel framework for guideline development with transferable lessons for similar initiatives.
  • The developed guideline and process aim to improve ACP uptake and quality of end-of-life care.