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

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.