Integrating early palliative care: Qualitative results from a multi-site implementation trial

Area of Science:

• Oncology
• Palliative Care
• Health Services Research

Background:

• Evidence supports early palliative care (EPC) benefits for cancer patients.
• Consistent translation of EPC into routine clinical practice remains a challenge.
• Effective implementation strategies are crucial for advancing EPC.

Purpose of the Study:

• To identify and understand implementation strategies perceived as effective for delivering EPC to cancer patients.
• To explore barriers and facilitators to EPC implementation.

Main Methods:

• A multi-site stepped-wedge implementation trial of the 'Care Plus' EPC model.
• Qualitative data collection through interviews with patients, caregivers, and healthcare providers.
• Analysis using a combined thematic inductive and theoretical deductive approach, guided by the RE-AIM framework.

Main Results:

• Fifty-one interviews were conducted with patients, caregivers, and diverse healthcare providers.
• Effective strategies included clinician-endorsed referral triggers, systematic patient identification, and integrated referral workflows.
• Other successful strategies involved 'Care Plus' branding, mentored training, clinician feedback, and co-located clinics.

Conclusions:

• Identified strategies are replicable and can support broader implementation of early palliative care.
• These findings offer practical solutions for overcoming barriers to EPC delivery in oncology settings.