Table 2.
Quantitative and qualitative evaluation of the feasibility of implementing and sustaining the Care Progamme for the Last Days of Life in the geriatric ward of Ghent University Hospital
| Component | Quantitative evaluation using the process evaluation tool | Perceived difficultiesa among staff in implementing the Care Programmeb | ||
|---|---|---|---|---|
| Indicator | Standard | Outcome | ||
| 1. Establishing the implementation project and preparing the environment | (1) Proportion of health care staff informed about implementation project (%)c | 100 % | 37 % (23/62) | ▪ Limited time to establish the implementation project, e.g. composition of steering group with facilitators ▪ Information momentd was organized too early ▪ Information moment did not reach all geriatric health care staff (1) ▪ Content of the 2 day intensive training is not yet fully adjusted to geriatric hospital setting |
| (2) Executive endorsement: management approval for organization training and audits | Yes | Yes | ||
| (3) Composition of steering group | 2 nurses 1 physician 1 PST membere |
2 nurses 1 physician 1 PST member |
||
| (4) Facilitators: Number Function |
≥2 nurse & physician |
2 nurse & physician |
||
| (5) Attendance at the 2 day intensive training by 2 facilitators | Yes | Yes | ||
| 2. Preparing the documentation | (6) Development of information leaflet concerning the facilities on the geriatric ward | Yes | Yes | |
| 3. Baseline reviewf | (7) Retrospective evaluation of medical/nursing files of deceased patients | Yes | Yes | ▪ Feedback of results to health care staff more feasible if incorporated in training sessions |
| (8) Feedback of results to staff | Yes | Yes | ||
| 4. Training health care staff on the geriatric ward | (9) Training health care staff | ▪ Only feasible if training content is well prepared by steering group ▪ Documents for training health care staff need adaptations (i.e. hand-outs, geriatric casus, manual for using the Care Guide for the Last Days of Lifeg) ▪ Care Guide needs adaptations |
||
| Duration (minutes per edition) | ≥90 min | 120 min | ||
| Editions (No.) | ≥2 editions | 2 editions | ||
| Nurses involved (%) | 100 % | 67 % (26/39) | ||
| Physicians involved (%) | 100 % | 25 % (1/4) | ||
| 5. Use of the Care Guide for the Last Days of Life with intensive support | (10) Introduction of the Care Guide on the ward | Yes | Yes | ▪ Training sessions dit not reach enough physicians (9) ▪ No audit was organized (11) ▪ Physicians are hesitant to initiate or use the Care Guide ▪ The term ‘care goal’ lead to misinterpretations and is perceived as being too coercive |
| (11) Clinical audit | ||||
| Organized Nurses involved (%) Physicians involved (%) |
Yes 100 % 100 % |
No No audit organized No audit organized |
||
| 6. Use of the Care Guide with semi-intensive support | (12) Clinical audit | ▪ Low attendance of health care staff during audit (12) ▪ Diagnosing dying is difficult ▪ Physicians are hesitant to initiate or use the Care Guide ▪ Nurses are too scared of taking responsibility ▪ The term ‘care goal’ is perceived as being too coercive ▪ High workload with double registration |
||
| Organized Nurses involved (%) Physicians involved (%) |
Yes 100 % 100 % |
Yes 20 % (9/39) 25 % (1/4) |
||
| 7. Evaluationh | (13) Qualitative evaluation of the implementation | Yes | Yes | |
| 8. Consolidation | (14) Clinical audit | ▪ Low attendance of health care staff during second audit (14) ▪ Diagnosing dying is difficult ▪ Physicians are hesitant to initiate or use the Care Guide ▪ Continuing support by all steering group members is important (one nurse of the ward is not sufficient) |
||
| Organized Nurses involved (%) Physicians involved (%) |
Yes 100 % 100 % |
Yes 26 % (10/39) 0 % (0/4) |
||
| (15) Proportion of dying patients cared for according to Care Guide during the implementation period (from component 5–8) (%) | ≥50 %i | 57.9 % (11/19) | ||
| 9. Use of the Care Guide with ongoing education, training and support | (16) Care Guide still in use on the ward after 1 year | Yes | Yes | The researcher only followed up during the implementation period |
| (17) Proportion of dying patients cared for according to Care Guide during the 6 months after completion of implemention period | ≥50 % | 56.7 % (17/30) | ||
aPerceived difficulties that emerged from the qualitative evaluation
bIn the further course of this table we used ‘Care Programme’ for the complete term ‘Care Programme for the Last Days of Life’
cHealth care staff refers to all health carers involved in care on the acute geriatric hospital ward, i.e. nurse, nursing aide, psychologist, physiotherapist, physician, etc
dDuring the information moment, the steering group aims to inform health care staff about the implementation project
eOne health carer of the Palliative Support Team (PST) should be member of the steering group
fTo highlight and reinforce the need for change within the ward, the care during the last days of life was retrospectively evaluated by reviewing the medical and nursing files
gIn the further course of this table we used ‘Care Guide’ for the complete term ‘Care Guide for the Last Days of Life’
hThe steering group needs to qualitatively evaluate and discuss the performance and progress of each of the previous components in order to identify staff’s training needs and barriers for the use of the Care Guide for the Last Days of Life and provision of optimum end-of-life care
iBased on the results of a study performed in the UK and the Netherlands