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Barriers to and facilitators for implementing quality improvements in palliative care – results from a qualitative interview study in Norway

Overview of attention for article published in BMC Palliative Care, July 2016
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Title
Barriers to and facilitators for implementing quality improvements in palliative care – results from a qualitative interview study in Norway
Published in
BMC Palliative Care, July 2016
DOI 10.1186/s12904-016-0132-5
Pubmed ID
Authors

Ragni Sommerbakk, Dagny Faksvåg Haugen, Aksel Tjora, Stein Kaasa, Marianne Jensen Hjermstad

Abstract

Implementation of quality improvements in palliative care (PC) is challenging, and detailed knowledge about factors that may facilitate or hinder implementation is essential for success. One part of the EU-funded IMPACT project (IMplementation of quality indicators in PAlliative Care sTudy) aiming to increase the knowledge base, was to conduct national studies in PC services. This study aims to identify factors perceived as barriers or facilitators for improving PC in cancer and dementia settings in Norway. Individual, dual-participant and focus group interviews were conducted with 20 employees working in different health care services in Norway: two hospitals, one nursing home, and two local medical centers. Thematic analysis with a combined inductive and theoretical approach was applied. Barriers and facilitators were connected to (1) the innovation (e.g. credibility, advantage, accessibility, attractiveness); (2) the individual professional (e.g. motivation, PC expertise, confidence); (3) the patient (e.g. compliance); (4) the social context (e.g. leadership, culture of change, face-to-face contact); (5) the organizational context (e.g. resources, structures/facilities, expertise); (6) the political and economic context (e.g. policy, legislation, financial arrangements) and (7) the implementation strategy (e.g. educational, meetings, reminders). Four barriers that were particular to PC were identified: the poor general condition of patients in need of PC, symptom assessment tools that were not validated in all patient groups, lack of PC expertise and changes perceived to be at odds with staff's philosophy of care. When planning an improvement project in PC, services should pay particular attention to factors associated with their chosen implementation strategy. Leaders should also involve staff early in the improvement process, ensure that they have the necessary training in PC and that the change is consistent with the staff's philosophy of care. An important consideration when implementing a symptom assessment tool is whether or not the tool has been validated for the relevant patient group, and to what degree patients need to be involved when using the tool.

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Mendeley readers

Mendeley readers

The data shown below were compiled from readership statistics for 315 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Unknown 315 100%

Demographic breakdown

Readers by professional status Count As %
Student > Master 56 18%
Student > Ph. D. Student 33 10%
Student > Bachelor 28 9%
Student > Doctoral Student 25 8%
Researcher 24 8%
Other 72 23%
Unknown 77 24%
Readers by discipline Count As %
Nursing and Health Professions 74 23%
Medicine and Dentistry 66 21%
Psychology 17 5%
Business, Management and Accounting 13 4%
Social Sciences 13 4%
Other 37 12%
Unknown 95 30%
Attention Score in Context

Attention Score in Context

This research output has an Altmetric Attention Score of 1. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 17 July 2016.
All research outputs
#20,335,770
of 22,880,691 outputs
Outputs from BMC Palliative Care
#1,239
of 1,255 outputs
Outputs of similar age
#310,050
of 355,956 outputs
Outputs of similar age from BMC Palliative Care
#28
of 28 outputs
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We're also able to compare this research output to 28 others from the same source and published within six weeks on either side of this one. This one is in the 1st percentile – i.e., 1% of its contemporaries scored the same or lower than it.