Formative Evaluation of a Multi-Component, Education-Based Intervention to Improve Processes of End-of-Life Care

Abstract

A multicomponent, palliative care, education-based intervention was implemented in six Veterans Affairs Medical Centers in the southeast United States. The intervention comprised onsite staff training plus supporting written materials, installation of an electronic order set, and follow-up consultations. Training included large-group didactic presentations, small-group clinical demonstrations, and one-on-one consultations. The intervention strategy was targeted broadly to hundreds of hospital providers, including physician, nursing, and ancillary staff. The purpose was to train staff in identifying actively dying patients and implementing best practices of home-based hospice care. A formative evaluation was conducted utilizing semistructured telephone interviews with key informants from each site. Qualitative data analysis revealed processes that facilitated or impeded uptake of the intervention. Results will be used to inform ongoing and future clinical initiatives and optimize future implementation of education-based interventions to improve adoption of best practices for end-of-life care within acute care settings.

Keywords:

• end-of-life care
• hospice
• implementation
• inpatient
• palliative care

ACKNOWLEDGMENTS

The authors thank the participating VA Medical Centers and their site principal investigators, palliative care teams, and chaplains for their roles in implementing the BEACON trial: Anna D. Senseney, MD, and John Painter, PhD (site principal investigators), Karen Lukacs, RN, APN, and the palliative care team at the Ralph H. Johnson VAMC, Charleston, SC; Theodore M. Johnson II, MD, MPH (site principal investigator), Adam Herman, MD, Orania Tigaieru, MD, Donna Lewis, CRNP, and the palliative care team at the Atlanta VAMC, Atlanta, GA; Kathlyn Sue Haddock, RN, PhD (site principal investigator), Debra Layer, CRNP, and the palliative care team at the William Jennings Bryan Dorn VAMC, Columbia, SC; Thomas Hartney, MD (site principal investigator), Michael Willoughby, MD, and the palliative care team at the Charlie Norwood VAMC, Augusta GA; Leslie Pennypacker, MD (site principal investigator), and the palliative care team at the Malcom Randall VAMC, Gainesville, FL; and Jessie Spencer, MD (site principal investigator), and the palliative care team at the G. V. Sonny Montgomery VAMC, Jackson, MS.

This article not subject to U.S. copyright law.