Here is the structured PICO analysis for the twenty-fourth article you uploaded:
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Full Title (verbatim and exact):
“Context and mechanisms that enable implementation of specialist palliative care Needs Rounds in care homes: results from a qualitative interview study”
Koerner J, Johnston N, Samara J, Liu W-M, Chapman M, Forbat L
BMC Palliative Care (2021); 20:118
DOI: https://doi.org/10.1186/s12904-021-00812-4
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Type of Article:
Qualitative implementation study (embedded within a stepped-wedge randomised controlled trial)
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PICO Analysis:
Population:
- Residential aged care home (RACF) staff and leadership across 11 care homes in the Australian Capital Territory
- Care homes involved in a larger stepped-wedge RCT on Palliative Care Needs Rounds (n = 12 care homes, 1700 residents total)
- Interview sample included nurses, care assistants, managers, and team leaders
Intervention:
- Specialist Palliative Care Needs Rounds (monthly, hour-long meetings):
- Focused on residents at risk of dying without a care plan
- Facilitated by a specialist palliative care nurse
- Used a structured checklist to guide case-based discussion
- Triggered advance care planning, symptom management, prescribing adjustments, and family case conferences
- Provided case-based education for care home staff
Comparator:
- No direct comparator group in this qualitative sub-study
- Data drawn from the implementation arm of a trial where Needs Rounds had been introduced for 6–8 months
Outcome:
1. Person-centred outcomes:
- Improved quality of death and dying, as perceived by staff
- Enhanced resident dignity, symptom relief, and respect for resident/family preferences (e.g., dying in place)
2. Process outcomes:
- Improved staff preparedness and confidence in delivering end-of-life care
- Strengthened communication within care teams and with families
- Development of clear, shared advance care plans
- Reduction in hospital transfers by aligning care with resident preferences and proactively managing symptoms
- Implementation success linked to:
- Organisational readiness for change
- Leadership engagement
- Staff as local facilitators
- Structured knowledge sharing and documentation strategies
- Shifts in hospital transfer policies (from “send out” to “care in place”)
3. Health system outcomes:
- Staff reported reduced unnecessary hospitalisations
- More consistent use of anticipatory medications
- Higher reliance on in-house care capacity rather than external referrals
- Recognition of resource and policy barriers (e.g., outdated protocols mandating hospital transfers)
Summary Conclusion:
This qualitative study highlights the contextual and operational enablers of implementing Palliative Care Needs Rounds in Australian residential aged care facilities. Needs Rounds supported advance care planning, improved staff confidence, and facilitated better end-of-life outcomes through education and interdisciplinary coordination. The findings offer practical guidance for scaling this model, identifying mechanisms such as team readiness, leadership support, and integrated education as key to success. While outcomes were self-reported, they complement quantitative evidence showing reduced hospital use and improved quality of dying in the parent trial.
Life In The Slower Lane 
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