Life In The Slower Lane

Here is the standardised PICO analysis for the fifty-second uploaded article:

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Full Title

Strategies for the implementation of palliative care education and organizational interventions in long-term care facilities: A scoping review

Authors: Danni Collingridge Moore, Sheila Payne, Lieve Van den Block, Julie Ling, Katherine Froggatt

Journal: Palliative Medicine, 2020; 34(5):558–570

DOI: 10.1177/0269216319893635

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Type of Study

Scoping review with thematic synthesis, following ENTREQ and PRISMA-ScR guidelines

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PICO Summary

Population (P)

• Older adults living in long-term care facilities (LTCFs) globally (defined as 24/7 residential care settings for older adults)
• Includes nurses, care assistants, managers, and occasionally external providers and families as implementation stakeholders
• Review includes 61 studies (73 papers) from UK (39%), USA/Canada (26%), Europe (18%), Australia/NZ (15%), and China (2%) 

Intervention (I)

• Organisational-level palliative care interventions in LTCFs, including:
  • Designated palliative care units
  • Symptom management models
  • Advance care planning (ACP)
  • Multicomponent interventions (e.g., Gold Standards Framework, Liverpool Care Pathway)
  • Staff education and training programs
• Implementation strategies categorised into four themes:
  1. Facilitation (internal/external, role clarity, support)
  2. Education/training
  3. Internal engagement (staff, managers)
  4. External engagement (GPs, palliative care teams)

Comparison (C)

• No direct control group; the review compares implementation approaches, barriers, and facilitators across studies rather than effectiveness outcomes

Outcomes (O)

Primary outcomes:

• Facilitators and barriers to implementation, grouped into three developmental stages:
  1. Establishing conditions: recognising palliative care needs, management support, stakeholder awareness
  2. Embedding in practice: aligning with existing workflows, whole-home approach, flexible delivery
  3. Sustaining change: ongoing training, facilitator support, integration into routine care 

Findings include:

• 85% of interventions used facilitation, most frequently external (82%)
• 97% included education/training components
• 97% engaged internal LTCF staff; only 11% involved families
• 52% included external clinical partnerships (e.g., with primary care, hospitals)

Common barriers:

• High staff turnover, inconsistent leadership
• Competing demands on time and resources
• Lack of clarity around facilitator roles
• Difficulty translating training into practice
• Low visibility of long-term sustainability strategies 

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Findings Summary

This review highlights that effective implementation of palliative care interventions in LTCFs depends not only on what the intervention is but how it is embedded, supported, and sustained. The authors propose a matrix of implementation strategies across three stages of change, offering a practical framework for future intervention planning.

Key messages:

• Implementation is not one-size-fits-all; strategies must be tailored to facility context and culture
• Facilitators include leadership support, flexible training, and internal champions
• Ongoing reflection and support structures are essential for sustainability
• Reporting of implementation fidelity is inadequate and limits generalisability
• Future interventions should integrate implementation planning from the outset, possibly guided by frameworks like PARiHS and TIDieR

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