Background Implementation of a comprehensive advance care planning (ACP) intervention package offered to nursing homes (NH) as part of a cluster-randomized trial (BEVOR) during the Covid-19 pandemic led to intensified efforts of the study team comprising ACP facilitators and trainers to improve take-up and adherence to intervention schedules. Analyzing institution-level barriers as well as enabling factors from the perspective of the study team aims to provide insights how to strengthen capacities of researchers and practitioners working towards organizational development and systems change.
Methods A qualitative approach drawing on data from documents containing guided structured self-reflection of the study team and notes from moderated case discussions with high-expertise ACP trainers and an professional organisation developer, using the framework analysis method to derive themes and compare patterns across the NHs participating in the study, pertaining to 3 experiential spaces (‘person’ ‘ACP facilitator’ and ‘NH’).
Results The structured self-reflection and intensive exchange supported the ability of the study team to deal with challenges during implementation. Preliminary results indicate emotional challenges e.g. feelings of rejection when access to NH staff and time resources is blocked, and stress due to time pressure (personal). Investment of single NH staff members to remove barriers such as mistrust or fear encapsulated feelings of encouragement (personal, ACP facilitator). Institution-level enablers and barriers (NH), such as the extent of commitment and initiative of NH staff and management or treating physicians’ investment, exposed a high temporal dynamic and unpredictability, e.g. sudden withdrawal or pick-up of commitment following changes in NH management.
Conclusion In depth-reflection and analysis, contextualizing experiences and practices, is a valuable resource during the ACP implementation to enhance intervention uptake in a trial or project context. Importantly, its collective character can help to refocus on the mutual goal of creating change as core driver and motivation for the work.
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