Professionals' experiences with implementing integrated palliative care for patients with copd: 'this really adds to the quality of care we provide!'

Background/ aims: In a hybrid type 2 effectiveness-implementation study, healthcare professionals (HCPs) of four hospital regions were trained in identification of palliative patients with COPD, multidimensional assessment, advance care planning (ACP) and care coordination. Subsequently, HCPs implemented these intervention elements in their region. To facilitate future implementation efforts, we examined HCPs' intervention experiences and identified barriers and facilitators. Methods: Semi-structured interviews were held with pulmonologists, COPD-nurses, general practitioners (GPs) and palliative care nurses. Data were inductively coded and analysed using content analysis. Next, barriers and facilitators were mapped to the domains of the Consolidated Framework for Implementation Research. Results: Six HCPs per hospital region (total n=24) participated;Interview duration varied (20 to 85 minutes). Most participants highly valued the intervention, and mentioned that ACP discussions provided patients with peace of mind and clarity, improved the HCP-patient relationship and increased job satisfaction. Collaboration between the hospital and GPs was inadequate in all regions, as judged by both primary care and hospital HCPs. The (satisfaction with the) extent of involvement of palliative care consultants varied. Key barriers identified were related to the inner setting (e.g. insufficient time, low priority due to COVID) and process (e.g. difficulty of engaging stakeholders). Key facilitators were related to the process (e.g. consistently planning of ACP discussions, regular meetings with a small project group) and inner setting (e.g. recognition that ACP is valuable). Conclusions: HCPs express that palliative care for patients with COPD is valuable because of its positive impacts on patients and HCPs. For successful implementation, we recommend to use a process-oriented approach. Further, more work is needed to improve collaboration between hospital and primary care HCPs.