Complexity of implementing a nationwide advance care planning program: results from a qualitative evaluation.
Background We evaluated Singapore's national advance care planning (ACP) program to understand challenges to its implementation within multiple clinical settings. Methods We conducted focus group discussions (FGDs) with a purposive sample of health care professionals (HCPs) involved in ACP program d...
| Publicado en: | Age & Ageing Vol. 51; no. 10; pp. 1 - 11 |
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| Autores principales: | , |
| Formato: | Artículo |
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Oxford University Press / USA
Oct2022
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ssf&AN=159980083&site=ehost-live header: @attributes: shortDbName: ssf uiTerm: 159980083 longDbName: Social Sciences Full Text (H.W. Wilson) uiTag: AN controlInfo: bkinfo: jinfo: jid: 00020729 AGA jtl: Age & Ageing issn: 00020729 maglogo: N pubinfo: dt: Oct2022 vid: 51 iid: 10 pid: 622 pub: Oxford University Press / USA artinfo: ui: 159980083 10.1093/ageing/afac224 ppf: 1 ppct: 10 formats: tig: atl: Complexity of implementing a nationwide advance care planning program: results from a qualitative evaluation. aug: au: Malhotra, Chetna Ramakrishnan, Chandrika affil: Lien Centre for Palliative Care, Duke-NUS Medical School , Singapore 169857 Program in Health Services and Systems Research, Duke-NUS Medical School , Singapore 169857 su: Focus groups Advance directives (Medical care) Human services programs Qualitative research Commitment (Psychology) Corporate culture Conceptual structures Judgment sampling Thematic analysis sug: subj: Focus groups Advance directives (Medical care) Human services programs Qualitative research Commitment (Psychology) Corporate culture Conceptual structures Judgment sampling Thematic analysis ab: Background We evaluated Singapore's national advance care planning (ACP) program to understand challenges to its implementation within multiple clinical settings. Methods We conducted focus group discussions (FGDs) with a purposive sample of health care professionals (HCPs) involved in ACP program delivery within acute care hospitals, primary care clinics and nursing homes. FGDs were stratified into three categories based on HCPs' role within the ACP framework—leaders versus facilitators and advocates versus nursing home heads. Using NVivo 11, we analysed data using thematic analysis and Conceptual Framework for Implementation Research. Results A total of 107 HCPs from 25 organisations participated in 22 FGDs. Findings revealed wide variation in ACP implementation among organisations and identified 12 themes organized within four domains—outer setting (lack of public awareness, shortcomings in inter-organisational partnerships, performance driven policies), inner setting (lack of commitment from organisational leadership, paucity of dedicated resources, absence of an institution-wide ACP culture, lack of physician engagement), characteristics of HCPs (language barriers) and process (inadequate training, complexity of conversations and documentations, challenges to retrieving ACP documents, absence of comprehensive monitoring and evaluation). Conclusion ACP program implementation is complex and faces multiple health care system challenges. To integrate ACP within routine clinical care, ACP processes should be simplified, training framework be strengthened, physicians be engaged and an ACP supportive culture be created within and outside organisations. Findings will be used to guide ACP implementation within the country and globally. pubtype: Academic Journal doctype: Article src: R language: English refInfo: copyright: @attributes: flag: N holdings: @attributes: islocal: N |
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