Supporting family members in their relative’s transition from hospital to home for end of life care - A participatory learning and action (PLA) study to design and implement an evidence based brief intervention in hospital palliative care practice and to assess its usability and acceptability

Duke, Susan, Campling, Natasha, Lund, Susan, Richardson, Alison, May, Carl R., Lunt, Neil and Firth, Pam (2018) Supporting family members in their relative’s transition from hospital to home for end of life care - A participatory learning and action (PLA) study to design and implement an evidence based brief intervention in hospital palliative care practice and to assess its usability and acceptability. Palliative Medicine, 32 (1S), 72.

Abstract

Aim: The transition from hospital to home for end of life care (eolc) is an
emotive time for family members, characterised by growing understanding that their relative is dying, getting things ready for discharge and continuing to provide support in hospital. This study aimed to implement
established research evidence to support family members during this time
and to assess its use in practice.
Methods: The research employed Participatory Learning and Action
(PLA) methodology, underpinned by a validated implementation theory,
Normalization Process Theory (NPT). Each PLA cycle addressed a NPT
implementation phase. Initial PLA cycles theoretically modelled a brief
intervention from active components of tested support interventions, identified from systematic reviews and meta-analysis. In later cycles, a training package was developed to support the resulting short, structured
conversation. Both were clinically piloted with hospital palliative care
teams in 3 acute hospital sites and rolled out to 7 additional sites, purposefully selected to include hospitals serving diverse populations. Qualitative
data were gathered via reflective discussions with clinicians during and
after implementation and via questionnaires and interviews with family
members who had received the intervention. Data were analysed using
Framework Analysis. We were interested in whether the intervention was
usable in practice and whether it was acceptable to family members.
Results: Practitioners found the intervention easy to adopt and embed in
practice, and that it facilitated family centred conversations about family
discharge concerns. Family members valued the focus on their needs and
found the conversations helped them consider discharge implications and
how to manage their concerns.
Conclusion: This brief intervention is a unique evidence-based contribution to family eolc discharge practice. It is readily adopted into practice
and facilitates family-focused planning for eolc at home.

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Contributors

Author: Susan Duke

Author: Natasha Campling

Author: Alison Richardson

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