Lack of integration, staff burden or time constraints as barriers to the implementation of an early palliative care intervention.

Introduction: Early palliative care (PC) has proven to be effective on improving patients' quality of life and symptoms control. However, most of the research has been focused on oncological patients. In this sense, the InAdvance project (825750) addresses early PC among older patients with non-malignant diseases. A needs assessment (NAT:PD) intervention is being performed under a clinical trial in four European sites (ISRCTN24825698): Valencia-Spain, Thessaloniki-Greece, Lisbon-Portugal and Highland-Scotland. The aim of this study is to explore the acceptability, feasibility and attitudes of key health and care professionals (HCPs) around the implementation of the NAT:PD. Methods: HCPs involved in the implementation of the NAT:PD intervention participated in this qualitative study through individual interviews or focus groups. The interview guide was designed using the Consolidated Framework for Implementation Research (CFIR), which is a robust model for systematically assessing potential barriers and facilitators in preparation for the implementation of an intervention. Data was analysed using grounded theory. Results: 29 HCPs participated in this study, which were mostly women (62%) and the average age was 42.6 years. All respondents replied positively to the implementation of the NAT:PD intervention in their settings. All considered it as useful and necessary to improve their work with chronically ill patients to timely detect their needs in a systematic manner. Some sites already had resources or services that the intervention could be aligned with and for others the NAT:PD would be a notable resource to fill gaps in their current work. Lack of integration with other services and multidisciplinary professionals - such as primary care or psychologists - was detected as a relevant concern. Also, all HCPs highlighted potential time constraints and fatigue due to COVID19 pandemic as barriers as most of the participants felt exhausted after these complicated months. However, most of them expressed enthusiasm with this new intervention as it was considered of great relevance for their units and patients. Conclusions: In general, the four sites considered the early intervention as relevant to address the needs of their patients and also as an asset to reinforce their current resources. However, there were significant differences between sites in the level of information provided and the detail on implementation plans that HCPs disposed to run the trial. Additionally, addressing the needs detected under the NAT:PD require integrated, comprehensive and continuity care throughout the whole care system and with the involvement of multidisciplinary and multilevel services. Implications for transferability, sustainability and limitations: We recommend that clear and detailed materials and trainings are offered to those HCPs in charge of the implementation of NAT:PD that can increase their confidence and decrease anxiety. Also, it is crucial to have proper connections and alliances with different health and care services and stakeholders to make effective referrals of patients in accordance to their needs. [ABSTRACT FROM AUTHOR]