Essential elements to implementing the Paramedics Providing Palliative Care at Home Program: An application of the Consolidated Framework for Implementation Research (CFIR)
Authors: Alix JE Carter, Michelle Harrison, Jennifer Kryworuchko, Tjingaita Kekwaletswe, Sabrina T. Wong, Judah Goldstein, Marianne Arab, Grace Warner
Background: Comfort care without transport to hospital was not traditionally a paramedic practice. The novel Paramedics Providing Palliative Care at Home Program includes a new clinical practice guideline, medications, a database to manage and share goals of care, and palliative care training. This study determined essential elements for implementation, scale and spread of this Program.
Methods: Deliberative dialogues, a qualitative method, were held with diverse stakeholders/experts in one province with the Program (Nova Scotia, March 2018) and one without (British Columbia, July 2018). The Consolidated Framework for Implementation Research (CFIR) informed the discussion guide and was used in a framework analysis. Four team members analyzed the data independently; themes were derived by consensus with the broader research team.
Results: CFIR constructs framed several key elements. Inter-sectoral communication is critical but challenged by privacy concerns and the siloed structure of the health system. Locally adapted training is an essential characteristic of the intervention; cost is a factor. A shift in mindset away from traditional paramedic roles is required; this can be facilitated by paramedic champions and a positive implementation climate. Early engagement of diverse stakeholders and planning for sustainability is key.
Conclusion: This framework analysis using CFIR constructs can guide successful scale and spread of the program. The constructs of Outer setting: Cosmopolitanism, Characteristics of the intervention: Adaptability, Inner Setting: Implementation climate, and Processes: Engagement, and Planning, emerged as essential.
About the author:
|Alix Carter is the Medical Director of Research at EHS Nova Scotia and Director, Division of EMS in the Department of Emergency Medicine at Dalhousie University. She is an associate professor and attending emergency physician at Dalhousie University/ QE II Health Science Centre. Alix came to Halifax in the summer of 2008 after completing a Masters of Public Health and a fellowship in Emergency Medical Services at Yale University. Dr Carter completed her Royal College emergency medicine residency at the University of Manitoba and medical school at the University of Western Ontario. Her research interests are in EMS policy and system design, particularly the idea of breaking out of silos and thinking of the system as an integrated whole. Most recently she is the Principal Investigator in a program of research stemming from the Paramedics Providing Palliative Care program.|