Understanding implementation strategies to support the delivery of palliative care in long term care facilities (LTCFs): a scoping review from the PACE study.

Background: The number of older people dying in long-term care facilities (LTCFs) is increasing and represents a public health challenge. Palliative care provision can be poor. Interventions to improve palliative care in LTCFs have been shown to be effective but little is known about their implementation. The aim of this review is to identify facilitators and barriers to implementing palliative care interventions in LTCFs and to describe the nature of implementation strategies Methods: A scoping review was undertaken: electronic databases including MEDLINE, EMBASE, PsycINFO, CINAHL, Proquest, the Cochrane Library and Web of Science were searched to identify studies published between January 2007 and January 2018. Controlled studies, non-controlled studies, qualitative studies and evaluations on the implementation of interventions to improve palliative care in long-term care facilities were included. Studies that met the inclusion criteria were selected and data extracted on key variables including, the implementation of the intervention and reported facilitators and barriers to implementation. Results: The review identified 8,071 abstracts, from which 55 studies were included in the review. Implementation strategies varied in four areas; internal and external facilitation, intended audience, extent of joint working and delivery of education/training. Support from managers, stakeholder involvement, flexibility in delivery of the intervention and adopting a ‘whole home’ approach to involvement were facilitators to implementation. High staff turnover, lack of physician involvement and failure to adopt changes into routine practice were identified as barriers to implementation. Conclusion: Limited implementation of interventions may lead to inequalities in palliative care among older adults who may benefit from it. The characteristics of palliative care interventions compared to their implementation can be difficult to separate and are often underreported. Further research is needed to understand the extent to which implementation can facilitate the uptake of palliative care interventions in long-term care facilities