Figure 1
Recruitment workflow of ViP.
Table 1
Initial underpinning program theories.
| IPT | IF | THEN | OUTCOME |
|---|---|---|---|
| 1 | If generalist nurses and doctors are trained with palliative care knowledge | Generalists will feel more confident in identifying cases and providing home PC | High acceptance, adoption and implementation fidelity of ViP |
| 2 | If advance care planning is conducted to support patients and caregivers in making informed decision related to care | Providers, patients and carers feel better prepared as there is an alignment for care at the end-of- life | High proportion of preferences honored at the end-of-life |
| 3 | If family carers are provided appropriate training and access to assistance to care for their loved ones at home | Carers will gain more confidence and feel more assured to provide care at home | Reduced caregiver burden and reduced acute hospital utilization |
| 4 | If a multidisciplinary team collaborate well through regular multidisciplinary meetings and open communication | Providers will work better with each other as they can trust each other to provide best care for patients and feel motivated to work towards a common goal of care | Adequate symptom management and appropriate coordination of services leading to reduced acute hospital utilization and healthcare cost |
| 5 | If guidelines and processes for provision of care under ViP is streamlined and implemented with high fidelity | Providers will be motivated to refer and participate in the provision of care with the common aim of providing best care for patients | Good quality of care |
| 6 | If there is sufficient support from key management and funding | Providers will feel supported and assured of the prospect of the program | Longer term sustainability |
[i] IPT: Initial program theory.
Figure 2
Realist Evaluation Phases of ViP.
Table 2
Data Framework for Data Collection.
| IPT | CONTEXT | MECHANISM | OUTCOME | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| INDICATORS | DATA SOURCE | MEASUREMENT MOMENT | INDICATORS | DATA SOURCE | MEASUREMENT MOMENT | SAMPLE SIZE | INDICATORS | DATA SOURCE | MEASUREMENT MOMENT | SAMPLE SIZE | |
| 1 | No. of generalist nurses and doctors who are trained with palliative care knowledge | Administrative database | Quarterly for the first 2 years of the programme | Confidence of generalists who were trained and completed training for ViP | Interviews with healthcare providers | At least 6 months after program implementation | 15/group | Perception among implementation stakeholders (providers and users) about the acceptability of the program | Interviews with healthcare providers & users | At least 6 months after program implementation | 15/group |
| Program acceptance rate (% of participants correctly identified in reference to all referrals) | Administrative database | Quarterly for the first 2 years of programme | Enrolees in year 1 and 2 | ||||||||
| Dropout rate (% of eligible participants who were initially enrolled but withdrew from the programme) | |||||||||||
| Timeliness of care (% of patients with their palliative care commence within 2 days after when they are deemed to be “ready for care”) | |||||||||||
| Responsiveness to urgent needs (% of patients unstable for ≤ 3 days) | |||||||||||
| 2 | % of enrolled patients with ACP reviewed or completed | Quarterly for the first 2 years of the programme | Patients’ and/or caregivers’ experience with ViP | Interviews with caregivers | At least 2 encounters with ViP team and <3 months after patient died | Concordance between documented treatment preference and actual treatment and place of death | At death | ||||
| 3 | % of needy patients who were provided support | Administrative database & interviews with caregivers | Quarterly for the first 2 years of the programme | Change in caregiver burden score before and after intervention | Zarit Burden Interview-12 | Baseline (at enrolment) and every 3 months after enrolmentuntil patients’ death | |||||
| No. of ED attendances, in-patient admission and length of stay (LOS) | Administrative databases | 1 month (30 days), 3 months (90 days) and 6 months (180 days) prior to death | |||||||||
| % of patients with good management of symptoms | PCOC – symptoms assessment | ||||||||||
| 4 | % of cases discussed in the MDM (multidisciplinary meetings) | Administrative database | Providers’ working experience | Interviews with providers | At least 6 months after program implementation | Development costs, program implementation costs and healthcare utilization costs | Administrative database | 6 months prior to death | |||
| Quality of collaborative and communications between providers | Interviews with providers | Average duration in each PCOC stage | 1 month (30 days), 3 months (90 days) and 6 months (180 days) prior to death | ||||||||
| 5 | Implementation experience | Interviews with providers | At least 6 months after program implementation | Perceived quality of care | Mortality follow-back survey | ≤3 months after death | |||||
| 6 | Extent of support from management | Sustainability | Clinical Sustainability Assessment Tool (CSAT) | At least 6 months after program implementation | |||||||