Barriers to and facilitators for implementing quality improvements in palliative care - results from a qualitative interview study in Norway

Topic: Risk, prevention and care in population studies

Background Implementation of quality improvements in palliative care (PC) is challenging, and detailed knowledge about factors that may facilitate or hinder implementation is essential for success. One part of the EU-funded IMPACT project (IMplementation of quality indicators in PAlliative Care sTudy) aiming to increase the knowledge base, was to conduct national studies in PC services. This study aims to identify factors perceived as barriers or facilitators for improving PC in cancer and dementia settings in Norway. Methods Individual, dual-participant and focus group interviews were conducted with 20 employees working in different health care services in Norway: two hospitals, one nursing home, and two local medical centers. Thematic analysis with a combined inductive and theoretical approach was applied. Results Barriers and facilitators were connected to (1) the innovation (e.g. credibility, advantage, accessibility, attractiveness); (2) the individual professional (e.g. motivation, PC expertise, confidence); (3) the patient (e.g. compliance); (4) the social context (e.g. leadership, culture of change, face-to-face contact); (5) the organizational context (e.g. resources, structures/facilities, expertise); (6) the political and economic context (e.g. policy, legislation, financial arrangements) and (7) the implementation strategy (e.g. educational, meetings, reminders). Four barriers that were particular to PC were identified: the poor general condition of patients in need of PC, symptom assessment tools that were not validated in all patient groups, lack of PC expertise and changes perceived to be at odds with staff's philosophy of care. Conclusion When planning an improvement project in PC, services should pay particular attention to factors associated with their chosen implementation strategy. Leaders should also involve staff early in the improvement process, ensure that they have the necessary training in PC and that the change is consistent with the staff's philosophy of care. An important consideration when implementing a symptom assessment tool is whether or not the tool has been validated for the relevant patient group, and to what degree patients need to be involved when using the tool.

Key findings

• Results Barriers and facilitators were connected to (1) the innovation (e.g. credibility, advantage, accessibility, attractiveness); (2) the individual professional (e.g. motivation, PC expertise, confidence); (3) the patient (e.g. compliance); (4) the social context (e.g. leadership, culture of change, face-to-face contact); (5) the organizational context (e.g. resources, structures/facilities, expertise); (6) the political and economic context (e.g. policy, legislation, financial arrangements) and (7) the implementation strategy (e.g. educational, meetings, reminders).
• Conclusion When planning an improvement project in PC, services should pay particular attention to factors associated with their chosen implementation strategy.

Study details

• Evidence strengthLow

Read the original

• DOI: 10.1186/s12904-016-0132-5
• PubMed: 27422410
• Original source →

Free copy unknown: no free-copy check has an answer for this record yet. That does not mean it is paywalled.

@article{sommerbakk2016-27422410,
  author  = {Sommerbakk, R. and Haugen, D. F. and Tjora, A. and Kaasa, S. and Hjermstad, M. J.},
  title   = {{Barriers to and facilitators for implementing quality improvements in palliative care - results from a qualitative interview study in Norway}},
  journal = {BMC palliative care},
  year    = {2016},
  doi     = {10.1186/s12904-016-0132-5},
  pmid    = {27422410},
  url     = {https://doi.org/10.1186/s12904-016-0132-5}
}

Related studies in End-of-life care

• Early identification of palliative care needs by family physicians: A qualitative study of barriers and facilitators from the perspective of family physicians, community nurses, and patients Palliative medicine · 2014-06-01 · usefulness score 43/100
• Barriers to the provision of high-quality palliative care for people with dementia in England: a qualitative study of professionals' experiences Health & social care in the community · 2013-12-27 · usefulness score 40/100
• Barriers and facilitators to the receipt of palliative care for people with dementia: the views of medical and nursing staff Palliative medicine · 2011-10-03 · usefulness score 43/100
• Perceived barriers and facilitators in providing palliative care for people with severe dementia: the healthcare professionals' experiences BMC health services research · 2018-09-12 · usefulness score 41/100
• Caregiver-Reported Barriers to Quality End-of-Life Care in Dementia With Lewy Bodies: A Qualitative Analysis The American journal of hospice & palliative care · 2020-01-06 · usefulness score 38/100
• The End of Life With Dementia in Asian Countries: Barriers, Facilitators and a Research Agenda for Advancing a Palliative Approach Journal of the American Geriatrics Society · 2026-01-13 · usefulness score 40/100

Similar studies

• General practitioners' perceptions of the barriers and solutions to good-quality palliative care in dementia 2017 · End-of-life care
• Quality palliative care for cancer and dementia in five European countries: some common challenges 2014 · End-of-life care
• Barriers to palliative care for advanced dementia: a scoping review 2017 · End-of-life care
• Strategies and innovative models for delivering palliative care in nursing homes 2011 · End-of-life care
• Palliative care for the older adult 2007 · End-of-life care
• Barriers to providing end-of-life care for people with dementia: a whole-system qualitative study 2012 · End-of-life care

More on End-of-life care

• A review that covers this ground Barriers and facilitators for GPs in dementia advance care planning: A systematic integrative review PloS one · 2018-06-20 · usefulness score 62/100
• Newest in this subject Patient-Reported Shared Decision-Making and Documented Advance Care Planning Among Adults With Alzheimer’s Disease and Related Dementias medRxiv · 2026-10-19 · Preprint — not yet peer-reviewed · usefulness score 16/100
• Newest in this subject Perceived Barriers for Advance Care Planning Among People with Dementia and Family Caregivers: A Systematic Review of Qualitative Studies Preprints.org · 2026-10-07 · Preprint — not yet peer-reviewed · usefulness score 16/100

See all studies in End-of-life care →