Optimising delivery of integrated palliative care and heart failure services: A realist evaluation (PalliatHeartSynthesis II)

Background

Inequity of palliative care provision is an ongoing problem for underserved groups, such as those with heart failure (HF) who are mostly older age with multi-morbidities. This puts considerable burden on patients, their caregivers and health services with frequent avoidable hospitalisations. Recognising the importance of this topic, the NIHR HS&DR funded our research team to complete a realist synthesis of the integrated palliative care (PC) and HF literature (PalliatHeartSynthesis – under review).

The aim was to understand what kind of integrated PC and HF services work, why, how and for whom. The synthesis found that integrated PC and HF services work when service providers are motivated to integrate services and have the right opportunities and capabilities to support behaviour change. However, our synthesis also identified significant knowledge gaps.

Most documents were from America: few focused on the UK NHS setting. While acknowledging these limitations, we developed a series of implications based on our programme theory of what strategies can help when integrating palliative care and heart failure services. Research question How do we set up, sustain, and embed integrated PC and HF services across the NHS?

Objectives

1. Use a realist approach to evaluate existing integrated PC and HF services in NHS organisations to understand how they have been set up, sustained, and embedded in routine practice.

2. Use these data to confirm, refute or refine our existing programme theory regarding this process to co-produce a detailed 'how to' guidance for setting up, sustaining, and embedding integrated PC and HF services across the NHS.

3. Develop a community of practice to support those who wish to set up, sustain and embed integrated HF and PC services. Methods This project will use co-design and realist evaluation approaches to generate

primary data across five NHS Sites (England x 2, Scotland, Wales, and Northern Ireland (NI). The five sites were purposively sampled for geographic and integrated PC and HF service variation. The research will be delivered via three work packages (WP).

WP1 will involve a realist evaluation at each site using documentary analysis, observations, and semi-structured interviews. WP2 will involve co-design of a detailed 'how to' guide for setting up and improving integrated HF and PC services in the NHS. WP3 will involve development of a community of practice to support those who wish to set up, sustain and embed integrated HF and PC services.

Timelines for delivery 36 months starting in January 2025. Anticipated impact and dissemination

This research will enable us to create the knowledge, and knowledge translation needed for better tailoring and implementation of NHS integrated PC and HF services and provide timely evidence for Integrated Care Boards and service providers to inform and optimise the integration of these services across the NHS.