Implementation science communications最新文献

{"title":"Culture eats evidence for breakfast: how culture influences implementation of evidence-based practices.","authors":"Per Nilsen, Jeanette Wassar Kirk","doi":"10.1186/s43058-026-00940-z","DOIUrl":"10.1186/s43058-026-00940-z","url":null,"abstract":"<p><strong>Background: </strong>Research has produced a substantial and expanding body of evidence-based practices (EBPs), encompassing interventions, programmes, clinical guidelines, protocols, care pathways and models of care supported by the best available evidence. Despite this, healthcare delivery is still frequently characterised as insufficiently evidence-based, reflecting a persistent gap between what is known to be effective and what is routinely implemented in practice. Traditional explanations only partially account for this gap, often overlooking culture as a critical yet under-theorized influence. Culture is a learned phenomenon rooted in social contexts, encompassing shared norms, values, beliefs and assumptions that define a group, whether a team, profession or organization. This paper argues that the uptake and sustainability of EBPs are profoundly shaped by cultural dynamics operating across three key layers: organizational, professional and disciplinary.</p><p><strong>Main body: </strong>Organizational culture shapes openness to change, learning and psychological safety, influencing whether EBPs are seen as improvements or burdens. Professional cultures, rooted in education and identity, affect how physicians, nurses and other professionals apply guidelines and protocols. Disciplinary cultures, tied to clinical environments (e.g. emergency, intensive, mental health, palliative care), also shape how EBPs are received. Enhancing cultural responsiveness requires aligning EBPs with the shared norms, values, beliefs and assumptions of the intended users. Strategies include fostering clinician engagement in the development of EBPs, cultural competence, local adaptation and leveraging cultural champions.</p><p><strong>Conclusion: </strong>Implementation of EBPs is shaped by culture, not solely by the strength of evidence or implementation strategies. Organizational, professional and disciplinary cultures interact to influence how EBPs are interpreted, accepted, adapted or resisted in practice, helping to explain persistent variation in uptake. Misalignment between EBPs and prevailing norms, values, beliefs and assumptions undermines implementation even when evidence is strong.</p>","PeriodicalId":73355,"journal":{"name":"Implementation science communications","volume":"7 1","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13127075/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147790600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of external and internal context on adoption and implementation of evidence-based practices: a serial case study qualitative analysis of top performers in the HEALing Communities Study.","authors":"Daniel M Walker, Alison M Aldrich, Sadie Chen, Elizabeth Jadovich, Michael Goetz, Shaquita Andrews-Higgins, Alexander Y Walley, Hannah K Knudsen, Timothy R Huerta, Timothy Hunt, Mari-Lynn Drainoni","doi":"10.1186/s43058-026-00952-9","DOIUrl":"10.1186/s43058-026-00952-9","url":null,"abstract":"<p><p>BACKGROUND: Community coalitions are a common implementation strategy for addressing public health challenges, such as the opioid epidemic. There remains a lack of understanding of the factors that support implementation effectiveness for community coalitions. This study leverages the HEALing Communities Study (HCS) which tested the Communities That HEAL (CTH) approach to supporting community coalitions to increase delivery of opioid overdose and naloxone distribution (OEND) and medication for opioid use disorder (MOUD) through facilitation, data-driven decision making, and a communications campaign. METHODS: Using a parallel convergent, nested serial case study with a positive deviance design, we selected high performing waitlist control communities participating in the HCS for further examination. Performance was defined based on average ranking across a set of implementation measures; the top performing urban and rural community within each of the four HCS sites was then selected for in-depth case study. For selected sites, we conducted thematic analysis of qualitative interviews with coalition members (n = 41) conducted at the end of the implementation phase. Analysis was aligned with the PRISM/ RE-AIM framework. RESULTS: Despite achieving top performance, these communities still faced persistent and varied challenges related to OUD service delivery and access. However, community assets and policy changes provide a foundation for improvement. Implementation success was supported by representative coalition membership, high engagement, and alignment with coalition goals. Coalition members were highly collaborative and shared a vision for their community. Implementation success was also supported by coalition buy-in to the CTH process. Structured data connectivity and sharing facilitated effective strategy selection, while multi-channel communications campaigns increased awareness and uptake of OUD and MOUD services. No differences were observed across urban and rural communities. CONCLUSIONS: Implementation success reflects the synergy among external context, coalition strength, and intervention processes. Community coalition–based strategies benefit from ensuring representative membership and shared goals to build buy-in, while also leveraging data infrastructure and communication campaigns to promote effective implementation of EBPs. TRIAL REGISTRATION: NCT04111939. </p>","PeriodicalId":73355,"journal":{"name":"Implementation science communications","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13267587/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147790621","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A pilot Roll-Out Implementation Optimization trial of an adjunctive intervention to improve teacher and caregiver uptake and adherence to a behavioral intervention for externalizing problems in preschool: a study protocol of Parent-Educator Action Response (PEAR).","authors":"Sarah R Eisenman, Jocelin Vanegas, Colleen Cicchetti, Scott N Compton, Walter S Gilliam, Iheoma U Iruka, Aaron R Lyon, Lauren S Wakschlag, Justin D Smith, Andrea E Spencer, Courtney A Zulauf-McCurdy","doi":"10.1186/s43058-026-00938-7","DOIUrl":"10.1186/s43058-026-00938-7","url":null,"abstract":"<p><strong>Background: </strong>Behavioral interventions are well-established treatments for emerging externalizing problems in preschool. However, caregivers and teachers face barriers to implementing behavioral interventions across home and school. The current study aims to improve joint teacher and caregiver uptake and adherence to a behavioral intervention by testing a new adjunctive intervention co-developed with early childhood constituents, Parent-Educator Action Response (PEAR). PEAR consists of group-based motivational interviewing, psychoeducation, and action planning sessions for preschool teachers and caregivers of a preschooler with elevated externalizing problems, followed by a meeting with each caregiver-teacher dyad to agree upon a plan for supporting improvements in the child's externalizing problems.</p><p><strong>Methods: </strong>We will use a pilot Roll-Out Implementation Optimization (ROIO) design, with three clusters over 18 months to implement and evaluate PEAR. Participants will be approximately 24 preschool teachers and 24 caregivers of a preschool child. All participants will receive PEAR, delivered by a licensed clinical psychologist and supported by a bilingual community health worker. Throughout the study period, participants will be asked to implement the Daily Report Card (DRC), an evidence-based behavioral intervention for externalizing problems. Implementation of the DRC at home and preschool, the primary outcome, will be measured weekly for eight weeks. Additional outcomes will be measured at baseline, post-PEAR, and follow-up (4 weeks post-PEAR).</p><p><strong>Discussion: </strong>This is one of the first pilot ROIO trials and trials in the preschool setting to study a new adjunctive intervention to improve both teacher and caregiver uptake and adherence to behavioral interventions for preschool externalizing problems. Findings are likely to generalize to other public health adjunctive interventions in community settings.</p><p><strong>Trial registration: </strong>clinicaltrials.gov NCT07203014 on 10-02-2025.</p>","PeriodicalId":73355,"journal":{"name":"Implementation science communications","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13235087/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147791213","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Matters arising: a commentary on \"Failing to succeed: advancing mechanistic understanding of implementation strategies through retrospective and prospective use of causal pathway diagrams\" by Austad et al. 2025.","authors":"Bo Kim, Cara C Lewis","doi":"10.1186/s43058-026-00914-1","DOIUrl":"10.1186/s43058-026-00914-1","url":null,"abstract":"","PeriodicalId":73355,"journal":{"name":"Implementation science communications","volume":"7 1","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13097804/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147790574","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physician-suggested strategies for deimplementing low-value care in Swedish primary care: a qualitative analysis across system levels.","authors":"Hanna Augustsson Öfverström, Sara Ingvarsson, Emma Hedberg Rundgren, Marta Roczniewska, Henna Hasson, Per Nilsen, Ulrica von Thiele Schwarz","doi":"10.1186/s43058-026-00947-6","DOIUrl":"10.1186/s43058-026-00947-6","url":null,"abstract":"<p><strong>Background: </strong>Low-value care (LVC) remains a persistent problem in primary healthcare. While various implementation strategies have been proposed and tested for deimplementation, there is limited knowledge about whether there are strategies uniquely suited to deimplementation. Furthermore, there is limited knowledge about system-level responsibilities for deimplementation. Given that implementation strategies are recommended to be tailored to the specific contextual factors surrounding LVC practices, involving primary care physicians in identifying contextually appropriate strategies holds promise. This study aimed to explore the strategies that primary care physicians suggest could facilitate the deimplementation of LVC and map them to the system levels responsible for initiating and deploying these strategies.</p><p><strong>Methods: </strong>This qualitative study was based on responses to an open-ended survey question asking physicians to suggest strategies that could facilitate the deimplementation of LVC practices within primary healthcare in Sweden. A national sample of 441 primary care physicians responded. Responses were analyzed via deductive content analysis categorized by the Expert Recommendations for Implementing Change (ERIC) compilation. Responses that could not be categorized via ERIC were analyzed inductively. The identified strategies were then mapped to the system levels (individual, group, leader, organization and overarching system) responsible for deploying these strategies.</p><p><strong>Results: </strong>Strategies were identified across all nine original ERIC domains, representing 39 (53%) of the original ERIC strategies, and later additions for deimplementation. Additionally, a set of strategies categorized under a new domain, develop better evidence, was identified. Most strategies were suitable for deployment at the organizational (31 strategies) and overarching (31 strategies) levels. Sixteen strategies were best suited for the group level, thirteen for the leadership level, and two for the individual level.</p><p><strong>Conclusion: </strong>Primary care physicians proposed strategies across all nine ERIC domains, with additional strategies beyond those previously described, including develop better evidence. From the physicians' perspective, deimplementation cannot rely solely on individuals but requires coordinated action across the organizational and system levels. Broader structural, policy, and cultural changes would support physicians and ensure that responsibility for deimplementation is shared across the healthcare system.</p>","PeriodicalId":73355,"journal":{"name":"Implementation science communications","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13094004/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147719165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of blueprint materials that strengthen and embed the infection control link nurse role in hospitals - an action research study.","authors":"Mireille Dekker, Christiaan Vis, Femke van Nassau, Per Nilsen, Rosa van Mansfeld, Irene P Jongerden","doi":"10.1186/s43058-026-00942-x","DOIUrl":"10.1186/s43058-026-00942-x","url":null,"abstract":"<p><strong>Background: </strong>In hospitals, infection control link nurses (ICLNs) serve as a bridge between their peers and the infection prevention team, driving infection prevention measures through motivation, practical guidance, and knowledge sharing. The success of the ICLN role varies depending on how well it is supported and integrated into hospital structures. In this study, we co-created materials for infection control practitioners (ICPs), incorporating activities to support ICLNs with strategies to strengthen and embed the ICLN role in hospitals. We aimed to develop materials to support and implement the role, and evaluated how cocreation contributed to its normalization in participating hospitals.</p><p><strong>Methods: </strong>We used an action research approach with co-creation as a general guiding principle. Stakeholders and end-users from ten participating hospitals collaboratively developed blueprint materials, including a role description, training resources and strategies for hospital-wide integration of the ICLN role. ICPs tested these materials in their respective hospitals. To explore their experiences with both the application of materials and the collaborative process, focus group interviews were conducted. Normalization Process Theory (NPT) was used as a framework to guide the analyses and the collaborative process itself.</p><p><strong>Results: </strong>Participants agreed upon the materials, but the extend to which their content became normalized in daily practice varied. In the interviews, ICPs mentioned that adoption and application of the materials depended on the implementation phase of the ICLN role. The collaborative process increased their confidence and intention to actively support ICLNs. It also helped them reflect on how to position the role within the organization, prompting them to consider various actions to embed the role structurally. Blueprint materials were considered helpful and provided practical strategies and hands-on activities and could be tailored to the local context.</p><p><strong>Conclusions: </strong>The collaborative process resulted in three practical, adaptable blueprint materials. The process helped ICPs reassess their own role in implementing the ICLN role, refine their training strategies, and strengthen their support for ICLNs at the ward level. Signs of normalization of the ICLN role varied across hospitals, influenced by both the stage of implementation and how ICPs interpreted and enacted their own role.</p>","PeriodicalId":73355,"journal":{"name":"Implementation science communications","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13220495/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147719123","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Difference-making factors in implementing a quality improvement program for sleep apnea in stroke/TIA patients.","authors":"Nicholas A Rattray, Edward J Miech, Dawn M Bravata, K Maya Story, Laura J Myers, Brian B Koo, Laura Burrone, Ali Sexson, Stanley E Taylor, Anthony J Perkins, Joanne Daggy, Jason J Sico","doi":"10.1186/s43058-026-00944-9","DOIUrl":"10.1186/s43058-026-00944-9","url":null,"abstract":"<p><strong>Background: </strong>Effective prevention of ischemic stroke and transient ischemic attack (TIA) involves timely, guideline-concordant risk factor management. Obstructive sleep apnea (OSA), a significant but underdiagnosed cerebrovascular risk factor, affects approximately 70% of stroke and TIA patients. Untreated OSA is linked to impaired post-stroke recovery, recurrent vascular events, and increased mortality. Despite guideline recommendations to consider early post-stroke/TIA OSA screening, few patients receive sleep studies. This study explores the implementation of a multidisciplinary quality improvement intervention for OSA management at six Department of Veterans Affairs medical centers between 2021 and 2024, focusing on contextual factors influencing implementation success.</p><p><strong>Methods: </strong>This mixed-methods study used data from the Addressing Sleep Apnea Post-Stroke/TIA (ASAP) stepped-wedge cluster-randomized clinical trial (NCT04322162). We conducted qualitative analyses of provider interviews and quantitative assessments via configurational comparative methods (CCMs) to identify difference-making conditions for successful implementation. The Group Organization (GO) score, a facility-level measure indicating team cohesion and activation in diagnosing and treating OSA among patients with acute cerebrovascular events, served as the primary implementation outcome.</p><p><strong>Results: </strong>Successful implementation, defined by a GO score of ≥ 6, was achieved at four of the six facilities. Four conditions were sufficient by themselves for implementation success: implementation of sleep test ordering, monitoring sleep testing processes, post-discharge care coordination, and positive influence of champions during implementation.</p><p><strong>Conclusions: </strong>This study highlights the interplay between local context and novel clinical practices in successful program implementation of an acute sleep service. Four difference-makers perfectly distinguished between sites with and without implementation success. These findings provide actionable insights for tailoring and timing implementation strategies to improve adoption.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov NCT04322162.</p>","PeriodicalId":73355,"journal":{"name":"Implementation science communications","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13224654/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147719132","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Strengthening community-based doula and clinician partnerships through implementation and dissemination science approaches: a mixed-methods pilot study.","authors":"Jessica Olson, Amber Chavez, Erica Marion, Katherine Quinn, Geraud Blanks, Maureen Post, Toni Whitaker, Juan Pablo Garnham, Camila Vallejo, Camille Johnson, Xavier Johnson, Dalvery Blackwell, Joni Williams, Anna Palatnik","doi":"10.1186/s43058-026-00948-5","DOIUrl":"10.1186/s43058-026-00948-5","url":null,"abstract":"<p><strong>Background: </strong>Collaboration between community-based doulas and clinical care teams improves birth outcomes, yet partnerships are hindered by operational, communication, and role clarity challenges. Evidence is lacking on scalable, low-burden strategies to strengthen these relationships outside of formal intervention settings.</p><p><strong>Methods: </strong>Rapid deductive content analysis of focus groups and interviews with 12 perinatal clinicians and 11 community-based doulas was conducted. Findings informed a five-minute video vignette illustrating the role of community-based doulas and their hopes for partnerships with clinical care teams. The vignette was screened in two settings: with community-based participants (n = 72), and with clinical healthcare professionals (n = 21).</p><p><strong>Results: </strong>In the first screening, 94% of participants indicated that the vignette honored doula voices either \"completely\" or \"mostly\" (n = 72). Participants reported that the vignette centered authentic voices and presented clear, relatable narratives. In the second screening (n = 21), the 13-item Interprofessional Collaboration Scale (ICS) assessed perceived interprofessional collaboration across three subscales (Communication, Accommodation, and Isolation). Mean total ICS scores increased from 2.63 to 2.90 (t(20) = 3.27, p = .004, Cohen's dz = 0.71). Communication and Accommodation subscales also improved significantly (Communication: 2.70 to 3.09, p < .001, dz = 0.87; Accommodation: 2.75 to 3.08, p = .010, dz = 0.62).</p><p><strong>Conclusions: </strong>Combining rapid qualitative analysis with vignette-based dissemination is a feasible approach to improve partnerships outside of intervention settings. The vignette's strongest influence was on perceptions and willingness to collaborate. This approach represents a scalable, low-burden strategy that may be adapted across interprofessional collaborations.</p>","PeriodicalId":73355,"journal":{"name":"Implementation science communications","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13224534/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147700675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrating narrative medicine into laboratory quality improvement: a sustainable model for reducing coagulation specimen rejections.","authors":"Yumei Huang, Zhaoxia Chen, Qinglin Liu, Hongyu Deng, Yonghong Hu","doi":"10.1186/s43058-026-00937-8","DOIUrl":"10.1186/s43058-026-00937-8","url":null,"abstract":"<p><strong>Background: </strong>Pre-analytical errors, particularly specimen rejections due to insufficient volume, represent a persistent challenge in coagulation testing, especially in oncology settings where patients often have compromised vascular access. Conventional quality improvement (QI) approaches frequently focus narrowly on procedural compliance and may inadvertently reinforce a punitive, blame-oriented culture between laboratory and nursing teams, thereby undermining systemic problem-solving. This study evaluated whether integrating narrative medicine principles into QI could reduce rejection rates while fostering a just culture grounded in empathy, shared accountability, and patient-centered learning.</p><p><strong>Methods: </strong>A longitudinal QI study using iterative Plan-Do-Study-Act (PDSA) cycles was conducted at a large tertiary oncology hospital (Jan 2019-Nov 2025). Root-cause analysis identified a \"culture of blame\" as core drivers. A narrative medicine curriculum utilizing \"parallel charts\" to foster empathy and mutual understanding was implemented. Monthly coagulation specimen rejection rates were analyzed across three phases using non-parametric statistics and staff behavioral changes were monitored.</p><p><strong>Results: </strong>Rejection rates decreased by 98.6%, from a median of 1.862% (baseline) to 0.026% (optimization phase; p < 0.001). This reduction remained stable during a major staff rotation, indicating the resilience of this system. Qualitative feedback indicated that narrative reflection rebuilt trust and created a \"just culture\" focused on patient safety rather than individual blame.</p><p><strong>Conclusions: </strong>Embedding narrative medicine in laboratory QI is a rigorous, evidence-informed strategy. By shifting the focus from technical compliance to human-centered understanding, healthcare systems may better bridge the gap between the laboratory and the clinic, and potentially achieve breakthroughs in patient safety.</p>","PeriodicalId":73355,"journal":{"name":"Implementation science communications","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13224501/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147700416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementing palliative care in intensive care units: assessing processes using the normalisation process theory NoMAD instrument.","authors":"Stephanie A Meddick-Dyson, Tracy Finch, Jason W Boland, Mark Pearson, Andy Bradshaw, Fliss E M Murtagh","doi":"10.1186/s43058-026-00945-8","DOIUrl":"10.1186/s43058-026-00945-8","url":null,"abstract":"<p><strong>Background: </strong>The importance of palliative care for Intensive Care Unit (ICU) patients/families is known. Little is known about implementing this care in practice, and how to support healthcare professionals in this implementation. This study uses survey methodology informed by Normalisation Process Theory to assess implementation processes for providing palliative care in the ICU.</p><p><strong>Methods: </strong>A descriptive cross-sectional survey was conducted with UK healthcare professionals involved in providing or organising palliative care in the ICU. Implementation processes were assessed using the validated 23-item Normalisation MeAsure Development (NoMAD) instrument. Absolute (n) and relative frequencies, median and interquartile ranges were reported. Mann-Whitney U Test assessed differences between specialist palliative care and ICU respondents. One open-ended item captured free-text responses, analysed using NPT-guided framework analysis.</p><p><strong>Results: </strong>From 153 completed surveys, 69% of respondents were ICU professionals, 31% were specialist palliative care professionals. There was no statistically significant difference between responses from ICU and specialist palliative care professionals. Likert responses showed that respondents felt familiar with palliative care in the ICU and felt it was part of their normal work. Positive tendency was found toward implementation of palliative care in the ICU with coherence (sense-making work), cognitive participation (relational work) and reflexive monitoring (appraisal work). Rating of collective action (operational work) showed a more neutral tendency, highlighting this as a potential target for improvement. Free-text responses were categorised into themes within Normalisation Process Theory constructs: Coherence-recognising and stratifying need, and nuances within palliative care in the ICU; Cognitive participation-interdisciplinary interfaces and building capacity; Collective action-procedures for provision, pressures on provision, and perceived capability; Reflexive monitoring-perceived value.</p><p><strong>Conclusion: </strong>This novel study uses NPT to assess professional processes relating to implementation of palliative care in the ICU. Findings suggest important perceived implementation gaps may lie within operational work such as tailoring utilisation of existing resources, ensuring leadership support, and building skill sets. Dedicated qualitative research is needed to explain how these issues operate in context and to examine potential patient- and family-related influences.</p>","PeriodicalId":73355,"journal":{"name":"Implementation science communications","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13195999/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147694111","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}