Using the RE‐AIM framework to evaluate existing services and inform the development of a new model of dementia palliative care

Abstract

AbstractBackgroundPalliative care is suitable for anyone with a life‐limiting illness, and addresses their physical, psychological, spiritual and social needs. People with dementia and their families can greatly benefit from a palliative approach to their care. The Model for Dementia Palliative Care Project is developing a new service delivery model for dementia palliative care for the Irish healthcare system. In this project, in‐depth examination of a purposive sample of existing services across Ireland and the UK has been carried out, using robust evaluation methods.MethodsExemplar services were identified across Ireland, Northern Ireland, and England. Existing data was collected at each service, along with primary data from interviews, focus‐groups, and questionnaires with service providers, and questionnaires of service‐users. Logic models were used to describe each service. Services were then compared using the RE‐AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework, with the domain of ‘context’ added for completeness.Results‘Reach’ data included service users’ demographics and geographical coverage of the service, used to estimate the size of a service needed for a certain location. ‘Effectiveness’ data pertained to service users’ satisfaction, for example a good service was associated with flexibility and good communication. ‘Adoption’ and ‘Implementation’ data assessed how well staff ‘bought into’ dementia palliative care practices, as well as barriers to certain components being implemented such as under‐funded homecare services blocking the goal of living and dying at home. ‘Context’ data helped to identify the local driving forces underpinning each service, e.g. an effective volunteer programme, or the local context of a hospice being located on hospital grounds encouraging transfers of non‐cancer patients, through awareness of the service.ConclusionBy using this summative evaluation technique to identify components/activities at each service, it aided the research team to make decisions on the core components to include in the proposed model of palliative care. The novel model of dementia palliative care will have to be flexible, will have a strong multidisciplinary team aspect, support for people with dementia and their families in the community, and education and training for both staff and loved ones of people with dementia.