JMIR Publications

ABSTRACT

Background:

This paper describes the protocol for a realist process evaluation of an intervention that aims to IMprove PAlliative care in Residential aged care using Telehealth (IMPART) to be trialled via a pragmatic stepped-wedge cluster-randomised controlled trial in Australia. IMPART consists of two key intervention activities; specialist palliative support provided via telehealth and tailored staff education.

Objective:

The aims of the realist process evaluation are to 1) identify and explore the contexts and mechanisms that enable and/or hinder the implementation of the IMPART intervention, and 2) develop and refine a program theory to determine whether and how successful implementation of IMPART can be facilitated.

Methods:

This process evaluation has three phases, guided by a realist framework. First, to hypothesise an initial program theory, trial documentation and literature will be reviewed to determine how IMPART is expected to work and how, along with what barriers and facilitators are likely to influence implementation. To test this theory in the second phase, a case study methodology will draw on multiple data sources (both qualitative and quantitative) from ten participating residential aged care facilities. This includes interviews with staff involved in implementation, data regarding staff engagement with training and collection of program documentation, activity logs, action plans and facility information. In the final phase, program theories developed from the case studies will be refined through consultation with the IMPART research team. This will inform the development of a final middle-range theory that provides key information about what works, for whom, how and in what circumstances in the implementation of interventions that aim to improve palliative care in residential aged care.

Results:

This project was reviewed and approved by the Royal Melbourne Hospital Human Research Ethics Committee. The RCT commenced in May 2023 with completion anticipated for November 2025.

Conclusions:

Applying a realist framework to explore process outcomes allows for an in-depth inquiry into what works, for whom, how and in what circumstances in the implementation of complex interventions that aim to improve palliative care in residential aged care. This realist process evaluation has the potential to provide transferable context specific findings that can support the development of meaningful policy and accelerate practice change. Clinical Trial: anzctr.org.au; ACTRN12622000760774. Prospectively registered on 27/05/2022.