Evidence map›Paper›PMID 39305080›Full record

ArticlePalliative medicine2024

Exploring the contextual assumptions, interventions and outcomes of digital advance care planning systems: A theory of change approach to understand implementation and evaluation.

Andy Bradshaw, Matthew J Allsop, Jacqueline Birtwistle, Catherine J Evans, Samuel D Relton, Suzanne H Richards, Maureen Twiddy, Robbie Foy, Pablo Millares Martin, Sarah Yardley and 1 more

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In one paragraph

Article in Palliative medicine, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed.

  1. Article
  2. Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

Andy BradshawCicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK.
Matthew J AllsopLeeds Institute of Health Sciences, University of Leeds, Leeds, UK.ORCID 0000-0002-7399-0194
Jacqueline BirtwistleLeeds Institute of Health Sciences, University of Leeds, Leeds, UK.ORCID 0000-0002-6083-589X
Catherine J EvansCicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK.ORCID 0000-0003-0034-7402
Samuel D ReltonLeeds Institute of Health Sciences, University of Leeds, Leeds, UK.
Suzanne H RichardsLeeds Institute of Health Sciences, University of Leeds, Leeds, UK.
Maureen TwiddyHull York Medical School, University of Hull, Hull, UK.
Robbie FoyLeeds Institute of Health Sciences, University of Leeds, Leeds, UK.
Pablo Millares MartinWhitehall Surgery, Leeds, UK.ORCID 0000-0001-7262-1592
Sarah YardleyMarie Curie Palliative Care Research Department, University College London, London, UK.ORCID 0000-0002-1645-642X
Katherine E SleemanCicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK.ORCID 0000-0002-9777-4373

Funding

National Institute for Health and Care Research (NIHR) NIHR129171
6 · The paper itself

Abstract

backgroundDigital advance care planning systems are used internationally to document and share patients' wishes and preferences to inform care delivery. However, their use is impeded by a limited understanding of factors influencing implementation and evaluation.

aimTo develop mid-range programme theory to account for technological, infrastructure and human factor influences on digital advance care planning systems.

designExploratory qualitative research design incorporating Theory of Change workshops that explored contextual assumptions affecting digital advance care planning in practice. A mid-range programme theory was developed through thematic framework analysis using the Non-adoption, Abandonment, Scale-up, Spread and Sustainability (NASSS) framework, generating a conceptual model depicting contextual assumptions, interventions and outcomes influencing implementation.

participantsA total of 38 participants (16 from London, 14 from West Yorkshire and 8 online) including patients, carers and health and care professionals (including those with commissioning responsibilities).

resultsA conceptual model was generated depicting five distinct components relating to digital advance care planning system use: (sociocultural, technical and structural prerequisites; recognition of the clinical need for conversation; having conversations and documenting decisions; accessing, actioning and amending; and using data to support evaluation, use and implementation). There were differences and uncertainty relating to what digital advance care planning systems are, who they are for and how they should be evaluated.

conclusionsDigital advance care planning lacks shared beliefs and practices, despite these being essential for complex technology implementation. Our mid-range programme theory can guide their further development and application by considering technological, infrastructure and human factor influences to optimise their implementation.

Indexed as

Advance Care PlanningQualitative ResearchAdultAgedFemaleHumansLondonMaleMiddle Agedadvance care planningelectronic health record systemsend of life caremid-range programme theoryPalliative caretechnology

Identifiers

PMID39305080
PMCPMC11613644

What OpenQuestion holds

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LicenceCC BY
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.