{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,2]],"date-time":"2025-08-02T14:51:17Z","timestamp":1754146277321,"version":"3.41.2"},"reference-count":27,"publisher":"Cambridge University Press (CUP)","license":[{"start":{"date-parts":[[2025,7,18]],"date-time":"2025-07-18T00:00:00Z","timestamp":1752796800000},"content-version":"unspecified","delay-in-days":198,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Pall Supp Care"],"published-print":{"date-parts":[[2025]]},"abstract":"<jats:title>Abstract<\/jats:title>\n\t  <jats:sec id=\"S1478951525100400_sec1a\">\n\t    <jats:title>Objectives<\/jats:title>\n\t    <jats:p>The hospital setting is often perceived as slow to change. While employee-driven approaches offer a promising alternative to traditional top-down methods, guidance is limited. This study provides a description and formative evaluation of an employee-driven working group (WG) approach to tailor ward-specific measures to improve care in the dying phase. The aim is to evaluate the WG process and offer practical insights for transferability to other hospitals.<\/jats:p>\n\t  <\/jats:sec>\n\t  <jats:sec id=\"S1478951525100400_sec2b\">\n\t    <jats:title>Methods<\/jats:title>\n\t    <jats:p>Formative mixed-methods evaluation of a WG process to tailor ward-specific evidence-informed measures on 10 wards outside specialized palliative care at 2 German medical centers. To analyze factors relevant for the WG process, the <jats:italic>Consolidated Framework for Implementation Research 2.0<\/jats:italic> was applied. Data included baseline evaluation (medical record analysis, staff survey and focus groups, informal caregiver interviews), WG protocols, and an online survey with WG participants.<\/jats:p>\n\t  <\/jats:sec>\n\t  <jats:sec id=\"S1478951525100400_sec3c\">\n\t    <jats:title>Results<\/jats:title>\n\t    <jats:p>Multiprofessional WGs were established on all hospital wards, with an average of 7 meetings per ward within 1 year and 4 participants per meeting. Adapting the process to participants\u2019 wishes and needs were crucial, particularly regarding the desired degree of external input. We identified 4 barriers (e.g. declining participation, institutional limits) and 7 facilitators (e.g. involvement of staff in leading positions, multiprofessional composition). The WGs tailored 34 measures, e.g. team meetings to improve communication within the team. Participants\u2019 views were generally positive: 91% felt able to share their thoughts, 66% were satisfied with the outcome, and 77% would participate again.<\/jats:p>\n\t  <\/jats:sec>\n\t  <jats:sec id=\"S1478951525100400_sec4d\">\n\t    <jats:title>Significance of results<\/jats:title>\n\t    <jats:p>The employee-driven approach was feasible and useful for tailoring ward-specific measures. However, integrating top-down elements proved to be beneficial. The identified barriers and facilitators provide insights for transferring an employee-driven approach to other hospitals to improve care in the dying phase outside specialized palliative care settings.<\/jats:p>\n\t  <\/jats:sec>\n\t  <jats:sec id=\"S1478951525100400_sec5e\">\n\t    <jats:title>Clinical trial registration<\/jats:title>\n\t    <jats:p>The study was registered in the German Clinical Trials Register (DRKS00025405).<\/jats:p>\n\t  <\/jats:sec>","DOI":"10.1017\/s1478951525100400","type":"journal-article","created":{"date-parts":[[2025,7,18]],"date-time":"2025-07-18T03:39:20Z","timestamp":1752809960000},"update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":0,"title":["Formative evaluation of an employee-driven approach to improve care in the dying phase in hospitals"],"prefix":"10.1017","volume":"23","author":[{"given":"Sophie","family":"Meesters","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-6252-6193","authenticated-orcid":false,"given":"Sukhvir","family":"Kaur","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Viola","family":"Milke","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christin","family":"Herrmann","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aneta","family":"Schieferdecker","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nikolas","family":"Oubaid","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karin","family":"Oechsle","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Holger","family":"Schulz","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Holger","family":"Pfaff","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Raymond","family":"Voltz","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kerstin","family":"Kremeike","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"56","published-online":{"date-parts":[[2025,7,18]]},"reference":[{"key":"S1478951525100400_ref20","doi-asserted-by":"publisher","DOI":"10.1055\/s-0034-1374104"},{"key":"S1478951525100400_ref27","doi-asserted-by":"publisher","DOI":"10.1002\/9781119488620.ch2"},{"key":"S1478951525100400_ref6","doi-asserted-by":"publisher","DOI":"10.1177\/0269216307085343"},{"key":"S1478951525100400_ref19","doi-asserted-by":"publisher","DOI":"10.1093\/intqhc\/mzaf025"},{"key":"S1478951525100400_ref25","doi-asserted-by":"publisher","DOI":"10.1177\/1049909114550392"},{"key":"S1478951525100400_ref12","doi-asserted-by":"publisher","DOI":"10.1002\/9781119488620.ch4"},{"key":"S1478951525100400_ref5","doi-asserted-by":"publisher","DOI":"10.1177\/0269216315570408"},{"key":"S1478951525100400_ref22","doi-asserted-by":"publisher","DOI":"10.1177\/00302228251322860"},{"key":"S1478951525100400_ref3","doi-asserted-by":"publisher","DOI":"10.34172\/ijhpm.2023.6734"},{"key":"S1478951525100400_ref9","doi-asserted-by":"publisher","DOI":"10.1080\/09540962.2018.1389505"},{"key":"S1478951525100400_ref14","article-title":"The AMBER care bundle for hospital inpatients with uncertain recovery nearing the end of life: the ImproveCare feasibility cluster RCT","volume":"23","author":"Koffman","year":"2019","journal-title":"Health Technology Assessment (Winchester, England)"},{"key":"S1478951525100400_ref23","doi-asserted-by":"publisher","DOI":"10.1186\/s13012-017-0552-5"},{"key":"S1478951525100400_ref24","doi-asserted-by":"publisher","DOI":"10.1177\/0269216313487568"},{"key":"S1478951525100400_ref7","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.f4428"},{"key":"S1478951525100400_ref18","doi-asserted-by":"publisher","DOI":"10.1136\/bmjspcare-2014-000810"},{"key":"S1478951525100400_ref17","doi-asserted-by":"publisher","DOI":"10.1016\/j.healthpol.2017.09.011"},{"key":"S1478951525100400_ref2","doi-asserted-by":"publisher","DOI":"10.1016\/j.technovation.2013.11.007"},{"key":"S1478951525100400_ref21","doi-asserted-by":"publisher","DOI":"10.12968\/bjhc.2017.23.7.324"},{"key":"S1478951525100400_ref1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD005470.pub2"},{"key":"S1478951525100400_ref26","doi-asserted-by":"publisher","DOI":"10.1108\/IJLSS-02-2021-0024"},{"key":"S1478951525100400_ref10","doi-asserted-by":"publisher","DOI":"10.1186\/s13012-018-0726-9"},{"key":"S1478951525100400_ref11","unstructured":"German Guideline Programme in Oncology (2020) Palliative care for patients with incurable cancer 2.2. 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Published by Cambridge University Press.","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http:\/\/creativecommons.org\/licenses\/by\/4.0), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This content has been made available to all.","name":"free","label":"Free to read"}],"article-number":"e135"}}