Co-construction of the Family-Focused Support Conversation:A Participatory Learning and Action Research Study to implement support for family members whose relatives are being discharged for end-of-life care at home or in a nursing home

Background Many people move in and out of hospital in the last few weeks of life. These care transitions can be distressing for family members because they signify the deterioration and impending death of their ill relative and forthcoming family bereavement. Whilst there is evidence about psycho-social support for family members providing end of life care at home, there is limited evidence about how this can be provided in acute hospitals during care transitions. Consequently, family members report a lack of support from hospital-based healthcare professionals. Methods The aim of the study was to implement research evidence for family support at the end of life into acute hospital care. Informed by Participatory Learning and Action Research and Normalization Process Theory (NPT) we co-designed a context-specific intervention, the Family-Focused Support Conversation, from a detailed review of research evidence. We undertook a pilot implementation in three acute hospital Trusts to assess the potential for the intervention to be used in clinical practice. Pilot implementation was undertaken during a three-month period by seven clinical coresearchers - nurses and occupational therapists in hospital specialist palliative care services. Implementation was evaluated by data comprised of reflective records of intervention delivery (n=22), in-depth records of telephone implementation support meetings, between research team members and co-researchers (n=3) and in-depth evaluation meetings (n=2). Data were qualitatively analysed using an NPT framework designed for intervention evaluation. Results Clinical co-researchers readily incorporated the Family-Focused Support Conversation into their everyday work. The key disruption to practice was a change in interactional practice, from being patient-focused, providing information about patient needs, to family-focused, identifying family concerns and facilitating family-focused solutions. Co-researchers reported an increase in family members’ involvement in discharge decisions and end of life care planning. Conclusion The Family-Focused Support Conversation is a novel, evidenced-based and context specific intervention. Pilot implementation demonstrated the potential for the intervention to be used in acute hospitals to support family members during end of life care transitions. This informed a larger scale implementation study, reported in a respective paper.