title: Why a carefully designed, nurse-led intervention failed to meet expectations: the case of the Care Programme for Palliative Radiotherapy.
abstract: OBJECTIVE
  Implement and evaluate the Care Programme for Palliative Radiotherapy (CPPR) in the Outpatient Clinic of the Department of Radiotherapy, Erasmus MC-Cancer Institute, Rotterdam, The Netherlands.
  
  
  METHODS
  Participatory Action Research (PAR). Qualitative descriptive design: participatory observations, semi-structured interviews with patients and professionals and focus groups with professionals; content analysis of documents.
  
  
  METHODS
  Patients with impending paraplegia due to metastatic spinal cord compression, nurse practitioners (NPs), nurse manager, staff and ward nurses, radiographers, radiotherapists and medical doctors.
  
  
  RESULTS
  After a shift from inpatient to outpatient radiotherapy treatment, patients and healthcare professionals perceived shortcomings in the oncological chain care. The CPPR was developed in a participative way giving a key role to the NP. Evaluation after implementation of the programme showed that patients and professionals were predominantly positive about its effects. However, implementation was not sustained due to lack of institutional and managerial support.
  
  
  CONCLUSIONS
  The technological innovation far preceded the organisational changes needed to provide innovative, patient-centred care. Implementing this programme with a central role for the NP was seen as the solution to the problems identified. However, in spite of the systematic approach using PAR, the programme was not successful in bringing about sustained improvements. NPs fulfil a valuable role in the care and support of patients with palliative care needs but need institutional support. More attention should have paid to the organisational context. Involve all relevant actors; use a participatory approach to enhance commitment; ensure the support of management during the whole project.
authors.affiliation: Rotterdam University, Centre of Expertise Innovations in Care, P.O. Box 25035, 3001 HA Rotterdam, The Netherlands. Electronic address: c.v.m.vahedi@hr.nl.
authors.forename: C V M
authors.initials: CV
authors.lastname: Vahedi Nikbakht-Van de Sande
authors.affiliation: Erasmus MC - Cancer Institute, P.O. Box 5201, 3008 AE Rotterdam, The Netherlands. Electronic address: c.braat.1@erasmusmc.nl.
authors.forename: C
authors.initials: C
authors.lastname: Braat
authors.affiliation: Rotterdam University, Centre of Expertise Innovations in Care, P.O. Box 25035, 3001 HA Rotterdam, The Netherlands. Electronic address: a.p.visser@hr.nl.
authors.forename: A Ph
authors.initials: AP
authors.lastname: Visser
authors.affiliation: Tilburg University, Tilburg School of Social and Behavioral Sciences, P.O. Box 90153, 5000 LE Tilburg, The Netherlands. Electronic address: DDelnoij@cvz.nl.
authors.forename: D M J
authors.initials: DM
authors.lastname: Delnoij
authors.affiliation: Rotterdam University, Centre of Expertise Innovations in Care, P.O. Box 25035, 3001 HA Rotterdam, The Netherlands; Erasmus University Rotterdam, Institute of Health Policy and Management, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands. Electronic address: a.van.staa@hr.nl.
authors.forename: A L
authors.initials: AL
authors.lastname: van Staa
mesh_terms: D000553:Ambulatory Care / Q000458:organization & administration; D005260:Female; D006284:Health Plan Implementation / Q000458:organization & administration*; D006302:Health Services Research; D006801:Humans; D008297:Male; D020380:Needs Assessment; D009426:Netherlands; D009722:Nurse Practitioners / Q000458:organization & administration*; D024802:Nurse's Role; D009859:Oncology Nursing / Q000458:organization & administration*; D010166:Palliative Care / Q000458:organization & administration*; D018802:Patient-Centered Care / Q000458:organization & administration*; D016730:Program Development; D015397:Program Evaluation; D011787:Quality of Health Care; D018714:Radiotherapy, Adjuvant; D016896:Treatment Outcome
keywords: Action research; Evaluation; Implementation; Intervention; Nurse practitioner; Oncology; Outpatient; Palliative; Programme development; Radiotherapy