title: Implementation of improvement strategies in palliative care: an integrative review.
abstract: BACKGROUND
  The European population is ageing, and as a consequence, an increasing number of patients are in need of palliative care, including those with dementia. Although a growing number of new insights and best practices in palliative care have been published, they are often not implemented in daily practice. The aim of this integrative review is to provide an overview of implementation strategies that have been used to improve the organisation of palliative care.
  
  
  METHODS
  Using an integrative literature review, we evaluated publications with strategies to improve the organisation of palliative care. Qualitative analysis of the included studies involved categorisation of the implementation strategies into subgroups, according to the type of implementation strategy.
  
  
  RESULTS
  From the 2379 publications identified, 68 studies with an experimental or quasi-experimental design were included. These studies described improvements using educational strategies (n = 14), process mapping (n = 1), feedback (n = 1), multidisciplinary meetings (n = 1) and multi-faceted implementation strategies (n = 51). Fifty-three studies reported positive outcomes, 11 studies reported mixed effects and four studies showed a limited effect (two educational and two multi-faceted strategies).
  
  
  CONCLUSIONS
  This review is one of the first to provide an overview of the available literature in relation to strategies used to improve the organisation of palliative care. Since most studies reported positive results, further research is needed to identify and improve the effects of strategies aiming to improve the organisation of palliative care.
authors.affiliation: Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands. Jasper.vanRietPaap@radboudumc.nl.
authors.forename: Jasper
authors.initials: J
authors.lastname: van Riet Paap
authors.affiliation: Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands. Myrra.Vernooij-Dassen@radboudumc.nl.|Nijmegen Alzheimer Centre, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands. Myrra.Vernooij-Dassen@radboudumc.nl.|Kalorama Foundation, Nijmegen, The Netherlands. Myrra.Vernooij-Dassen@radboudumc.nl.
authors.forename: Myrra
authors.initials: M
authors.lastname: Vernooij-Dassen
authors.affiliation: European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, P.O. Box 8905, N-7491, Trondheim, Norway. ragni.sommerbakk@ntnu.no.
authors.forename: Ragni
authors.initials: R
authors.lastname: Sommerbakk
authors.affiliation: Centre for Health Practice Innovation, Griffith Health Institute, Griffith University, 170 Kessels Road, Nathan, Brisbane, Australia. w.moyle@griffith.edu.au.
authors.forename: Wendy
authors.initials: W
authors.lastname: Moyle
authors.affiliation: European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, P.O. Box 8905, N-7491, Trondheim, Norway. marianne.j.hjermstad@ntnu.no.|Regional Centre for Excellence in Palliative Care Department of Oncology, Oslo University Hospital, P.O. Box 4956, Nydalen, 0424, Oslo, Norway. marianne.j.hjermstad@ntnu.no.
authors.forename: Marianne J
authors.initials: MJ
authors.lastname: Hjermstad
authors.affiliation: Department of Palliative Medicine, Poznan University of Medical Sciences, 61-245, Poznan, Poland. wojciechleppert@wp.pl.
authors.forename: Wojciech
authors.initials: W
authors.lastname: Leppert
authors.affiliation: Department of Anaesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands. Kris.Vissers@radboudumc.nl.
authors.forename: Kris
authors.initials: K
authors.lastname: Vissers
authors.affiliation: Department of Anaesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands. Yvonne.Engels@radboudumc.nl.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Engels
mesh_terms: D006801:Humans; D010166:Palliative Care / Q000379:methods* / Q000458:organization & administration / Q000592:standards; D016730:Program Development / Q000379:methods; D058996:Quality Improvement