BEreavement SupporT for Families – Tailored implementation of evidence-informed family end-of-life and BEreavement SupporT (BEST for Family) in acute palliative care: A mixed-methods study with health professionals and family members

Family caregiving followed by the loss of a close other is a stressful, incisive experience that may impact negatively physical and mental health. Evidence-based, health-promoting bereavement care is insufficiently adopted and inconsistently delivered in Swiss palliative care services.

The aims of this implementation research project are first, to adopt the evidence to local conditions and tailor implementation to barriers / enablers, and second, to evaluate the ability to ensure full integration of this evidence-based BEreavement SupporT services for families (= BEST for Family) through a set of co-developed implementation strategies in palliative care by investigating implementation, service, and health outcomes from health professionals and bereaved families’ perspectives.

The BEST for Family is carried out in two specialized palliative care inpatient services in two large Swiss hospitals. Health professionals, namely, nurses, physicians, chaplains, social workers, psychologists, and other palliative staff members working in the services, and bereaved family members receiving the support are included.

The study includes preparation, implementation, and evaluation phase with five work packages. First, evidence-based recommendations are identified through a literature review and adapted to the Swiss context through practice partner workshops, resulting in the BEST for Family pathway. Second, implementation strategies are developed in collaboration with practice partners through contextual analysis focus groups guided by the Updated Consolidated Framework for Implementation Research. Third, evidence-informed BEST for Family pathway is implemented and delivered. Fourth, using a pre-mid-post survey study with embedded qualitative interviews, the implementation process and outcomes are evaluated with health professionals. Fifth, using mixed methods, service and health outcomes are assessed with families.

The evidence available on how to best support bereaved families according to their individual needs and risks requires better translation into specialized palliative care in Switzerland. Therefore, this study addresses a significant know-do gap in palliative care by using implementation science knowledge and methods. Study findings will provide important knowledge on implementation processes and outcomes of family care, which will inform scalability to other palliative care services and settings in Switzerland and ensure improved and equitable access to evidence-informed, health-promoting engagement and support to families at the end-of-life and in bereavement.