Clinician perspectives of an improvement bundle to improve integrated palliative care: a qualitative study
8 affiliations
- 1Flinders Research Centre for Palliative Care, Death, and Dying, College of Health and Enablement, Flinders University, Sturt Road, Bedford Park SA 5042, Adelaide, South Australia Australia
- 2Cancer & Palliative Care Outcomes Centre, School of Nursing, Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology (QUT), Brisbane, Queensland Australia
- 3Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney (UTS), Sydney, New South Wales Australia
- 4Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology (QUT), Brisbane, Queensland Australia
- 5Health Services and Implementation Research, College of Health and Enablement, Flinders University, Adelaide, South Australia Australia
- 6School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, Queensland Australia
- 7Department of Internal Medicine and Aged Care, Royal Brisbane and Women’s Hospital, Butterfield Street, Herston, Queensland Australia
- 8Frazer Institute, The University of Queensland, Brisbane, Queensland Australia
Abstract
Background: Improving the quality of hospital-based palliative care remains a persistent challenge. Patient-reported experience measures (PREMs) offer a mechanism to centre improvement on what matters most to patients. Yet, there is limited evidence on how PREM data can support meaningful change. The Listen, Empower and Act to improve Hospital Palliative care (LEAHP) bundle is a facilitated, PREM-informed intervention designed to support hospital-based multidisciplinary teams to co-design and implement locally relevant improvements. This study explored clinicians’ perspectives on the acceptability and feasibility of the LEAHP bundle.
Methods: An exploratory qualitative study was conducted following pilot implementation of the LEAHP bundle across three acute Australian hospital wards. Semi-structured interviews with multidisciplinary clinicians and managers were informed by the Theoretical Framework of Acceptability, with additional prompts to explore feasibility. Data were analysed using practical thematic analysis.
Results: Twenty-seven interviews were conducted (nursing (n = 20); medicine (n = 6); and allied health (n = 1)), with a median duration of 27 min (range 17 to 40 min). Six themes were identified: 1). Clinicians valued PREM data to guide improvement; 2). Clinicians valued authentic engagement and collaboration; 3). Collaborative improvement required a new way of working; 4). Facilitation enabled collaboration; 5). Representation, power and workload realities were a challenge to collaboration; and 6). Building and maintaining gains is challenging. Participants valued PREM data as a credible driver for change and described the process as meaningful and engaging. Facilitation was critical in enabling collaboration, interpreting data, and sustaining momentum. Feasibility challenges included workload pressures, staffing variability, and reliance on sustained facilitation.
Conclusions: The LEAHP bundle was perceived as acceptable and meaningful, supporting a shift toward collaborative, patient-centred improvement. However, operationalising the bundle was contingent on skilled facilitation, organisational support, and integration into routine workflows. Future implementation should address sustainability and support balanced participation across disciplines and roles.
Related
- Stakeholder perspectives on sustainable antenatal point-of-care ultrasound (APOCUS) implementation in rural Australia: a qualitative study of professional body submissions and clinician focus groups.
- Ensuring quality in research, 'Authorship Effect' & Conflict of Interest. Response submitted to BMJ Mental Health in response to 'Clinician perspectives on the utility and acceptability of OxSATS: a qualitative study of a novel structured suicide risk assessment tool
- Parental perspectives on clinician guidance in value-laden NICU conversations: a qualitative study.
- Meeting the needs of people with pulmonary fibrosis: patient perspectives on improving palliative care provision: a qualitative study
- Missed, Misclassified or Misunderstood? Clinician Perspectives on Congenital Uterine Anomalies in Australia and New Zealand
BibTeX
@article{virdun2026clinician,
title = {{Clinician perspectives of an improvement bundle to improve integrated palliative care: a qualitative study}},
author = {Claudia Virdun and Gursharan K. Singh and Gillian Harvey and Patsy Yates and Jane L. Phillips and Alison Mudge},
journal = {BMC Palliative Care},
year = {2026},
month = oct,
doi = {10.1186/s12904-026-02361-0},
url = {https://doi.org/10.1186/s12904-026-02361-0},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Clinician perspectives of an improvement bundle to improve integrated palliative care: a qualitative study
AU - Claudia Virdun
AU - Gursharan K. Singh
AU - Gillian Harvey
AU - Patsy Yates
AU - Jane L. Phillips
AU - Alison Mudge
PY - 2026
DA - 2026/10/09
JO - BMC Palliative Care
DO - 10.1186/s12904-026-02361-0
UR - https://doi.org/10.1186/s12904-026-02361-0
AB - Background: Improving the quality of hospital-based palliative care remains a persistent challenge. Patient-reported experience measures (PREMs) offer a mechanism to centre improvement on what matters most to patients. Yet, there is limited evidence on how PREM data can support meaningful change. The Listen, Empower and Act to improve Hospital Palliative care (LEAHP) bundle is a facilitated, PREM-informed intervention designed to support hospital-based multidisciplinary teams to co-design and implement locally relevant improvements. This study explored clinicians’ perspectives on the acceptability and feasibility of the LEAHP bundle. Methods: An exploratory qualitative study was conducted following pilot implementation of the LEAHP bundle across three acute Australian hospital wards. Semi-structured interviews with multidisciplinary clinicians and managers were informed by the Theoretical Framework of Acceptability, with additional prompts to explore feasibility. Data were analysed using practical thematic analysis. Results: Twenty-seven interviews were conducted (nursing (n = 20); medicine (n = 6); and allied health (n = 1)), with a median duration of 27 min (range 17 to 40 min). Six themes were identified: 1). Clinicians valued PREM data to guide improvement; 2). Clinicians valued authentic engagement and collaboration; 3). Collaborative improvement required a new way of working; 4). Facilitation enabled collaboration; 5). Representation, power and workload realities were a challenge to collaboration; and 6). Building and maintaining gains is challenging. Participants valued PREM data as a credible driver for change and described the process as meaningful and engaging. Facilitation was critical in enabling collaboration, interpreting data, and sustaining momentum. Feasibility challenges included workload pressures, staffing variability, and reliance on sustained facilitation. Conclusions: The LEAHP bundle was perceived as acceptable and meaningful, supporting a shift toward collaborative, patient-centred improvement. However, operationalising the bundle was contingent on skilled facilitation, organisational support, and integration into routine workflows. Future implementation should address sustainability and support balanced participation across disciplines and roles.
SN - 1472-684X
ER -