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<p>In 2017, the United States Department of Veterans Affairs launched the Life-Sustaining Treatment Decisions Initiative, promoting goals of care conversations and standardizing documentation of Veterans’ life-sustaining treatment preferences in the electronic medical record. The VA Preferences Elicited and Respected for Seriously Ill Veterans through Enhanced Decision-Making or PERSIVED Program began in 2020 to improve these processes for Veterans receiving Home-Based Primary Care. We worked with 11 VA Home-Based Primary Care teams, providing monthly coaching calls and feedback reports showing life-sustaining treatment template completion rates. This manuscript describes facilitators and barriers to template completion. We conducted (<i>n</i>=67) process evaluation interviews with champions and site leadership from Home-Based Primary Care sites at 12- and 18-months post-enrollment into PERSIVED. We analyzed data through applying the Tailored Implementation in Chronic Diseases framework. PERSIVED raised awareness about requirements for life-sustaining treatment template completion, fostered increased discussion of Veterans’ life-sustaining treatment wishes, and increased staff comfort in having goals of care conversations. Some teams incorporated healthy competition to increase template completion and improved self-efficacy. Strong leadership support and reviewing feedback reports facilitated improvements in template completion. Barriers included confusion over when to use the template versus other advance care planning documentation, weak leadership support, and limited time and appropriate staffing levels as teams expanded. Application of the Tailored Implementation in Chronic Diseases framework effectively identified facilitators and barriers to improving life-sustaining treatment template documentation. Evaluators should consider incorporating similar steps to identify factors influencing intervention implementation, adoption, and long-term sustainability of implementation outcomes after intervention cessation.</p>

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Applying the Tailored Implementation in Chronic Diseases Framework to Analyze Process Evaluation Interviews over Time

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年4月21日

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  • Leah Haverhals,
  • Kate Magid,
  • Jennifer Kononowech,
  • Jazmin Beltran,
  • Amber Lane,
  • Cari Levy

摘要

In 2017, the United States Department of Veterans Affairs launched the Life-Sustaining Treatment Decisions Initiative, promoting goals of care conversations and standardizing documentation of Veterans’ life-sustaining treatment preferences in the electronic medical record. The VA Preferences Elicited and Respected for Seriously Ill Veterans through Enhanced Decision-Making or PERSIVED Program began in 2020 to improve these processes for Veterans receiving Home-Based Primary Care. We worked with 11 VA Home-Based Primary Care teams, providing monthly coaching calls and feedback reports showing life-sustaining treatment template completion rates. This manuscript describes facilitators and barriers to template completion. We conducted (n=67) process evaluation interviews with champions and site leadership from Home-Based Primary Care sites at 12- and 18-months post-enrollment into PERSIVED. We analyzed data through applying the Tailored Implementation in Chronic Diseases framework. PERSIVED raised awareness about requirements for life-sustaining treatment template completion, fostered increased discussion of Veterans’ life-sustaining treatment wishes, and increased staff comfort in having goals of care conversations. Some teams incorporated healthy competition to increase template completion and improved self-efficacy. Strong leadership support and reviewing feedback reports facilitated improvements in template completion. Barriers included confusion over when to use the template versus other advance care planning documentation, weak leadership support, and limited time and appropriate staffing levels as teams expanded. Application of the Tailored Implementation in Chronic Diseases framework effectively identified facilitators and barriers to improving life-sustaining treatment template documentation. Evaluators should consider incorporating similar steps to identify factors influencing intervention implementation, adoption, and long-term sustainability of implementation outcomes after intervention cessation.