Implementing a Dignity Care Intervention (DCI) for Individuals with LifelimitingIllness in a Community Setting in Ireland

Background: Evidence indicates that people at end of life fear loss of dignity more thananything else. What defines dignity for the individual patient and his or her family is unique.A central tenet of palliative care is to help people die with dignity. Whilst there has been anincrease in emphasis on care in the community, there is lack of guidance on palliative carefor community healthcare professionals.Aim: To implement a Dignity Care Intervention for individuals nearing the end of life in acommunity setting in Ireland.Methods: The MRC Framework for Developing and Evaluating Complex Interventions wasused for this multiphase mixed methods study.Phase 1: Contextualising the DCI tool using focus group interviews with user/carerrepresentatives (n=10) and community nurses (n=18). These explored the use andapplicability of the tool for an Irish context.Phase 2: Educational programme for community nurses (n=54);Phase 3: Implementation and evaluation of DCI in practice: 4 pilot sites, across rural andurban areas are implementing the DCI tool in practice.Results: Findings from Phase 1 identified issues such as reluctance to discuss ‘feelings’;having a ‘desire to please others’ alongside issues of communication within the primary carecontext. Feedback from the educational sessions indicated an increase in confidence andcompetence for implementing the tool in practice. Realistic evaluation approach is ongoingincluding focus groups (n=4) and semi-structured interviews with patients and carers (n=20).Conclusion: The complexity of implementing a tool in practice cannot be underestimated.Greater understanding of such issues will contribute to the future development of practiceand subsequent improved care for patients approaching the end of life.14th