Disseminating and Sustaining the Integrated Care Pathway for the Last Days of Life Throughout Wales

Abstract

Implementation of the integrated care pathway for the last days of life throughout Wales was expected to gradually disseminate the use of the pathway across care settings in each of the 38 original localities. In January 2004, a brief postal survey was circulated among the 38 participating sites across Wales. These sites reflected four care settings, acute care, specialist inpatient care, hospice care and care in the community, and crossed the statutory and voluntary boundaries. Initially there was a 42% (16) response rate; this exceeded the expected response rate of 30% for postal surveys reported in the literature. Telephone follow-up and local knowledge supplemented the response data, bringing the final response rate to 63%. Overall, the dissemination of the pathway into clinical settings other than the original sites is taking place. It would seem that frequent staff changes affected the progress of the dissemination process. The need for regular ‘refresher’ sessions was highlighted, as was the requirement for a lead person to ‘drive’ the dissemination of the pathway.