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This paper outlines the need for developing a new training model for Integrated Care Medical Consultants in rural Northern Ireland, how the model was developed in collaboration with key stakeholders in the community using ECHO methodology, the implementation of the Integrated Care Fellowship scheme and the potential that this model offers for other rural areas where there are medical workforce challenges. Across the world sustaining a medical workforce in rural areas is a challenge. Existing training schemes tend to be based around major population areas and it is often hard to attract consultants to rural areas. In addition, existing training schemes may not be geared to the particular needs of a rural population, and recent changes in the training programmes of both Care of the Elderly and Palliative Care Doctors in the UK has been implicated for a fall off in numbers seeking such training. Through the Pathfinder project key stakeholders across the Western Trust used the ECHO methodology to identify the key priorities that the community living in rural Tyrone and Fermanagh wanted from a health service in relation to the elderly, frail and those needing palliative care services. The findings can be summarised as wanting more integrated and locally connected services. To respond to this and the demographic need of rapidly increasing numbers of elderly and frail people in the population we created an Integrated Care Fellowship training scheme combining the Care of the Elderly Curriculum with that of the Palliative Care Curriculum. The four year fellowship seeks to create a robust consultant workforce equipped with the skills and knowledge to lead the development of a more integrated way of working across the geography and in collaboration with existing assets and supports from both the statutory and voluntary sector to better deliver the care of the future that people in rural areas want. Support for the programme has been demonstrated by the Western Trust, the numbers of applicants for the programme, the quality of those candidates and by existing traditional training scheme leaders.  

Background The publication of the United Kingdom (UK) Standards for Public Involvement (PI) (UK Standards) in research drew a clear line in the sand regarding the importance of utilising the unique experience, skills and expertise that lay people may offer to the development, conduct and dissemination of clinical research. The UK Standards provide a benchmark which researchers should aim to achieve, yet its implementation continues to be a step wise iterative process of change management. A recent evaluation by a regional research group has suggested that our understanding of PI is enhanced through reflection on the UK Standards. We report on the utility of PI in the design, conduct and dissemination of the HIDDen study, a national, multicentre clinical study based across three UK centres. Methods A retrospective review of PI within the HIDDen study was conducted using field notes taken by the lead author from interactions throughout their involvement as a lay representative on the study. Key members of the HIDDen study were interviewed and data analysed to explore adherence to the UK Standards. Results There was universal support for PI across the study management group with genuine inclusivity of lay members of the committee. All six of the UK Standards were met to varying degrees. The greatest opportunities lay in ‘working together’ and ‘support and learning’. There were challenges meeting ‘governance’ with evidence of participation in decision making but less evidence of opportunities in management, regulation, leadership. Conclusion This study concurs with previous research supporting the utility of the Standards in the conduct and evaluation of PI in clinical research. To our knowledge this is the first multi-national study to be evaluated against the UK Standards.

Background More people living into old age with dementia. The complexity of treatment and care, particularly those with multiple health problems, can be experienced as disjointed. As part of an evaluation of a ‘healthcare passport’ for people living with dementia we undertook a realist review of communication tools within health and social care for people living with dementia. Aims To explore how a ‘healthcare passport’ might work in the ‘real world’ of people living with dementia through a better understanding of the theoretical issues related to, and the contextual issues that facilitate, successful communication. Methods A realist review was considered the most appropriate methodology to inform the further development and evaluation of the healthcare passport. We undertook a purposive literature search related to communication tools to identify (a) underlying programme theories; (b) published reports and papers on their use in various healthcare settings; (c) evidence on barriers and facliitators of their use. Results Communication tools were noted as a way of improving communication and outcomes through: (1) improvement of service user autonomy; (2) strengthening the therapeutic alliance; and (3) building integrated care. However, while intuitively perceived to of benefit, evidence on their use is limited and key barriers to their acceptance and use include: (1) difficulties in clearly defining purpose, content, ownership and usage; (2) understanding the role of family caregivers; and (3) preparation among healthcare professionsals. Conclusion Patient-held communication tools may be helpful to some people living with dementia but will require considerable preparation and engagement with key stakeholders.

The findings within this short report, generated from thematic analysis of nine semistructured interviews with the Northern Ireland Project ECHO team (including authors of this reflection) and informed by reflective practice literature,7 highlight important additional lessons for other teams and organisations using the ECHO approach. Participatory approaches to setting curriculum and programme content, and linking objectives to wider service goals such as integration of care, service transformation and achieving measurable patient outcomes, were consistently present in networks that were considered most effective by the Northern Ireland Project ECHO operational team. Participants must feel safe in sharing sensitive information, discussing challenging cases, while being open to learning and critical feedback. Funding This study was undertaken as part of programmatic and process evaluation with healthcare providers funded through the Health and Social Care Board of Northern Ireland.

Background Internationally, it is widely accepted that holistic care is as an integral part of the care for people with motor neurone disease (MND), and their informal carers. However the optimal role of generalist and specialist palliative care, and how it integrates with specialist neurology services, is not fully established. Using a qualitative approach we sought to examine end of life care for people with MND in Northern Ireland, and the role of specialist and generalist palliative care. Methods Qualitative study involving a convenience sample of 13 bereaved carers recruited using the Northern Ireland MND Register. Data collection consisted of semi-structured interviews with the bereaved carers of patients who had died 3–24 months previously with a diagnosis of MND. Data were analysed using thematic analysis. Results Findings illuminated variations in relation to the levels of holistic care provided to this cohort of patients. Unmanaged respiratory and psychological symptoms caused perceived distress amongst patients. Participants’ experiences additionally highlighted reluctance amongst patients with MND to engage with services such as specialist palliative care. Conversely, for those who received input from specialist palliative care services carers portrayed these services to be of great benefit to the patient. Conclusions Patients with MND in Northern Ireland may have many unmet holistic care needs. Key areas that require particular focus in terms of service development include neuromuscular respiratory physiotherapy and psychological services for patients. Future research must explore an optimal model of holistic care delivery for patients with MND and how this can be effectively integrated to best meet this patient cohorts palliative care needs.

Background Pain assessment and management in advanced and end-stage dementia are challenging; patients are at risk of under-diagnosis, under-assessment and under-treatment. Previous research has highlighted the importance of needs-driven training and development in this area for physicians, nurses and healthcare assistants (HCAs) across specialties, disciplines and care settings. This study used teleconferencing technology to connect healthcare professionals across multiple settings and disciplines in real-time clinics, based on the Project ECHO© model. This paper reports the evaluation of the clinics by physicians, nurses and HCAs, including their knowledge and self-efficacy in pain assessment and management for patients with advanced and end-stage dementia. Methods A mixed method evaluation comprising quantitative survey of self-reported knowledge and self-efficacy pre- and post-ECHO clinic participation, and qualitative exploration of experiences of the clinics using focus group interviews. A census approach to sampling was undertaken. Pre- and post-ECHO evaluations were administered electronically using Survey Monkey software. Mann-Whitney U tests were used to explore differences in knowledge and self-efficacy scores pre- and post-ECHO clinic participation. Statistical significance was set a-priori at p  = 0.05. Focus groups were video- and audio-recorded, transcribed verbatim and analysed using Braun & Clarke’s model of thematic analysis. Results Eighteen healthcare professionals [HCPs] (physicians [ n  = 7], nurses [ n  = 10], HCA [ n  = 1]) and twenty HCPs (physicians [ n  = 10], nurses [ n  = 10]) completed pre- and post-ECHO evaluations respectively, reporting improvements in knowledge and self-efficacy on participation in ECHO clinics and perceived utility of the clinics. Seven HCPs (physicians [ n  = 2], nurses [ n  = 5]) participated in two focus groups. Four themes emerged: knowledge and skills development and dissemination; protected time; areas for improvement; and the future of ECHO. Conclusions Telementoring clinics for HCP education and training in pain assessment and management in advanced and end-stage dementia demonstrate a positive impact on knowledge and self-efficacy of HCPs and highlight the value of a cross-specialty network of practice which spans across disciplines/HCP types, care settings and geographical areas. Further development of ECHO services in this and in other clinical areas, shows significant potential to support delivery of high-quality care to complex patient populations.

Prior to the COVID-19 pandemic, Hospice UK held a version of Partner Launch Training derived from the ECHO Institute’s programme in-person over three continuous days at offices in London and Belfast. However, the national lockdowns and social distancing measures made such an approach impossible. Hospice UK thus transformed their training programme to meet the virtual environment’s opportunities and challenges, and chose Zoom as the vehicle for training delivery. Between September 2020 and October 2022, Hospice UK has delivered Partner Launch Training via Zoom to 83 participants from 32 organisations. This presentation will aim to describe the changes made to the traditional programme and their impact. Adapting to a virtual format required a complete revision of the programme to maximise learning, increase interactivity, and to take account of both ‘Zoom fatigue’ and the participants’ different learning styles. The ECHO team decided to run training over a three-week period, one day each week, and reformatted the programme sessions into 10 frequently asked questions that aimed to cover ‘The What?’, ‘The How?’ and ‘The Strategy’ of becoming an ECHO Hub. The team designed a Virtual Immersion ‘Learning Guide’ that accompanies the information provided within the Partner Launch Training Handbook. The Learning Guide is composed of three sections: pre-training activities, the nine questions and post-training activities.51 participants (September 2020-October 2022) responded to the ECHO Institute evaluation: 98% were satisfied with the learning experience.94% would recommend this learning opportunity to others. 86% found the virtual experience better than or the same as they imagine an in-person session might be.96% agreed that this learning experience had given them the skills to build an ECHO programme.Internally, Hospice UK learnt that the virtual format of Partner Launch Training allows them to reduce the cost of training by 20% per participant and expand participant numbers.