Identified barriers by COM-B attribute and TDF domain and strategies for optimisation
| Barrier | TDF domain(s) | COM-B attribute | Change concept | Change idea |
| Organised debriefings are not offered, and informal debriefings rarely occur | Environmental context and resources; Social influences | Opportunity | Enhance opportunity | In collaboration with ward managers and educators, develop sessions that will combine education and open discussion opportunities on end-of-life care topics that are important to nursing staff (eg, palliative sedation, ethics at the end-of-life). |
| Lack of information resources for family | Environmental context and resources | Opportunity | Remove constraints; enhance opportunity | Work with key stakeholder groups (eg, palliative and spiritual care teams, physician group, social work, family partners) to develop a comprehensive information resource that can be tailored for families. Information could include medical team members (eg, nursing, physician, therapy staff), medications that might be used, resources for support, what to do after death, etc. |
| Need more education on common medication practices | Knowledge; Beliefs about consequences | Capability; Motivation | Remove constraints | Develop an accessible, easy-to-read medication resource for specific medications and how they are used in end-of-life care in collaboration with pharmacists and physicians. |
| Lack of understanding of team and programme roles (ie, palliative care, spiritual care, 3WP) | Knowledge; Social influences | Capability; Opportunity | Remove constraints; use visual cues | Develop an infographic highlighting services available at the end of life, including palliative and spiritual care and the 3WP. Have one version tailored towards families/loved ones and another specific for staff. Place these visual reminders in the hallways, nursing station, conference room, etc to encourage engagement from staff and patients’ loved ones. |
| Staffing challenges | Environmental context and resources | Opportunity | Enhance opportunity; have contingency plans | Introduce a volunteer role on the wards to assist with certain activities (eg, offering the patient ice water or a comfortable blanket, help direct family to various like cafeteria, parking services) for dying patients and their loved ones. |
COM-B, Capability–Opportunity–Motivation–Behaviour; TDF, Theoretical Domains Framework; 3WP, 3 Wishes Project.