Co-Design Use in the Development and Implementation of Palliative Care Interventions: A Systematic Review (GP110)

Outcomes 1. Describe the way in which co-design with diverse stakeholders (caregivers, patients, community elders, ethnic minorities, and healthcare providers) has been used to develop palliative care interventions.2. Understand co-design phases of intervention development: ideation, design refinement, pretesting/prototyping, implementation, and stakeholder evaluation. Key Message Our study synthesized evidence on co-design of palliative care interventions. Of 1,036 screened studies, 28 met criteria. Stakeholder engagement and iterative processes, involving healthcare providers and caregivers, proved vital for successful outcomes. Highly varied design parameters underline the importance of standardizing the collaborative process in palliative care intervention development. Importance Co-design is a methodology that includes active collaboration between stakeholders in designing solutions, and has been used in the development and implementation of palliative care (PC) interventions. Objective(s) To synthesize the state of evidence for co-design in the development of PC interventions. Scientific Methods Utilized We searched PubMed, EMBASE, and CINAHL for peer-reviewed studies published after 1995 that reported evidence of co-designed interventions and outcomes in patients receiving palliative, hospice, or end-of-life care. We screened studies through independent and blinded dual review within Covidence and assessed study quality with the 2018 Mixed Methods Appraisal Tool. We narratively synthesized co-design duration, engagement approach, and stakeholders involved, as well as, intervention designs, follow-ups, and outcomes, comparing among co-designs that reported meaningful improvement in outcomes. Results 1,036 abstracts and 54 full text articles were screened. 28 studies met inclusion criteria and were abstracted. Feedback collection modalities ranged from iterative drafting, pilot testing, advisory panels, workshops, focus groups, and interviewing stakeholders. 13 studies applied pretesting/prototyping through pre-test post-test, focus groups, app prototypes, alpha and beta testing, and mock-ups. 11 studies reported improved outcomes, 8 of which utilized an iterative co-design process. All the studies that reported improved outcomes mentioned meeting with stakeholders at least twice throughout the study. Out of the 8 iterative studies, 5 reported meeting with stakeholders at least 4 times or recurrently throughout the study. All 11 studies that reported improvements in outcomes involved healthcare providers; 6 of the 11 involved caregivers. Of the studies that pretested, only 5 had improved intervention outcomes. Conclusion(s) To date, co-designed PC interventions across all assessed studies demonstrate high variance in the modality of acquiring feedback and the ways in which co-design has been applied. Impact A successful PC co-design process that leads to significant improvement in outcomes is achieved by involving providers and caregivers iterating intervention design.