Barriers and facilitators to the implementation of a paediatric palliative care team

Verberne, Lisa M.; Kars, Marijke C.; Schepers, Sasja A.; Schouten-van Meeteren, Antoinette Y. N.; Grootenhuis, Martha A.; van Delden, Johannes J. M.

doi:10.1186/s12904-018-0274-8

Cited by 93Palliative Care and End-of-Life IssuesHealth Policy Implementation SciencePalliative and Oncologic Care

Barriers and facilitators to the implementation of a paediatric palliative care team

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Verberne, Lisa M., Kars, Marijke C., Schepers, Sasja A., Schouten-van Meeteren, Antoinette Y. N., Grootenhuis, Martha A., van Delden, Johannes J. M.·2018·BMC Palliative Care

DOI 10.1186/s12904-018-0274-8PMC PMC5810030

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Abstract

BACKGROUND: Over the last decade, paediatric palliative care teams (PPCTs) have been introduced to support children with life-limiting diseases and their families and to ensure continuity, coordination and quality of paediatric palliative care (PPC). However, implementing a PPCT into an organisation is a challenge. The objective of this study was to identify barriers and facilitators reported by healthcare professionals (HCPs) in primary, secondary or tertiary care for implementing a newly initiated multidisciplinary PPCT to bridge the gap between hospital and home. METHODS: The Measurement Instrument for Determinants of Innovations (MIDI) was used to assess responses of 71 HCPs providing PPC to one or more of the 129 children included in a pilot study of a PPCT based at a university children's hospital. The MIDI (29 items) assessed barriers and facilitators to implementing the PPCT by using a 5-point scale (completely disagree to completely agree) and additional open-ended questions. Items to which ≥20% of participants responded with 'totally disagree/disagree' and ≥80% responded with 'agree/totally agree' were considered as barriers and facilitators, respectively. A general inductive approach was used for open-ended questions. RESULTS: Reported barriers to implementing a PPCT were related to the HCP's own organisation (e.g., no working arrangements related to use of the intervention [PPCT] registered, other organisational changes such as merger going on). Reported facilitators were mainly related to the intervention (correctness, simplicity, observability and relevancy) and the user scale (positive outcome expectations, patient satisfaction) and only once to the organisation scale (information accessibility). Additionally, HCPs expressed the need for clarity about tasks of the PPCT and reported having made a transition from feeling threatened by the PPCT to satisfaction about the PPCT. CONCLUSION: Positive experiences with the PPCT are a major facilitator for implementing a PPCT. Tailored organisational strategies such as working arrangements by management, concrete information about the PPCT itself and the type of support provided by the PPCT should be clearly communicated to involved HCPs to increase awareness about benefits of the PPCT and ensure a successful implementation. New PPCTs need protection and resources in their initial year to develop into experienced and qualified PPCTs.

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The barrier questionnaire used is based on the Measurement Instrument for Determinants of Innovations (MIDI), a Dutch validated questionnaire developed by Fleuren et al. and used in several Dutch studies.
“The used questionnaire was based on the Measurement Instrument for Determinants of Innovations (MIDI), a Dutch validated questionnaire developed by Fleuren et al. [31] and used in several Dutch studies [37,38].”
From The Healthy Primary School of the Future: A Contextual Action-Oriented Research Approach (2018) · cites this paper as [38]

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“2016 [acesso 15 jan 2019];19(11):1218-23.”
Rib Fixation for Multiple Rib Fractures: Healthcare Professionals Perceived Barriers and Facilitators to Clinical Implementation
Spronk, I., Wijck, S. F. M. V., Lieshout, E. M. M. V., Verhofstad, M. H. J., Prins, J. T. H., Wijffels, M. M. E., Polinder, S., the FixCon Study Group, Blokhuis, T. J., de Loos, E. R., et al. (2023) · World Journal of Surgery · doi:10.1007/s00268-023-06973-y · Cited by 12 · see citing works
The impact of home-based physical rehabilitation program on parents' experience with children in palliative care: a qualitative study
Rico-Mena, P., Palacios‐Ceña, D., Alba, R. M., González, L. C., & Güeita‐Rodríguez, J. (2019) · European Journal of Physical and Rehabilitation Medicine · doi:10.23736/s1973-9087.19.05474-1 · Cited by 13 · see citing works
Barriers and facilitators for healthcare professionals to the implementation of Multidisciplinary Timely Undertaken Advance Care Planning conversations at the outpatient clinic (the MUTUAL intervention): a sequential exploratory mixed-methods study
van Lummel, E. V. T. J., Meijer, Y., Tjan, D. H. T., & van Delden, J. J. M. (2023) · BMC Palliative Care · doi:10.1186/s12904-023-01139-y · Cited by 12 · see citing works
“Adaptations to the MIDI In line with other research [18], two open-ended questions were added to the MIDI.”
Method
I CONGRESSO NACIONAL DE CUIDADOS PALIATIVOS
da Silva, R. R. C. P., Sousa, T. D. O., Silva, R. T., Silva, I. C., de Moura, J. P., & do Nascimento, C. E. M. (2021) · Jornal de Ciências da Saúde do Hospital Universitário da Universidade Federal do Piauí · doi:10.26694/jcshuufpi.v3isupl.3.898 · Cited by 11 · see citing works
Palliative Care Practitioners’ Perception toward Pediatric Palliative Care in the Republic of Korea
Moon, Y. J., Shin, H. Y., Kim, M. S., Song, I. G., Kim, C. H., Yu, J., & Park, H. Y. (2019) · The Korean Journal of Hospice and Palliative Care · doi:10.14475/kjhpc.2019.22.1.39 · Cited by 11 · see citing works
“또한 소아완화의료에 대한 인식의 부족은 제도화 구 축 및 시스템 확산에 커다란 장애물로 작용하기에(11) 현재 국내 호스피스·완화의료 전문기관(이하 전문기관) 종사자가 소아완화 의료 제공에 대해 어떠한 인식을 가지고 있는지 파악하고 소아완 화의료 모델을 구축하기 위한 방향성을 제시할 필요가 있다.”
Palliative care services in paediatric oncology centres across Europe: A cross-sectional survey
Pedraza, E. C., Raguindin, P. F., Hendriks, M. J., Vokinger, A. K., Clercq, E. D., Rüesch, K., Hjorth, L., von Bueren, A. O., Tinner, E. M., Bergsträßer, E., et al. (2023) · EJC Paediatric Oncology · doi:10.1016/j.ejcped.2023.100125 · Cited by 10 · see citing works
Implementation of a first-trimester prognostic model to improve screening for gestational diabetes mellitus
On behalf of the RESPECT 2 study group, van Hoorn, F., Koster, M. P. H., Kwee, A., Groenendaal, F., Franx, A., & Bekker, M. N. (2021) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-021-03749-x · Cited by 9 · see citing works
“Subconstructs to which ≥20% of the healthcare professionals responded with ‘strongly disagree’ or ‘disagree’ were considered barriers, and those to which ≥80% responded ‘strongly agree’ or ‘agree’ were considered facilitators [23].”
Background
Improvement and implementation of a national individual care plan in paediatric palliative care: a study protocol
Joren, C. Y., Kars, M. C., Kremer, L. C. M., Rippen, H., Verhagen, E. A. A., & Aris-Meijer, J. (2023) · BMJ Paediatrics Open · doi:10.1136/bmjpo-2022-001677 · Cited by 9 · see citing works
Self-citation
Virtual Reality to Support Inpatient Addiction Treatment: Patients Are Ready, What About Therapists? A Feasibility Study
Arissen, C., van der Helm, L., Dijkstra, B. A. G., & Markus, W. (2022) · International Journal of Mental Health and Addiction · doi:10.1007/s11469-022-00843-9 · Cited by 8 · see citing works
“In line with Verberne et al. (2018), MIDI items where ≥ 20% of participants scored “Disagree” or “Strongly disagree” were flagged as barriers, while items where ≥ 80% of participants scored “Agree” or “Strongly agree” were flagged as facilitators for implementation.”
Result
Innovative communication approaches for initializing pediatric palliative care: perspectives of family caregivers and treating specialists
Hrdličková, L., Poláková, K., & Loučka, M. (2023) · BMC Palliative Care · doi:10.1186/s12904-023-01269-3 · Cited by 8 · see citing works
“The treating physician attending the initial PPC consultation may also represent an important step towards advocating for palliative care in the hospital and to improve implementation of PPC, which can be very challenging [7, 8, 10].”
Background
Challenges of paediatric palliative care in the intensive care unit during the COVID-19 pandemic
Hasanpour, M., Tahmasebi, M., Mohammadpour, M., Pouraboli, B., & Sabeti, F. (2021) · International Journal of Palliative Nursing · doi:10.12968/ijpn.2021.27.6.303 · Cited by 7 · see citing works
Barriers and facilitators influencing implementation of care technology for people with intellectual disabilities: A cross‐sectional study among care professionals
Siebelink, N. M., Gaasterland, A., Gielissen, M. F. M., van der Weegen, S., Boon, B. J. F., & van der Poel, A. (2024) · Journal of Applied Research in Intellectual Disabilities · doi:10.1111/jar.13262 · Cited by 5 · see citing works
Perceived facilitating and limiting factors for healthcare professionals to adopting a patient decision aid for breast cancer aftercare: A cross-sectional study
Klaassen, L. A., Friesen-Storms, J. H. H. M., Bours, G. J. J. W., Dirksen, C. D., Boersma, L. J., & Hoving, C. (2019) · Patient Education and Counseling · doi:10.1016/j.pec.2019.07.024 · Cited by 6 · see citing works
Needs for Pediatric Palliative Care among Parents of Children with Complex Chronic Conditions
Yun, H., Hwang, A.-R., Kim, S., & Choi, E. K. (2018) · Child Health Nursing Research · doi:10.4094/chnr.2018.24.4.527 · Cited by 5 · see citing works
Thinking inside the box
Deenik, J. (2019) · doi:10.26481/dis.20190522jd · Cited by 5 · see citing works
Implementation Frameworks, Strategies, and Outcomes in Optimizing Central Venous Access Device Practice in Neonates: A Scoping Review
Comber, E. R., August, D. L., Nguyen, L. N., de Souza, S., Ullman, A. J., Byrnes, J., & Keogh, S. J. (2025) · Hospital Pediatrics · doi:10.1542/hpeds.2024-008248 · Cited by 4 · see citing works
Starting of a new pediatric palliative care program in a general hospital: characteristics of the population and use of resources
Cabetas, L. G.-T., Guerra, P. D. V., Rincón, L. L., & Cano, A. (2022) · Anales del Sistema Sanitario de Navarra · doi:10.23938/assn.0989 · Cited by 4 · see citing works
Unfolding parental knowledge, attitudes, and beliefs toward palliative care for children with cancer
Rassam, R. S., Abu‐Saad, H. H., Noureddine, S., Smith, E., Wolfe, J., Fares, S. A., & Abboud, M. R. (2023) · Pediatric Blood & Cancer · doi:10.1002/pbc.30484 · Cited by 4 · see citing works
Healthcare Professionals’ Attitudes towards and Knowledge and Understanding of Paediatric Palliative Medicine (PPM) and Its Meaning within the Paediatric Intensive Care Unit (PICU): A Summative Content Analysis in a Tertiary Children’s Hospital in Scotland—“An In Vitro Study”
Ray, S., McLorie, E. V., & Downie, J. (2023) · Healthcare · doi:10.3390/healthcare11172438 · Cited by 4 · see citing works
“To lessen the barriers identified in this study, palliative care teams have the opportunity to act as facilitators by developing working relationships with other teams [41].”
Background
Factors Associated With Medical Staff’s Engagement and Perception of a Quality Improvement Program for Acute Coronary Syndromes in Hospitals: A Nationally Representative Mixed‐Methods Study in China
Zhou, S., Jin, Y., Ma, J., Dong, X., Li, N., Shi, H., Zhang, Y., Guan, X., LaBresh, K. A., Smith, S. C., et al. (2022) · Journal of the American Heart Association · doi:10.1161/jaha.121.024845 · Cited by 3 · see citing works
Shared decision-making in pediatric palliative care in the Netherlands
Michiels, E. M. C., Joren, C. Y., Kars, M. C., Aris-Meijer, J., & Verhagen, E. A. A. (2024) · Current problems in pediatric and adolescent health care · doi:10.1016/j.cppeds.2023.101549 · Cited by 3 · see citing works
Self-citation
Implementing the My Positive Health dialogue tool for children with a chronic condition: barriers and facilitators
de Jong-Witjes, S., van der Sprenkel, E. E. B., Kars, M. C., Huber, M., Nijhof, S. L., Nuboer, R., Henten, D. M. B.-V., Lasham, C. A., van Mil, E., & van de Putte, E. M. (2025) · BMC Pediatrics · doi:10.1186/s12887-024-05258-0 · Cited by 4 · see citing works
Self-citation
Mending the gaps: A systems-focused rapid review on paediatric palliative care for health leaders
Bailey, L., Wright, M., & Goodman, K. (2025) · Healthcare Management Forum · doi:10.1177/08404704251322481 · Cited by 3 · see citing works
The Prevalence of Nonprescription Cannabinoid-Based Medicines in British Children's Hospices: Results of a National Survey
Tatterton, M. J., & Walker, C. (2019) · Journal of Palliative Medicine · doi:10.1089/jpm.2018.0522 · Cited by 3 · see citing works
An Ongoing Process: The Implementation of an Intervention for People With Profound Intellectual and Multiple Disabilities Over Time
Schaafsma, J., ten Brug, A., & van der Putten, A. A. J. (2025) · Journal of Applied Research in Intellectual Disabilities · doi:10.1111/jar.70098 · Cited by 2 · see citing works
Evaluation of an Adaptive Implementation Program for Cognitive Adaptation Training for People With Severe Mental Illness: Protocol for a Randomized Controlled Trial
van Dam, M., van Weeghel, J., Castelein, S., Pijnenborg, G. H. M., & van der Meer, L. (2020) · JMIR Research Protocols · doi:10.2196/17412 · Cited by 2 · see citing works
“Although psychometric properties have not yet been established, other studies in mental health administering the MIDI among health care professionals showed an internal consistency (Cronbach α ) between .61-.93 [32,33].”
Facilitators and barriers to the transition from outpatient clinic visits to home-based check-ups for children being treated with growth hormone: a mixed-methods study
Remmits, A. J. W., van Mastrigt, G. A. P. G., Evers, S., & van Setten, P. A. (2024) · European Journal of Pediatrics · doi:10.1007/s00431-023-05408-z · Cited by 1 · see citing works
Barriers and facilitators of inpatients and healthcare professionals prior to the implementation of a Multidisciplinary Lifestyle-Focused Approach in the Treatment of Inpatients With Mental Illness (MULTI+): The MULTI+ Study II
van Schothorst, M. M. E., den Bleijker, N. M., van Harten, P. N., de Vries, N. K., & Deenik, J. (2025) · Implementation Research and Practice · doi:10.1177/26334895251351663 · Cited by 1 · see citing works
“Following recent studies (Deenik et al., 2019a; Verberne et al., 2018), items on which 20% of participants scored negatively (score of <3 = disagree/totally disagree ) were considered barriers and items on which 80% of participants scored positively (score of >3 = agree/totally agree ) were…”
Pediatric advance care planning: a mixed-methods evaluation of documentation and sharing in current practice
Tooten, S., Hermens, R., Verhoeven, M., Vierhoven, E. M., Boulakhrif, F., Reintjes, J. M., Willemsen, M., Aris-Meijer, J. L., Fahner, J., Engel, M., et al. (2026) · BMC Palliative Care · doi:10.1186/s12904-026-01992-7 · Cited by 1 · see citing works
“This is an interesting finding, as pediatric palliative care team members [41, 42] are well positioned to assume greater responsibility in discussing, documenting, and sharing ACP elements, which could improve coordination in these complex care networks.”
Self-citation
Enhancing implementation and compliance of the Screening Instrument for Child Abuse and Neglect (SCAN) in emergency departments in the Netherlands
van den Heuvel, E. A. L., de Vries, E., Kempen, B. D. J.-V., Bakx, R., Bos, R. F., van Empelen, P., Hoedeman, F., Kappen, T. H., Russel, I. M. B., Puiman, P. J., et al. (2026) · BMJ Paediatrics Open · doi:10.1136/bmjpo-2025-003362 · Cited by 1 · see citing works
Perceived barriers to paediatric palliative care in a Palestinian children's hospital
Ghareeb, G., & Kelly, D. M. (2025) · International Journal of Palliative Nursing · doi:10.12968/ijpn.2025.31.1.40 · Cited by 1 · see citing works
“Paediatric palliative care (PPC) is a holistic approach focused on the physical, emotional, and spiritual well-being of children, whilst also providing support to their families (Akard et al. 2019; Verberne et al. 2018).”
Timely integration of palliative care into oncology in hospitals in the Netherlands: a feasibility study
Heipon, C. S., Brom, L., van der Deure, W. M., Dingemans, I., Geerse, O. P., Lauer, S., Vos, F. D., van der Linden, Y. M., Reyners, A. K. L., & Raijmakers, N. J. H. (2025) · BMC Health Services Research · doi:10.1186/s12913-025-13199-2 · Cited by 1 · see citing works
“Based on previous research, aspects of the MIDI instrument were considered important for the applicability if ≥ 80 of the participants agreed or strongly agreed [28].”
CURA: Developing, evaluating and implementing a new clinical ethics support instrument in palliative care
van Schaik, M. V. (2024) · doi:10.5463/thesis.532 · Cited by 1 · see citing works
How to move forward with evidence-based practice in nursing
Storms, F. (2019) · doi:10.26481/dis.20190614jfs
Implementation of the self-management of well-being interventions: determinants and effects
Kuiper, D. (2020) · doi:10.33612/diss.127415575
Tradução e adaptação transcultural do Pediatric Palliative Care Questionnaire (PPCQ) para o português do Brasil
Leite, F. D. A. (2020) · doi:10.11606/t.17.2020.tde-23082020-143411
Barriers and Enablers in the Implementation of a Quality Improvement Program for Acute Coronary Syndromes in Hospitals: A Qualitive Analysis Using the Consolidated Framework for Implementation ResearchPreprint
Zhou, S., Ma, J., Dong, X., Li, N., Duan, Y., Wang, Z., Gao, L., Han, L., Tu, S., Liang, Z., et al. (2021) · Research Square · doi:10.21203/rs.3.rs-1089585/v1
Why We Need to Talk About Teams and Communication in Palliative Care
(2020) · Springer Publishing Company eBooks · doi:10.1891/9780826158062.0001
Barriers And Facilitators For Therapeutic Drug Monitoring Of Beta-Lactams And Ciprofloxacin In The ICU: A Nationwide Cross-Sectional StudyPreprint
Ewoldt, T. M. J., Abdulla, A., van den Broek, P., Hunfeld, N., Bahmany, S., Muller, A. E., Gommers, D. A. M. P. J., Polinder, S., Endeman, H., Spronk, I., et al. (2022) · Research Square · doi:10.21203/rs.3.rs-1213794/v1
Predicting therapist adherence to the CRA manual in addiction care
Kraan, A. E. M., Markus, W., Schellekens, A., & Dijkstra, B. A. G. (2023) · The Cognitive Behaviour Therapist · doi:10.1017/s1754470x23000120
“The MIDI has been used successfully to evaluate the adherence to guidelines on preventing child abuse and to study barriers and facilitators to the implementation of a pediatric palliative care team (Konijnendijk et al., 2016; Verberne et al., 2018).”
Method
Avaliação do conhecimento de pediatras sobre cuidados paliativos
Neto, O. P. D. A., Toledo, M. C. A., de Sousa, M. N. A., Bezerra, A. L. D., Dias, T. R., da Nobriga, E. R., Mazzaro, V. D. D. M., Filho, R. N. D. P., Medeiros, N. M. H. D., & do Egypto, I. A. S. (2023) · OBSERVATÓRIO DE LA ECONOMÍA LATINOAMERICANA · doi:10.55905/oelv21n10-180
Palliative Care for Children with CNS Tumors
Pearlman, L., & Zelcer, S. M. (2024) · Springer eBooks · doi:10.1007/978-3-031-62017-1_27
Towards uniform recognition of child abuse in the Netherlands: implementing the Screening instrument for Child Abuse and Neglect (SCAN)Preprint
van den Heuvel, E. A. L., de Vries, D. S., Kempen, B. M. D. J.-V., Bakx, R., Bos, R. F., van Empelen, P., Hoedeman, F., Kappen, T. H., Russel, I. M. B., Puiman, P. J., et al. (2025) · medRxiv · doi:10.1101/2025.01.24.25321079
Needs of key stakeholders to make advance care plans and advance directives for people with dementia – A scoping reviewPreprint
Vinay, R., Ferrario, A., Gloeckler, S., & Biller‐Andorno, N. (2025) · medRxiv · doi:10.1101/2025.06.30.25330415
Does Hospital Palliative Care Have the Potential to Change a Patient's Healthcare Trajectory and Associated Healthcare Costs? A Retrospective Population-Based Case-Control StudyPreprint
Křemenová, Z., Vlckova, K. H., Kopecký, O., Sláma, O., Dušek, L., Jarkovský, J., Benešová, H., Pinkasová, P., Hálek, J., Dušánková, J., et al. (2025) · SSRN Electronic Journal · doi:10.2139/ssrn.5413578
In the Field: Visiting Peer Institutions to Inform Pediatric Palliative Care Program Redevelopment
Cleveland, R. W., Heneghan, C. E., Gouda, S. R., Liaw, S.-N., Murphy, T., Battista, V., Frechette, E. M., Larocque, C., & Rosenberg, A. R. (2025) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2025.09.012
Mechanical ventilation for young people with Duchenne muscular dystrophy: a factorial survey of the main influences on clinician decision-making
Quirke, M. B., Hill, K., Alexander, D., Walsh, C., & Brenner, M. (2025) · European Journal of Pediatrics · doi:10.1007/s00431-025-06473-2
“Opportunity for clinician education and training, as well as time available to spend with the young person and their families, are key to ensuring effective communication and building of trust [36, 37].”
Implementing the SAFE@home digital platform for blood pressure home monitoring for patients with (a risk of) hypertensive disorders of pregnancy: A barrier and facilitator analysis among obstetric healthcare professionals
Moes, S. L., Depmann, M., Kvamme, I., Anker, E., Dirken, J., van Eerden, L., Franx, A., de Heus, R., Gordijn, S. J., Koenen, S. V., et al. (2025) · Digital Health · doi:10.1177/20552076251376518
“16 – 19 A review by Gijsbers et al., that identi ﬁ ed the enablers and barriers for upscaling of telemonitoring, con ﬁ rmed the challenges regarding suf ﬁ ciency of resources and the need for OHP training.”
Additional file 1 of Barriers and facilitators for healthcare professionals to the implementation of Multidisciplinary Timely Undertaken Advance Care Planning conversations at the outpatient clinic (the MUTUAL intervention): a sequential exploratory mixed-methods study
van Lummel, E. V. T. J., Meijer, Y., Tjan, D. H. T., & van Delden, J. J. M. (2023) · Figshare · doi:10.6084/m9.figshare.22623160
Additional file 2 of Innovative communication approaches for initializing pediatric palliative care: perspectives of family caregivers and treating specialists
Hrdlickova, L., Poláková, K., & Loucka, M. (2024) · Figshare · doi:10.6084/m9.figshare.26624899
Additional file 4 of Barriers and enablers in the implementation of a quality improvement program for acute coronary syndromes in hospitals: a qualitative analysis using the consolidated framework for implementation research
Zhou, S., Ma, J., Dong, X., Li, N., Duan, Y., Wang, Z., Gao, L., Han, L., Tu, S., Liang, Z., et al. (2022) · Figshare · doi:10.6084/m9.figshare.19955701
Additional file 1 of Barriers and facilitators for therapeutic drug monitoring of beta-lactams and ciprofloxacin in the ICU: a nationwide cross-sectional study
Ewoldt, T. M. J., Abdulla, A., van den Broek, P., Hunfeld, N., Bahmany, S., Muller, A. E., Gommers, D., Polinder, S., Endeman, H., Spronk, I., et al. (2022) · Figshare · doi:10.6084/m9.figshare.20307967
Additional file 1 of Barriers and enablers in the implementation of a quality improvement program for acute coronary syndromes in hospitals: a qualitative analysis using the consolidated framework for implementation research
Zhou, S., Ma, J., Dong, X., Li, N., Duan, Y., Wang, Z., Gao, L., Han, L., Tu, S., Liang, Z., et al. (2022) · Figshare · doi:10.6084/m9.figshare.19955692
Additional file 2 of Barriers and enablers in the implementation of a quality improvement program for acute coronary syndromes in hospitals: a qualitative analysis using the consolidated framework for implementation research
Zhou, S., Ma, J., Dong, X., Li, N., Duan, Y., Wang, Z., Gao, L., Han, L., Tu, S., Liang, Z., et al. (2022) · Figshare · doi:10.6084/m9.figshare.19955695
Additional file 3 of Innovative communication approaches for initializing pediatric palliative care: perspectives of family caregivers and treating specialists
Hrdlickova, L., Poláková, K., & Loucka, M. (2024) · Figshare · doi:10.6084/m9.figshare.26624902
Additional file 4 of Innovative communication approaches for initializing pediatric palliative care: perspectives of family caregivers and treating specialists
Hrdlickova, L., Poláková, K., & Loucka, M. (2024) · Figshare · doi:10.6084/m9.figshare.26624905
Additional file 2 of Barriers and facilitators for therapeutic drug monitoring of beta-lactams and ciprofloxacin in the ICU: a nationwide cross-sectional study
Ewoldt, T. M. J., Abdulla, A., van den Broek, P., Hunfeld, N., Bahmany, S., Muller, A. E., Gommers, D., Polinder, S., Endeman, H., Spronk, I., et al. (2022) · Figshare · doi:10.6084/m9.figshare.20307970
Additional file 3 of Barriers and enablers in the implementation of a quality improvement program for acute coronary syndromes in hospitals: a qualitative analysis using the consolidated framework for implementation research
Zhou, S., Ma, J., Dong, X., Li, N., Duan, Y., Wang, Z., Gao, L., Han, L., Tu, S., Liang, Z., et al. (2022) · Figshare · doi:10.6084/m9.figshare.19955698
Additional file 1 of Implementation of a first-trimester prognostic model to improve screening for gestational diabetes mellitus
van Hoorn, F., Koster, M. P. H., Kwee, A., Groenendaal, F., Franx, A., & Bekker, M. N. (2021) · Figshare · doi:10.6084/m9.figshare.14411602
Additional file 2 of Barriers and facilitators for healthcare professionals to the implementation of Multidisciplinary Timely Undertaken Advance Care Planning conversations at the outpatient clinic (the MUTUAL intervention): a sequential exploratory mixed-methods study
van Lummel, E. V. T. J., Meijer, Y., Tjan, D. H. T., & van Delden, J. J. M. (2023) · Figshare · doi:10.6084/m9.figshare.22623163
Additional file 1 of Innovative communication approaches for initializing pediatric palliative care: perspectives of family caregivers and treating specialists
Hrdlickova, L., Poláková, K., & Loucka, M. (2024) · Figshare · doi:10.6084/m9.figshare.26624896
Determinants of Adoption of a Mechanical Ventilation Dashboard in Intensive Care: A MIDI-Based Evaluation (Preprint)Preprint
Mugge, S. F. C., van Leijsen, T. D., Reuland, M. C., Visser, A., Paulus, F., & Dongelmans, D. A. (2026) · doi:10.2196/preprints.92313
Pediatric Palliative care: Evaluation of knowledge, experience and confidence among physicians in a university outpatient setting
Young, P. D. A., Rocha, A. M. D. O., Iglesias, S., & Strufaldi, M. W. L. (2026) · Clinical Epidemiology and Global Health · doi:10.1016/j.cegh.2026.102310
Nurses’ perspectives on implementing pediatric palliative care: a qualitative participatory study on the emerging role of the advanced practice nurse
Saringer-Siegl, S., Eßl‐Maurer, R., & Paal, P. (2026) · European Journal of Pediatrics · doi:10.1007/s00431-026-06790-0
Improving the recognition of child maltreatment in emergency departments in Europe: healthcare professionals’ perceived barriers and facilitators for implementation of a comprehensive toolkit design
Hoedeman, F., Puiman, P. J., Smits, A. W., Dekker, M., Lauwaert, D., Oostenbrink, R., Parri, N., Riesgo, L. G.-C., Polinder, S., & Moll, H. A. (2026) · European Journal of Pediatrics · doi:10.1007/s00431-026-06815-8
“Barriers and facilitators were identified in accordance with earlier studies [35–37].”
Utilization of palliative care services among adult patients with cancer at Jimma University Medical Center, Jimma, southwestern Ethiopia: a cross-sectional study
Biratu, A., Gela, D., & Tilahun, S. W. (2026) · BMJ Open · doi:10.1136/bmjopen-2025-110338
Facilitators and barriers to the implementation of critical care ultrasound (CCUS): an international survey
Mousa, A., Plantinga, C., Vignon, P., Klompmaker, P., Bos, L. D. J., Chew, M. S., Duška, F., Galarza, L., Goffi, A., Hunsicker, O., et al. (2026) · Journal of Critical Care · doi:10.1016/j.jcrc.2026.155651
Determinants of Adoption of a Mechanical Ventilation Dashboard in Intensive Care: Measurement Instrument for Determinants of Innovations–Based, Single-Center, Cross-Sectional Evaluation
Mugge, S. F. C., van Leijsen, T. D., Reuland, M. C., Visser, A., Paulus, F., & Dongelmans, D. A. (2026) · JMIR Human Factors · doi:10.2196/92313
“In accordance with the MIDI developer recommendations, determinants were classified as facilitators when ≥80% of respondents scored 4 or 5 and as barriers when ≥20% scored 1 or 2 [30].”
Facilitators and barriers for interdisciplinary collaboration in pediatric palliative care: A cross-sectional survey
Kemna, M. M., Engel, M., de Graaf, E., Verhagen, E. A. A., Teunissen, S. C. C. M., Kars, M. C., & Aris-Meijer, J. (2026) · Palliative Medicine · doi:10.1177/02692163261482013
Self-citation
Patient-based evidence in mechanism-based drug repurposing: Challenges and recommendations
Kimman, M., Joore, M. A., & Grimm, S. E. (2026) · Drug Discovery Today · doi:10.1016/j.drudis.2026.104813
Barriers and facilitators for the uptake of the national INOCA recommendation among Dutch cardiologists: A survey study
Göttgens, I., Roelofs, L. C. G., Smeenk, J., Modderkolk, L., & Oertelt‐Prigione, S. (2026) · International Journal of Cardiology Cardiovascular Risk and Prevention · doi:10.1016/j.ijcrp.2026.200718
“Second, determinants were classified as barriers or facilitators using the 80%/20% thresholds established in prior MIDI literature [13 – 18].”

Additional file 1: of Barriers and facilitators to the implementation of a paediatric palliative care team
Verberne, L. M., Kars, M. C., Schepers, S. A., Meeteren, A. Y. N. S., Grootenhuis, M. A., & van Delden, J. J. M. (2018) · Figshare · doi:10.6084/m9.figshare.5882077
Self-citation
Organizational and individual barriers and facilitators to the integration of pediatric palliative care for children: A grounded theory study
Laronne, A., Granek, L., Wiener, L. S., Feder‐Bubis, P., & Golan, H. (2021) · Palliative Medicine · doi:10.1177/02692163211026171 · Cited by 37 · see citing works
Challenges in establishing optimal pediatric palliative care at the university hospital in Slovenia
Meglič, J., Lisec, A., Lepej, D., Loboda, T., Bertok, S., Musek, P. L., Hausmeister, I. K., Oštir, M., Ponjević, T., & Meglič, A. (2023) · European Journal of Pediatrics · doi:10.1007/s00431-023-04806-7 · Cited by 5 · see citing works
First Do No Harm: Identifying Barriers and Facilitators To Early Integration of a Pediatric Palliative Care Team as Perceived by Pediatric Oncology Providers (738)
Dalberg, T., Carney, P. A., Thomas, G. A., Fromme, E. K., Jacob‐Files, E., & Meyrowitz, J. (2012) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2011.12.216
Percepción de facilitadores y barreras para la derivación a cuidados paliativos pediátricos
Yáñez, D. C., Patricio Astudillo, P., & Eugenin-Soto, M. I. (2023) · Andes pediatrica · doi:10.32641/andespediatr.v94i3.4382 · Cited by 3 · see citing works

Authors: Verberne, L. M., Kars, M. C., Schepers, S. A., Schouten-van Meeteren, A. Y. N., Grootenhuis, M. A., & van Delden, J. J. M.
Affiliations: University Medical Center Utrecht (NL)
St. Jude Children's Research Hospital (US)
Amsterdam UMC Location University of Amsterdam (NL)
Corresponding author: Verberne, Lisa M.
ORCID: Kars, Marijke C.
Schepers, Sasja A.
Grootenhuis, Martha A.
Venue: BMC Palliative Care
Publisher: Springer Science and Business Media LLC
Published: 2018-02-12
Volume: 17
Issue: 1
Pages: 23-23
ISSN: 1472-684X (ISSN-L)
DOI: 10.1186/s12904-018-0274-8
PMC: PMC5810030
OpenAlex: W2794786943
Cited by: 92
References: 47
Citations by year: 2026: 12 · 2025: 13 · 2024: 9 · 2023: 12 · 2022: 15 · 2021: 10 · 2020: 9 · 2019: 9 · 2018: 3
FWCI: 7.33
Type: journal article
Language: en
Open access: gold
doi.org
Licence: cc-by
Locations: BMC Palliative Care (publishedVersion, cc-by)
Europe PMC (PubMed Central) (publishedVersion, cc-by)
PubMed Central (publishedVersion, cc-by)
PubMed (publishedVersion)
Pure Amsterdam UMC (submittedVersion, other-oa)
Data Archiving and Networked Services (DANS) (submittedVersion)
DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
Utrecht University Repository (Utrecht University) (submittedVersion, other-oa)
Funders: PAL Foundation
Topics: Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative and Oncologic Care
Keywords: pediatric palliative care, palliative care team, implementation barriers, implementation facilitators, healthcare workers, multidisciplinary care, organizational change, clinician attitudes
MeSH terms: Adolescent, Child, Child, Preschool, Cross-Sectional Studies, Female, Health Resources, Hospitals, University, Humans, Infant, Male, Netherlands, Palliative Care, Pediatrics, Pilot Projects, Program Development

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