Facilitators and barriers of implementing end-of-life care volunteering in a hospital in five European countries: the iLIVE study
Authors: Yildiz Berivan , van der Heide Agnes , Bakan Misa , Iversen Grethe Skorpen , Haugen Dagny Faksvåg , McGlinchey Tamsin , Smeding Ruthmarijke , Ellershaw John , Fischer Claudia , Simon Judit , Vibora-Martin Eva , Ruiz-Torreras Inmaculada , Goossensen Anne ,   the iLIVE consortium, Allan Simon , Barnestein-Fonseca Pilar , Boughey Mark , Christen Andri , Lüthi Nora , Egloff Martina , Eychmüller Steffen , Zambrano Sofia C. , De Simone Gustavo G. , Elsten Eline E. C. M. , Geijteman Eric C. T. , Pot Iris , van der Rijt Carin C. D. , Fürst Carl Johan , Rasmussen Birgit H. , Schelin Maria E. C. , Hedman Christel , Goldraij Gabriel , Halfdanardottir Svandis Iris , Sigurdardottir Valgerdur , Hoppe Tanja , Joshi Melanie , Strupp Julia , Voltz Raymond , Martín-Roselló Maria Luisa , Montilla Silvi , Veloso Verónica I. , Tripodoro Vilma , Sigurdardottir Katrin Ruth , van der Kuy Hugo M. , van Zuylen Lia , Berger Michael , Hughes Rosemary , Kodba-Ceh Hana , Korfage Ida J. , Lunder Urska , Mason Stephen , Morris Beth , Solvåg Kjersti 
Published: April 2024

Abstract
Background
End-of-life (EoL) care volunteers in hospitals are a novel approach to support patients and their close ones. The iLIVE Volunteer Study supported hospital volunteer coordinators from five European countries to design and implement an EoL care volunteer service on general wards in their hospitals. This study aimed to identify and explore barriers and facilitators to the implementation of EoL care volunteer services in the five hospitals.

Methods
Volunteer coordinators (VCs) from the Netherlands (NL), Norway (NO), Slovenia (SI), Spain (ES) and United Kingdom (UK) participated in a focus group interview and subsequent in-depth one-to-one interviews. A theory-inspired framework based on the five domains of the Consolidated Framework for Implementation Research (CFIR) was used for data collection and analysis. Results from the focus group were depicted in radar charts per hospital.

Results
Barriers across all hospitals were the COVID-19 pandemic delaying the implementation process, and the lack of recognition of the added value of EoL care volunteers by hospital staff. Site-specific barriers were struggles with promoting the service in a highly structured setting with many stakeholders (NL), negative views among nurses on hospital volunteering (NL, NO), a lack of support from healthcare professionals and the management (SI, ES), and uncertainty about their role in implementation among VCs (ES). Site-specific facilitators were training of volunteers (NO, SI, NL), involving volunteers in promoting the service (NO), and education and awareness for healthcare professionals about the role and boundaries of volunteers (UK).

Conclusion
Establishing a comprehensive EoL care volunteer service for patients in non-specialist palliative care wards involves multiple considerations including training, creating awareness and ensuring management support. Implementation requires involvement of stakeholders in a way that enables medical EoL care and volunteering to co-exist. Further research is needed to explore how trust and equal partnerships between volunteers and professional staff can be built and sustained.

Trial registration
NCT04678310. Registered 21/12/2020.