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An analysis of the implementation of palliative rehabilitation in five UK hospices using the Stakeholder Salience Model

Abstract Background Although rehabilitation is recognized in policy documents as an integral component of palliative care, evidence suggests that it is not always a core part of hospice service provision. Rehabilitation in the sense of promoting function and independence can appear in tension with meeting the needs of people at the end of life, and a change in organizational culture may be required in hospices for rehabilitation services to be accepted and developed. This study sought to identify factors facilitating change in hospice culture and structure that might be required for a successful initiative to optimize the provision of rehabilitation. Method The Stakeholder Salience Model (SSM) was used as a framework to examine rehabilitation provision in five hospices where allied health professionals (AHPs) were employed, and where staff considered that rehabilitation had a strong presence. Semi-structured interviews were carried out with AHP and nursing staff and content analysis was used to identify instances of the SSM attributes of power, legitimacy, and urgency as main themes. Findings In order for changes in culture and the implementation of new, evidence-based approaches such as palliative rehabilitation to be successfully achieved, all three elements in the SSM are required, with power being crucial. Conclusions Rehabilitation remains a scarce resource in palliative care, and there is scope for further, larger studies examining the drivers for establishing rehabilitation services which could enable patients to live life as fully as possible, for whatever time they have remaining.