The Family Talk Intervention in clinical practice when a parent with children or youth has a life-threatening illness and palliative care needs : Hospital Social Workers’ experiences of contextual factors

Background: There is a lack of evidence-based psychosocial support interventions in palliative care that includes the entire family. The Family Talk Intervention (FTI) is currently being evaluated for its effectiveness in supporting families facing a parent's life-threatening illness. Implementing FTI in clinical settings involves complex processes influenced by contextual factors. In this study, Hospital Social Workers (HSWs) were educated in FTI before integrating it into practice. Given the limited understanding of how contextual factors affect FTI implementation in palliative care, this needs investigation. Aim: This study aims to describe the impact of contextual factors in the implementation of FTI in palliative care settings from the perspective of HSWs after 12-18 months of using the intervention. Methods: Thirteen FTI-educated HSWs working with families in cancer care or specialized home care services where a parent has a life-threatening illness were interviewed after working with FTI for at least one year. Qualitative conventional content analysis was used. Results: HSWs identified contextual factors that facilitate or hinder the use of FTI. Being alone in their profession, lack of interest and support from managers and colleagues in the multi-professional teams, resource constraints, e.g., lack of time forcing them to prioritize among patients' needs hindered use, while seeing families empowered by the support motivated to continued use of FTI despite contextual constraints. Discussion: Results suggest that contextual factors can support motivation and receptiveness for using new methods. When HSWs saw families strengthened by participating in FTI, it motivated them to continue using FTI despite constraints. This leads to the question of whether it is up to each HSW to endure constraints for families to receive support or can organizationally facilitating factors be increased to enable sustainable use of new psychosocial support such as FTI.