BACKGROUND The PACE 'Steps to Success' programme is a complex educational and development intervention for staff to improve palliative care in long-term care facilities (LTCFs). In a cluster randomized controlled trial, this programme has been implemented in 37 LTCFs in 7 European countries. Alongside an effectiveness study, a process evaluation study was conducted. This paper reports on the results of this process evaluation, of which the aim was to provide a more detailed understanding of the implementation of the PACE Programme across and within countries. METHODS The process evaluation followed the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework and involved various measures and tools, including diaries for country trainers, evaluation questionnaires for care staff, attendance lists and interviews (online and face-to-face, individual and in groups) with country trainers, managers, PACE coordinators and other staff members. Based on key elements of the PACE Programme, a priori criteria for a high, medium and low level of the RE-AIM components Reach, Adoption, Implementation and intention to Maintenance were defined. Qualitative data on factors affecting each RE-AIM component gathered in the online discussion groups and interviews were analysed according to the principles of thematic analysis. RESULTS The performance of the PACE Programme on the RE-AIM components was highly variable within and across countries, with a high or medium score for in total 28 (out of 37) LTCFs on Reach, for 26 LTCFs on Adoption, for 35 LTCFs on Implementation and for 34 LTCFs on intention to Maintenance. The factors affecting performance on the different RE-AIM components could be classified into three major categories: (1) the PACE Programme itself and its way of delivery, (2) people working with the PACE Programme and (3) contextual factors. Several country-specific challenges in implementing the PACE Programme were identified. CONCLUSIONS The implementation of the PACE Programme was feasible but leaves room for improvement. Our analysis helps to better understand the optimal levels of training and facilitation and provides recommendations to improve implementation in the LTC setting. The results of the process evaluation will be used to further adapt and improve the PACE Programme prior to its further dissemination. TRIAL REGISTRATION The PACE study was registered at www.isrctn.com-ISRCTN14741671 (FP7-HEALTH-2013-INNOVATION-1 603111) July 30, 2015.

中文翻译：

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根据 RE-AIM 框架评估七个国家长期护理机构 PACE 成功步骤计划的实施情况。


背景 PACE“迈向成功”计划是针对工作人员的一项复杂的教育和发展干预措施，旨在改善长期护理机构 (LTCF) 的姑息治疗。在一项整群随机对照试验中，该计划已在 7 个欧洲国家的 37 个 LTCF 中实施。除了有效性研究之外，还进行了过程评估研究。本文报告了这一过程评估的结果，其目的是更详细地了解各国之间和国家内部 PACE 计划的实施情况。方法 过程评估遵循范围、有效性、采用、实施、维护 (RE-AIM) 框架，涉及各种措施和工具，包括国家培训师日记、护理人员评估问卷、出勤名单和访谈（在线和面对面） - 与国家培训师、经理、PACE 协调员和其他工作人员面对面（个人和团体）。根据 PACE 计划的关键要素，定义了 RE-AIM 组件达到、采用、实施和维护意图的高、中、低水平的先验标准。根据主题分析的原则，对在线讨论组和访谈中收集的影响每个 RE-AIM 组成部分的因素的定性数据进行了分析。结果 PACE 计划在 RE-AIM 组件上的表现在国家内部和国家之间存在很大差异，在 Reach 上总共 28 个（共 37 个）LTCF 得分为高或中分，在采用上得分为 26 个 LTCF，在采用上得分为 35 个 LTCF实施并针对 34 个 LTCF 进行维护意向。 影响不同 RE-AIM 组件绩效的因素可分为三大类：(1) PACE 计划本身及其交付方式，(2) 参与 PACE 计划的人员，以及 (3) 背景因素。确定了实施 PACE 计划时针对具体国家的一些挑战。结论 PACE 计划的实施是可行的，但仍有改进的空间。我们的分析有助于更好地了解培训和便利的最佳水平，并提供改进 LTC 环境实施的建议。过程评估的结果将用于在进一步传播之前进一步调整和改进 PACE 计划。试验注册 PACE 研究于 2015 年 7 月 30 日在 www.isrctn.com-ISRCTN14741671 (FP7-HEALTH-2013-INNOVATION-1 603111) 上注册。