Screening individuals via patient-reported outcome tools helps uncover important palliative care issues. The Integrated Palliative Care Outcome Scale (IPOS) was originally designed in the United Kingdom to serve this function. However, measures created in one healthcare system often face challenges when applied in different local environments. Our team had earlier tested the validity and reliability of IPOS in our cardiology unit. Despite this, questions remain about the specific elements that would shape its successful integration into standard screening for patients with advanced heart failure in day-to-day clinical work. This study aimed to identify factors that could affect IPOS implementation in patients with advanced heart failure. The study employed a qualitative design and was conducted at the National Heart Centre Singapore. We deliberately invited patients with advanced heart failure who had joined our previous IPOS validation research to take part in semi-structured interviews. In addition, healthcare staff responsible for caring for these patients and who had helped test the IPOS instrument were also asked to participate. The collected interviews underwent thematic analysis and were aligned with the Consolidated Framework for Implementation Research (CFIR). The analysis uncovered six potential facilitators and six potential barriers influencing implementation. These were distributed across five key domains of the CFIR (intervention characteristics, inner setting, outer setting, individual characteristics, and process). Facilitators include: (i) perception of utility, (ii) perception of minimal complexity, (iii) perception of relatability, (iv) conducive culture, (v) dedicated resources, and (vi) advocates for implementation. Barriers include: (i) need for adaptation, (ii) mindsets/role strains, (iii) resource constraints, (iv) cultural concerns, (v) individual needs, and (vi) change process. Organizations should prioritize building favorable views of the tool, fostering supportive workplace cultures, ensuring sufficient dedicated resources, and recruiting strong champions to promote adoption. Modifying IPOS to better align with existing workflows and patient preferences, thoughtfully planning the transition process, and addressing broader organizational issues such as culture, staffing pressures, and resource limitations would markedly increase the likelihood of successful IPOS integration into routine clinical practice.
