# Small Steps, Big Vision: using multi-stage qualitative research to develop a grab-and-go guide to support utilisation of the Ambitions for Palliative and End of Life Care framework

## TL;DR

This study created a practical guide to help implement a national framework for improving palliative and end-of-life care in England.

## Contribution

The novel contribution is a co-produced 'grab-and-go' guide based on multi-stage qualitative research to support the Framework's use.

## Key findings

- A four-stage qualitative approach was used to develop the guide, informed by interviews, focus groups, workshops, and Evidence Cafés.
- The guide includes definitions, prompt questions, and real-world examples for each of the eight foundations in the Framework.
- Engagement with implementers is crucial for successful policy adoption in palliative and end-of-life care.

## Abstract

The Ambitions for Palliative and End of Life Care is a national framework for local action in England co-produced by over 30 partners; little research has been conducted on how the Framework is received and used. This study sought to examine and support how people understand, interpret, and implement the Framework.

A multi-stage qualitative methodology involving four stages of data collection: (1) case study interviews, (2) focus groups, (3) interactive workshops, and (4) Evidence Cafés. From initial interviews, ongoing thematic data analysis informed the design and focus of subsequent stages as part of a process of knowledge transfer.

A practical resource to support service provision and development was produced; a grab-and-go guide called “Small Steps, Big Visions”. It focuses on the eight foundations in the Ambitions Framework, with additional guidance on collaboration and partnership working, and sharing learning. Each foundation is presented with a ‘what’ (definition), ‘ask’ (prompt questions), and ‘examples in action’ (drawn from case studies).

Research can contribute to policy implementation to advance palliative and end of life care. The engagement and input of those responsible for implementation is key.

The online version contains supplementary material available at 10.1186/s12904-024-01466-8.