Implementation of a Web-Based Program for Advance Care Planning and Evaluation: Evaluation of complexity with the NASSS Framework

Background:

The implementation of eHealth applications often fails. The NASSS (non-adoption, abandonment, or fail to scale-up, spread and sustain over time) framework aims to identify complexities in eHealth applications; the more complex, the more risk of implementation failure. Using NASSS, we analyzed the implementation of a web-based advance care planning (ACP) program.

Objective:

We aimed to analyze the implementation of the web-based ACP program ‘Explore your preferences for treatment and care’ using the NASSS framework.

Methods:

We used the NASSS framework to analyze a multi-modal dataset on the web-based ACP program ‘Explore your preferences for treatment and care’ and its development and evaluation, including peer reviewed publications, notes of stakeholder group meetings, and interviews with stakeholders.

Results:

The analysis showed that the web-based ACP program uses straightforward technology, is embedded in a well-established online health platform, and in general appears to generate a positive value for stakeholders. A complexity is the rather broad target population of the program. A potential complexity considers the limited insight into the extent to which healthcare professionals adopt the program. Awareness of the relevance of the web-based ACP program may still be improved among target populations of ACP and among healthcare professionals. Furthermore, the program may especially appeal to those who value individual autonomy, self-management and an explicit and direct communicative approach.

Conclusions:

Relatively few complexities were identified considering the implementation of the web-based ACP program ‘Explore your preferences for treatment and care’. Its uptake might be improved by increasing awareness of ACP and the program among a wider population of potential users and among healthcare professionals.