BACKGROUND AND OBJECTIVES: The inability of individuals in the advanced stage of dementia to communicate about preferences in care at the end-of-life poses a challenge for healthcare professionals and family carers. The proven effective Family Carer Decision Support intervention has been designed to inform family carers about end-of-life care options available to a person living with advanced dementia. The objectives of the mySupport study were to adapt the application of the intervention for use in different countries, assess impact on family satisfaction and decision-making, and identify costs and supportive conditions for the implementation of the intervention. RESEARCH DESIGN AND METHODS: A multiple-case study design was chosen where the nursing home was the case. Nursing homes were enrolled from six countries: Canada, Czech Republic, Italy, Netherlands, Republic of Ireland, and United Kingdom. RESULTS: Seventeen cases (nursing homes) participated, with a total of 296 interviews completed including family carers, nursing home staff, and health providers. Five themes relevant to the implementation of the intervention were identified: supportive relationships; committed staff; perceived value of the intervention; the influence of external factors on the nursing home; and resource impact of delivery. DISCUSSION AND IMPLICATIONS: There is a commonality of facilitators and barriers across countries when introducing practice innovation. A key learning point was the importance of implementation being accompanied by committed and supported nursing home leadership. The nursing home context is dynamic and multiple factors influence implementation at different points of time.

3rd Faculty of Medicine Charles University Prague Czech Republic

Care Policy and Evaluation Centre The London School of Economics and Political Science London UK

Department of Primary and Community Care Radboud University Medical Center Radboudumc Alzheimer Center Nijmegen The Netherlands

Department of Public Health and Pediatrics University of Torino Turin Italy

International Observatory on End of Life Care Lancaster University Lancaster UK

Medical Research Ethics Committees United St Andonius Hospital Nieuwegein The Netherlands

School of Nursing and Midwifery Queen's University Belfast Belfast UK

School of Nursing and Midwifery University College Cork Cork Republic of Ireland

School of Nursing McMaster University Hamilton Ontario Canada

School of Social Work McGill University Montreal Quebec Canada

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