For example, different practical approaches to addressing Volasertib stroke patients’ palliative care needs may need to be tailored to individual circumstances such as patient preferences and expectations, and should reflect the varying skills and capacities of individual clinicians for palliative care, and the settings within which they work. Experimental theory testing in a randomised controlled trial seeks to remove the influence of context. A realist Inhibitors,research,lifescience,medical approach to programme theory development

and testing focuses on the contingent and cumulative nature of change, and reflects a more contingent view of ‘what works’ [20]. Located within critical realism, realist theories are described in terms of the contextual conditions and mechanisms of action that are activated or released through intervention, which cumulatively realise outcomes [21]. Inhibitors,research,lifescience,medical At their simplest level, interventions (such as components of palliative care) will, in the right conditions (context), change the thinking or behaviours Inhibitors,research,lifescience,medical (mechanisms) of clinicians, patients and others. It is these changes which, assuming that contextual factors remain supportive, cumulatively affect outcomes. Different stakeholder groups will hold different

views about theoretical explanations embedded within programme theory [16], and reports of realist theory development pay little attention to how different perspectives should Inhibitors,research,lifescience,medical be accommodated. This paper synthesises three sources of data collected from a programme of studies undertaken by the authors: an investigation of palliative care needs in acute stroke (Study 1) [1], an exploration of patient and family preferences and experiences of palliative care (Study 2) [2], and group interviews with health professionals from three UK stroke services. In doing so, we aim to produce an explanatory practice model to help clinicians meet the

palliative and end of life care needs of patients and families through the integration of palliative care within acute stroke services. In study 1, a consecutive Inhibitors,research,lifescience,medical tuclazepam cohort of acute adult stroke admissions (n=191) was assessed using the Sheffield Profile for Assessment and Referral to Care (SPARC) [22], which measures perceptions of needs across physical, social domains. Through the use of a structured assessment completed on average one week after stroke onset, study 1 provided a comprehensive overview of the range and intensity of problems. Study 2 comprised interviews that explored service experience, knowledge, preferences for care and perceptions of the future were conducted with 28 patients and 25 adult family members. The importance of excellent communication reinforced through inter-personal relationships between staff and families appeared to mitigate the difficulties associated with prognostic uncertainty.