[Journal article] “Triggering the palliative intent”?: A qualitative implementation evaluation of a prognostication model for advanced dementia (PRO-MADE) in a geriatric tertiary care setting for the integration of early palliative care
Authors: Araviinthansai Subramaniam, Woan Shin Tan, Hwee Teng Robyn Tan, Qing Wang, Yew Yoong Ding, Allyn Hum & PRO-MADE Implementation Group
Published in: BMC Palliative Care Published online: 12 May 2026. DOI: https://doi.org/10.1186/s12904-026-02138-5
Summary points:
- Prognostication Alone Is Insufficient to Change Clinical Behaviour: Professional Identity and Role Boundaries Matter
Geriatric medicine and palliative medicine represent two disciplines with shared but overlapping responsibilities in end-of-life care. PROMADE’s adoption was complicated by such shared role identities. Interprofessional role clarification and co-design with frontline physicians is therefore essential before deploying similar prognostication models.
- Workflow Integration and EMR Design Are as Critical as Model Validity
While prediction models should be accurate to support clinical decision-making, they also require effective workflow integration. Streamlining EMR interfaces, reducing documentational burden through automation, and ensuring intuitive workflow design are key opportunities to optimise real-world adoption.
- Family Readiness and Needs-Based Considerations Should Complement Prognostication-Driven Referrals
Families’ limited familiarity with the disease trajectory and prognosis informed their reluctance to accept referrals to palliative care services. This underscores that prognostication models must be complemented by family education strategies and needs-based assessments. Mortality risk stratification alone may not overcome the cultural and emotional barriers that shape families’ receptivity to palliative care.
