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- Adapting a palliative care intervention across seven European countries: the Pal-Cycles interventionPublication . Hooley, Rachel Louise; Payne, Sheila; Brunsch, Holger; Surges, Severine Marie; Mosoiu, Daniela; Hurducas, Flavia; Hernández-Marrero, Pablo; Pereira, Sandra Martins; Csikós, Ágnes; Pozsgai, Éva; Leppert, Wojciech; Forycka-Ast, Maria; Brand, Pippa Van Den; Hasselaar, Jeroen; Preston, NancyBackground: International adaptation of healthcare interventions requires sensitivity to local contexts, especially in palliative care, where healthcare systems and cultural expectations about end of life differ widely. PalCycles is an intervention that aims to improve transitions in care for patients with advanced cancer. This intervention was adapted for implementation across seven European countries. This paper aims to illustrate the process of adapting a palliative care intervention (Pal-Cycles) to meet the needs of those using healthcare settings across seven European countries. Methods: Adapted nominal group techniques were used, which involved the use of both in country and crosscountry adaptation meetings focussed on the five key components of the original intervention design, to ensure cultural sensitivity and best fit. Each country convened a group of clinicians and five countries also convened a secondary group of patient and family members. The adaptation process occurred in a series of meetings, which were mostly held online to accommodate participants’ schedules. Results: A total of 36 clinicians, 14 patients or family members, and 16 facilitators participated in the adaptation process over a four-month period. Structured guidance and iterative consultation meetings ensured that the final intervention was both standardised and adaptable to each country’s healthcare setting. Conclusions: This paper provides a model for future cross-cultural adaptation of palliative care interventions, illustrating the value of detailed methodological planning, structured guidance, and multi-stakeholder engagement in the adaptation process.
- Understanding multilevel influences on the adaptation of a complex intervention for oncology to palliative care transitions: a qualitative study across seven European countriesPublication . Radojicic, Tamara; Belar, Alazne; Preston, Nancy; Payne, Sheila; Surges, Séverine Marie; Hurducas, Flavia; Leppert, Wojciech; Koper, Ian; Pereira, Sandra Martins; Fülop, Balázs Daniel; Hasselaar, Jeroen; Arantzamendi, MaríaBackground: Adapting complex healthcare interventions for use across diverse healthcare systems requires balancing fidelity to core components with responsiveness to local contexts. The Pal-Cycles project aims to support transitions in care for patients with advanced cancer across seven European countries. Understanding the multilevel factors that influence adaptation is essential to ensure contextual fit while maintaining intervention integrity. Aim: To explore the multilevel factors that influenced the adaptation of the Pal-Cycles intervention across seven European countries. Methods: A qualitative study was conducted with purposively sampled country lead team members from all participating countries. Data were derived from cross-country adaptation meetings and follow-up focus groups, and analysed using framework analysis. Results: Fourteen country lead team members participated in the study. Analysis identified five areas reflecting multilevel factors that influenced the adaptation of the Pal-Cycles intervention: 1) Organisational variability as a barrier to adapting the Pal-Cycles intervention, 2) Disparities in training and shared motivation to improve palliative care communication, 3) Multidisciplinary collaboration shaped by organisational and cultural contexts, 4) Balancing optimism and practical constraints: stakeholder views on the Pal-Cycles intervention, 5) Working together to adapt the Pal-Cycles intervention across cultures. Organisational variability influenced service availability, integration between oncology and palliative care, and communication pathways. Disparities in previous training and shared motivation shaped clinicians’ engagement with the intervention’s training component. Multidisciplinary collaboration varied across settings, affecting role clarity and coordination among healthcare professionals. Stakeholder perspectives, including those of cancer clinicians, general practitioners, and consortium members, informed decisions about which elements of the intervention were most relevant in each context. Finally, working together to adapt the intervention across diverse cultural and organisational settings involved iterative discussions that balanced flexibility with preservation of the intervention’s core components. Conclusion: The adaptation of Pal-Cycles was shaped by interrelated organisational, professional, and cultural factors. Recognising how local contexts influence the prioritisation and operationalisation of intervention components is essential for achieving a balance between standardisation and flexibility in cross-national healthcare interventions.
- Balanced assignment of patients to healthcare centers using dispatching rulesPublication . Teymourifar, Aydin; Trindade, Maria A. M.Background: In the realm of public health management, ensuring a balanced assignment of patients to healthcare centers is a critical concern. This study introduces a novel approach for this purpose, utilizing dispatching rules. Highlighting the need for an easily applicable approach to regulating patient flow efficiently, the study shows the benefit of utilizing dispatching rules in healthcare management. Methods: Innovatively, this research departs from traditional approaches by introducing a multi-objective model grounded in the concept of sectorization. This model, unique in the public health literature, leverages dispatching rules to simplify complex, dynamic patient assignment scenarios. The model is simulated using Rockwell Arena software, incorporating various temporal factors. The optimization of these dispatching rules is performed through OptQuest software. Results: The study’s findings demonstrate that the optimized dispatching rule significantly enhances the model’s efficacy in balancing patient assignments across healthcare centers. This improvement is pivotal in addressing the uneven distribution of healthcare resources. Conclusions: This research makes a substantial contribution to the public health literature by offering a novel and practical solution for balancing patient load among healthcare centers. Its successful application in simulated environments suggests a promising pathway for real-world implementations, potentially leading to more efficient healthcare systems and improved patient care outcomes.
- Palliative care yields cancer wellbeing support (Pal-Cycles): evaluating a transitional palliative care intervention to reduce readmissions for patients with advanced cancer and palliative care needs: an international stepped-wedge randomized clinical trial protocolPublication . Brand, Pippa; Koper, Ian; Brunsch, Holger; Csikos, Agnes; Fülop, Balázs Daniel; Hernandez-Marrero, Pablo; Hurducas, Flavia; Kuip, Evelien; Leppert, Wojciech; Martins-Pereira, Sandra; Mosoiu, Daniela; Payne, Sheila; Preston, Nancy; Surges, Séverine; Hasselaar, JeroenBackground: Palliative care in combination with or after oncological treatment has been found to increase the quality of life and quality of care for patients with advanced cancer. This often means change in goals of care, sometimes along with a change of healthcare provider or place of care. These types of changes are frequently referred to as care transitions. Ensuring continuity of care during these types of transitions is crucial, yet previous research has shown that essential information is not always effectively communicated. Sometimes, this leads to avoidable hospital readmissions, which may cause distress and decreases the quality of life for patients in the last phase of life. This study aims to evaluate the effectiveness of a transitional palliative care intervention in reducing hospital readmissions. Methods: This study will employ a stepped wedge cluster randomized controlled trial (RCT) design conducted across 14 settings in seven European countries. (Germany, Hungary, the Netherlands, Poland, Portugal, Romania and the United Kingdom). Over a 25 months recruitment-period, 1,050 patients with advanced cancer and if possible, a relative will be enrolled. Patients will be followed for 90 days after inclusion. The primary outcome is the number of hospital readmissions, with secondary outcomes being quality of life and quality of care. Once data collection is complete, a multilevel regression analysis will compare outcomes between the control and intervention groups within each setting, accounting for the hierarchical structure of the data. Discussion: The study results will determine the effectiveness of the Pal-Cycles intervention in decreasing the number of readmissions to hospital, and increasing the quality of life and the quality of care for patients with advanced cancer.
- Governing intangible assets across institutional spaces the standardization-adaptation frontier and channel choice in international retailPublication . Madsen, Ana Oliveira; Silva, Francisca Correia daThis paper models the global standardization-adaptation trade-off as a firm-level optimization problem within the frameworks of Industrial Organization and Transaction Cost Economics. Using an empirical qualitative case study methodology focused on international fashion retailer Parfois, we analyze how a multinational enterprise minimizes unit production costs via economies of scale while mitigating local market frictions and information asymmetries. We investigate how specific intangible assets -corporate name, product portfolio, positioning, and brand origin - are managed across diverse regulatory and culturais regimes. Findings reveal that this corporate strategy is non-binary. Centralized governance maximizes minimum efficient scale through global standardization, while selective market differentiation via local adaptation serves as a tactical market-capture mechanism. This strategic posture is determined dynamically by cost structures, technological maturity, and market complexity. Ultimately, we propose a framework of modern operational balance, demonstrating how Industry 4.0 technologies bridge high-efficiency scale and customized cross-border performance under conditions of varying operational and demand-side heterogeneity.
- Planted forests are a vital resource for future green economies: summary report of the 3rd International Congress on Planted Forests based on three scientific workshops held in Bordeaux (France), Dublin (Ireland) and Porto (Portugal), and one plenary meeting held in Estoril (Portugal) from May 15th to 21st, 2013Publication . Mendes, Américo; Mason, Bill; Orazio, Christophe; Nabuurs, Gert-Jan; Jactel, Hervé; Martinez, Inazio; Carnus, Jean-Michel; Tomé, Margarida; Freer-Smith, Peter; Kollert, Walter
- Endogenous product design and quality when consumers have heterogeneous limited attentionPublication . Cunha, Mariana; Osório C., António M.; Ribeiro, Ricardo M.In some markets, consumers do not know the attributes of all the products that are available in the market, or the prices at which they are offered. To reduce this uncertainty consumers may, at a cost, gather and process information about the attributes and prices of the different products. The uncertainty that persists at the time of purchase affects the competition in the market, via product attributes and prices. We examine the consequences of information costs on firms' product multi-attribute and pricing decisions when consumers have heterogeneous information costs and limited attention. We find that consumers that can gather and process information at approximately no cost rationally select to be attentive while consumers that must incur a cost rationally select to be inattentive. We find also that firms have an incentive to respond to lower information costs by increasing differentiation, but solely along the least-costly attribute dimension and if the proportion of attentive consumers in the market is small. This implies that, as information costs decrease, equilibrium prices may increase in some markets and decrease in others. Further, it implies also that when the cost of an attribute dimension in a market changes, there can be radical shifts in product attributes.
- Mergers of consumer cooperativesPublication . Khorasani, Sina; Korpeoglu, GizemProblem definition: Consumer cooperatives are consumer-owned and managed enterprises that aim to achieve buyer power and maximize their members' welfare. Recently, several cooperatives in major economies, such as the United Kingdom (UK), Italy, and Switzerland, have merged to increase their buyer power and provide lower prices for their members. We seek to understand how these mergers affect market outcomes and consumer welfare. Methodology/results: We build a game-theoretic model of a two-tier supply chain where multiple consumer cooperatives procure a product from a market on behalf of their member consumers. Multiple suppliers produce for this market and can increase their supply by incurring a scale-up cost. We show that mergers of cooperatives reduce the wholesale price, as intended. This enables consumers to allocate more of their income to purchasing other goods, which improves consumer welfare. However, the lower price also induces suppliers to reduce their production quantities, thereby causing each consumer to receive less of the supplied product, which reduces consumer welfare. We find that this underproduction is even more pronounced in industries with low scale-up costs. Thus, we show that mergers harm all consumers when the pre-merger number of cooperatives or the production scale-up cost is below a certain threshold. Otherwise, mergers benefit all consumers. We expand our results by considering horizontally and vertically differentiated cooperatives and show that our main results are robust. We also show that greater differentiation among cooperatives increases the benefit of mergers. Managerial implications: Mergers of cooperatives make a nuanced impact on consumer welfare due to their effect on wholesale prices and production incentives. Policymakers should maintain healthy competition among cooperatives to maximize consumer welfare, especially in markets with low production scale-up costs.
- Barriers to social innovationPublication . Mendes, Américo M. S. Carvalho; Batista, António; Fernandes, Liliana; Macedo, Palmira; Pinto, Filipe; Rebelo, Luis; Ribeiro, Marta; Sottomayor, Miguel; Tavares, Marisa; Verdelho, VítorA deliverable of the project: “The theoretical, empirical and policy foundations for building social innovation in Europe
- Why are incubators important for social innovation?Publication . Mendes, Américo M. S. Carvalho