Publishing pilot intervention work

Mapping review of 'proof-of-concept' in mental health implementation research using the TRL framework: a need for a better focus and conceptual clarification

BACKGROUND

Proof-of-concept (PoC) development is a key step in implementation sciences. However, there is a dearth of studies in this area and the use of this term in health and social sciences is ambiguous.

OBJECTIVE

The objective was to remove the ambiguity surrounding the PoC and pilot study stage in the research development process using a standard system to rate the development of projects and applications provided by the Technology Readiness Levels (TRL) framework.

DESIGN

Mapping review and critical analysis using TRL as the standard measure.

SEARCH STRATEGY AND CHARTING METHOD

PubMed and PsycInfo databases were searched for papers that reported PoC studies of mental health interventions up to August 2023. Data were extracted, described and tabulated.

ELIGIBILITY CRITERIA

Included were PoC studies in mental health implementation research. Exclusion criteria were research relating to biomedical (drugs) development, neurocognitive tools, neuropsychology, medical devices, literature reviews or discussion papers or that did not include the term 'proof-of-concept' in the title, abstract or text.

RESULTS

From the 83 citations generated from the database search, 22 studies were included in this mapping review. Based on the study title, abstract and text, studies were categorised by research development stage according to the TRL framework. This review showed 95% of the studies used PoC incorrectly to describe the development stage of their research but which were not at this specific level of project development.

CONCLUSIONS

The TRL was a useful reference framework to improve terminological clarity around the term 'proof-of-concept' in implementation research. To extend the use of TRL in implementation sciences, this framework has now been adapted and validated to a health and social science-related research context accompanied by a health-related glossary of research process terms and definitions to promote a common vocabulary and shared understanding in implementation sciences.

Leveraging Parents and Peer Recovery Supports to Increase Recovery Capital in Emerging Adults With Polysubstance Use: Protocol for a Feasibility, Acceptability, and Appropriateness Study of Launch

BACKGROUND

Emerging adults (aged 18-26 years) are the most at-risk yet underserved age group among people with substance use disorder, especially rural emerging adults, and polysubstance use is common. Recovery capital is lower among emerging adults than older adults, and evidence-based treatments are typically unavailable or not developmentally tailored, especially in rural areas. Both supportive parents (or parental figures) and peer recovery support services (PRSS) can be leveraged to better support these emerging adults. Previous research indicates parents can be engaged to deliver contingency management (CM), an extensively researched evidence-based intervention for substance use.

OBJECTIVE

This protocol describes a funded pilot of Launch, a novel, scalable service package that pairs web-based coaching for parents to deliver CM for emerging adults (CM-EA) at home and in-person PRSS with educational and vocational goal setting. Specifically, this protocol describes feasibility, acceptability, and appropriateness testing (implementation-related outcomes) and steps taken to prepare for a future large-scale trial of Launch.

METHODS

Upon the recruitment of 48 emerging adult and parent pairs from sites serving primarily rural clients, participants will be randomized into 1 of 3 conditions for this randomized controlled trial: virtual parent coaching to deliver CM-EA, in-person PRSS for emerging adults, or both sets of services. Emerging adult eligibility includes polysubstance use, a substance use disorder, and availability of a consenting parent. Emerging adults will be interviewed at baseline and 6 months about substance use, quality of life, recovery capital, parental relationship, and Launch implementation-related outcomes (6-month follow-up only). Parents, peer workers delivering PRSS, and parent CM-EA coaches will be interviewed about implementation-related outcomes at the end of the study period. Peer workers and CM-EA coaches will be asked to complete checklists of services delivered after each session. Finally, payers and providers will be interviewed for additional insights into Launch implementation and to identify key outcomes of Launch. Data analysis for emerging adult outcomes will be primarily descriptive, but parent CM-EA training adherence will be assessed using nested mixed-effects regression models of repeated measures.

RESULTS

Launch is currently ongoing, with funding received in August 2023, and is expected to end in September 2025, with data analysis and results in December 2026. Participants are expected to begin enrolling in June 2024.

CONCLUSIONS

While this pilot is limited by the small sample size and restriction to emerging adults with an involved parent, this is mitigated by the study's strengths and is appropriate for the pilot stage. Launch uses an innovative combination of existing strategies to generate better outcomes for emerging adults while remaining scalable. This pilot will provide insights into the feasibility and acceptability of Launch from the perspectives of service recipients, providers, and payers to inform a larger-scale effectiveness trial.

TRIAL REGISTRATION

ClinicalTrials.gov NCT06414993; https://clinicaltrials.gov/study/NCT06414993.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/60671.

An Introduction to Implementing and Conducting the Study

Editor's note: This is the 21st article in a series on clinical research by nurses. The series is designed to be used as a resource for nurses to understand the concepts and principles essential to research. Each column will present the concepts that underpin evidence-based practice-from research design to data interpretation. To see all the articles in the series, go to https://links.lww.com/AJN/A204.

Feasibility and implementation of a grocery shopping intervention for adults diagnosed with or at-risk for type 2 diabetes

OBJECTIVE

To examine the feasibility and implementation of an optimal defaults intervention designed to align grocery purchases with a diet recommended for people with or at-risk for type 2 diabetes.

DESIGN

This was a 5-week pilot randomised trial with three groups: in-person grocery shopping, shopping online and shopping online with 'default' carts. Participants were asked to shop normally in Week One, according to group assignment in Weeks Two-Four (intervention period), and as preferred in Week Five. All groups received diabetes-friendly recipes via email each intervention week.

SETTING

Participants grocery shopped in person or online. Grocery receipt forms, enrolment information and exit surveys were collected remotely and used to assess feasibility and implementation.

PARTICIPANTS

Sixty-five adults with or at-risk for type 2 diabetes.

RESULTS

Sixty-two participants completed the exit survey and fifty-five submitted receipts all 5 weeks. Forty utilised recipes, 95 % of whom indicated recipes were somewhat or very useful. Orange chicken, quesadillas and pork with potato and apples were the most liked recipes. Most Defaults group participants accepted at least some default cart items. Recipes with the highest default acceptance were whole grain pasta and chicken, quesadillas with black beans and chicken with olives. Participants' primary concerns about the intervention were costs associated with online shopping, inability to select preferred foods and some recipes including ingredients household members would not eat.

CONCLUSIONS

The study had high retention, data were successfully collected remotely and the intervention was acceptable to most participants. Tailoring recipes to household preferences may be beneficial in future studies.

Development and Evaluation of a Data-Driven, Interactive Workshop to Facilitate Communication and Teamwork in Ambulatory Medical Oncology Settings

Background

While adverse events and toxicities related to cancer drug therapy in the ambulatory oncology setting are common and often rooted in communication challenges, few studies have examined the problems of communication or tested tools to improve communication in this unique, high-risk setting.

Objective

To determine the feasibility and acceptability of a virtual interdisciplinary communication Workshop designed to strengthen communication across ambulatory oncology teams members.

Methods

Surveys of patients and clinicians in one ambulatory oncology clinic were analyzed and informed the communication intervention: an interdisciplinary virtual Workshop. Workshop evaluation included an implementation survey measure and a structured debrief with Workshop attendees.

Results

87 patients and 56 clinicians participated in pre-workshop surveys that revealed patient satisfaction with timely care and information, yet a range of rating communication experiences with the clinical team, and clinicians perceiving a high amount of organizational safety, yet rated discussion of alternatives to normal work processes low. Survey results guided reflection and discussion within the Workshop. Six clinicians participated in the interactive Workshop. Feasibility and acceptability of the virtual Workshop were supported by formative and summative data, along with suggestions for improvement.

Conclusions

The patient and clinician surveys coupled with an interactive virtual Workshop were feasible and acceptable.

Implications for Practice

The Workshop identified opportunities for individual- and system-level improvements in clinical team communication. This promising strategy requires replication in larger, diverse practice samples.

Foundational

Clinicians accepted an interactive workshop that incorporated clinic-specific data and communication strategies. The program is feasible and acceptable in ambulatory oncology settings.

Parental developmental screening with CARE: A pilot hybrid assessment and intervention with vulnerable families in Colombia

Poverty and scarcity of resources make children in low-and-middle-income countries at risk of not reaching their developmental potential. Despite a near-universal interest in risk reduction, effective interventions like enhancing reading skills in parents to diminish developmental delay remain elusive for the great majority of vulnerable families. We undertook a efficacy study for parental use of a booklet called CARE for developmental screening of children between 36 to 60 months old (M = 44.0, SD = 7.5). All participants (N = 50), lived in vulnerable, low-income neighborhoods in Colombia. The study followed a pilot Quasi-Randomised Control Trial design (i.e., control group participants assigned based on non-random criteria) of parent training with a CARE intervention group compared to a control group. Data was analyzed using two-way ANCOVA for sociodemographic variables' interaction with follow-up results and one-way ANCOVA to evaluate the relations between the intervention and post-measurement of developmental delays and cautions and other language related-skills outcomes, while controlling for pre-measurements. These analyses indicated that the CARE booklet intervention enhanced children's developmental status and narrative skills (developmental screening delay items, F(1, 47) = 10.45, p = .002, partial η2 = .182; narrative devices scores, F(1, 17) = 4.87, p = .041, partial η2 = .223). Several limitations (e.g., sample size) and possible implications for the analysis of children's developmental potential are discussed and considered for future research, along with the effects of the COVID-19 pandemic on the closure of preschools and community care centers.

Involvement of End Users in the Development of Serious Games for Health Care Professions Education: Systematic Descriptive Review

BACKGROUND

On the basis of ethical and methodological arguments, numerous calls have been made to increase the involvement of end users in the development of serious games (SGs). Involving end users in the development process is considered a way to give them power and control over educational software that is designed for them. It can also help identify areas for improvement in the design of SGs and improve their efficacy in targeted learning outcomes. However, no recognized guidelines or frameworks exist to guide end users' involvement in SG development.

OBJECTIVE

The aim of this study is to describe how end users are involved in the development of SGs for health care professions education.

METHODS

We examined the literature presenting the development of 45 SGs that had reached the stage of efficacy evaluation in randomized trials. One author performed data extraction using an ad hoc form based on a design and development framework for SGs. Data were then coded and synthesized on the basis of similarities. The coding scheme was refined iteratively with the involvement of a second author. Results are presented using frequencies and percentages.

RESULTS

End users' involvement was mentioned in the development of 21 of 45 SGs. The number of end users involved ranged from 12 to 36. End users were often involved in answering specific concerns that arose during the SG design (n=6) or in testing a prototype (n=12). In many cases, researchers solicited input from end users regarding the goals to reach (n=10) or the functional esthetics of the SGs (n=7). Most researchers used self-reported questionnaires (n=7).

CONCLUSIONS

Researchers mentioned end users' involvement in the development of less than half of the identified SGs, and this involvement was also poorly described. These findings represent significant limitations to evaluating the impact of the involvement of end users on the efficacy of SGs and in making recommendations regarding their involvement.

Applying the Multiphase Optimization Strategy for the Development of Optimized Interventions in Palliative Care

Recent systematic reviews and meta-analyses have reported positive benefit of multicomponent "bundled" palliative care interventions for patients and family caregivers while highlighting limitations in determining key elements and mechanisms of improvement. Traditional research approaches, such as the randomized controlled trial (RCT), typically treat interventions as "bundled" treatment packages, making it difficult to assess definitively which aspects of an intervention can be reduced or replaced or whether there are synergistic or antagonistic interactions between intervention components. Progressing toward palliative care interventions that are effective, efficient, and scalable will require new strategies and novel approaches. One such approach is the Multiphase Optimization Strategy (MOST), a framework informed by engineering principles, that uses a systematic process to empirically identify an intervention comprised of components that positively contribute to desired outcomes under real-life constraints. This article provides a brief overview and application of MOST and factorial trial design in palliative care research, including our insights from conducting a pilot factorial trial of an early palliative care intervention to enhance the decision support skills of advanced cancer family caregivers (Project CASCADE).

Persuasive communication and the diminution of the salt intake in heart failure patients: a pilot study

OBJECTIVES

to evaluate the effect of persuasive communication in the modulation of the behavioral intention of reducing the consumption of salt in heart failure patients.

METHODS

pilot quasi-experimental study with one group, before and after the application of audiovisual persuasive communication, as guided by the Theory of Planned Behavior. This study used a form built and validated to measure behavioral variables (Beliefs, Attitude, Subjective Norm, and Perceived Behavioral Control). Wilcoxon's test and Spearman's correlation were applied.

RESULTS

82 heart failure patients who were being monitored in outpatient clinics participated. The medians of the behavioral variables increased significantly after the exposition to persuasive communication, showing a high level of intention to execute the behavior.

CONCLUSIONS

persuasive communication positively contributed to influence the behavioral intention of reducing the consumption of salt in people with cardiac insufficiency.

A Study of the Families Included in Receiving Better Special Education Services (FIRME) Project for Latinx Families of Children with Autism and Developmental Disabilities

Family-professional partnership is an essential component of the special education process for children with intellectual and/or developmental disabilities (IDD), including autism spectrum disorder (ASD). Latinx families face systemic barriers when participating in educational decision-making for their children with IDD. Few studies have examined the effectiveness of advocacy trainings among Latinx families of children with IDD, including ASD. The purpose of this pilot study was to examine the effectiveness and feasibility of the Familias Incluidas en Recibiendo Mejor Educación Especial (FIRME), an advocacy program for Latinx families of children with IDD, with respect to increasing special education knowledge, advocacy, empowerment, and receipt of services; and decreasing stress. After completing the FIRME program, participants demonstrated significantly increased: special education knowledge; advocacy; and empowerment.

Fixation Using Alternative Implants for the Treatment of Hip Fractures (FAITH-2): The Clinical Outcomes of a Multicenter 2 × 2 Factorial Randomized Controlled Pilot Trial in Young Femoral Neck Fracture Patients

OBJECTIVE

To assess whether the fixation method and vitamin D supplementation affect the risk of patient-important outcomes within 12 months of injury in nongeriatric femoral neck fracture patients.

DESIGN

A pilot factorial randomized controlled trial.

SETTING

Fifteen North American clinical sites.

PARTICIPANTS

Ninety-one adults 18-60 years of age with a femoral neck fracture requiring surgical fixation.

INTERVENTION

Participants were randomized to a surgical intervention (sliding hip screw or cancellous screws) and a vitamin D intervention (vitamin D3 4000 IU daily vs. placebo for 6 months).

MAIN OUTCOME MEASUREMENTS

The primary clinical outcome was a composite of patient-important complications (reoperation, femoral head osteonecrosis, severe femoral neck malunion, and nonunion). Secondary outcomes included fracture-healing complications and radiographic fracture healing.

RESULTS

Eighty-six participants with a mean age of 41 years were included. We found no statistically significant difference in the risk of patient-important outcomes between the surgical treatment arms (hazard ratio 0.90, 95% confidence interval 0.40-2.02, P = 0.80) and vitamin D supplementation treatment arms (hazard ratio 0.96, 95% confidence interval 0.42-2.18, P = 0.92).

CONCLUSIONS

These pilot trial results continue to describe the results of current fixation implants, inform the challenges of improving outcomes in this fracture population, and may guide future vitamin D trials to improve healing outcomes in young fracture populations. Although the pilot trial was not adequately powered to detect treatment effects, publishing these results may facilitate future meta-analyses on this topic.

LEVEL OF EVIDENCE

Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Faculty Attitudes About Caring for People Living With HIV/AIDS: A Comparative Study

BACKGROUND

People living with HIV/AIDS (PLHIV) experience stigma and discrimination. Negative attitudes of nursing faculty about caring for PLHIV can adversely affect student perceptions and their nursing care. The study purpose was to describe nursing faculty attitudes and beliefs about caring for PLHIV.

METHOD

The HPASS (Healthcare Provider HIV/AIDS Stigma Scale), Spanish version, was delivered to nursing faculty in Colombia and Peru.

RESULTS

The HPASS was completed by 98 nursing faculty. The overall mean score was 2.41 (SD = 0.69), with subscale scores: stereotypes, 2.55 (SD = 0.84); discrimination, 2.28 (SD = 0.74); and prejudices, 2.41 (SD = 0.63). Peruvian faculty had the highest scores, statistically correlated with the importance of religion, whereas Colombia had the lowest.

CONCLUSION

Nursing faculty attitudes toward PLHIV were slightly positive in Colombia to slightly negative in Peru; however, both countries had negative stereotypes. Knowledge deficiencies about HIV persist and attitudes appear to be influenced by culture and religion. [J Nurs Educ. 2019;58(12):712-717.].

The project ENABLE Cornerstone randomized pilot trial: Protocol for lay navigator-led early palliative care for African-American and rural advanced cancer family caregivers

BACKGROUND

Patients newly-diagnosed with advanced cancer often rely on family caregivers to provide daily support to manage healthcare needs and maintain quality of life. Early telehealth palliative care has been shown to effectively provide an extra layer of support to family caregivers, however there has been little work with underserved populations, especially African-Americans and rural-dwellers. This is concerning given the lack of palliative care access for these underserved groups.

STUDY DESIGN

Single-site, small-scale pilot randomized controlled trial (RCT) of Project ENABLE (Educate, Nurture, Advise, Before Life Ends) Cornerstone, a lay navigator-led, early palliative care coaching intervention for family caregivers of African-American and rural-dwelling patients with newly-diagnosed advanced cancer. Family caregivers are paired with a trained lay navigator overseen by specialist palliative care clinicians and receive a series of brief in-person and telehealth sessions focusing on stress management and coping, caregiving skills and organization, getting help, self-care, and preparing for the future/advance care planning. This pilot trial is assessing acceptability of the intervention, feasibility of recruitment and data collection procedures, and preliminary efficacy compared to usual care on caregiver and patient quality of life and mood over 24 weeks.

CONCLUSION

Once acceptability and feasibility are determined and issues addressed, the ENABLE Cornerstone intervention for underserved family caregivers of persons with advanced cancer will be primed for a fully powered efficacy RCT. Given its use of lay navigators and telehealth delivery, the intervention is potentially highly scalable and capable of overcoming many of the geographic, human resource, and cultural obstacles to accessing early palliative care support.

Spirituality, Social Support, and Diabetes: A Cross-Sectional Study of People Enrolled in a Nurse-Led Diabetes Management Program in Peru

INTRODUCTION

In Peru, people living with diabetes mellitus (PLDM) represent 7% of the adult population, each with a $54,000 lifetime cost. For Latinos, spirituality provides meaning and purpose of life while social support affects behavioral choices and adherence decisions. The purpose of this study was to determine the relationship between spirituality and social support for PLDM participating in a nurse-led diabetes management program in a public hospital in Lima, Peru.

METHOD

This cross-sectional study included adult PLDM (N = 54). The instrument included demographic items and the Spanish versions of the social/vocational concern dimension of the Diabetes Quality of Life Questionnaire and the Reed's scale of spiritual perspective.

RESULTS

There was an inverse relation between social support and spiritually practices (p = .020) and spiritual beliefs (p = .005). PLDM with 5 years or more in the program had significantly higher scores in social support (p = .020) and spiritual practices (p = .010).

CONCLUSION

Spirituality and social support are important factors for managing PLDM. Nurse-led diabetes management programs with Latino participants should consider targeted spiritual and social support strategies to expand the holistic management. Future studies should explore the impact and effectiveness of spiritual and social support interventions on clinical outcomes.

The feasibility and promise of mobile technology with community health worker reinforcement to reduce rural preterm birth

OBJECTIVES

(1) Assess feasibility of a smartphone platform intervention combined with Community Health Worker (CHW) reinforcement in rural pregnant women; (2) Obtain data on the promise of the intervention on birth outcomes, patient activation, and medical care adherence; and (3) Explore financial implications of the intervention using return on investment (ROI).

SAMPLE

A total of 98 rural pregnant women were enrolled and assigned to intervention or control groups in this two-group experimental design.

INTERVENTION

The intervention group received usual prenatal care plus a smartphone preloaded with a tailored prenatal platform with automated texting, chat function, and hyperlinks and weekly contact from the CHW. The control group received usual prenatal care and printed educational materials.

MEASUREMENTS

Demographics, health risk data, interaction with platform, medical records, hospital billing charges, Client Satisfaction Questionnaire-8, satisfaction comments, and the Patient Activation Measure.

RESULTS

A total of 77 women completed the study. The intervention was well-received, showed promise for improving birth outcomes, patient activation, and medical care adherence. Financial analysis showed a positive ROI under two scenarios.

CONCLUSIONS

Despite several practical issues, the study appears feasible. The intervention shows promise for extending prenatal care and improving birth outcomes in rural communities. Further research is needed with a larger and more at-risk population to appreciate the impact of the intervention.

Feasibility Studies: What They Are, How They Are Done, and What We Can Learn From Them

Nursing clinical research is a growing field, and as more nurses become engaged in conducting clinical research, feasibility studies may be their first encounter. Understanding what they are, how to conduct them, and the importance of properly reporting their outcomes is vital to the continued advancement of nursing science.

Quality of abstracts of pilot trials in heart failure: A protocol for a systematic survey

INTRODUCTION

Pilot trials are initial small-scale studies done to inform the design of larger trials. Their findings like other studies are usually disseminated as peer-reviewed journal articles. Abstracts are used to introduce the contents to readers, and give a general idea about the full reports and sometimes are the only source of information available to readers. Despite their importance, the contents of abstracts of trial reports are usually not informative enough and lack the essential details.

METHODS AND ANALYSIS

This is a protocol for a planned systematic survey with a primary aim of analyzing the reporting quality measured as the completeness of the reporting of pilot trial abstracts in heart failure. The secondary aim will be to explore factors associated with better reporting quality.Abstracts of heart failure pilot trials in humans (journal and conference abstracts) published in the English language from 1 January 1990 to 30 November 2016 will be assessed to determine the reporting quality, based on the CONSORT 2010 statement extension to randomized pilot and feasibility trials. All non-pilot/feasibility trials and non-human pilot trials will be excluded. We will search Medline (PUBMED), Cochrane controlled trials register, Scopus and African wide information databases for pilot trials in heart failure. Title and abstracts of identified studies will be screened for inclusion and data extracted independently by two reviewers in duplicate without using the full text. Reported and unreported items on the abstracts will be presented as frequencies and percentages, a descriptive analysis will be used to interpret the reporting quality and regression analysis used for characteristics associated with greater statistical reporting at 95% confidence interval.

REVIEW REGISTRATION NUMBER

PROSPERO CRD42016049911.

Feasibility and Pilot Studies in Palliative Care Research: A Systematic Review

CONTEXT

Feasibility and pilot study designs are common in palliative care research. Finding standard guidelines on the structure and reporting of these study types is difficult.

OBJECTIVES

In feasibility and pilot studies in palliative care research, to determine 1) how commonly a priori feasibility are criteria reported and whether results are subsequently reported against these criteria? and 2) how commonly are participants' views on acceptability of burden of the study protocol assessed?

METHODS

Four databases (OVID Medline, EMBASE, CINAHL, and PubMed via caresearch.com.au.) were searched. Search terms included palliative care, terminal care, advance care planning, hospice, pilot, feasibility, with a publication date between January 1, 2012 and December 31, 2013. Articles were selected and appraised by two independent reviewers.

RESULTS

Fifty-six feasibility and/or pilot studies were included in this review. Only three studies had clear a priori criteria to measure success. Sixteen studies reported participant acceptability or burden with measures. Forty-eight studies concluded feasibility.

CONCLUSION

The terms "feasibility" and "pilot" are used synonymously in palliative care research when describing studies that test for feasibility. Few studies in palliative care research outline clear criteria for success. The assessment of participant acceptability and burden is uncommon. A gold standard for feasibility study design in palliative care research that includes both clear criteria for success and testing of the study protocol for participant acceptability and burden is needed. Such a standard would assist with consistency in the design, conduct and reporting of feasibility and pilot studies.

Where have all the pilot studies gone? A follow-up on 30 years of pilot studies in Clinical Rehabilitation

Introduction:

Pilot studies are meritorious for determining the feasibility of a definitive clinical trial in terms of conduct and potential for efficacy, but their possible applications for planning a future trial are not always fully realized. The purpose of this review was to estimate the extent to which pilot/feasibility studies: (i) addressed needed objectives; (ii) led to definitive trials; and (iii) whether the subsequent undertaking of a definitive trial was influenced by the strength of the evidence of outcome improvement.

Methods:

Trials published in the journal Clinical Rehabilitation, since its inception, were eligible if the word ‘pilot’ or ‘feasibility’ was specified somewhere in the article. A total of 191 studies were reviewed, results were summarized descriptively, and between-group effect sizes were computed.

Results:

The specific purposes of piloting were stated in only 58% (n = 110) of the studies. The most frequent purpose was to estimate the potential for efficacy (85%), followed by testing the feasibility of the intervention (60%). Only 12% of the studies were followed by a definitive trial; <4% of studies had a main study underway or a published study protocol. There was no relationship between observed effect size and follow-up of pilot studies, although the confidence intervals were very wide owing to small number of trials that followed on.

Discussion:

Labelling and reporting of pilot studies needs to be improved to be concordant with the recently issued CONSORT guidelines. Feasibility needs to be fully tested and demonstrated prior to committing considerable human and monetary resources.

Revie ⊕: the influence of a life review intervention including a positive, patient-centered approach towards enhancing the personal dignity of patients with advanced cancer-a study protocol for a feasibility study using a mixed method investigation

BACKGROUND

It is generally recognized that existential concerns must be addressed to promote the dignity of patients with advanced cancer. A number of interventions have been developed in this regard, such as dignity therapy and other life review interventions (LRI). However, so far, none have focused on a positive approach or evaluated its effects on dignity and personal growth. This study aims to explore the feasibility of Revie ⊕, a life review intervention comprising a positive, patient-centered approach, and to determine potential changes of patients' sense of dignity, posttraumatic growth, and satisfaction with life.

METHODS

A mixed method study will be performed, which includes specialized nurses and 40 patients with advanced cancer in an ambulatory and in-patient setting of a Swiss university hospital. Quantitative methods involve a single group, pre- and post-intervention, and outcome measurements include the Patient Dignity Inventory, the Posttraumatic Growth Inventory, and the Satisfaction with Life Scale. Feasibility data relating to process, resource, and scientific elements of the trial will also be collected. A semi-directed interview will be used to collect qualitative data about the process and the participants' experiences of the intervention. In this way, enhanced quantitative-qualitative evidence can be drawn from outcome measures as well as individual, contextualized personal views, to help inform researchers about the plausibility of this complex intervention before testing its effectiveness in a subsequent full trial.

DISCUSSION

Patient dignity is a goal of quality end-of-life care. To our knowledge, this is the first trial to evaluate the role of a life review intervention that is focused on personal growth and on changes relating to the experience of having cancer. This study will evaluate the feasibility of a novel intervention, Revie ⊕, which we hope will contribute to promote the dignity, personal growth, and overall life satisfaction of patients with advanced cancer.

TRIAL REGISTRATION

ISRCTN, ISRCTN12497093.

Evaluation of the preliminary effectiveness of hand massage therapy on postoperative pain of adults in the intensive care unit after cardiac surgery: a pilot randomized controlled trial

Although many intensive care unit patients experience significant pain, very few studies explored massage to maximize their pain relief. This study aimed to evaluate the preliminary effects of hand massage on pain after cardiac surgery in the adult intensive care unit. A pilot randomized controlled trial was used for this study. The study was conducted in a Canadian medical-surgical intensive care unit. Forty adults who were admitted to the intensive care unit after undergoing elective cardiac surgery in the previous 24 hours participated in the study. They were randomly assigned to the experimental (n = 21) or control (n = 19) group. The experimental group received a 15-minute hand massage, and the control group received a 15-minute hand-holding without massage. In both groups the intervention was followed by a 30-minute rest period. The interventions were offered on 2-3 occasions within 24 hours after surgery. Pain, muscle tension, and vital signs were assessed. Pain intensity and behavioral scores were decreased for the experimental group. Although hand massage decreased muscle tension, fluctuations in vital signs were not significant. This study supports potential benefits of hand massage for intensive care unit postoperative pain management. Although larger randomized controlled trials are necessary, this low-cost nonpharmacologic intervention can be safely administered.

Crave-Out: A Distraction/Motivation Mobile Game to Assist in Smoking Cessation

Background

Smoking is still the number one preventable cause of death. Cravings—an intense desire or longing for a cigarette—are a major contributor to quit attempt failure. New tools to help smokers’ manage their cravings are needed.

Objective

To present a case study of the development process and testing of a distraction/motivation game (Crave-Out) to help manage cravings.

Methods

We used a phased approach: in Phase 1 (alpha testing), we tested and refined the game concept, using a Web-based prototype. In Phase 2 (beta testing), we evaluated the distraction/motivation potential of the mobile game prototype, using a prepost design. After varying duration of abstinence, smokers completed the Questionnaire of Smoking Urge-Brief (QSU-Brief) measurement before and after playing Crave-Out. Paired t tests were used to compare pregame and postgame QSU-Brief levels. To test dissemination potential, we released the game on the Apple iTunes App Store and tracked downloads between December 22, 2011, and May 5, 2014.

Results

Our concept refinement resulted in a multilevel, pattern memory challenge game, with each level increasing in difficulty. Smokers could play the game as long as they wanted. At the end of each level, smokers were provided clear goals for the next level and rewards (positive reinforcement using motivational tokens that represented a benefit of quitting smoking). Negative reinforcement was removed in alpha testing as smokers felt it reminded them of smoking. Measurement of QSU-Brief (N=30) resulted in a pregame mean of 3.24 (SD 1.65) and postgame mean of 2.99 (SD 1.40) with an overall decrease of 0.25 in cravings (not statistically significant). In a subset analysis, the QSU-Brief decrease was significant for smokers abstinent for more than 48 hours (N=5) with a pregame mean of 2.84 (SD 1.16) and a postgame mean of 2.0 (SD 0.94; change=0.84; P =.03). Between December 22, 2011, and May 29, 2014, the game was downloaded 3372 times from the App-Store, with 1526 smokers visiting the online resource www.decide2quit.org linked to the game.

Conclusions

Overall, playing the game resulted in small, but nonsignificant decreases in cravings, with changes greater for those had already quit for more than 48 hours. Lessons learned can inform further development. Future research could incorporate mHealth games in multicomponent cessation interventions.

Trial Registration

Clinicaltrials.gov NCT00797628; https://clinicaltrials.gov/ct2/show/NCT00797628 (Archived by WebCite at http://www.webcitation.org/6hbJr6LWG)

Nursing intervention versus usual care to improve delirium among home-dwelling older adults receiving homecare after hospitalization: feasibility and acceptability of a Randomized Controlled Trail

BACKGROUND

Delirium is an acute cognitive impairment among older hospitalized patients. It can persist until discharge and for months after that. Despite proof that evidence-based nursing interventions are effective in preventing delirium in acute hospitals, interventions among home-dwelling older patients is lacking. The aim was to assess feasibility and acceptability of a nursing intervention designed to detect and reduce delirium in older adults after discharge from hospital.

METHODS

Randomized clinical pilot trial with a before/after design was used. One hundred and three older adults were recruited in a home healthcare service in French-speaking Switzerland and randomized into an experimental group (EG, n = 51) and a control group (CG, n = 52). The CG received usual homecare. The EG received usual homecare plus five additional nursing interventions at 48 and 72 h and at 7, 14 and 21 days after discharge. These interventions were tailored for detecting and reducing delirium and were conducted by a geriatric clinical nurse (GCN). All patients were monitored at the start of the study (M1) and throughout the month for symptoms of delirium (M2). This was documented in patients' records after usual homecare using the Confusion Assessment Method (CAM). At one month (M2), symptoms of delirium were measured using the CAM, cognitive status was measured using the Mini-Mental State Examination (MMSE), and functional status was measured using Katz and Lawton Index of activities of daily living (ADL/IADL). At the end of the study, participants in the EG and homecare nurses were interviewed about the acceptability of the nursing interventions and the study itself.

RESULTS

Feasibility and acceptability indicators reported excellent results. Recruitment, retention, randomization, and other procedures were efficient, although some potentially issues were identified. Participants and nurses considered organizational procedures, data collection, intervention content, the dose-effect of the interventions, and methodology all to be feasible. Duration, patient adherence and fidelity were judged acceptable. Nurses, participants and informal caregivers were satisfied with the relevance and safety of the interventions.

CONCLUSIONS

Nursing interventions to detect/improve delirium at home are feasible and acceptable. These results confirm that developing a large-scale randomized controlled trial would be appropriate.

TRIAL REGESTRATION

ISRCTN registry no: 16103589 - 19 February 2016.

Acceptability of an intelligent wireless sensor system for the rapid detection of health issues: findings among home-dwelling older adults and their informal caregivers

BACKGROUND

Aging at home rather than in an institution is now considered the gold standard. Public health figures document an important demographic transition to an increasingly elderly society. At the same time, this is accompanied by the emergence of significant numbers of innovative technologies to help and support home-dwelling older adults in declining health who wish to remain at home.

STUDY AIM

To explore the acceptability of intelligent wireless sensor system (IWSS) among home-dwelling older adults in rapidly detecting their health issues.

METHODS

Data were sourced from a pilot 3-month randomized clinical trial that involved 34 older patients in the experimental group (EG) using an IWSS to rapidly detect falls and other health issues at home. The effectiveness of the IWSS was assessed by comparing it to participants' functional and cognitive status, as measured both before and after the trial. The Resident Assessment Instrument for Home Care, Confusion Assessment Method, Cognitive Performance Scale, Geriatric Depression Scale, and Informed Questionnaire on Cognitive Decline in the Elderly were used for the assessments. Acceptability of the IWSS was explored at the end of the study.

RESULTS

Both older adults and their informal caregivers considered the performance and usefulness of the IWSS intervention to be low to moderate. A majority of the participants were unsatisfied with its ease of use and found multiple obstacles in using and having an intention to use the IWSS. However, their informal caregivers were more satisfied with the program and gave higher scores for usefulness, ease of use, and intention to use IWSS technology.

CONCLUSION

The IWSS displayed low-to-moderate acceptability among the older participants and their informal caregivers. We recommend improving and clarifying several components in the IWSS for the development of a design that is user-centered.

A demonstration of peer support for Ugandan adults with type 2 diabetes

BACKGROUND

By 2030, 80% of people with diabetes will be living in developing countries.

PURPOSE

The purpose of this pre-post quasi-experimental study was to test the feasibility of a peer intervention to improve the following: (1) diabetes self-care behaviors, (2) glycemic control, (3) social support and emotional well-being, (4) linkages to health care providers, and (5) to assess the sustainability of the intervention 18 months later.

METHOD

Participants were adults with type 2 diabetes who resided in rural Uganda. Participants (n = 46) attended a 1-day diabetes education program and agreed to make weekly contacts over 4 months with each other by phone or in person to assist with daily management, provide social and emotional support, and encourage appropriate contact with health care providers.

RESULTS

Results indicated improvement in glycosylated hemoglobin (A1C), diastolic blood pressure, and eating behaviors.

CONCLUSIONS

A short-term peer support program was a feasible intervention to improve diabetes care in rural Uganda. Participants were successfully recruited and retained, and they experienced positive behavioral and physiologic outcomes. Elements of the intervention were sustained 18 months after the intervention.

Feasibility of using high-definition transcranial direct current stimulation (HD-tDCS) to enhance treatment outcomes in persons with aphasia

BACKGROUND

Transcranial direct current stimulation (tDCS) enhances treatment outcomes post-stroke. Feasibility and tolerability of high-definition (HD) tDCS (a technique that increases current focality and intensity) for consecutive weekdays as an adjuvant to behavioral treatment in a clinical population has not been demonstrated.

OBJECTIVE

To determine HD-tDCS feasibility outcomes: 1) ability to implement study as designed, 2) acceptability of repeated HD-tDCS administration to patients, and 3) preliminary efficacy.

METHODS

Eight patients with chronic post-stroke aphasia participated in a randomized crossover trial with two arms: conventional sponge-based (CS) tDCS and HD-tDCS. Computerized anomia treatment was administered for five consecutive days during each treatment arm.

RESULTS

Individualized modeling/targeting procedures and an 8-channel HD-tDCS device were developed. CS-tDCS and HD-tDCS were comparable in terms of implementation, acceptability, and outcomes. Naming accuracy and response time improved for both stimulation conditions. Change in accuracy of trained items was numerically higher (but not statistically significant) for HD-tDCS compared to CS-tDCS for most patients.

CONCLUSIONS

Regarding feasibility, HD-tDCS treatment studies can be implemented when designed similarly to documented CS-tDCS studies. HD-tDCS is likely to be acceptable to patients and clinicians. Preliminary efficacy data suggest that HD-tDCS effects, using only 4 electrodes, are at least comparable to CS-tDCS.

A Pilot Evaluation of Psychosocial Support for Family Caregivers of Relatives with Dementia in Long-Term Care: The Residential Care Transition Module

This multiple method pilot evaluation aimed to generate preliminary data on the effectiveness of the Residential Care Transition Module (RCTM). The RCTM is a six-session, 4-month psychosocial intervention designed to help families manage their emotional and psychological distress following residential care placement of a cognitively impaired relative. Seventeen family caregivers of relatives in a nursing home or assisted living memory care unit were randomly assigned to the RCTM treatment condition and 19 family caregivers were assigned to a usual care control group. Caregivers in the treatment condition reported significantly (p < 0.05) less emotional distress at 4 and 8 months on self-reported surveys than those in the control group. Post-RCTM focus groups emphasized the importance of readily available psychosocial support for families following the placement transition. The findings suggest that the provision of skilled psychosocial support can help families manage emotional distress and crises in the months following a cognitively impaired relative's admission to residential long-term care.

Feasibility of a Photovoice Study Promoting Respirator Use among Russian Health Care Workers

OBJECTIVES

Russian health care workers in tuberculosis hospitals have a high incidence of nosocomial TB. Proper use of respirators in high-risk settings can lower this threat, but health care workers do not always follow protocols that minimize risk. Our objectives were to: (1) determine feasibility of conducting a larger scale study, and (2) test effectiveness of a photovoice intervention for changing attitudes and behaviors of Russian HCWs with regard to following protocols.

DESIGN AND SAMPLE

A convenience sample of 20 HCWs was recruited from a regional TB hospital in Russia to participate in this single-group experimental-design feasibility study.

MEASURES

Participants completed a survey prior to and following the intervention.

INTERVENTION

Participants photographed someone important to them then wrote a short narrative describing why that significant other motivated them to wear and fit-check respirators.

AUTHOR

As per journal style, "Intervention" subheading to be included in the "Abstract" section if this heading appears in the "Methods" section. Therefore, either include this heading in the "Methods" section or delete the subheading "Intervention" along with its text found in the "Abstract" section.

RESULTS

We identified four areas to revise prior to undertaking a larger experimental study. The intervention had a significant effect on intention to wear and fit-check respirators. Perceived behavioral control predicted intention to wear respirators, F(3,16) = 20.383, p < .001. Subjective norm and perceived behavioral control predicted intention to fit-check respirators, F(3,16) = 44.571, p < .001.

CONCLUSIONS

Results suggest photovoice may be an efficacious intervention and larger scale testing is warranted.

Retaining homeless veterans in outpatient care: a pilot study of mobile phone text message appointment reminders

OBJECTIVES

We examined the feasibility of using mobile phone text messaging with homeless veterans to increase their engagement in care and reduce appointment no-shows.

METHODS

We sent 2 text message reminders to participants (n = 20) before each of their outpatient appointments at an urban Veterans Affairs medical center. Evaluation included pre- and postsurvey questionnaires, open-ended questions, and review of medical records. We estimated costs and savings of large-scale implementation.

RESULTS

Participants were satisfied with the text-messaging intervention, had very few technical difficulties, and were interested in continuing. Patient-cancelled visits and no-shows trended downward from 53 to 37 and from 31 to 25, respectively. Participants also experienced a statistically significant reduction in emergency department visits, from 15 to 5 (difference of 10; 95% confidence interval [CI]  = 2.2, 17.8; P = .01), and a borderline significant reduction in hospitalizations, from 3 to 0 (difference of 3; 95% CI = -0.4, 6.4; P = .08).

CONCLUSIONS

Text message reminders are a feasible means of reaching homeless veterans, and users consider it acceptable and useful. Implementation may reduce missed visits and emergency department use, and thus produce substantial cost savings.

Feasibility and acceptability of hand massage therapy for pain management of postoperative cardiac surgery patients in the intensive care unit

OBJECTIVE

The purpose was to evaluate the acceptability and feasibility of hand massage therapy in the intensive care unit (ICU).

BACKGROUND

Clinical guidelines suggest the use of non-pharmacological interventions for pain management in ICU adults. The results presented are secondary to a pilot RCT evaluating the preliminary effectiveness of hand massage on pain after cardiac surgery.

METHODS

A qualitative descriptive design was used. Acceptability was evaluated using individual interviews with participants in both groups i.e., experimental and control (n = 40). Feasibility was examined using field notes and video recordings.

RESULTS

While participants receiving the massage perceived it as appropriate, the control group suggested different dosages of the treatment and body areas targeted. Results also suggest that barriers (e.g. noise, numerous clinical activities) need to be overcome.

CONCLUSIONS

Increasing staff acceptance, reducing the rest period, involving families, and repeating the treatment are avenues to consider. Building evidence for non-pharmacological pain management in the critical care setting is necessary.

Psychological responses and adherence to exercise in heart failure

PURPOSE

The purpose of this study was to describe psychological effects and exercise adherence during a multicomponent exercise training intervention.

METHODS

A sample of 42 patients with heart failure were randomized into an exercise (INV) group (n = 22) and an attention control (AC) group (n = 20). The exercise protocol included two 12-week phases, a structured phase and a self-managed phase. The psychological responses assessed were mood states and exercise self-efficacy. To meet the second purpose of the study, the exercise group was dichotomized based on the number of sessions completed to create two adherence subgroups.

FINDINGS

Results indicate self-efficacy improved for the INV group and was maintained during the self-management phase. The adherence subgroups demonstrated different patterns for weekly exercise. Depression and confusion scores improved for the high-adherence group in contrast to worsening for the low-adherence group.

CONCLUSIONS

Results suggest a need for further study of the psychological responses of exercise adherence for patients with heart failure.

CLINICAL RELEVANCE

The study indicates the importance of continuous assessment of exercise participation and longer term adherence support for patients with heart failure.

Health promotion for cancer survivors: adaptation and implementation of an intervention

Randomized control trial of a health promotion intervention was implemented for low-income cancer survivors. The majority of participants were female, older, divorced, educated, and unemployed or on disability leave. Findings indicate the health promotion intervention improved cancer survivors' self-efficacy and increased their use of health-promoting behaviors.

Creating Avenues for Parent Partnership (CAPP): an intervention for parents of children with epilepsy and learning problems

Caregivers of children with both epilepsy and learning problems need assistance to manage their child's complex medical and mental health problems. We tested the cognitive behavioral intervention "Creating Avenues for Parent Partnership" (CAPP) which was designed to help caregivers develop knowledge as well as the confidence and skills to manage their child's condition. The CAPP intervention consisted of a one-day cognitive behavioral program and three follow-up group sessions. The sample comprised 31 primary caregivers. Caregivers reported that the program was useful (mean = 3.66 on a 4-point scale), acceptable (mean = 4.28 on a 5-point scale), and "pretty easy" (mean = 1.97 on a 4-point scale). Effect sizes were small to medium in paired t tests (comparison of intervention to control) and paired analysis of key variables in the pre- and post-tests. The CAPP program shows promise in helping caregivers build skills to manage their child's condition.

Making sense(s) in dementia: a multisensory and motor-based group activity program

Lack of engagement in meaningful activities is associated with poor quality of life in dementia; thus, the development of these activities has been recommended. This pilot study aimed to develop a multisensory and motor-based group activity program for residents with dementia and assess its impact on residents' behavior. The program was designed using a multisensory and motor-based approach in sixteen 45-minute weekly sessions tailored to residents' characteristics. Four residents with advanced dementia participated in the program. The frequency and duration of the residents' behavior were assessed using video recordings. All residents participated in the proposed activities, although they were more participative and communicative in some sessions than in others. Group activity programs based on multisensory and motor stimulation can be a promising approach for people with advanced dementia; however, further research is needed. This study may serve as reference to the implementation of future programs aiming to increase person-centeredness of the care provided.

A brief intervention to minimize psychosexual morbidity in dyads coping with breast cancer

PURPOSE/OBJECTIVES

To develop and evaluate the feasibility of a brief intervention to attenuate the incidence of psychosexual morbidity within the dyad secondary to the diagnosis and treatment of breast cancer.

DESIGN

Quasiexperimental, including intervention and treatment-as-usual comparison groups.

SETTING

Breast clinic of a comprehensive cancer center in the Midwest United States.

SAMPLE

65 recently diagnosed breast cancer survivors who were pre- or perimenopausal and aged 20-55 years, and their partners.

METHODS

Three intervention sessions were delivered based on a manual developed for the study. Twenty-five dyads received treatment as usual, 26 dyads received a face-to-face intervention, and 14 dyads received the same intervention by telephone. Questionnaires were completed at baseline, following completion of the intervention, six months postintervention, and from the comparison group at equivalent data points.

MAIN RESEARCH VARIABLES

Intimacy, sexual functioning, and dyadic adjustment.

FINDINGS

About 98% of dyads completed all intervention sessions, with an equal level of satisfaction among those in the telephone and face-to-face groups. Interesting trends in differences between the intervention and comparison groups on the relationship variables of intimacy, sexual functioning, and dyadic adjustment were obtained; however, given the sample size, power was not sufficient to reach statistical significance.

CONCLUSIONS

The intervention is feasible and acceptable for dyads comfortable discussing their relationship. Intervention by telephone was demonstrated to be as effective as the face-to-face mode of delivery.

IMPLICATIONS FOR NURSING

Nurses need to provide an opportunity for women to discuss problems they are experiencing relative to sexuality, intimacy, and body image.

Exploring the effects of dance-based therapy on balance and mobility in older adults

Balance and mobility are a common concern among older adults. This pilot randomized controlled study examines the effect of dance-based therapy to increase balance and mobility in 27 participants with mean age 85 years (±7.5) from a single aging-in-place facility in the Midwest. Multidirectional reach, velocity, step length differential, and a Functional Ambulation Profile were measured before and after 18 sessions of low-impact dance-based therapy. Although a Wilcoxon rank sum test showed no significance, effect size analyses suggest that dance-based therapy was mildly or moderately effective in several components of balance and mobility. Additional research is needed with a full-scale trial.

Protecting the power of interventions through proper reporting

Authors, reviewers, and journal editors are responsible for ensuring that standards of research reporting include detailed descriptions of interventions. The impact of nursing intervention research is much reduced when interventions are poorly described. Nursing research reports often fail to detail descriptions of interventions sufficiently to move future research forward, apply new knowledge in practice, and refine theories. To address this deficit, the authors constructed detailed guidelines for reporting interventions. Based on a review of health care literature, these guidelines include a discussion of theoretical, participant, interventionist, content, and delivery intervention elements with rationale for their inclusion. Suggestions for presenting this information in limited journal space are also presented.

Feasibility, acceptability, and initial efficacy of a knowledge-contact program to reduce mental illness stigma and improve mental health literacy in adolescents

The purpose of this school-based cluster-randomized trial was to determine the initial acceptability, feasibility, and efficacy of an existing community-based intervention, In Our Own Voice, in a sample of US adolescent girls aged 13-17 years (n = 156). In Our Own Voice is a knowledge-contact intervention that provides knowledge about mental illness to improve mental health literacy and facilitates intergroup contact with persons with mental illness as a means to reduce mental illness stigma. This longitudinal study was set in two public high schools located in a southern urban community of the U.S. Outcomes included measures of mental illness stigma and mental health literacy. Findings support the acceptability and feasibility of the intervention for adolescents who enrolled in the study. Findings to support the efficacy of In Our Own Voice to reduce stigma and improve mental health literacy are mixed. The intervention did not reduce mental illness stigma or improve mental health literacy at one week follow up. The intervention did not reduce mental illness stigma at 4 and 8 weeks follow up. The intervention did improve mental health literacy at 4 and 8 weeks follow up. Previous studies have assessed the preliminary efficacy In Our Own Voice among young adults; rarely has In Our Own Voice been investigated longitudinally and with adolescents in the United States. This study provides initial data on the effects of In Our Own Voice for this population and can be used to further adapt the intervention for adolescents.

Team Clinical Supervision in Acute Hospital Wards

Clinical supervision provides a strategy to mitigate nurses’ workplace stress and enhance retention, but the literature provides little guidance about its implementation beyond mental health nursing. This study explored the feasibility of implementing and evaluating ward-based team clinical supervision for general nurses on two separate wards at one public and one private hospital. Nurses completed the Work Environment Questionnaire pre- ( n = 36) and postintervention ( n = 27), and focus groups ( n = 20) explored their perceptions of supervision. Staff were unfamiliar with clinical supervision, so information sessions were required. The questionnaire may not have been suitable to evaluate this type of intervention. Focus group findings revealed that team supervision improved communication, enhanced working relationships, and empowered nurses to challenge existing practices, which had a positive impact on their perceived stress. This study provides insights to guide implementation and evaluation of clinical supervision in acute settings.