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Basinska K, Zúñiga F, Simon M, De Geest S, Guerbaai RA, Wellens NIH, Nicca D, Brunkert T. Implementation of a complex intervention to reduce hospitalizations from nursing homes: a mixed-method evaluation of implementation processes and outcomes. BMC Geriatr 2022; 22:196. [PMID: 35279088 PMCID: PMC8918313 DOI: 10.1186/s12877-022-02878-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 02/28/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background | objective
To evaluate the implementation of three intervention elements to reduce hospitalizations in nursing home residents.
Design
Convergent mixed-method design within a hybrid type-2 effectiveness-implementation study.
Setting
Eleven nursing homes in the German-speaking region of Switzerland.
Participants
Quantitative data were collected from 573 care workers; qualitative data were collected from 108 care workers and the leadership from 11 nursing homes.
Intervention
Three intervention elements targeting care workers were implemented to reduce unplanned hospitalizations: (1) the STOP&WATCH instrument for early recognition of changes in resident condition; (2) the ISBAR instrument for structured communication; and (3) specially-trained INTERCARE nurses providing on-site geriatric support. Multifaceted implementation strategies focusing both on the overall nursing home organization and on the care workers were used.
Methods
The quantitative part comprised surveys of care workers six- and twelve-months post-intervention. The intervention’s acceptability, feasibility and uptake were assessed using validated and self-developed scales.
Qualitative data were collected in 22 focus groups with care workers, then analyzed using thematic analysis methodology. Data on implementation processes were collected during implementation meetings with nursing home leadership and were analyzed via content analysis. Findings were integrated using a complementary approach.
Results
The ISBAR instrument and the INTERCARE nurse role were considered acceptable, feasible, and taken up by > 70% of care workers. The STOP&WATCH instrument showed the lowest acceptance (mean: 68%), ranging from 24 to 100% across eleven nursing homes. A combination of factors, including the amount of information received, the amount of support provided in daily practice, the users’ perceived ease of using the intervention and its adaptations, and the intervention’s usefulness, appeared to influence the implementation’s success. Two exemplary nursing homes illustrated context-specific implementation processes that serve as either barriers or facilitators to implementation.
Conclusions
Our findings suggest that, alongside the provision of information shortly before intervention start, constant daily support is crucial for implementation success. Ideally, this support is provided by designated and trained individuals who oversee implementation at the organizational and unit levels. Leaders who seek to implement interventions in nursing homes should consider their complexity and their consequences for workflow to optimize implementation processes accordingly.
Trial registration
This study was registered at clinicaltrials.gov (NCT03590470) on the 18/06/2018.
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Austin PD, Siddall PJ, Lovell MR. Feasibility and acceptability of virtual reality for cancer pain in people receiving palliative care: a randomised cross-over study. Support Care Cancer 2022; 30:3995-4005. [PMID: 35064330 PMCID: PMC8782583 DOI: 10.1007/s00520-022-06824-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 01/10/2022] [Indexed: 10/26/2022]
Abstract
CONTEXT Pain management in palliative care remains inadequate; the development of innovative therapeutic options is needed. OBJECTIVES To determine the feasibility and preliminary effectiveness for larger randomised controlled trials of 3D head-mounted (HMD) virtual reality (VR) for managing cancer pain (CP) in adults. METHODS Thirteen people receiving palliative care participated in a single-session randomised cross-over trial, after which they completed a qualitative semi-structured interview. We also compared the effects of 3D HMD VR and 2D screen applications on CP intensity and levels of perceived presence. Feasibility was assessed with recruitment, completion rates and time required to recruit target sample. RESULTS Although recruitment was slow, completion rate was high (93%). Participants reported that the intervention was acceptable and caused few side effects. Although participants reported significantly reduced CP intensity after 3D HMD VR (1.9 ± 1.8, P = .003) and 2D screen applications (1.5 ± 1.6, P = .007), no significant differences were found between interventions (-.38 ± 1.2, 95% CI: -1.1-.29, P = .23). Participants reported significantly higher levels of presence with the 3D HMD VR compared to 2D screen (60.7 ± SD 12.4 versus 34.3 ± SD 17.1, mean 95% CI: 16.4-40.7, P = .001). Increased presence was associated with significantly lower pain intensity (mean 95% CI: -.04--0.01, P = 0.02). CONCLUSIONS Our preliminary findings support growing evidence that both 3D and 2D virtual applications provide pain relief for people receiving palliative care. Given the relative lack of cybersickness and increasing access to portable VR, we suggest that larger clinical studies are warranted.
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Affiliation(s)
- Philip D Austin
- Department of Palliative Care, HammondCare, Greenwich Hospital, Sydney, New South Wales, Australia.
| | - Philip J Siddall
- Department of Pain Management, HammondCare, Greenwich Hospital, Sydney, New South Wales, Australia.,Sydney Medical School-Northern, University of Sydney, Sydney, New South Wales, Australia
| | - Melanie R Lovell
- Department of Palliative Care, HammondCare, Greenwich Hospital, Sydney, New South Wales, Australia.,Sydney Medical School-Northern, University of Sydney, Sydney, New South Wales, Australia
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Wyatt G, Lehto R, Guha-Niyogi P, Brewer S, Victorson D, Pace T, Badger T, Sikorskii A. Reflexology and meditative practices for symptom management among people with cancer: Results from a sequential multiple assignment randomized trial. Res Nurs Health 2021; 44:796-810. [PMID: 34515341 PMCID: PMC8438223 DOI: 10.1002/nur.22169] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 06/03/2021] [Accepted: 07/03/2021] [Indexed: 12/12/2022]
Abstract
Optimal sequencing of complementary therapies can help improve symptom management through nonpharmacological approaches. A 12-week sequential multiple assignment randomized trial comparing home-based reflexology and meditative practices on severity of fatigue and other symptoms was conducted among patients with cancer and their informal caregivers. Dyads were initially randomized to reflexology (N = 150), meditative practices (N = 150), or control (N = 47). If patient's fatigue did not improve (nonresponse) after 4 weeks of reflexology or meditative practices, the dyad was rerandomized to either add the other therapy or continue with the original therapy for weeks 5-8. Four decision rules (DRs) were compared: (1) Initiating reflexology, and if nonresponse on fatigue after 4 weeks, continue with reflexology for another 4 weeks, thus providing a higher dose; (2) Initiating reflexology, and if nonresponse on fatigue after 4 weeks, add meditative practices for the next 4 weeks; (3) Initiating meditative practices, and if nonresponse on fatigue after 4 weeks, continue meditative practices for another 4 weeks, thus providing a higher dose; and (4) Initiating meditative practices, and if nonresponse on fatigue after 4 weeks, add reflexology for the next 4 weeks. Symptoms were evaluated weekly using the M.D. Anderson Symptom Inventory (MDASI). Clinically, nurses can recommend either therapy since no differences were found among the 4 DRs, with the exception of lower severity for summed MDASI symptoms at week 8 for the use of reflexology only (DR-1) versus DR-2 (sequencing reflexology to meditative practices). Adding the other therapy for nonresponders after 4 weeks may not be warranted.
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Affiliation(s)
- Gwen Wyatt
- College of Nursing, Michigan State University, East Lansing, Michigan, USA
| | - Rebecca Lehto
- College of Nursing, Michigan State University, East Lansing, Michigan, USA
| | - Pratim Guha-Niyogi
- Department of Statistics and Probability, Michigan State University, East Lansing, Michigan, USA
| | - Sarah Brewer
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan, USA
| | - David Victorson
- Feinberg School of Medicine, Northwestern University, Evanston, Illinois, USA
| | - Thaddeus Pace
- University of Arizona College of Nursing, Tucson, Arizona, USA
| | - Terry Badger
- University of Arizona College of Nursing, Tucson, Arizona, USA
| | - Alla Sikorskii
- Department of Psychiatry, Michigan State University, East Lansing, Michigan, USA
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Courtier N, Armes J, Smith A, Radley L, Hopkinson JB. Targeted self-management limits fatigue for women undergoing radiotherapy for early breast cancer: results from the ACTIVE randomised feasibility trial. Support Care Cancer 2021; 30:389-400. [PMID: 34297221 PMCID: PMC8298947 DOI: 10.1007/s00520-021-06360-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 06/09/2021] [Indexed: 10/31/2022]
Abstract
PURPOSE The ACTIVE intervention uses a novel fatigue propensity tool to target a behavioural fatigue self-management programme for women undergoing radiotherapy for early breast cancer. We assess feasibility and outcomes for ACTIVE. METHODS Mixed methods comprised a randomised feasibility trial with qualitative process evaluation and a nested fatigue risk substudy. Participants at a higher risk of fatigue were allocated 2:1 to behavioural intervention or information alone. Participants at a lower risk of fatigue entered the fatigue risk substudy. Feasibility was assessed by rates of eligibility, recruitment, retention and adherence. Qualitative interviews explored acceptability of the intervention and trial processes. Measures of fatigue, anxiety, depression, quality of life and self-efficacy were self-reported before, during and 10 days, 3 weeks and 6 months after radiotherapy. Pre-treatment fatigue risk score and post-treatment fatigue were correlated. RESULTS Fifty percent (n = 75) of eligible patients were recruited with 33 higher risk participants randomised to the trial and 42 entering the fatigue risk score substudy. Trial design and methods were feasible and acceptable with 91% of participants completing all measures according to protocol. Fatigue was clinically-significantly lower in the intervention group during, and in the weeks after, treatment compared to the control: all secondary measures favoured the intervention group. Positive group differences were not maintained at 6 months. CONCLUSION Our targeted approach to fatigue self-management is feasible and acceptable within the early breast cancer pathway. Multiple benefits were reported by patients who received the intervention, which is worthy of further investigation. TRIAL REGISTRATION ISRCTN 10303368. Registered August 2017. Health and Care Research Wales Clinical Trial Portfolio Registration 31419.
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Affiliation(s)
- Nick Courtier
- School of Healthcare Sciences, Cardiff University, Eastgate House, 35-43 Newport Road, Cardiff, CF24 0AB, UK.
| | - Jo Armes
- School of Health Sciences, Faculty of Health and Medical Sciences, Duke of Kent Building, University of Surrey, Guildford, GU2 7XH, UK
| | - Andrew Smith
- Centre for Occupational and Health Psychology, Cardiff University, 63 Park Place, Cardiff, CF10 3AS, UK
| | | | - Jane B Hopkinson
- School of Healthcare Sciences, Cardiff University, Eastgate House, 35-43 Newport Road, Cardiff, CF24 0AB, UK
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Kowalczyk L, Deutschmann C, Crevenna R, Konrad S, Singer CF, Farr A. Radiotherapy-Induced Fatigue in Breast Cancer Patients. Breast Care (Basel) 2020; 16:236-242. [PMID: 34248464 DOI: 10.1159/000509410] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 06/15/2020] [Indexed: 11/19/2022] Open
Abstract
Background A large proportion of breast cancer patients who undergo adjuvant radiotherapy suffer from radiotherapy-induced fatigue. The possible causative factors of this specific side effect are diverse. Summary Prevalence, duration, and severity of radiotherapy-induced fatigue are dependent on the type of radiotherapy, as well as on the irradiated volume, dose scheme, on the number of radiation fields, the combination with other treatments, diurnal rhythm, smoking, and time-to-hospitalization. Recommended treatments include non-pharmacologic interventions, such as physical and psychosocial interventions. Pharmacologic therapies include treatment with methylphenidate and modafinil. In addition to its early detection with standardized instruments, adequate education to breast cancer patients about risks and predisposing factors of radiotherapy-induced fatigue is essential. Multidimensional strategies help to maintain the patients' quality of life and therefore guarantee treatment adherence and efficacy. Key Messages Radiotherapy-induced fatigue is an underreported, underdiagnosed, and undertreated side effect. This review provides an overview of radiotherapy-induced fatigue in breast cancer patients receiving adjuvant radiotherapy.
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Affiliation(s)
- Lidia Kowalczyk
- Clinical Unit of Anesthesiology and Perioperative Intensive-Care Medicine, University of Veterinary Medicine, Vienna, Austria
| | - Christine Deutschmann
- Department of Obstetrics and Gynecology, Division of Gynecology and Gynecologic Oncology, Medical University of Vienna, Vienna, Austria
| | - Richard Crevenna
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Vienna, Austria
| | - Stefan Konrad
- Department of Radiation Oncology, Medical University of Vienna, Vienna, Austria
| | - Christian F Singer
- Department of Obstetrics and Gynecology, Division of Gynecology and Gynecologic Oncology, Medical University of Vienna, Vienna, Austria
| | - Alex Farr
- Department of Obstetrics and Gynecology, Division of Gynecology and Gynecologic Oncology, Medical University of Vienna, Vienna, Austria
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