Process evaluation of a tailored nudge intervention to promote appropriate care and treatment of older patients at the end-of-life

被引：3

作者：

Bracci, Ella L. ^{[1
]}

Barnett, Adrian G. ^{[2
,3
]}

Brown, Christine ^{[2
,3
]}

Callaway, Leonie ^{[4
,5
]}

Cardona, Magnolia ^{[6
,10
]}

Carter, Hannah E. ^{[2
,3
]}

Graves, Nicholas ^{[2
,3
,7
]}

Hillman, Kenneth ^{[8
]}

Lee, Xing J. ^{[2
,3
]}

McPhail, Steven M. ^{[2
,3
]}

White, Ben P. ^{[9
]}

Willmott, Lindy ^{[9
]}

Harvey, Gillian ^{[1
,2
,3
]}

机构：

[1] Flinders Univ S Australia, Caring Futures Inst, Coll Nursing & Hlth Sci, Adelaide, SA, Australia

[2] Queensland Univ Technol, Fac Hlth, Australian Ctr Hlth Serv Innovat, Sch Publ Hlth & Social Work, Brisbane, Qld, Australia

[3] Queensland Univ Technol, Fac Hlth, Ctr Healthcare Transformat, Sch Publ Hlth & Social Work, Brisbane, Qld, Australia

[4] Univ Queensland, Fac Med, Herston, Qld, Australia

[5] Royal Brisbane & Womens Hosp, Herston, Qld, Australia

[6] Bond Univ, Inst Evidence Based Hlth Care, Robina, Qld, Australia

[7] Natl Univ Singapore, Duke NUS Postgrad Med Sch, Singapore, Singapore

[8] Sch Clin Med, Discipline Crit Care, UNSW Med & Hlth, Southwest Sydney Clin Campuses, Sydney, NSW, Australia

[9] Queensland Univ Technol, Fac Business & Law, Australia Ctr Heath Law Res, Brisbane, Qld, Australia

[10] Univ Queensland, Sch Psychol, Herston, Qld, Australia

来源：

BMC GERIATRICS | 2024年 / 24卷 / 01期

基金：

英国医学研究理事会; 澳大利亚国家健康与医学研究理事会;

关键词：

Non-beneficial treatment; End-of-life; Clinical audit; Nudge intervention; Hospital; IMPACT; TOOL;

D O I：

10.1186/s12877-024-04818-4

中图分类号：

R592 [老年病学]; C [社会科学总论];

学科分类号：

03 ; 0303 ; 100203 ;

摘要：

BackgroundNon-beneficial treatment affects a considerable proportion of older people in hospital, and some will choose to decline invasive treatments when they are approaching the end of their life. The Intervention for Appropriate Care and Treatment (InterACT) intervention was a 12-month stepped wedge randomised controlled trial with an embedded process evaluation in three hospitals in Brisbane, Australia. The aim was to increase appropriate care and treatment decisions for older people at the end-of-life, through implementing a nudge intervention in the form of a prospective feedback loop. However, the trial results indicated that the expected practice change did not occur. The process evaluation aimed to assess implementation using the Consolidated Framework for Implementation Research, identify barriers and enablers to implementation and provide insights into the lack of effect of the InterACT intervention.MethodsQualitative data collection involved 38 semi-structured interviews with participating clinicians, members of the executive advisory groups overseeing the intervention at a site level, clinical auditors, and project leads. Online interviews were conducted at two times: implementation onset and completion. Data were coded to the Consolidated Framework for Implementation Research and deductively analysed.ResultsOverall, clinicians felt the premise and clinical reasoning behind InterACT were strong and could improve patient management. However, several prominent barriers affected implementation. These related to the potency of the nudge intervention and its integration into routine clinical practice, clinician beliefs and perceived self-efficacy, and wider contextual factors at the health system level.ConclusionsAn intervention designed to change clinical practice for patients at or near to end-of-life did not have the intended effect. Future interventions targeting this area of care should consider using multi-component strategies that address the identified barriers to implementation and clinician change of practice.Trial registrationAustralia New Zealand Clinical Trial Registry (ANZCTR), ACTRN12619000675123p (approved 06/05/2019).

引用

页数：12

共 25 条

[11] Moral Distress Amongst American Physician Trainees Regarding Futile Treatments at the End of Life: A Qualitative Study [J].