Abstract
BackgroundResearch suggests that palliative home care should be integrated early into standard care for end-stage COPD patients. Patients also express the wish to be cared for and to die at home. However, a practice model for early integration of palliative home care (PHC) into standard care for end-stage COPD has not been fully developed.AimTo develop an intervention for early integration of PHC into standard care for end-stage COPD patients.MethodsWe conducted a Phase 0–I study according to the Medical Research Council Framework for the development of complex interventions. Phase 0 aimed to identify the inclusion criteria and key components of the intervention by way of an explorative literature search of interventions, expert consultations, and seven focus groups with general practitioners and community nurses on perceived barriers to and facilitators of early integrated PHC for COPD. In Phase 1, the intervention, its inclusion criteria and its components were developed and further refined by an expert panel and two expert opinions.ResultsPhase 0 resulted in identification of inclusion criteria and components from existing interventions, and barriers to and facilitators of early integration of PHC for end-stage COPD. Based on these findings, a nurse-led intervention was developed in Phase I consisting of training for PHC nurses in symptom recognition and physical therapy exercises for end-stage COPD, regular visits by PHC nurses at the patients’ homes, two information leaflets on self-management, a semi-structured protocol and follow-up plan to record the outcomes of the home visits, and integration of care by enabling collaboration and communication between home and hospital-based professional caregivers.ConclusionThis Phase 0-I trial succeeded in developing a complex intervention for early integration of PHC for end-stage COPD. The use of three methods in Phase 0 gave reliable data on which to base inclusion criteria and components of the intervention. The preliminary effectiveness, feasibility and acceptability of the intervention will be subsequently tested in a Phase II study.
Highlights
Research suggests that palliative home care should be integrated early into standard care for end-stage Chronic Obstructive Pulmonary Disease (COPD) patients
Phase 0 resulted in identification of inclusion criteria and components from existing interventions, and barriers to and facilitators of early integration of palliative home care (PHC) for end-stage COPD
COPD and early integrated palliative home care for PHC nurses in symptom recognition and physical therapy exercises for end-stage COPD, regular visits by PHC nurses at the patients’ homes, two information leaflets on selfmanagement, a semi-structured protocol and follow-up plan to record the outcomes of the home visits, and integration of care by enabling collaboration and communication between home and hospital-based professional caregivers
Summary
We conducted a Phase 0–I study according to the Medical Research Council Framework for the development of complex interventions. In Phase 1, the intervention, its inclusion criteria and its components were developed and further refined by an expert panel and two expert opinions. The intervention was developed using the Medical Research Council (MRC) framework for complex intervention design[26]. This framework provides multiples steps (from Phase 0 to Phase IV) for developing and evaluating complex interventions. The process may take different forms, with several Phases consisting of key functions and activities. This study consists of a Phase 0-I trial involving the identification and modelling of the inclusion criteria, core components of the intervention
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