The CHOICE Project: A Randomised Exploratory Pilot Trial Testing the Acceptability and Preliminary Efficacy of a Public Health Communication Intervention

Abstract

Referral to palliative care frequently occurs late in the illness course, despite evidence to support the benefits of early integration. A systematic approach to community engagement is required. Narrative communication is increasingly understood as a promising way of promoting health behaviour change. However few empirical approaches have been developed and tested seeking to change attitudes or behaviours related to palliative care. To evaluate the acceptability (primary outcome), feasibility, and preliminary efficacy (secondary outcome) of narrative communication as a public health intervention to educate community about palliative care. Based on the MRC Framework for the development of complex interventions, a series of 2-minute visual educational stories were developed to address common misperceptions raised by earlier qualitative data. These were piloted with a community-based sample using a phase 2, online, computer-randomised controlled trial design involving six experimental (narrative) conditions. Descriptive statistics described the sample characteristics and intervention acceptability. A repeated measures analysis of covariance (ANCOVA) assessed preliminary change in attitude to palliative care (measured on a 10-point Likert scale) post intervention, controlling for baseline variables. Of 164 participants (median age 51, range 23-82; 75% female), 150 completed post-intervention data (92% completion rate), with a mean completion time of 14.5 minutes. Visual educational stories were shown to be an acceptable approach to public health communication about palliative care, with respondents reporting a median of 7 positive ratings (IQR 6, 9) out of the 10 acceptability items. A majority of participants reported the intervention was easy to understand (100%), believable (93%), and made them feel more likely to likely to consider palliative care if they became seriously ill (68%) or talk to someone else about palliative care (65%). Most agreed it taught them something new (68%) and make them stop and think (59%). ANCOVA analyses showed a significant main effect, whereby regardless of narrative assignment, mean attitudes toward palliative care were improved after viewing the educational information (m 9.4, sd 1.0) compared to baseline (m 8.9, sd 1.6), F(1,132)=21.0, p< .001, np2 =.15 (large effect). This study provides novel pilot data addressing an important gap in the literature around the question of how to engage community about palliative care. Narrative communication is an acceptable public health intervention to communicate information about palliative care and may improve community attitudes to engagement with palliative care services.