Interventions In Routine Care Research Articles

Effect of nursing on postoperative respiratory function and mental health of lung cancer patients.

Both pulmonary rehabilitation training and psychological care have been shown to have a positive effect on the postoperative recovery of patients with lung cancer. However, few studies have combined the two to explore their combined effect. Therefore, this study aimed to investigate the effects of pulmonary rehabilitation training combined with psychological care on postoperative respiratory function and mental health in lung cancer patients. To investigate effect of nursing on postoperative respiratory function and mental health of lung cancer patients. 122 cases of lung cancer patients who underwent surgical treatment in our hospital and were treated in our department from January 2022 to April 2023 were selected and randomly divided into the control group and observation group. The control group performed the routine care intervention. The observation group was given pulmonary rehabilitation training and psychological care based on conventional nursing interventions. Forced expiratory volume, forced vital capacity. Maximum ventilatory volume (MVV) in one second was measured, and the patient's 6-min walking distance and dyspnoea index scale were used to assess the patient's respiratory condition. The Connor-Davidson resilience scale (CD-RISC), self-rating anxiety scale (SAS), and self-rating depression scale (SDS) were used to evaluate the mental health of the patients. There was no difference between the two groups regarding age, gender, education level, surgical procedure, type of pathology, and treatment (P > 0.05). After treatment, MVV, 6-min walking distance, toughness, strength, optimism, and total CD-RISC scores were significantly higher in the observation group (P < 0.05), dyspnoea scores, SAS, and SDS scores were substantially lower in the control group compared to the observation group (P < 0.05). Pulmonary rehabilitation training combined with psychological care for patients after lung cancer resection could improve lung function, enhance daily activities, effectively relieve negative emotions such as anxiety and depression, and reduce complications.

Different nursing interventions on sleep quality among critically ill patients: A systematic review and network meta-analysis.

Critically ill patients in intensive care often struggle with disrupted sleep, a prevalent issue in this population. However, the question of which non-pharmacological intervention is most effective in enhancing sleep quality remains unanswered. This study was conducted to comprehensively evaluate and compare the efficacy of various non-pharmacological interventions aimed at improving sleep quality among critically ill individuals. We conducted a search of PubMed, Embase, and the Cochrane Library (Cochrane Central Register of Controlled Trials) without language restrictions to identify articles published until July 15, 2023. Randomized controlled trials (RCTs) that investigated various nursing interventions designed to improve sleep quality in critically ill patients were included in this network meta-analysis. All analyses were performed using R software (version 3.4.3) with the "gemtc" package. A total of 2036 patients from 31 RCTs were included in the network meta-analysis, involving 11 different nursing interventions (routine care, relaxation combined with imagery (RI), nursel, music + earplugs + eye masks, music, eye masks, earplugs + eye masks, earplugs, aromatherapy, Warm footbath combined with acupoint exercise (WFA), Virtual reality meditation (VR)). Eye masks and earplugs + eye masks were associated with improved sleep quality compared to routine care intervention (P < .05). In summary, eye masks and earplugs + eye masks stand out as the most effective interventions for enhancing sleep quality in critically ill patients. Therefore, critical care nurses should consider incorporating the use of eye masks alone or combining music with eye masks into the sleep care regimen for critically ill patients.

FRI060 Real World Experience Of Weight Management In Low Socioeconomic Community Clinic

Abstract Disclosure: B.A. West: None. S. Mon: None. Pilot Study: Real-world experience of weight management in low socioeconomic community clinic Introduction: Management of obesity and unhealthy behaviors is an essential step in patients with Prediabetes and T2DM, particularly those with socioeconomic status (SES) in whom obesity is more prevalent. While several behavior interventions targeting obesity exist, a successful adaptation of interventions in routine care is challenging especially in those with low SES. We examined the real word experience of weight loss management in our community clinic. Method: Retrospective chart review of consecutive patients seen in an endocrinology clinic at a hospital-based community clinic. Result: A total of 23 female patients, average age 48.4 ± 10.8 years, with average BMI 37.4 ± 6.9 kg/m2, were provided comprehensive lifestyle counseling focusing on nutrition, exercise, sleep health at each visits along with semaglutide at the highest tolerable dose of 2.4 mg/dl weekly. Within 6 months from the initiation of semaglutide and the weight loss intervention, 11/23 (48%) patients lost weight by &amp;gt;5% from their baseline visit, and 17/20 (85%) patients at the end of 1 year. 12/20 (60%) and 6/20 (30%) lost weight at least by 10% and 15% respectively at the end of 1 year. Compared to the baseline data, weight ( 101.2±18.4) kg, SBP 127.6 ± 13.4 mmHg, HbA1C 6.0 ± 1.1 mg/dL, Total Cholesterol 182.1 ± 40.4 mg/dL, LDL 102.4 ± 35.8 mg/dL, most parameters were improved at the end of 6 and 12 months respectively: weight 91.0± 18.6 vs 88.4± 16.2 kg, SBP 125.2± 16.8 vs. 126.9± 15.6 mmHg, HbA1C 5.8 ± 1.2 vs 6.3 ± 1.4 mg/dl, Total cholesterol 178.9± 33.1 vs 175.0 ± 50.7mg/dl, LDL 100.4± 27.7 vs 101.8± 47.7 mg/dL. Conclusion: This real-world implementation study reported the benefits of weight loss and other clinical parameters after the intervention consisting of a combined health behavior counseling and use of semaglutide at the low-SES community clinic. Presentation: Friday, June 16, 2023

Online cognitive behaviour therapy for maternal antenatal and postnatal anxiety and depression in routine care

BackgroundPerinatal depression and anxiety are associated with significant adverse effects for the mother and child. Online cognitive behavioural therapy (iCBT) can provide scalable access to psychological interventions to improve perinatal depression and anxiety, however, few studies have examined the effectiveness of these interventions in routine care. This study investigated the uptake and treatment outcomes of women living in the Australian community who enrolled in a pregnancy or postnatal iCBT program for their symptoms of depression and anxiety. Methods1502 women commenced iCBT (529 pregnancy and 973 postnatal) and completed measures of anxiety and depression symptom severity, and psychological distress pre- and post-treatment. Results35.0 % of women in the pregnancy program and 41.6 % in the postnatal program completed all 3 lessons, with lower pre-treatment depression symptom severity significantly associated with increased likelihood of perinatal program completion. Both iCBT programs were associated with medium pre- to post-treatment effect size reductions in generalised anxiety symptom severity (gs = 0.63 and 0.71), depression symptom severity (gs = 0.58 and 0.64), and psychological distress (gs = 0.52 and 0.60). LimitationsLack of control group and long-term follow-up, as well as detailed information on nature of the sample (e.g., health status, relationship status). Additionally, the sample was limited to Australian residents. ConclusioniCBT for perinatal anxiety and depression was associated with significant symptom improvement. Current findings support the use of iCBT in perinatal populations and its integration within routine healthcare provision.

Effect of mindfulness on sexual self-efficacy and sexual satisfaction among Iranian postmenopausal women: a quasi-experimental study

Abstract Background Menopause with anatomical, physiological, and psychological changes can affect sexual satisfaction and consequently the quality of life. Aims The study sought to evaluate the effects of mindfulness-based counseling on sexual self-efficacy and sexual satisfaction among Iranian postmenopausal women. Methods This quasi-experimental study was conducted on 110 women who were assigned to an intervention group (n = 55) and a control group (n = 55). The intervention group received 8 sessions of mindfulness-based training and daily mindfulness exercises. Data collection tools included questionnaires of demographics and midwifery, sexual self-efficacy, and sexual satisfaction. They were completed before and 8 weeks after the intervention. The collected data were analyzed through a t test, a chi-square test, and repeated-measures analysis of variance. Outcomes Changes in sexual self-efficacy and sexual satisfaction scores were evaluated. Results The mindfulness-based intervention significantly improved sexual self-efficacy (F = 146.98, P = .000, ƞ2 = 0.576) and sexual satisfaction (F = 129.47, P = .000, ƞ2 = 0.545) over time. The mean scores of sexual self-efficacy (17.03 ± 2.08) and sexual satisfaction (87.94 ± 8.26) in the intervention group increased after the intervention as opposed to the mean scores of sexual self-efficacy (12.65 ± 1.70) and sexual satisfaction (76.61 ± 6.45) in the control group. Clinical Implications Mindfulness training can improve sexual self-efficacy and sexual satisfaction in postmenopausal women. Strengths and Limitations The intervention was implemented on a population of menopausal women in a culture in which the expression of sexual issues is taboo and has not been noticed in the past. The main limitation of this study was self-reporting, which may have affected the responses. The next limitation was the nonrandomized controlled design. Finally, the research sample included menopausal women who were heterosexual and married. Hence, the findings may not be generalizable to more diverse samples. In this study, psychological maladjustment or psychological distress was not analyzed. They should also be considered in future research. Conclusion According to the results, it is advisable to employ mindfulness-based intervention in routine care, because it can improve different aspects of menopausal women’s life.

Protocol of an implementation study of a clinician intervention to reduce fear of recurrence in cancer survivors (CIFeR_2 implementation study)

BackgroundFear of cancer recurrence (FCR) affects 50–70% of cancer survivors with 30% reporting an unmet need for help with managing FCR. Patients indicate desire to discuss FCR with clinicians, however clinicians indicate discomfort with managing FCR and no formal educational interventions on how to discuss FCR or worry exists for oncology clinicians. Our team developed a novel clinician-driven brief education intervention to help patients manage FCR (the Clinician Intervention to Reduce Fear of Recurrence (CIFeR) intervention). In earlier work, we demonstrated the feasibility, acceptability, and efficacy of CIFeR in reducing FCR in breast cancer patients. We now aim to explore the barriers and facilitators to implementing this low-cost brief intervention within routine oncology practice in Australia. The primary objective is to assess the adoption of CIFeR in routine clinical practice. Secondary objectives are to identify the uptake and sustainability, perceived acceptability, feasibility, costs, barriers and facilitators of implementation of CIFeR in routine clinical practice, and to assess whether training in CIFeR increases clinicians’ self-efficacy in managing FCR with their patients.MethodsThis multicentre, single-arm Phase I/II implementation study will recruit medical and radiation oncologists and oncology surgeons who treat women with early breast cancer. Participants will complete online CIFeR training. They will then be asked to use CIFeR with suitable patients for the next 6 months. Participants will complete questionnaires prior to, immediately after and 3 and 6 months after training to assess confidence addressing FCR, and 3 and 6 months after training to assess Proctor Implementation outcomes. At 6 months, they will also be asked to participate in a semi-structured telephone interview to elicit their feedback about barriers and facilitators to using CIFeR in routine clinical practice.DiscussionThis study will provide further data to support the routine use of an evidence-based, clinician-lead educational intervention to reduce FCR in breast cancer patients. Additionally, this study will identify any barriers and facilitators to implementing the CIFeR intervention in routine care and evidence for integration of FCR training into oncology communication skills education.Trial registrationProspectively registered with the Australian New Zealand Clinical Trials Registry, ACTRN12621001697875.Trial sponsorChris O’Brien Lifehouse.Protocol version2.6, Dated 28th February 2023.

Ten clinical pharmacological interventions in routine care to ensure better treatment outcomes.

Clinical Pharmacologists play a major role in facilitating the rational use of medicines.[1] The World Health Organization insists on integrating the Clinical Pharmacology discipline with the health service system[2]; however, there is procrastination in materializing this.[3] We describe ten instances wherein Clinical Pharmacological interventions improved prescribing and patient outcomes (Table 1). ... ... Clinical Pharmacologists and clinical pharmacists promote the safer and effective use of medicines.[13] Their consultations should be encouraged to improve treatment outcomes. No funding was obtained for this work. The authors have no relevant financial or non-financial interests to disclose. The idea for drafting this article was conceptualised by SD, SSS, and SKT. The patients described in this article were treated and consulted by SD, SSS, S. Sarkar, S. Sen, S. Selvarajan, SKT, JP, NC, and SRJ. The literature search was performed by SD and SM. Expert inputs were provided by AP, CSL, S. Selvarajan, and SKT. All authors contributed to the writing and proofreading of the final manuscript. The final manuscript was discussed and approved by all authors.

Improving quality of life in patients with rare autoimmune liver diseases by structured peer-delivered support (Q.RARE.LI): study protocol for a transnational effectiveness-implementation hybrid trial

BackgroundPsychosocial support is a crucial component of adequate rare disease care, but to date psychosocial support needs of this patient population are insufficiently met. Within Q.RARE.LI, we strive to evaluate the effectiveness of a structured, transdiagnostic, and location-independent psychosocial support intervention in routine care of patients with rare autoimmune liver diseases in five countries and prepare its implementation.MethodsWithin an effectiveness-implementation hybrid trial, we aim to a) investigate the effectiveness of the intervention in routine care in five diverse healthcare systems and b) assess implementation outcomes, examine and prepare the implementation context, and develop country-specific implementation strategies. To assess effectiveness, we will include N = 240 patients with rare autoimmune liver diseases. Within a two-armed randomized controlled trial (allocation ratio 1:1), we will compare structured and peer-delivered psychosocial support in addition to care-as-usual (CAU) with CAU alone. Outcomes will be assessed via electronic database entry prior to intervention, directly after, and at a three-month follow-up. Our primary effectiveness outcome will be mental health-related quality of life at post-assessment. Secondary outcomes include depression and anxiety severity, perceived social support, helplessness, and disease acceptance. Implementation outcomes will be assessed within a mixed-methods process evaluation. In a quantitative cross-sectional survey, we will examine perceived acceptability and feasibility in patients, peer-counselors, and healthcare providers involved in delivery of the intervention. In qualitative focus groups, we will analyze the implementation context and determine barriers and facilitators for implementation with different stakeholders (patients and/or representatives, peer-counselors, healthcare providers, health insurers). Based on these results, we will derive country-specific implementation strategies and develop a concrete implementation plan for each country.DiscussionThe intervention is expected to help patients adjust to their disease and improve their mental quality of life. The transdiagnostic and location-independent program has the potential to reach patients for psychosocial support who are usually hard to reach. By preparing the implementation in five countries, the project can help to make low-threshold psychosocial support available to many patients with rare diseases and improve comprehensive healthcare for an often neglected group.Trial registrationISRCTN15030282

Study on the intervention effect of SMG health management in patients with ischemic stroke.

The aim of the study was to explore the clinical effect of brain and heart health managers combined with the "SMG" health management mode on nursing intervention in ischemic stroke patients. A total of 187 ischemic stroke patients divided into 96 patients in the observation group and 91 patients in the control group with the random number table method. The control group conducted the routine care intervention, and the observation group used the brain and heart health managers combined with the "SMG" health management model for the nursing intervention. The control of stroke risk factors was explored by comparing blood pressure, blood glucose and blood lipid and other indicators between the two groups before and after treatment. Compared with that before the intervention, the Stroke Self-Efficacy Questionnaire (SSEQ) score of both the observation group and the control group were significantly higher ( p < 0.05), and the Hamilton Anxiety Scale (HAMA), Hamilton Depression Scale (HAMD), National Institutes of Health Stroke Scale (NIHSS) and modified Rankin scale (mRS) scores were all decreased ( p < 0.05). The proportion of patients with treatment adherence did not differ significantly before and after the intervention in the control group ( p > 0.05), and it increased significantly in the observation group after the intervention ( p < 0.05). The observation group had higher SSEQ score and lower HAMA, HAMD, NIHSS, and mRS scores after the intervention compared with the control group, with statistically significant differences. The combination of brain and heart health managers and "SMG" is more conducive to improving the selfefficacy of ischemic stroke patients, alleviating patient anxiety and depression, improving patient treatment compliance, controlling stroke risk factors, and promoting neurological function recovery.

Effects of Eligibility Criteria on Patient Selection and Treatment Implications from 10 Multidomain Dementia Prevention Trials: A Population-Based Study

Introduction: Dementia prevention trials have so far shown little benefit of multidomain interventions against cognitive decline. Recruitment strategies in these trials often centre around dementia risk or cardiovascular risk profile, but it is uncertain whether this leads to inclusion of individuals who may benefit most from the intervention. We determined the effects of eligibility criteria on the recruitment of potential trial participants in the general population. Methods: In a systematic search until January 1, 2022, we identified all published and ongoing large (≥500 participants), phase-3 multidomain trials for the prevention of cognitive decline or dementia. We applied trial eligibility criteria to 5,381 participants of the population-based Rotterdam Study (mean age: 72 years, 58% women), to compare participant characteristics, predicted risk of cardiovascular disease, and dementia risk, between trial eligible and ineligible persons. Results: We identified 10 trials, of which 5 had been published (DR’s EXTRA, FINGER, preDIVA, MAPT, and HATICE) and 5 are ongoing (US-POINTER, MIND-CHINA, MYB, AgeWell.de, and J-Mint). Among all Rotterdam Study participants, eligibility across published trials ranged from 48% for MAPT to 87% for preDIVA, in line with original trial reports. Variability in eligibility was wider for ongoing trials, from 1% for US-POINTER to over 94% for MYB trial. Over 70% of trial eligible individuals are recommended preventive intervention in routine care based on their cardiovascular risk, similar for lipid-lowering (71%) and blood pressure-lowering treatment (73%). Ten-year risks of dementia were similar for eligible compared to ineligible individuals (12 vs. 11%). Conclusion: Multidomain dementia prevention trials fail to preferentially include those at the highest risk of dementia and mostly include individuals who qualify for interventions already on the basis of cardiovascular prevention guidelines. These findings call for better targeted enrolment of individuals for whom trial results can improve clinical decision-making.

Analysing and improving preoperative medication management in cardiac surgery.

The objective of this study was to analyse the preoperative medication management within the cardiac surgery patient population and measure the effectiveness of an interprofessional intervention in routine care. A jointly developed preoperative medication management was implemented in routine care on multiple levels (inclusion in admission letter to primary care, hotline for inquiries, pocket cards for physicians and correspondence with referring centres). The effectiveness was evaluated by analysing preoperative management before and after implementation. The primary endpoint was the number of drugs managed correctly according to the guidelines after implementation. Secondary endpoints consisted amongst others of bleeding on the intensive care unit, re-thoracotomy, postoperative infarction and cerebrovascular complications. Additionally, possible associations between the correct management and different variables were investigated by multivariate analysis. After the implementation, the number of drugs managed correctly according to guidelines increased from 54.0 to 73.5% (P< .001). The effect was more prominent for direct oral anticoagulants and prophylactic aspirin where the guideline adherence increased from 29.2 to 74.5% and from 78.6 to 95.1%, respectively. No difference was seen for sodium-glucose transporter-2 inhibitors, metformin, vitamin-K antagonists and dual-antiplatelet therapy. Secondary endpoints showed no safety signals with regard to bleeding or thrombotic events. In multivariate analysis, the intervention was effective (odds ratio 2.17, 95% confidence interval [1.32-3.62]) after adjusting for possible confounders. An interprofessional programme was effective to improve preoperative medication management in cardiac surgery patients. Sodium-glucose transporter-2 inhibitors, metformin and direct oral anticoagulants appear to be especially at risk for incorrect management before cardiac surgery with possible adverse events.

Establishing the worth of deprescribing inappropriate medications: are we there yet?

Medical Journal of AustraliaVolume 217, Issue 6 p. 283-286 PerspectivesOpen Access Establishing the worth of deprescribing inappropriate medications: are we there yet? Ian A Scott, Corresponding Author Ian A Scott ian.scott@health.qld.gov.au orcid.org/0000-0002-7596-0837 Princess Alexandra Hospital, Brisbane, QLD University of Queensland, Brisbane, QLDE-mail: ian.scott@health.qld.gov.auSearch for more papers by this authorEmily Reeve, Emily Reeve University of South Australia, Adelaide, SASearch for more papers by this authorSarah N Hilmer, Sarah N Hilmer orcid.org/0000-0002-5970-1501 Royal North Shore Hospital, Sydney, NSW University of Sydney, Sydney, NSWSearch for more papers by this author Ian A Scott, Corresponding Author Ian A Scott ian.scott@health.qld.gov.au orcid.org/0000-0002-7596-0837 Princess Alexandra Hospital, Brisbane, QLD University of Queensland, Brisbane, QLDE-mail: ian.scott@health.qld.gov.auSearch for more papers by this authorEmily Reeve, Emily Reeve University of South Australia, Adelaide, SASearch for more papers by this authorSarah N Hilmer, Sarah N Hilmer orcid.org/0000-0002-5970-1501 Royal North Shore Hospital, Sydney, NSW University of Sydney, Sydney, NSWSearch for more papers by this author First published: 28 August 2022 https://doi.org/10.5694/mja2.51686AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Ceasing unnecessary medications is a worthy act, but impacts on clinical outcomes are proving elusive The burden and costs of potentially inappropriate medications (PIMs) and polypharmacy are major public health challenges. Medicines that are ineffective or no longer indicated, discordant with care goals or where harms outweigh benefits should be deprescribed.1 However, despite the publication of numerous deprescribing studies and guidelines over the past decade, the effectiveness of deprescribing interventions in routine care remains unclear. In this Perspective, we describe the impacts of deprescribing on clinical outcomes, draw insights from recent trials, and discuss opportunities for designing future trials better able to demonstrate the patient-important effects of deprescribing. Efficacy and safety of deprescribing interventions Recent systematic reviews of deprescribing trials consistently show decreased prescribing of PIMs2-4 with no safety concerns due to drug withdrawal. However, while animal studies show that deprescribing reduces frailty and functional impairment,5 clinical studies in humans have failed to consistently show changes in clinical outcomes such as falls, hospitalisations, adverse drug events, and cognitive and physical function. This may be attributable to limitations in study design, such as: • underpowered studies; • residual confounding in uncontrolled trials; • short term follow-up that fails to ascertain long term effects; • infrequent use of quality-of-life measures sensitive to change with deprescribing; • insufficient targeting of patients at highest risk of medication-related harm; • suboptimal intensity and/or duration of deprescribing interventions; and • limited use of potentially useful computerised decision support systems to assist deprescribing.6 Over the past 5 years, several multicentre randomised controlled trials (RCTs) have attempted to address some of these limitations. The SPPiRE (Supporting Prescribing in Older Adults with Multimorbidity in Irish Primary Care) cluster RCT involving 51 Irish general practices enrolled 404 multimorbid patients aged 65 years or over and receiving 15 or more regular medicines.7 Intervention practices accessed a website for clinicians to complete an education module and use a template for a once-off patient medication review lasting 30–40 minutes. At the 6-month follow-up, there was a small but significant increase in PIMs reduction in the intervention group (incidence rate ratio, 0.95; 95%CI, 0.899–0.999; P = 0.045) but no change in self-reported patient outcomes. In the SENATOR (Development and clinical trials of a new Software ENgine for the Assessment and optimization of drug and non-drug Therapy in Older peRsons) trial involving 1537 multimorbid older patients with polypharmacy admitted to six European hospitals, computer-generated medication optimisation advice for attending physicians was compared with standard care.8 Uptake of advice was low (about 15%), and no between-group differences were seen for adverse drug events at 14 days or all-cause death or re-hospitalisations at 12 weeks after discharge. Another cluster RCT of 3904 adults (aged ≥ 75 years; receiving eight or more regular medications) attending 359 general practices across four European countries evaluated an electronic decision support tool for deprescribing PIMs, incorporated into a comprehensive medication review, against standard care.9 The composite of unplanned hospital admissions or death at 24 months was no different between groups. The OPERAM (OPtimising thERapy to prevent Avoidable hospital admissions in the Multimorbid older people) trial enrolled 2008 patients aged 70 years or over (three or more chronic conditions; five or more long term medications), and randomised 110 clusters of attending hospital physicians across four European countries to usual care or structured medication optimisation reviews performed jointly by a physician and a pharmacist, aided by a decision support system using the STOPP/START (Screening Tool of Older Person’s Prescriptions and the Screening Tool to Alert to the Right Treatment) criteria.10 Despite 61.3% of intervention patients having one or more predominantly PIM recommendations enacted at 2 months, at 12 months drug-related readmissions, all-cause mortality, falls, pain, and activities of daily living status were unchanged, although the quality of life was slightly better in the intervention group. Most recently, a Canadian cluster RCT enrolled 5698 patients aged 65 years or over who were admitted to 11 hospitals and were taking five or more medications daily.11 Personalised deprescribing suggestions were generated for the hospital physician, community pharmacist and usual attending doctor by a computerised decision tool (MedSafer). This tool integrated data about home medication lists and patient characteristics, including laboratory investigations and measures of prognosis and frailty, with prescribing guidelines and dosing rules. Even though deprescribing increased from 29.8% among control patients to 55.4% of intervention patients, at 30 days after discharge there was no difference in adverse drug events, falls, emergency department visits and/or hospitalisations, deaths, or quality of life, with no variations according to sex, palliative designation, frailty, or residence in a care facility. Insights for future research While all these studies confirm deprescribing as being safe, patient-important measures of medication-related harm did not improve. Several possible explanations deserve consideration in designing future deprescribing trials. Small reductions in harmful medications: Absolute reductions in PIMs were ≤ 1.0 additional medication ceased per intervention patient, and those most frequently deprescribed, such as proton pump inhibitors and vitamin/mineral supplements, infrequently cause measurable harm. Low uptake of advice: Reported acceptance of deprescribing advice was less than 50%, for various reasons,12 including delays in clinicians receiving advice, prescriber inertia and lack of self-efficacy in deprescribing medications (especially those outside their specialty or initiated by other clinicians), recommendations of low clinical relevance to individuals, and divergence of opinion among doctors, pharmacists, patients, and family members. Low intervention intensity: One-off medication reviews performed by a single person may not provide clinicians and patients with adequate time, encounters, information and incentive to formulate, agree, initiate and monitor deprescribing decisions over the long term. Heterogeneity of treatment effects: Individual patient response to drugs can differ significantly from reported average treatment effects due to age, comorbidity burden and other factors, leading to variable response to deprescribing. At the population level, such heterogeneity may render deprescribing effects undetectable without large samples and subgroup analyses. Insensitive outcome measures: While adverse drug events are important, other relevant outcomes such as medication burden may not be reliably measured, and multifactorial outcomes such as quality of life and falls may be insensitive to change by an intervention targeting only one of many contributors. Certain benefits may also take a long time to manifest, beyond the sometimes short term follow-up periods of existing trials. Fragmented care: As patient care spans multiple clinical settings, disconnected information communication results in failure of propagation of, and adherence to, deprescribing decisions through the chain of multiple prescribers.13 Changing illness trajectories: Deprescribing is not a one-off activity but needs to be repeated when changes occur in patients’ clinical status that alter benefit–harm estimates for specific medications. Enhancing deprescribing intervention trials Learnings from these and other studies generate opportunities for designing future trials with greatest potential to demonstrate patient benefit. First, researchers need to consider the barriers and enablers towards deprescribing that exist at multiple levels (Box).14 Implementation science theories and frameworks15 may support designing interventions that integrate with clinical workflows and seek to change both clinician and patient behaviour. An interdisciplinary approach to codesigning interventions with medical practitioners, pharmacists and other disciplines may enhance effectiveness through combining existing knowledge with consideration of local context.16 Continuing patient and provider education tailored to their needs, patient-specific drug recommendations, close clinical follow-up with multiple visits, and reliable communication of deprescribing actions and advice between all participating clinicians are key areas for future work. While researchers can redesign local practice only so much, efforts to apply multiple strategies should be pursued as much as practicable. Box 1. Barriers and enablers to deprescribing: examples across different levels of the health care system14 Barriers Potential enablers Individuals/public (including patients and their caregivers) Fear or ambivalence about ceasing medications Belief that their medication is necessary and beneficial Misperceptions of deprescribing motives (care rationing, or that the prescriber is “giving up”) Previous bad experiences with deprescribing Shared decision making that embraces discussion of care goals and treatment preferences Consumer-facing websites and portals that provide education in medication effects Decision aids and educational materials that inform and empower patients in shared decision making Support for the process of deprescribing (eg, follow-up) Health care professionals Lack of tools or resources to assist with deprescribing (or lack of awareness of such tools) Clinical inertia Lack of self-efficacy Personal beliefs and attitudes towards deprescribing (eg, fear of withdrawal reactions) Deference to professional etiquette/hierarchies Easy to use, accessible tools and resources that account for the whole person with comorbid conditions and frailty Data to inform nuanced medication-specific benefit–harm estimates of both continuation and discontinuation Guidelines that use such data to provide nuanced recommendations about individuals most likely to benefit from deprescribing Deprescribing viewed by all clinicians and disciplines as a normal and positive part of regular care System of care (local health care organisations and the broader environment) Limited time and resources for deprescribing Focus on acute/presenting problem and culture which drives prescribing Lack of incentive or renumeration for deprescribing/deprescribing activities Disconnected information and communication systems relating to medication use Organisational and financial support for multidisciplinary care and non-pharmacological alternatives Protected and scheduled time, financial reimbursement and professional recognition (eg, CPD credits) for conducting regular deprescribing reviews Fully connected electronic medical records for transferring medication-related information Clinical decision support systems to trigger the deprescribing process CPD = continuing professional development. Second, hybrid implementation efficacy trials can be used to identify deficiencies in intervention design and delivery while also measuring outcomes.17 For example, process evaluations in one trial confirmed the utility of awareness-raising strategies for evidence-based prescribing, but in changing behaviour identified additional facilitators, such as academic outreach visits to prescribers, better targeting of high risk patients, more nuanced evidence on medication appropriateness, better integration of decision support tools into practice software, and patient information materials in tailored formats.18 Adaptive trials with pre-specified interim analyses could identify ineffective interventions or implementation failures (eg, low enactment of deprescribing recommendations) while the trial is running and make adjustments as required. Alternative evidence sources, such as modelling techniques and expert consensus conferences, may need to be considered where the costs and logistical challenges of long term trials prove prohibitive. Third, where evidence reveals factors predicting individuals more likely to benefit or be harmed by withdrawing problematic medications, such as anticonvulsant19 and antihypertensive drugs,20 these should be integrated into guidelines and decision support systems. Machine learning applied to large-scale clinical trial or pharmacovigilance data are identifying patient phenotypes at greater risk of medication-specific harm to whom deprescribing interventions could be targeted.21, 22 Fourth, sensitive medication-related quality of life measures relevant to both medication class-specific effects and individual goals of care may be better able to detect subtle but important patient-centred outcomes.23 Finally, n-of-1 trials, in which patients act as their own control during randomised cycles of exposure to a drug or placebo, may provide more nuanced assessment of deprescribing effects in individuals. In a systematic review that found only six deprescribing studies using the n-of-1 method, four were able to show between 44% and 64% of patients successfully ceasing the targeted medication due to non-significant treatment benefits.24 Although recent deprescribing trials do not conclude improvement in clinical outcomes, they have signalled areas of innovation and offered insights into designing future trials more likely to establish the worth of deprescribing inappropriate medications. We are not there yet but we are making progress. The members of the Australian Deprescribing Network, the first deprescribing network established internationally and which led the way with policy and practice recommendations,1, 25 are actively contributing to this challenging research agenda. Acknowledgements Emily Reeve is supported by a National Health and Medical Research Council (NHMRC) Investigator Grant (APP1195460). Open access Open access publishing facilitated by The University of Queensland, as part of the Wiley - The University of Queensland agreement via the Council of Australian University Librarians. Competing interests Emily Reeve has received royalties from UpToDate (Wolters Kluwer) for writing a chapter on deprescribing, outside the submitted work. Provenance Not commissioned; externally peer reviewed. References 1Scott IA, Hilmer SN, Reeve E, et al. Reducing inappropriate polypharmacy: the process of deprescribing. JAMA Intern Med 2015; 175: 827- 834. CrossrefPubMedWeb of Science®Google Scholar 2Thillainadesan J, Gnjidic D, Green S, Hilmer SN. Impact of deprescribing interventions in older hospitalised patients on prescribing and clinical outcomes: a systematic review of randomised trials. Drugs Aging 2018; 35: 303- 319. CrossrefCASPubMedWeb of Science®Google Scholar 3Kua CH, Mak VSL, Huey Lee SW. Health outcomes of deprescribing interventions among older residents in nursing homes: a systematic review and meta-analysis. J Am Med Dir Assoc 2019; 20: 362- 372. CrossrefPubMedWeb of Science®Google Scholar 4Bloomfield HE, Greer N, Linsky AM, et al. Deprescribing for community-dwelling older adults: a systematic review and meta-analysis. J Gen Intern Med 2020; 35: 3323- 3332. CrossrefPubMedWeb of Science®Google Scholar 5Mach J, Gemikonakli G, Logan C, et al. Chronic polypharmacy with increasing Drug Burden Index exacerbates frailty and impairs physical function, with effects attenuated by deprescribing, in aged mice. J Gerontol A Biol Sci Med Sci 2021; 76: 1010- 1018. CrossrefPubMedWeb of Science®Google Scholar 6Scott IA, Pillans PI, Barras M, Morris C. Using EMR-enabled computerized decision support systems to reduce prescribing of potentially inappropriate medications: a narrative review. Ther Adv Drug Saf 2018; 9: 559- 573. CrossrefPubMedWeb of Science®Google Scholar 7McCarthy C, Clyne B, Boland F, et al. GP-delivered medication review of polypharmacy, deprescribing, and patient priorities in older people with multimorbidity in Irish primary care (SPPiRE Study): a cluster randomised controlled trial. PLoS Med 2022; 19: e1003862. CrossrefPubMedGoogle Scholar 8O’Mahony D, Gudmundsson A, Soiza RL, et al. Prevention of adverse drug reactions in hospitalized older patients with multi-morbidity and polypharmacy: the SENATOR* randomized controlled clinical trial. Age Ageing 2020; 49: 605- 614. CrossrefPubMedWeb of Science®Google Scholar 9Rieckert A, Reeves D, Altiner A, et al. Use of an electronic decision support tool to reduce polypharmacy in elderly people with chronic diseases: cluster randomised controlled trial. BMJ 2020; 369: m1822. CrossrefPubMedGoogle Scholar 10Blum MR, Sallevelt BTGM, Spinewine A, et al. Optimizing therapy to prevent avoidable hospital admissions in multimorbid older adults (OPERAM): cluster randomised controlled trial. BMJ 2021; 374: n1585. CrossrefPubMedGoogle Scholar 11McDonald EG, Wu PE, Rashidi B, et al. The MedSafer study — electronic decision support for deprescribing in hospitalized older adults: a cluster randomized clinical trial. JAMA Intern Med 2022; 182: 265- 273. CrossrefPubMedWeb of Science®Google Scholar 12Dalton K, O’Mahony D, Cullinan S, Byrne S. Factors affecting prescriber implementation of computer-generated medication recommendations in the SENATOR trial: a qualitative study. Drugs Aging 2020; 37: 703- 713. CrossrefPubMedWeb of Science®Google Scholar 13Nguyen AD, Baysari MT, Duong M, et al. Communicating deprescribing decisions made in hospital with general practitioners in the community. Intern Med J 2021; 51: 1473- 1478. Wiley Online LibraryPubMedWeb of Science®Google Scholar 14Sawan M, Reeve E, Turner J, et al. A systems approach to identifying the challenges of implementing deprescribing in older adults across different health care settings and countries: a narrative review. Exp Rev Clin Pharmacol 2020; 13: 233- 245. CrossrefCASPubMedWeb of Science®Google Scholar 15Ailabouni NJ, Reeve E, Helfrich CD, et al. Leveraging implementation science to increase the translation of deprescribing evidence into practice. Res Soc Admin Pharm 2022; 18: 2550- 2555. CrossrefPubMedWeb of Science®Google Scholar 16Anderson K, Foster MM, Freeman CR, Scott IA. A multifaceted intervention to reduce inappropriate polypharmacy in primary care: research co-creation opportunities in a pilot study. Med J Aust 2016; 204 (Suppl): S41- S44. https://www.mja.com.au/journal/2016/204/7/multifaceted-intervention-reduce-inappropriate-polypharmacy-primary-careWiley Online LibraryPubMedWeb of Science®Google Scholar 17Cateau D, Ballabeni P, Mena S, et al. Deprescribing in nursing homes: Protocol for nested, randomised controlled hybrid trials of deprescribing interventions. Res Social Adm Pharm 2021; 17: 786- 794. CrossrefPubMedWeb of Science®Google Scholar 18Jäger C, Steinhäuser J, Freund T, et al. A tailored programme to implement recommendations for multimorbid patients with polypharmacy in primary care practices-process evaluation of a cluster randomized trial. Implement Sci 2017; 12: 31. CrossrefPubMedWeb of Science®Google Scholar 19Lamberink HJ, Otte WM, Geerts AT, et al. Individualised prediction model of seizure recurrence and long-term outcomes after withdrawal of antiepileptic drugs in seizure-free patients: a systematic review and individual participant data meta-analysis. Lancet Neurol 2017; 16: 523- 531. CrossrefPubMedWeb of Science®Google Scholar 20Scott IA, Hilmer SN, Le Couteur DG. Going beyond the guidelines in individualising the use of antihypertensive drugs in older patients. Drugs Aging 2019; 36: 675- 685. CrossrefPubMedWeb of Science®Google Scholar 21Duan T, Rajpurkar P, Laird D, et al. Clinical value of predicting individual treatment effects for intensive blood pressure therapy: a machine learning experiment to estimate treatment effects from randomized trial data. Circ Cardiovasc Qual Outcomes 2019; 12: e005010. CrossrefPubMedWeb of Science®Google Scholar 22Meid AD, Wirbka L, Groll A, Haefeli WE. Can machine learning from real-world data support drug treatment decisions? A prediction modeling case for direct oral anticoagulants. Med Decis Mak 2022; 42: 587- 598. CrossrefPubMedWeb of Science®Google Scholar 23Mohammed MA, Moles RJ, Hilmer SN, et al. Development and validation of an instrument for measuring the burden of medicine on functioning and well-being: the Medication-Related Burden Quality of Life (MRB-QoL) tool. BMJ Open 2018; 8: e018880. CrossrefPubMedWeb of Science®Google Scholar 24Clough A, Hilmer S, Naismith SL, et al. N-of-1 trials for assessing the effects of deprescribing medications on short-term clinical outcomes in older adults: a systematic review. J Clin Epidemiol 2018; 93: 112- 119. CrossrefPubMedWeb of Science®Google Scholar 25Kouladjian O’Donnell L, Reeve E, Cumming A, et al. Development and dissemination of the national strategic action plan for reducing inappropriate polypharmacy in older Australians. Intern Med J 2021; 51: 111- 115. Wiley Online LibraryPubMedWeb of Science®Google Scholar Volume217, Issue6September 2022Pages 283-286 ReferencesRelatedInformation

Effectiveness and implementation success of a co-produced physical activity referral scheme in Germany: study protocol of a pragmatic cluster randomised trial

BackgroundWhile effective physical activity referral schemes (PARSs) and related structures for promoting physical activity (PA) already exist in several countries, in Germany, PARSs have not yet been implemented systematically and nationwide. Through a co-production approach with relevant actors in the German healthcare system, a PARS was developed, and an implementation plan was created (e.g. financing). This study protocol aims to evaluate the developed PARS for people with non-communicable diseases (NCDs) in Germany regarding its potential effectiveness and implementation success.MethodsTo evaluate the effectiveness and implementation success of the PARS, we will apply a pragmatic cluster-randomised controlled trial (cRCT) in Hybrid II design by comparing two intervention groups (PARS vs PA advice [PAA]). The trial will take place in the Nürnberg metropolitan region, with 24 physician practices recruiting 567 people with NCDs. Both groups will receive brief PA advice from a physician to initially increase the participants’ motivation to change their activity level. Subsequently, the PARS group will be given individualised support from an exercise professional to increase their PA levels and be transferred to local exercise opportunities. In contrast, participants in the PAA group will receive only the brief PA advice as well as information and an overview of regional PA offerings to become more active at their own initiative. After 12 and 24 weeks, changes in moderate to vigorous PA and in physical activity-related health competence (movement competence, control competence, self-regulation competence) will be measured as primary outcomes. Secondary outcomes will include changes in quality of life. To measure implementation success, we refer to the RE-AIM framework and draw on patient documentation, interviews, focus groups and surveys of the participating actors (physicians, exercise professionals).DiscussionThrough a between-group comparison, we will investigate whether additional individual support by an exercise professional compared to brief PA advice alone leads to higher PA levels in people with NCDs. The acceptance and feasibility of both interventions in routine care in the German healthcare system will also be evaluated.Trial registrationClinicalTrials.gov, NCT04947787. Registered 01 June 2021.

Effects of Psychoeducation on People With Schizophrenia in Long-Term Care: An Intervention Study.

The aim of the current study was to examine the effect of a psychoeducation intervention on knowledge, insight, and internalized stigma among people with schizophrenia in a long-term care (LTC) facility in Jordan. This study was conducted based on cluster randomization using a pre- and post-test design. The intervention group (n = 66) received seven sessions about schizophrenia over a 3-week period along with usual treatment. The control group (n = 56) received usual treatment only. The psychoeducation intervention significantly improved knowledge (15.5%) and insight (22.5%) and reduced stigma (18%) among participants in the intervention group compared to the control group (2.6%, 4.7%, and 3.6%, respectively). This study shows the importance of integrating psychoeducation interventions in routine care for people with schizophrenia in LTC. [Journal of Psychosocial Nursing and Mental Health Services, 61(2), 9-18.].

Evaluation of an Adaptive Implementation Program for Cognitive Adaptation Training for People With Severe Mental Illness: a cluster-randomized controlled trial

IntroductionCognitive Adaptation Training (CAT) is a psychosocial intervention focusing on reducing the impact of cognitive disorders on daily functioning in people with severe mental illness (SMI). Similar to many evidence based practices (EBP), implementation of CAT in routine care lags behind, despite the established effectiveness of the intervention. This so called ‘science-to-service gap’ is a widespread problem in mental health care. We developed an innovative implementation program to facilitate implementation of CAT and similar interventions in routine care.ObjectivesThe aim of this study is to evaluate the effectiveness of the implementation program and to determine factors that impede or facilitate the implementation process.MethodsWe conducted a multicenter cluster randomized controlled trial comparing the implementation program to a single training program in four mental health institutions (a total of 21 rehabilitation teams) in The Netherlands. Focus groups, semistructured interviews and questionnaires were used at multiple levels of service delivery (service user, professional, team, organization). Assessments took place before, during and after implementation and at follow-up, adding up to a total duration of 14 months. Data were analyzed using multilevel modeling.ResultsData collection is complete and analyses on the effectiveness of the implementation program are ongoing. Preliminary analyses show that team climate (p&lt;.008) and organizational climate (p&lt;.043) significantly predict the attitudes of mental health providers toward EBP.ConclusionsThis implementation research may provide important information about the implementation of psychosocial interventions in practice and may result in a program that is useful for Cognitive Adaptation Training, and possibly for psychosocial interventions in general.DisclosureNo significant relationships.

A systematic review and meta-analysis of the effect of transitional care interventions on the prognosis of patients with heart failure.

BackgroundThe purpose of this study was to explore the impact of transitional care interventions on the prognosis of patients with heart failure.MethodsLiterature on transitional care interventions in patients with heart failure were retrieved from PubMed, Medline, Embase, and CENTRAL databases. The literature retrieval date was October 12, 2021. The inclusion criteria were based on PICOS principles. A researcher independently extracted information from the literature included in the meta-analysis, including author, title, publication date, patient baseline information, intervention measures, and observation indicators. Two other researchers checked the extracted data. Cochrane bias risk assessment was used to evaluate the quality of the included study. The chi-square test was used for heterogeneity test. Egger test was used for publication bias test. Data were statistically analyzed using Cochrane software RevMan 5.3. The Chi-square test was used to assess heterogeneity. The odds ratio (OR) and 95% confidence interval (CI) were used to describe the count data statistically.ResultsA total of 567 related articles were retrieved, and 18 studies were further screened for meta-analysis, 13 with low risk of overall bias, and 5 with high risk of overall bias. A total of 4,123 patients with heart failure were included, comprising 1,914 patients receiving transitional care interventions (46.42%) and 2,209 patients receiving routine care interventions (53.58%). The readmission rate of heart failure in patients receiving transitional care interventions was lower than that of patients receiving routine care interventions. There was heterogeneity among the literatures, and the source analysis of heterogeneity showed that the results were stable, and the random effect model was adopted without publication bias. The emergency visit rate of patients with heart failure receiving transitional care interventions was lower than that of patients receiving usual care interventions. There was no significant difference in mortality between patients receiving transitional care interventions and patients receiving usual care interventions.DiscussionTransitional care interventions can reduce the rate of patient readmission and emergency visits but have no significant impact on the mortality of patients. This study suggests the establishment of a transitional care intervention system for patients with heart failure

Quality Care Alleviates Behavioral Cognitive Impairment and Reduces Complications in Elderly Patients with Cardiovascular and Cerebrovascular Diseases.

Objective Cardiovascular and cerebrovascular disease (CCVD) remains the most common factor of death around the world. Nursing care plays a key role in the recovery of patients with CCVD. This study was to explore the application of quality care in aged patients with CCVD. Methods Totally, 74 aged CCVD patients admitted from June 2018 to June 2019 in Dongying People's Hospital were randomly assigned in 2 groups with the same treatment. The control group was treated with routine care intervention, and the observation group was treated with quality care intervention for 12 weeks. Meanwhile, the frequency of agitation behaviors and cognitive ability were assessed, and complication was counted. Results The observation group showed decreased Cohen-Mansfield Agitation Inventory (CAMI) scores from 47.31 ± 8.27 to 38.73 ± 6.94, raised Mini-Mental State Examination (MMSE) scores from 15.01 ± 3.9 to 19.34 ± 3.15 and Montreal Cognitive Assessment (MoCA) scores from 16.92 ± 5.48 to 20.37 ± 4.16, and reduced complications after quality care intervention. Conclusion Quality care intervention exerted a better application effect on aged CCVD patients, along with reduction of agitation, improvement of mental condition and behavioral cognitive function, and reduced complications.

Fear of cancer recurrence in young women 5years after diagnosis with a good-prognosis cancer: the VICAN-5 national survey.

Fear of cancer recurrence (FCR) is frequent in survivors, but less is known about FCR in long-term survivors with very low risk of relapse. Our aim was to estimate the prevalence and clinical and socio-behavioural factors associated with FCR in young women 5years after diagnosis of a good-prognosis cancer. Using data from the VICAN-5 survey, conducted in 2015-2016 amongst a national representative French sample of cancer survivors, we included women with non-metastatic melanoma, breast, or thyroid cancer, aged 55years or under at diagnosis, who experienced no disease progression in the 5years post-diagnosis. Multinomial logistic regression was used to identify factors associated with FCR, characterised using a three-level indicator: no, mild, and moderate/severe FCR. Amongst the 1153 women included, mean age was 44years at diagnosis, and 81.8% had breast cancer, 12.5% thyroid cancer, and 5.8% melanoma. Five years after diagnosis, 35.4% reported no FCR, 46.0% mild FCR, and 18.6% moderate/severe FCR. Women with thyroid cancer were less likely to suffer from mild or moderate/severe FCR, while cancer-related treatment sequelae, fatigue, and anxiety were more likely. Limited health literacy was associated with mild FCR. Women who reported only occasionally consulting a general practitioner (GP) for the management of their cancer had a higher probability of FCR. Moderate/severe FCR affected nearly 20% of young female long-term survivors diagnosed with a good-prognosis cancer, particularly those reporting cancer-related sequelae, suffering from fatigue or anxiety, with breast cancer or melanoma (versus thyroid cancer), and consulting a GP only occasionally for cancer management. Given the recognised impact of FCR on quality of life, it is essential to detect it as early as possible, and to implement targeted interventions in routine care.

Child Anthropometrics and Neurodevelopment at 2 and 3 Years of Age Following an Antenatal Lifestyle Intervention in Routine Care-A Secondary Analysis from the Cluster-Randomised GeliS Trial.

Maternal characteristics around pregnancy may influence obesity risk and neurodevelopment in children. To date, the effect of antenatal lifestyle interventions on long-term child development is unclear. The objective was to investigate the potential long-term effects of an antenatal lifestyle intervention programme conducted alongside routine care on child anthropometrics and neurodevelopment up to 3 years of age. Mother-child pairs from the cluster-randomised GeliS trial were followed up to 3 years of age. Data on child anthropometrics in both groups were collected from routine health examinations. Neurodevelopment was assessed via questionnaire. Of the 2286 study participants, 1644 mother-child pairs were included in the analysis. Children from the intervention group were less likely to score below the cut-off in Fine motor (p = 0.002), and more likely to have a score below the cut-off in Problem-solving (p < 0.001) compared to the control group at 3 years of age. Mean weight, height, head circumference, body mass index, and the respective z-scores and percentiles were comparable between the groups at 2 and 3 years of age. We found no evidence that the lifestyle intervention affected offspring development up to 3 years of age. Further innovative intervention approaches are required to improve child health in the long-term.

Barriers and facilitators to implementation of cognitive adaptation training in long-term inpatient facilities for people diagnosed with severe mental illness: A nursing perspective.

Accessible SummaryWhat is known on the subject? To date, the majority of the research regarding innovative psychosocial interventions in psychiatry focuses upon the development and effectiveness of the interventions. Despite the fact that these are important clinical and scientific contributions, only a small percentage of the evidence‐based interventions reach clinical practice.Cognitive Adaptation Training (CAT) is an effective psychosocial intervention to increase daily functioning and cognitive functioning in people diagnosed with severe mental illness (SMI) in inpatient and outpatient psychiatric care.Despite knowledge on the intervention's effectiveness, systematic use of CAT in the daily routine of mental health nurses is insufficient. What the paper adds to existing knowledge? To date, no research is available that describes the factors associated to the implementation of CAT from a nursing perspective.This research also adds to the literature on rehabilitation in people diagnosed with SMI in an inpatient setting.The results contribute to the science of implementing interventions in long‐term psychiatric care and may help future interventions in their implementation process. What are the implications for practice? This study highlights that multiple factors need to be considered when implementing an intervention in routine care and that it is a complicated process.Future implementation initiatives require ongoing training and supervision of CAT specialists, appointment of local champions to increase commitment among nursing staff and inclusion and commitment of management to overcome organizational barriers.Without acknowledging the presence of barriers to implementation and considering strategies to overcome these barriers, sustainable implementation is likely to be unsuccessful. IntroductionEvidence‐based interventions in psychiatry often fail to reach clinical practice. Cognitive Adaptation Training (CAT) is an evidence‐based psychosocial intervention that aims to improve daily functioning of people diagnosed with a severe mental illness. Implementation of CAT remains challenging, despite demonstrated effectiveness.AimIdentifying facilitators and barriers of CAT on the intervention, nursing, and organizational levels, and investigating relationships between capability, opportunity, motivation, and appraisal using the COM‐B model.MethodThe Measurement Instrument for Determinants of Innovations and CAT‐specific questions were administered to 46 nurses. The relationship among capability, opportunity, motivation and appraisal was calculated using the Pearson's r correlation coefficient.ResultsNine barriers (mostly organizational level) and 13 facilitators (mostly intervention and nursing level) were identified. Significant moderate correlations were found between capability and opportunity, capability and motivation, capability and appraisal and a strong correlation between motivation and appraisal.DiscussionThe results suggest that barriers at the organizational level should be removed and facilitators at intervention and nursing levels may be exploited to improve implementation.Implications for practiceFuture implementation initiatives require ongoing training and supervision of CAT specialists, appointment of local champions to increase commitment among nursing staff and inclusion and commitment of management to overcome organizational barriers.