Evidence map›Paper›PMID 31357993›Full record

ArticleBMC health services research2019

Barriers and facilitators to implementing a pragmatic trial to improve advance care planning in the nursing home setting.

Jennifer A Palmer, Victoria A Parker, Vincent Mor, Angelo E Volandes, Lacey R Barre, Emmanuelle Belanger, Phoebe Carter, Lacey Loomer, Ellen McCreedy, Susan L Mitchell

Registry-linked trialAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in BMC health services research, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT02612688 (PROVEN), which is not on this map. Cited by 19 papers.

0numbers the graph read from it
0cells of the map it votes in
19citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT02612688 nacompletednot on this map

PROVEN: Pragmatic Trial of Video Education in Nursing Homes

TypeinterventionalSponsorBrown UniversityRan2016 to 2019Enrolled197,692ConditionsAlzheimer Disease, Dementia, Heart Failure, Pulmonary Disease, Chronic ObstructiveArmsACP Video Program
3 · Its place in the literature

Who cites it

19 citing papers in PubMed.

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  11. The care planning umbrella: The evolution of advance care planning.Journal of the American Geriatrics Society · 2023
    Article
  12. Provider adherence to training components from theContemporary clinical trials communications · 2022
    Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Jennifer A PalmerHarvard Medical School, 25 Shattuck Street, Boston, MA, 02215, USA. jennypalmer@hsl.harvard.edu.
Victoria A ParkerPeter T. Paul College of Business and Economics, University of New Hampshire, 10 Garrison Avenue, Durham, NH, 03824, USA.
Vincent MorCenter for Gerontology and Healthcare Research, School of Public Health, Brown University, 121 S Main Street, Providence, RI, 02903, USA.
Angelo E VolandesHarvard Medical School, 25 Shattuck Street, Boston, MA, 02215, USA.
Lacey R BarreDepartment of Health Services, Policy, and Practice, School of Public Health, Brown University, 121 S Main Street, Providence, RI, 02903, USA.
Emmanuelle BelangerCenter for Gerontology and Healthcare Research, School of Public Health, Brown University, 121 S Main Street, Providence, RI, 02903, USA.
Phoebe CarterHebrew SeniorLife, Hinda & Arthur Marcus Institute for Aging Research, 1200 Centre Street, Roslindale, MA, 02131, USA.
Lacey LoomerDepartment of Health Services, Policy, and Practice, School of Public Health, Brown University, 121 S Main Street, Providence, RI, 02903, USA.
Ellen McCreedyCenter for Gerontology and Healthcare Research, School of Public Health, Brown University, 121 S Main Street, Providence, RI, 02903, USA.
Susan L MitchellHarvard Medical School, 25 Shattuck Street, Boston, MA, 02215, USA.

Funding

Translational Researchin Aging Trainnig ProgramT32AG023480 · NIA · HEBREW REHABILITATION CENTER FOR AGED · PI LIPSITZ, LEWIS · 2004 to 2024
$7.6M
PROVEN: PRagmatic trial Of Video Education in Nursing homesUH3AG049619 · NIA · BROWN UNIVERSITY · PI MITCHELL, SUSAN L, MOR, VINCENT · 2015 to 2018
$6.2M
TRAINing in Aging Health & Health Services for Alzheimer's Disease and Related Dementias (TRAIN-ADRD)T32AG023482 · NIA · BROWN UNIVERSITY · PI Vincent Mor, Theresa I. Shireman · 2004 to 2026
$3.0M
Midcareer Mentoring Award for Patient-Oriented Research in AgingK24AG033640 · NIA · HEBREW REHABILITATION CENTER FOR AGED · PI MITCHELL, SUSAN L · 2009 to 2018
$1.8M
Agency for Healthcare Research & Quality 4T32HS000011AHRQ HHS T32 HS000011NIA NIH HHS 2T32AG023482-13NIA NIH HHS K24 AG033640NIA NIH HHS K24AG033640NIA NIH HHS T32 AG023480NIA NIH HHS T32AG023480NIA NIH HHS T32 AG023482NIA NIH HHS UH3 AG049619NIA NIH HHS UH3AG49619
6 · The paper itself

Abstract

backgroundThe PRagmatic trial Of Video Education in Nursing homes (PROVEN) aims to test the effectiveness of an advance care planning (ACP) video intervention. Relatively little is known about the challenges associated with implementing ACP interventions in the nursing home (NH) setting, especially within a pragmatic trial. To address this research gap, this report sought to identify facilitators of and barriers to implementing PROVEN from the perspective of the Champions charged with introducing the ACP video program delivery to patients and families.

methodsIn semi-structured telephone interviews at 4 and 15 months of the 18-month implementation period, ACP Champions at all PROVEN intervention facilities (N = 119) were asked about their perceptions of program implementation. Forty interviews were purposively sampled, transcribed, and analyzed using a hybrid deductive/inductive approach to thematic analysis incorporating the Consolidated Framework for Implementation Research's domains: Intervention Characteristics (IC), Inner Setting (IS), Characteristics of Individuals (CI), Outer Setting (OS), and Process (P).

resultsImplementation facilitators identified by Champions included: the intervention's adaptable mode of presentation and minimal time burden (IC) as well as the program's customizable delivery to patients and families and opportunity for group reflection on implementation among ACP Champions (P). Barriers included mandated protocol-driven aspects of the program (OS), limited time to deliver the intervention (IS), and lack of perceived relevance and emotional readiness for ACP amongst stakeholders (CI).

conclusionsDespite the promise of PROVEN's intervention for improving ACP in nursing homes, unchangeable setting and characteristics of Champions, patients, and family members presented implementation barriers. Researchers need to engage all program participants (i.e., facility staff, patients, and families), in addition to corporate-level stakeholders, in early pragmatic trial design to minimize such obstacles. Further, despite the facilitating nature of PROVEN's implementation processes, the study encountered tension between scientific rigor and real-world demands. Researchers need to optimize the real-world authenticity of pragmatic trial design while avoiding excessive implementation protocol deviations.

trial registrationClinicalTrials.gov Identifier: NCT02612688. Registered 19 November 2015.

Indexed as

Advance Care PlanningNursing HomesPatient Education as TopicVideo RecordingAttitude of Health PersonnelFemaleHealth PersonnelHumansInservice TrainingInterviews as TopicMaleSocial WorkersImplementationNursing homesPragmatic trial

Identifiers

PMID31357993
PMCPMC6664774

What OpenQuestion holds

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.