Evidence map›Paper›PMID 38413877›Full record

Trial reportBMC geriatrics2024

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

Ella L Bracci, Adrian G Barnett, Christine Brown, Leonie Callaway, Magnolia Cardona, Hannah E Carter, Nicholas Graves, Kenneth Hillman, Xing J Lee, Steven M McPhail and 3 more

Open access · goldAbstract readMulticenter StudyRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in BMC geriatrics, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
3.3field-weighted citation impact, top 9% of its field
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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 6 citations in OpenAlex.

  1. Trial
  2. Trial
  3. Article
  4. Article
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

13 authors at 5 institutions in 2 countries.

Ella L BracciCaring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia. ella.bracci@flinders.edu.au.
Adrian G BarnettAustralian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Australia.
Christine BrownAustralian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Australia.
Leonie CallawayFaculty of Medicine, University of Queensland, Herston, Queensland, Australia.
Magnolia CardonaInstitute for Evidence-Based Health Care, Bond University, Robina, Queensland, Australia.
Hannah E CarterAustralian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Australia.
Nicholas GravesAustralian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Australia.
Kenneth HillmanSchool of Clinical Medicine, UNSW Medicine & Health, Southwest Sydney Clinical Campuses, Discipline of Critical Care, Sydney, NSW, Australia.
Xing J LeeAustralian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Australia.
Steven M McPhailAustralian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Australia.
Ben P WhiteAustralia Centre for Heath Law Research, Faculty of Business and Law, Queensland University of Technology, Brisbane, Queensland, Australia.
Lindy WillmottAustralia Centre for Heath Law Research, Faculty of Business and Law, Queensland University of Technology, Brisbane, Queensland, Australia.
Gillian HarveyCaring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia.
Queensland University of Technology · AUFlinders University · AUNational University of Singapore · SGRoyal Brisbane and Women's Hospital · AUUniversity of Queensland · AU

Funding

Medical Research Council
6 · The paper itself

Abstract

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).

Indexed as

DeathPatientsAgedAustraliaHospitalsHumansProspective StudiesClinical auditEnd-of-lifeHospitalNon-beneficial treatmentNudge intervention

Identifiers

PMID38413877
PMCPMC10900675
OpenAlexW4392235804

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

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.