The objective of this study is to compare the efficacy and cost of specialised individually delivered parent training (PT) for preschool children with attention-deficit/hyperactivity disorder (ADHD) against generic group-based PT and treatment as usual (TAU). This is a multi-centre three-arm, parallel group randomised controlled trial conducted in National Health Service Trusts. The participants included in this study were preschool children (33–54 months) fulfilling ADHD research diagnostic criteria. New Forest Parenting Programme (NFPP)—12-week individual, home-delivered ADHD PT programme; Incredible Years (IY)—12-week group-based, PT programme initially designed for children with behaviour problems were the interventions. Primary outcome—Parent ratings of child’s ADHD symptoms (Swanson, Nolan & Pelham Questionnaire—SNAP-IV). Secondary outcomes—teacher ratings (SNAP-IV) and direct observations of ADHD symptoms and parent/teacher ratings of conduct problems. NFPP, IY and TAU outcomes were measured at baseline (T1) and post treatment (T2). NFPP and IY outcomes only were measured 6 months post treatment (T3). Researchers, but not therapists or parents, were blind to treatment allocation. Analysis employed mixed effect regression models (multiple imputations). Intervention and other costs were estimated using standardized approaches. NFPP and IY did not differ on parent-rated SNAP-IV, ADHD combined symptoms [mean difference − 0.009 95% CI (− 0.191, 0.173), p = 0.921] or any other measure. Small, non-significant, benefits of NFPP over TAU were seen for parent-rated SNAP-IV, ADHD combined symptoms [− 0.189 95% CI (− 0.380, 0.003), p = 0.053]. NFPP significantly reduced parent-rated conduct problems compared to TAU across scales (p values < 0.05). No significant benefits of IY over TAU were seen for parent-rated SNAP, ADHD symptoms [− 0.16 95% CI (− 0.37, 0.04), p = 0.121] or parent-rated conduct problems (p > 0.05). The cost per family of providing NFPP in the trial was significantly lower than IY (£1591 versus £2103). Although, there were no differences between NFPP and IY with regards clinical effectiveness, individually delivered NFPP cost less. However, this difference may be reduced when implemented in routine clinical practice. Clinical decisions should take into account parental preferences between delivery approaches.
ObjectiveCompassionate care continues to be a focus for national and international
attention, but the existing evidence base lacks the experimental methodology
necessary to guide the selection of effective interventions for practice. This
study aimed to evaluate the Creating Learning Environments for Compassionate Care
(CLECC) intervention in improving compassionate care.SettingWard nursing teams (clusters) in two English National Health Service hospitals
randomised to intervention (n=4) or control (n=2). Intervention wards comprised
two medicines for older people (MOPs) wards and two medical/surgical wards.
Control wards were both MOPs.ParticipantsData collected from 627 patients and 178 staff. Exclusion criteria: reverse
barrier nursed, critically ill, palliative or non-English speaking. All other
patients and all nursing staff and Health Care Assistant HCAs were invited to
participant, agency and bank staff were excluded.InterventionCLECC, a workplace intervention focused on developing sustainable leadership and
work-team practices to support the delivery of compassionate care. Control: No
educational activity.Primary and secondary outcome measuresPrimary—Quality of Interaction Schedule (QuIS) for observed
staff–patient interactions. Secondary—patient-reported evaluations
of emotional care in hospital (PEECH); nurse-reported empathy (Jefferson Scale of
Empathy).ResultsTrial proceeded as per protocol, randomisation was acceptable. Some but not all
blinding strategies were successful. QuIS observations achieved 93% recruitment
rate with 25% of patient sample cognitively impaired. At follow-up there were more
total positive (78% vs 74%) and less total negative (8% vs 11%) QuIS ratings for
intervention wards versus control wards. Sixty-three per cent of intervention ward
patients scored lowest (ie, more negative) scores on PEECH connection subscale,
versus 79% of control. This was not a statistically significant difference. No
statistically significant differences in nursing empathy were observed.ConclusionsUse of experimental methods is feasible. The use of structured observation of
staff–patient interaction quality is a promising outcome measure inclusive
of hard to reach groups.Trial registration numberISRCTN16789770.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.