Interventionist training and intervention fidelity monitoring and maintenance for CONNECT, a nurse-led primary palliative care in oncology trial

Abstract

ContextIntervention fidelity is a critical component of behavioral research that has received inadequate attention in palliative care studies. With increasing focus on the need for palliative care models that can be widely disseminated and delivered by non-specialists, rigorous yet pragmatic strategies for training interventionists and maintaining intervention fidelity are needed.Objectives(1) Describe components of a plan for interventionist training and monitoring and maintaining intervention fidelity as part of a primary palliative care trial (CONNECT) and (2) present data about perceived training effectiveness and delivery of key intervention content.MethodsPost-training evaluations, visit checklists, and visit audio-recordings.ResultsData were collected from June, 2016 through April, 2017. We include procedures for (1) identification, training and certification of oncology nurses as CONNECT interventionists; (2) monitoring intervention delivery; and (3) maintaining intervention quality. All nurses (N = 14) felt prepared to deliver key competencies after a 3-day in-person training. As assessed via visit checklists, interventionists delivered an average of 94% (SD 13%) of key content for first intervention visits and 85% (SD 14%) for subsequent visits. As assessed via audio-recordings, interventionists delivered an average of 85% (SD 8%) of key content for initial visits and 85% (SD 12%) for subsequent visits.ConclusionWe present a 3-part strategy for training interventionists and monitoring and maintaining intervention delivery in a primary palliative care trial. Training was effective in having nurses feel prepared to deliver primary palliative care skills. As assessed via nursing checklists and visit audio-recordings, intervention fidelity was high.

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“…Therefore, the intervention was divided into several clear defined components. For all components the fidelty was over 80% [23]. The difference with our study may be caused by a different method for assessing intervention fidelity, by the focus on routine clinical practice, by differences in the situation at baseline, or by other differences.…”

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“…We found that in PROVEN’s high-adherence facilities, champions perceived that facilitation driven by the leadership team (i.e., ongoing qualitative feedback and coaching via conference calls) was beneficial. These leadership team-driven activities, promoted by other studies of palliative care interventions [35–38], may have differentially enhanced participant responsiveness if high-adherence (versus low-adherence) facility champions self-selected into conference call participation. Indeed, investigators from the INTERACT trial and from a feasibility study of another long-term care-based ACP intervention revealed the influence of sharing successes with champions [33, 39].…”

A qualitative study exploring patient, family carer and healthcare professional perceptions of providing palliative care for advanced head and neck cancer

“…Additionally, the pivotal role of the Clinical Nurse Specialist requires further definition. This may contribute to research exploring the role of oncology nurses to help address symptom needs, coordinate care and offer advance care planning [41].…”