Implementation of the milestones communication approach for patients with limited prognosis: evaluation of intervention fidelity

Abstract

Background: Despite improvements in diagnostics and therapy, the majority of lung tumours are diagnosed at advanced stage IV with a poor prognosis. Due to the nature of an incurable disease, patients need to engage in shared decision making on advance care planning. To implement this in clinical practice, effective communication between patients, caregivers and healthcare professionals is essential. The Heidelberg Milestones Communication Approach (MCA) is delivered by a specifically trained interprofessional tandem and consists of four milestone conversations (MCs) at pivotal times in the disease trajectory. MC 1 (Diagnosis): i.e. prognosis; MC 2 (Stable disease): i.e. prognostic awareness; MC 3 (Progression): i.e. reassessment; MC 4 (Best supportive care): i.e. end of treatment. In between MCs, follow-up calls are carried out to sustain communication. This study aimed to assess to what extent the MCA was implemented as planned and consolidated in specialized oncology practice. Methods: A prospective observational process evaluation study was conducted, which focused on the implementation fidelity of the MCA. All MCs during two assessment periods were included. We analysed all written records of the conversations, which are part of the routine documentation during MCs and follow-up calls. Adherence to key aspects of the manual was documented on structured checklists at the beginning of the implementation of the MCA and after 6 months. The analysis was descriptive. Differences between the two assessment periods are analysed with chi-square tests. Results: A total of 133 MCs and 54 follow-up-calls (t1) and of 172 MCs and 92 follow-up calls (t2) were analysed. MC 2 were the most frequently completed conversations (n = 51 and n = 47). Advance care planning was discussed in 26 and 13% of MC 2 in the respective assessment periods; in 31 and 47% of MC 2, prognostic awareness was recorded. The most frequently documented topic in the follow-up calls was the physical condition in patients (82 and 83%). Conclusion: The implementation of a trajectory-specific communication concept was largely successful. Additional studies are needed to understand how fidelity could be further improved. Trial registration: DRKS00013469 / Date of registration: 22.12.2017.

Dignity therapy intervention fidelity: a cross-sectional descriptive study with older adult outpatients with cancer

“…Our findings have prompted us to examine how we used the Adherence Checklist and Code Book with a focus on understanding how to evaluate fidelity when so much content is in the subjective experience of communications between people on highly emotion-laden topics. This is in keeping with other researchers who have identified the need for clarification regarding intervention fidelity in psychotherapeutic and communication-based interventions [ 1 ]. Vital to this endeavor is the development of well-defined coding definitions that can inform all team members in implementing their roles, including attention to apparent and possible subjective experience.…”

“…Although there is increasing attention to the imperative for intervention fidelity, there are no clear standards established [ 26 , 27 ]. Further, the literature regarding fidelity in brief psychotherapies and communication interventions is more scant than in research regarding fidelity with medication or other physical treatments [ 1 ]. Some literature surveyed considered > 70% to be adequate [ 28 ] or high fidelity [ 27 ]; others considered 80% to be acceptable, or high fidelity or the minimum criterion below which remedial training would be required for interventionists [ 29 ].…”

“…In a healthcare environment, it indicates that all providers have done what they were trained to do, intended to do, and what they promised to do; they deliver all of the intervention components with authenticity. This authentic adherence, which is imperative both in research and in clinical practice to achieve desired effects, is particularly challenging to measure for communication-based interventions such as Dignity Therapy (DT) [ 1 – 3 ]. DT is a psychotherapeutic intervention developed by Dr. Harvey Max Chochinov with the goal of supporting the dignity of the person through a supportive conversation with a trained therapist designed to facilitate development of a legacy document that the person may share with a significant person(s) in his/her life [ 2 ].…”

Consideration of sense of coherence in a structured communication approach with stage IV lung cancer patients and their informal caregivers: a qualitative interview study

“…For most patients and informal caregivers, the diagnosis of lung cancer comes suddenly and surprisingly, causing an exceptional psychological and emotional situation. At the same time, they receive a lot of healthcare information, including treatment options, further procedures and organisational aspects [ 12 ]. In this situation, the interprofessional tandem is perceived as a great gain for patient care and support.…”

Intervention en soins de soutien auprès de survivants du cancer prostatique avancé : Revue intégrative de la littérature

“…The majority of the studies reviewed were exploratory with small sample sizes. Also, studies used different outcome measures and the interventions varied in dose, frequency (ranging from 1 to 5 days per week), and length (8 to 24 weeks), making it difficult to determine which supportive care interventions were the most effective (Bossert et al, 2020;Carey et al, 2012). Despite some promising results, it is premature to generalize the findings to practice in all the settings caring for these survivors.…”