Mixed Methods Research in the Development and Evaluation of Complex Interventions in Palliative and End-of-Life Care: Report on the MORECare Consensus Exercise

Farquhar, Morag; Preston, Nancy; Evans, Catherine J; Grande, Gunn; Short, V; Benalia, Hamid; Higginson, Irene J; Todd, Chris

doi:10.1089/jpm.2012.0572

Cited by 34 publications

(32 citation statements)

References 46 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Survey responses were analysed using descriptive statistics [frequencies, median, interquartile range (IQR), range]. Predetermined categories from previous TECs were used to determine levels of agreement and consensus 146,147 (Table 4). Narrative comments were collated within each category and thematically analysed to aid understanding and provide illustrative examples of the issues raised by stakeholders' suggestions.…”

Section: Discussionmentioning

confidence: 99%

“…The consensus survey response rate was limited, although a high proportion of those completing the workshop booklets participated (74%) and the overall response rate was similar to studies that have previously utilised this method. [146][147][148] Importantly, all key stakeholder groups were represented.…”

Section: Discussionmentioning

confidence: 99%

“…Transparent expert consultation (TEC) methods have, therefore, been developed in response to these limitations, 93,144 and have been successfully used to elicit recommendations in palliative and end-of-life care research. [145][146][147][148][149] DOI: 10.3310/hsdr07220 HEALTH SERVICES AND DELIVERY RESEARCH 2019 VOL. 7 NO.…”

Section: Designmentioning

confidence: 99%

See 2 more Smart Citations

Holistic services for people with advanced disease and chronic or refractory breathlessness: a mixed-methods evidence synthesis

Maddocks

Brighton

Farquhar

et al. 2019

Health Serv Deliv Res

Self Cite

View full text Add to dashboard Cite

Background Breathlessness is a common and distressing symptom of many advanced diseases, affecting around 2 million people in the UK. Breathlessness increases with disease progression and often becomes chronic or refractory. Breathlessness-triggered services that integrate holistic assessment and specialist palliative care input as part of a multiprofessional approach have been developed for this group, offering tailored interventions to support self-management and reduce distress. Objectives The aim was to synthesise evidence on holistic breathlessness services for people with advanced disease and chronic or refractory breathlessness. The objectives were to describe the structure, organisation and delivery of services, determine clinical effectiveness, cost-effectiveness and acceptability, identify predictors of treatment response, and elicit stakeholders’ evidence-based priorities for clinical practice, policy and research. Design The mixed-methods evidence synthesis comprised three components: (1) a systematic review to determine the clinical effectiveness, cost-effectiveness and acceptability of holistic breathlessness services; (2) a secondary analysis of pooled individual data from three trials to determine predictors of clinical response; and (3) a transparent expert consultation (TEC), comprising a stakeholder workshop and an online consensus survey, to identify stakeholders’ priorities. Results Thirty-seven papers reporting on 18 holistic breathlessness services were included in the systematic review. Most studies enrolled people with thoracic cancer, were delivered over 4–6 weeks, and included breathing training, relaxation techniques and psychological support. Meta-analysis demonstrated significant reductions in the Numeric Rating Scale (NRS) distress due to breathlessness, significant reductions in the Hospital Anxiety and Depressions Scale (HADS) depression scores, and non-significant reductions in the Chronic Respiratory Disease Questionnaire (CRQ) mastery and HADS anxiety, favouring the intervention. Recipients valued education, self-management interventions, and expertise of the staff in breathlessness and person-centred care. Evidence for cost-effectiveness was limited and inconclusive. The responder analysis (n = 259) revealed baseline CRQ mastery and NRS distress to be strong predictors of the response to breathlessness services assessed by these same measures, and no significant influence from baseline breathlessness intensity, patient diagnosis, lung function, health status, anxiety or depression. The TEC elicited 34 priorities from stakeholders. Seven priorities received high agreement and consensus, reflecting stakeholders’ (n = 74) views that services should be person-centred and multiprofessional, share their breathlessness management skills with others, and recognise the roles and support needs of informal carers. Limitations The evidence synthesis draws predominantly from UK services and may not be generalisable to other settings. Some meta-analyses were restricted by reporting biases and statistical heterogeneity. Conclusions Despite heterogeneity in composition and delivery, holistic breathlessness services are highly valued by recipients and can lead to significant improvements in the distress caused by breathlessness and depression. Outcomes of improved mastery and reduced distress caused by breathlessness are not influenced by patient diagnosis, lung function or health status. Stakeholders highlighted the need for improved access to person-centred, multiprofessional breathlessness services and support for informal carers. Future work Our research suggests that key therapeutic components of holistic breathlessness services be considered in clinical practice and models of delivery and educational strategies to address stakeholders’ priorities tested. Study registration This study is registered as PROSPERO CRD42017057508. Funding The National Institute for Health Research (NIHR) Health Services and Delivery programme. Matthew Maddocks, Wei Gao and Irene J Higginson are supported by the NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) South London; Matthew Maddocks is supported by a NIHR Career Development Fellowship (CDF-2017-009), William D-C Man is supported by the NIHR CLAHRC Northwest London and Irene J Higginson holds a NIHR Emeritus Senior Investigator Award.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Holistic services for people with advanced disease and chronic or refractory breathlessness: a mixed-methods evidence synthesis

Maddocks

Brighton

Farquhar

et al. 2019

Health Serv Deliv Res

Self Cite

View full text Add to dashboard Cite

show abstract

“…However, this year the MORECare guidance has been published, which provides methodological development of existing best practice in the development and testing (RCTs) of complex interventions [23,24]. The MORECare outputs [25][26][27][28][29][30] provide guidance on all stages of trial design and implementation, including ethical aspects, handling of missing data, and mixed methods designs.…”

Section: Key Pointsmentioning

confidence: 99%

Caregivers of people at the end of life

Harding¹

2014

Current Opinion in Supportive &Amp; Palliative Care

View full text Add to dashboard Cite

show abstract

“…Sie zeichnen sich durch die Kombination und Integration qualitativer und quantitativer Elemente aus, mit dem Ziel, ein inhaltlich breites und tiefes Verständnis über den Forschungsgegenstand zu gewinnen [2] und durch die Kombination der Stärken gleichzeitig die Schwächen der Methoden auszugleichen [1]. Auch für die Forschung zur Palliativversorgung wird die Bedeutung gemischt-methodischer Ansätze hervorgehoben [3,4]; sie werden zunehmend angewandt, publiziert und diskutiert [5].…”

Section: Introductionunclassified