Corry 2021 - ACP patient acceptability - journal.pone.0251978.pdf (766.37 kB)

Acceptability of a nurse-led, person-centred, anticipatory care planning intervention for older people at risk of functional decline: A qualitative study

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posted on 02.07.2021, 15:19 by Dagmar A. S. Corry, Julie Doherty, Gillian Carter, Frank Doyle, Tom Fahey, Peter O’Halloran, Kieran McGlade, Emma Wallace, Kevin Brazil
Background:
As the population of older adults increases, the complexity of care required to support those who choose to remain in the community amplifies. Anticipatory Care Planning (ACP), through earlier identification of healthcare needs, is evidenced to improve quality of life, decrease aggressive interventions, and prolong life. With patient acceptability of growing importance in the design, implementation, and evaluation of healthcare interventions, this study reports on the acceptability of a primary care based ACP intervention on the island of Ireland.

Methods: As part of the evaluation of a feasibility cluster randomized controlled trial (cRCT) testing an ACP intervention for older people at risk of functional decline, intervention participants [n = 34] were interviewed in their homes at 10-week follow-up to determine acceptability. The intervention consisted of home visits by specifically trained registered nurses who assessed participants' health, discussed their health goals and plans, and devised an anticipatory care plan in collaboration with participants' GPs and adjunct clinical pharmacist. Thematic analysis was employed to analyze interview data. The feasibility cRCT involved eight general practitioner (GP) practices as cluster sites, stratified by jurisdiction, four in Northern Ireland (NI) (two intervention, two control), and four in the Republic of Ireland (ROI) (two intervention, two control). Participants were assessed for risk of functional decline. A total of 34 patients received the intervention and 31 received usual care.

Findings: Thematic analysis resulted in five main themes: timing of intervention, understanding of ACP, personality & individual differences, loneliness & social isolation, and views on healthcare provision. These map across the Four Factor Model of Acceptability ('4FMA'), a newly developed conceptual framework comprising four components: intervention factors, personal factors, social support factors, and healthcare provision factors.

Conclusion: Acceptability of this primary care based ACP intervention was high, with nurses' home visits, GP anchorage, multidisciplinary working, personalized approach, and active listening regarded as beneficial. Appropriate timing, and patient health education emerged as vital.

Funding

INTERREG VA / Cross-border Healthcare Intervention Trials in Ireland Network (CHITIN) Grant number: CHI-5426

History

Comments

The original article is available at https://journals.plos.org/

Published Citation

Corry DAS, et al. Acceptability of a nurse-led, person-centred, anticipatory care planning intervention for older people at risk of functional decline: A qualitative study. PLoS One. 2021 May 16(5):e0251978.

Publication Date

20 May 2021

PubMed ID

34015046

Department/Unit

  • General Practice
  • Health Psychology

Research Area

  • Population Health and Health Services

Publisher

Public Library of Science (PLoS)

Version

  • Published Version (Version of Record)