OBJECTIVES: To improve transmural palliative care for acutely admitted older patients, the PalliSupport transmural care pathway was developed. Implementation of this care pathway was challenging. The aim of this study was to improve understanding why the implementation partly failed.DESIGN: A qualitative process evaluation study.SETTING/PARTICIPANTS: 17 professionals who were involved in the PalliSupport program were interviewed.METHODS: Online semi-structured interviews. Thematic analysis to create themes according to the implementation framework of Grol & Wensing.RESULTS: From this study, themes within four levels of implementation emerged: 1) The innovation: challenges in current palliative care, the setting of the pathway and boost for improvement; 2) Individual professional: feeling (un)involved and motivation; 3) Organizational level: project management; 4) Political and economic level: project plan and evaluation.CONCLUSION AND IMPLICATIONS: We learned that the challenges involved in implementing a transmural care pathway in palliative care should not be underestimated. For successful implementation, we emphasize the importance of creating a program that fits the complexity of transmural palliative care. We suggest starting on a small scale and invest in project management. This could help to involve all stakeholders and anticipate current challenges in palliative care. To increase acceptance, create one care pathway that can start and be used in all care settings. Make sure that there is sufficient flexibility in time and room to adjust the project plan, so that a second pilot study can possibly be performed, and choose a scientific evaluation with both rigor and practical usefulness to evaluate effectiveness.
BACKGROUND: Since 2011, a tailored, interdisciplinary head and neck rehabilitation (IHNR) program, covered by the basic healthcare insurance, is offered to advanced head and neck cancer (HNC) patients in the Netherlands Cancer Institute (NKI). This program is developed to preserve or restore patients' functioning, and to optimize health-related quality of life (HRQoL). It applies an integrated approach to define patients' individual goals and provide rehabilitation care throughout the cancer care continuum. The aim of the current study is to assess the (cost-) effectiveness of the IHNR approach compared to usual supportive care (USC) consisting of monodisciplinary and multidisciplinary care in advanced HNC patients.METHODS: This multicenter prospective observational study is designed to compare (cost-)effectiveness of the IHNR to USC for advanced HNC patients treated with chemoradiotherapy (CRT) or bioradiotherapy (BRT). The primary outcome is HRQoL represented in the EORTC QLQ-C30 summary score. Functional HRQoL, societal participation, utility values, return to work (RTW), unmet needs (UN), patient satisfaction and clinical outcomes are secondary outcomes, assessed using the EORTC QLQ-H&N35, USER-P, EQ-5D-5 L, and study-specific questionnaires, respectively. Both patient groups (required sample size: 64 per arm) are requested to complete the questionnaires at: diagnosis (baseline; T0), 3 months (T1), 6 months (T2), 9 months (T3) and 12 months (T4) after start of medical treatment. Differences in outcomes between the intervention and control group will be analyzed using mixed effects models, Chi-square test and descriptive statistics. In addition, a cost-effectiveness analysis (CEA) will be performed by means of a Markov decision model. The CEA will be performed using a societal perspective of the Netherlands.DISCUSSION: This prospective multicenter study will provide evidence on the effectiveness and cost-effectiveness of IHNR compared to USC. RTW and societal participation, included as secondary outcomes, have not been studied sufficiently yet in cancer rehabilitation. Interdisciplinary rehabilitation has not yet been implemented as usual care in all centers, which offers the opportunity to perform a controlled clinical study. If demonstrated to be (cost-)effective, national provision of the program can probably be advised.TRIAL REGISTRATION: The study has been retrospectively registered in the Netherlands Trial Registry on April 24th 2018 ( NTR7140 ).
Background/Objectives: Homecare staff often take over activities instead of “doing activities with” clients, thereby hampering clients from remaining active in daily life. Training and supporting staff to integrate reablement into their working practices may reduce clients' sedentary behavior and improve their independence. This study evaluated the effectiveness of the “Stay Active at Home” (SAaH) reablement training program for homecare staff on older homecare clients' sedentary behavior. Design: Cluster randomized controlled trial (c-RCT). Setting: Dutch homecare (10 nursing teams comprising a total of 313 staff members). Participants: 264 clients (aged ≥65 years). Intervention: SAaH seeks to equip staff with knowledge, attitude, and skills on reablement, and to provide social and organizational support to implement reablement in homecare practice. SAaH consists of program meetings, practical assignments, and weekly newsletters over a 9-month period. The control group received no additional training and delivered care as usual. Measurements: Sedentary behavior (primary outcome) was measured using tri-axial wrist-worn accelerometers. Secondary outcomes included daily functioning (GARS), physical functioning (SPPB), psychological functioning (PHQ-9), and falls. Data were collected at baseline and at 12 months; data on falls were also collected at 6 months. Intention-to-treat analyses using mixed-effects linear and logistic regression were performed. Results: We found no statistically significant differences between the study groups for sedentary time expressed as daily minutes (adjusted mean difference: β 18.5 (95% confidence interval [CI] 22.4, 59.3), p = 0.374) and as proportion of wake/wear time (β 0.6 [95% CI 1.5, 2.6], p = 0.589) or for most secondary outcomes. Conclusion: Our c-RCT showed no evidence for the effectiveness of SAaH for all client outcomes. Refining SAaH, by adding components that intervene directly on homecare clients, may optimize the program and require further research. Additional research should explore the effectiveness of SAaH on behavioral determinants of clients and staff and cost-effectiveness.
Een vraagarticulatieproces met projectmanagers en -leiders uit private en Triple-Helix organisaties laat zien dat zij behoefte hebben aan tools voor: 1. Het bepalen van de juiste incentives om stakeholders actief te betrekken in multi-sector collaboratieve innovatieprojecten (verder verwezen als innovatieprojecten), en 2. Het concreet, transparant en op één lijn te krijgen van de belangen van de partners. Vandaar dat dit project betreft het doorontwikkelen van het Degrees of Engagement diagram (DoE-diagram), een tool voor het managen van stakeholder engagement in innovatieprojecten voor het behalen van de maatschappelijke opgaven. Hiermee sluit het project aan bij de programmalijn ‘rollen, belangen en coördinatie’ van de Kennis en Innovatieagenda van de missie Maatschappelijke Verdienvermogen- thema’s Klimaat & Energie en Circulaire economie. Het consortium bestaat uit de Hogeschool van Amsterdam (HvA), KplusV en Amsterdam Smart City (ASC). De HvA ontwikkelde het DoE-diagram. Voor het identificeren van stakeholders bevat het DoE-diagram attributen op project- en organisatieniveau. In dit project wordt het DoE doorontwikkeld door onderzoek te doen naar: 1. De attributen op individuniveau en potentiele nieuwe attributen op project- en organisatieniveau, 2. De mate waarin deze attributen invloed hebben op het bepalen van de passende incentives, de concretisering van de partnerbelangen en al dan niet succesvolle verloop van innovatieprojecten, 3. Een verkenning van een digitale versie van het DoE voor het managen van in- en uitstappen van partners. Hiermee beoogt het project twee doelen: 1. Inzicht verkrijgen in stakeholderconfiguraties voor het ondersteunen van beslissingen met betrekking tot stakeholder-engagement, 2. Bouwen van een consortium van partijen die vervolg aan het project gaan geven door longitudinaal onderzoek te doen naar de inzet van de uitbreiding van het DoE-diagram en het maken van een werkend prototype en testen van de digitale versie ervan.
E-cycling intelligence is a research project directly connected to the PhD-research of Joost de Kruijf at the Utrecht University. Within the program the effects of the introduction of e-bikes in daily commuting are being investigated. Using a large-scale incentive program targeting on behavioral change among car-oriented commuters the next four specific components are being :- Modal shift to e-cycling- Well-being and travel satisfaction of e-bikes vs. car- Weather circumstances and e-cycling- Behavioral intention to e-bike vs. actual behavior Using a combination of three surveys (baseline, one month and half a year) and continuous GPS-measurement on the behavior of more than 800 participants makes this research unique. In collaboration with the TU/e the GPS-dataset is being translated into relevant information on modal shift on different trip purposes offering a new range of possibilities to analyses behavioral change. Knowledge on every of the four topics in the project is translated scientific paper. The expected end of the project is July 2021.With the research not new insights are being gained, the Breda University of Applied Sciences also develops a scientific network of cycling related researchers together with a network of cycling engaged road authorities.
