Development of a nursing intervention to prepare frail older patients for cardiac surgery (the PREDOCS programme), following phase one of the guidelines of the Medical Research Council
Abstract
Background: In older patients undergoing elective cardiac surgery, the timely identification and preparation of patients at risk for frequent postoperative hospital complications provide opportunities to reduce the risk of these complications. Aims: We developed an evidence-based, multi-component nursing intervention (Prevention of Decline in Older Cardiac Surgery Patients; the PREDOCS programme) for application in the preadmission period to improve patients’ physical and psychosocial condition to reduce their risk of postoperative complications. This paper describes in detail the process used to design and develop this multi-component intervention. Methods: In a team of researchers, experts, cardiac surgeons, registered cardiac surgery nurses, and patients, the revised guidelines for developing and evaluating complex interventions of the Medical Research Council (MRC) were followed, including identifying existing evidence, identifying and developing theory and modelling the process and outcomes. Additionally, the criteria for reporting the development of complex interventions in healthcare (CReDECI) were followed. Results: The intervention is administered during a consultation by the nurse two to four weeks before the surgery procedure. The consultation includes three parts: a general part for all patients, a second part in which patients with an increased risk are identified, and a third part in which selected patients are informed about how to prepare themselves for the hospital admission to reduce their risk. Conclusions: Following the MRC guidelines, an extended, stepwise, multi-method procedure was used to develop the multi-component nursing intervention to prepare older patients for cardiac surgery, creating transparency in the assumed working mechanisms. Additionally, a detailed description of the intervention is provided.
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Seven included studies were a preliminary investigation of the effect of the intervention or a combination of its components on proxy or final outcomes and intervention long-term impact.
“Seven studies were a preliminary investigation of the effect of the intervention or a combination of its components on proxy or final outcomes and intervention long-term impact [10, 24, 44–46, 49, 50].”
From Optimisation of complex health interventions prior to a randomised controlled trial: a scoping review of strategies used (2016) · cites this paper as [24]
17 of the 27 included studies used the MRC 2000 framework, the updated 2008 version, or a combination of the two.
“In particular, 17 of the 27 studies included in this review used the MRC 2000 framework, the updated 2008 version or a combination of the two [24–40].”
From Optimisation of complex health interventions prior to a randomised controlled trial: a scoping review of strategies used (2016) · cites this paper as [24]
Two included studies reported on preventive interventions targeting older people and one on a programme to empower patients undergoing gynaecological surgery during the perioperative period.
“Two studies reported on preventive interventions targeting older people [24, 50] and one on a programme to empower patients undergoing gynaecological surgery during the perioperative period [43].”
From Optimisation of complex health interventions prior to a randomised controlled trial: a scoping review of strategies used (2016) · cites this paper as [24]
Several included studies used mixed methods, combining qualitative strategies to explore stakeholders' perspectives and quantitative analysis to estimate the intervention effect.
“Several studies used mixed methods, combining qualitative strategies to explore stakeholders’ perspectives and quantitative analysis to estimate the intervention effect [24, 27, 28, 33, 35–37, 40, 42].”
From Optimisation of complex health interventions prior to a randomised controlled trial: a scoping review of strategies used (2016) · cites this paper as [24]
The majority of included studies (n = 16) subsequently refined the intervention to then test the optimised version within pilot studies or full-scale RCTs.
“The majority of studies (n = 16) subsequently refined the intervention to then test the optimised version of the intervention within pilot studies or full-scale RCTs [24–32, 34, 38–40, 43, 47, 48].”
From Optimisation of complex health interventions prior to a randomised controlled trial: a scoping review of strategies used (2016) · cites this paper as [24]
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References 44 · Cited by 21
- Authors
- Ettema, R. G., Hoogendoorn, M. E., Kalkman, C. J., & Schuurmans, M. J.
- Affiliations
- University of Applied Sciences Utrecht (NL)
- Isala (NL)
- University Medical Center Utrecht (NL)
- Corresponding author
- Ettema, Roelof GA
- Venue
- European Journal of Cardiovascular Nursing
- Publisher
- Oxford University Press (OUP)
- Published
- 2013-11-01
- Volume
- 13
- Issue
- 6
- Pages
- 494-505
- ISSN
- 1474-5151 (ISSN-L)
- 1873-1953
- OpenAlex
- W2135399584
- Cited by
- 21
- References
- 44
- Citations by year
- 2025: 1 · 2024: 2 · 2022: 2 · 2021: 3 · 2020: 2 · 2019: 1 · 2018: 2 · 2017: 2 · 2016: 3 · 2015: 1 · 2014: 2
- FWCI
- 0.19
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- European Journal of Cardiovascular Nursing (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Health Sciences › Health Professions › General Health Professions › Health Sciences Research and Education
- Keywords
- frail elderly patients, cardiac surgery, postoperative complications, preoperative preparation, complex intervention development, risk identification, cardiac surgery nursing
- MeSH terms
- Aged, 80 and over, Female, Cardiac Surgical Procedures, Humans, Male, Netherlands, Nursing Assessment, Patient Care Team, Postoperative Complications, Program Evaluation, Geriatric Assessment, Survival Analysis, Frail Elderly, Program Development, Practice Guidelines as Topic, Evidence-Based Medicine, Nurse's Role, Interdisciplinary Communication, Biomedical Research
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