The DOI matches its Crossref record; 30 of the 30 references it cites were found in a registry or an index.
Developing a complex intervention for the outpatient management of incidentally diagnosed pulmonary embolism in cancer patients
Open accessAbstract
Background: Most patients with pulmonary embolism (PE) spend 5–7 days in hospital even though only 4.5% will develop serious complications during this time. In particular, the group of patients with incidentally diagnosed PE (i-PE) includes many patients with low risk features potentially ideal for outpatient management; however the evidence for their optimal management is lacking hence relative practices may vary considerably. We describe the development process, components, links and function of a nurse-led service for the management of patients with i-PE, developed in accordance to the UK Medical Research Council complex intervention guidance. Methods: Phase 0 (Theoretical underpinning): The Pulmonary Embolism Severity Index (PESI) was selected for patient risk assessment and the American Society of Clinical Oncology (ASCO) guideline for the management of PE in cancer patients (2007) was selected as quality measure. Historical registry and audit data from our centre regarding i-PE incidence and management for the period between 2006 and 2009 illustrating the then current practices were reviewed. Phase 1 (Modelling): Modelling of the pathway included the following: a) Identification of training needs, planning and implementation of training schemes and development of transferable competencies and training materials. b) Mapping patient pathways and flow and c) Production of key documentation and Standard Operating Procedures for the delivery of the service. Results: Phase 2 (Implementation and testing of the intervention): During the initial 12 months of implementation, remedial action was taken to address identified deficiencies regarding patient referral to the pathway, compliance with treatment protocol, patient follow up, selection challenges from the use of PESI in cancer patients and challenges regarding the “first-pass” identification of i-PE. Conclusion: We have developed and piloted a complex intervention to manage cancer patients with incidental PE in an outpatient setting. Adherence to evidence- based care, improvement of communication between professionals and patients, and improved quality of data is demonstrated.
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Interventions were delivered in a variety of settings (e.g. inpatient, outpatient clinics and home-based settings) and targeted a wide range of conditions, such as mental health conditions, stroke, cancer and other chronic illnesses.
“Interventions were delivered in a variety of settings (e.g. inpatient, outpatient clinics and home-based settings) and targeted a wide range of conditions, such as mental health conditions [28, 30, 35, 40, 47], stroke [31, 36, 39], cancer [29, 32, 33, 37, 42] and other chronic illnesses [25, 34, 38].”
From Optimisation of complex health interventions prior to a randomised controlled trial: a scoping review of strategies used (2016) · cites this paper as [29]
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 [29]
Fourteen included studies explored the acceptability and/or feasibility of the intervention to different stakeholders, including providers, recipients or policy makers and service commissioners.
“Fourteen studies explored the acceptability and/or feasibility of the intervention to different stakeholders, including providers, recipients or policy makers and service commissioners [27, 29–32, 34, 36, 37, 39, 40, 42, 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 [29]
In vivo strategies explore actual implementation issues by allowing researchers to immediately respond to problems and deviations arising in practice in a pilot setting.
“In vivo strategies, such as the real-time re-modelling and optimisation approach applied by Palmer and colleagues [29], explore actual implementation issues, by allowing researchers to immediately respond to problems and deviations arising in practice in a pilot setting.”
From Optimisation of complex health interventions prior to a randomised controlled trial: a scoping review of strategies used (2016) · cites this paper as [29]
Factorial experiments, uncontrolled pilot studies and probability models tended to be used to test specific components and to identify an intervention's potential effect.
“For example, factorial experiments, uncontrolled pilot studies and probability models tended to be used to test specific components and to identify an intervention’s potential effect [10, 25, 29, 38, 44, 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 [29]
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 [29]
A number of included studies adopted quantitative methods such as fractional factorial experiments, economic modelling, small uncontrolled pilot studies (with no control group), experimental 2×2 randomised controlled trials, probability models and evaluation questionnaires.
“A number of studies adopted quantitative methods such as fractional factorial experiments [10, 44], economic modelling [33], small uncontrolled pilot studies (with no control group) [25, 29, 38], experimental 2 × 2 randomised controlled trials [45, 46], probability models [49, 50] and evaluation questionnaires [43].”
From Optimisation of complex health interventions prior to a randomised controlled trial: a scoping review of strategies used (2016) · cites this paper as [29]
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Metadata
- Authors
- Palmer, J., Bozas, G., Stephens, A., Johnson, M., Avery, G., O’Toole, L., & Maraveyas, A.
- Affiliations
- Castle Hill Hospital (GB)
- University of Hull (GB)
- Corresponding author
- Bozas, George
- Venue
- BMC Health Services Research
- Published
- 2013-06-27
- Volume
- 13
- Issue
- 1
- Pages
- 235-235
- ISSN
- 1472-6963 (ISSN-L)
- PMC
- PMC3718646
- OpenAlex
- W2054662655
- Cited by
- 11
- References
- 30
- Citations by year
- 2023: 1 · 2022: 1 · 2021: 2 · 2019: 2 · 2018: 1 · 2017: 2 · 2016: 2
- FWCI
- 0.58
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMC Health Services Research (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Internal Medicine › Venous Thromboembolism Diagnosis and Management
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
- Keywords
- cancer patients, outpatient management, nurse-led services, complex intervention development, Pulmonary Embolism Severity Index, care pathways, standard operating procedures, employee training, quality of care
- MeSH terms
- Ambulatory Care, Humans, Neoplasms, Pulmonary Embolism, Registries, Risk Assessment, Critical Pathways, Incidental Findings
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