Which behavioural change interventions improve clinicians' practice with advance care planning in heart failure?

Conference:

SAPC ASM 2020 - cancelled due to pandemic

Talk Code:

D.13

Presenter:

Markus Schichtel

Twitter:

@MS_CAM_UNI

Co-authors:

Rafael Perera, Bee Wee, Charlotte Albury, Igho Onakpoya, Sarah Collins

Author institutions:

University of Cambridge, University of Oxford,

Problem

National and international guidelines advocate advance care planning (ACP) to improve end-of-life care for patients with heart failure. ACP improves quality of life and patient satisfaction with care but clinicians are hesitant to engage with ACP. Only 8% of eligible patients have an advance care plan and patient care is affected.Behaviour change techniques (BCTs) have been used in the past to change clinicians’ practice pattern. But there is no systematic evaluation of the evidence base for effective behaviour change techniques to support clinicians with ACP in heart failure. Our aim was to identify interventions with the greatest potential to engage clinicians.

Approach

We conducted a systematic review and meta-analysis and searched CINAHL, Cochrane Central Register of Controlled Trials, Database of Systematic Reviews, Embase, ERIC, Ovid MEDLINE, Science Citation Index, PsycINFO for randomised controlled trials (RCTs) from inception to August 2019. Three reviewers independently extracted data, assessed risk of bias (Cochrane risk of bias tool), the quality of evidence (GRADE) and intervention synergy according to the Behaviour Change Wheel and Behaviour Change Techniques (BCTs). Odds ratios (ORs) were calculated for pooled effects.

Findings

We conducted a systematic review and meta-analysis and searched CINAHL, Cochrane Central Register of Controlled Trials, Database of Systematic Reviews, Embase, ERIC, Ovid MEDLINE, Science Citation Index, PsycINFO for randomised controlled trials (RCTs) from inception to August 2019. Three reviewers independently extracted data, assessed risk of bias (Cochrane risk of bias tool), the quality of evidence (GRADE) and intervention synergy according to the Behaviour Change Wheel and Behaviour Change Techniques (BCTs). Odds ratios (ORs) were calculated for pooled effects.Of 14483 articles screened, we assessed the full text of 131 studies. 13 RCTs including 3709 participants met all of the inclusion criteria. The BCTs of prompts/ cues (OR, 4.18; 95% CI [2.03 - 8.59]), credible source (OR, 3.24; 95% CI [1.44 - 7.28]), goal setting (outcome) (OR, 2.67; 95% CI [1.56 - 4.57]), behavioural practice/ rehearsal (OR, 2.64; 95% CI [1.50 - 4.67]); instruction on behaviour performance (OR, 2.49; 95% CI [1.63 - 3.79]), goal setting (behaviour) (OR, 2.12; 95% CI [1.57 - 2.87]), and information about consequences (OR, 2.06; 95% CI [1.40 - 3.05]) showed statistically significant effects to engage clinicians with ACP.

Consequences

BCTs that simultaneously involved prompts, goal setting (outcome), patients and credible source were among the most effective interventions to improve clinicians’ practice with ACP in heart failure. Heart failure services should consider these components for implementation into routine clinical practice.

Submitted by:

Markus Schichtel

Funding acknowledgement:

No funding was involved. We acknowledge and thank Nia Roberts, health science librarian, Bodleian Library, University of Oxford, for running the literature data base searches.