Pilot Evaluation of the TANDEM intervention to reduce anxiety and depression in COPD: The importance of fidelity assessment for intervention refinement

Conference:

SAPC ASM 2018 - London

Talk Code:

P2.71

Presenter:

Liz Steed

Twitter:

@lizsteed

Co-authors:

Steed L., Wileman V., Marshall K., Sohanpal R., Kelly M., Pinnock H., Taylor S.

Author institutions:

Queen Mary University of London, University College London, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, University of Edinburgh

Problem

Pulmonary Rehabilitation (PR) is a proven exercise and educational therapy for Chronic Obstructive Pulmonary Disease (COPD). Benefits are limited however by poor uptake and retention, often due to depression or anxiety. TANDEM is a tailored cognitive behavioural (CBA) intervention targeted at improving depression or anxiety in COPD prior to PR. It is delivered individually over 6-8 sessions by trained respiratory health care professionals (rHCP) in participants own homes or clinics according to preference and links into PR.

Approach

rHCPs from primary or secondary care underwent three days training to deliver TANDEM to 23 individuals in a pilot randomised controlled trial. rHCPs competence was assessed at post-training using the cognitive first aid rating scale (CFARS) and observation. Fidelity of delivery was assessed using audio-recordings of TANDEM sessions. These were coded using the CFARS and a study adherence scale.

Findings

Nine rHCPs were trained, eight of which were deemed competent post training. Three facilitators withdrew prior to intervention delivery due to maternity leave or work commitments and three during the delivery phase due to personal reasons. Mean therapeutic competency for facilitators was 43 out of 60 on the CFARS scale and adherence was >95%. Adherence was lower to CBA specific skills than self-management skills but still acceptable Sessions were typically longer than planned, although patients did not report this as a problem of the intervention. Participant retention was 87% and participant feedback suggested TANDEM was highly acceptable to paarticipants.

Consequences

The TANDEM intervention is feasible and acceptable and can be delivered with good fidelity though attrition of the rHCPs was greater than expected. On-going monitoring of fidelity is essential, and training for the main trial will be adapted to address the more challenging aspects of delivering CBA including further support through online resources and ongoing peer support.

Submitted by:

Liz Steed

Funding acknowledgement:

NIHR HTA 13/146/02