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Implementation of the milestones communication approach for patients with limited prognosis: evaluation of intervention fidelity.
BMC Palliat Care. 2020 Feb 18; 19(1):21.BP

Abstract

BACKGROUND

Despite improvements in diagnostics and therapy, the majority of lung tumours are diagnosed at advanced stage IV with a poor prognosis. Due to the nature of an incurable disease, patients need to engage in shared decision making on advance care planning. To implement this in clinical practice, effective communication between patients, caregivers and healthcare professionals is essential. The Heidelberg Milestones Communication Approach (MCA) is delivered by a specifically trained interprofessional tandem and consists of four milestone conversations (MCs) at pivotal times in the disease trajectory. MC 1 (Diagnosis): i.e. prognosis; MC 2 (Stable disease): i.e. prognostic awareness; MC 3 (Progression): i.e. reassessment; MC 4 (Best supportive care): i.e. end of treatment. In between MCs, follow-up calls are carried out to sustain communication. This study aimed to assess to what extent the MCA was implemented as planned and consolidated in specialized oncology practice.

METHODS

A prospective observational process evaluation study was conducted, which focused on the implementation fidelity of the MCA. All MCs during two assessment periods were included. We analysed all written records of the conversations, which are part of the routine documentation during MCs and follow-up calls. Adherence to key aspects of the manual was documented on structured checklists at the beginning of the implementation of the MCA and after 6 months. The analysis was descriptive. Differences between the two assessment periods are analysed with chi-square tests.

RESULTS

A total of 133 MCs and 54 follow-up-calls (t1) and of 172 MCs and 92 follow-up calls (t2) were analysed. MC 2 were the most frequently completed conversations (n = 51 and n = 47). Advance care planning was discussed in 26 and 13% of MC 2 in the respective assessment periods; in 31 and 47% of MC 2, prognostic awareness was recorded. The most frequently documented topic in the follow-up calls was the physical condition in patients (82 and 83%).

CONCLUSION

The implementation of a trajectory-specific communication concept was largely successful. Additional studies are needed to understand how fidelity could be further improved.

TRIAL REGISTRATION

DRKS00013469 / Date of registration: 22.12.2017.

Authors+Show Affiliations

Department of General Practice and Health Service Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany. jasmin.bossert@med.uni-heidelberg.de.Department of General Practice and Health Service Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany.Department of Thoracic Oncology, Thoraxklinik Heidelberg, Heidelberg University Hospital, Röntgenstraβe 1, D-69126, Heidelberg, Germany.Department of Thoracic Oncology, Thoraxklinik Heidelberg, Heidelberg University Hospital, Röntgenstraβe 1, D-69126, Heidelberg, Germany.Department of Thoracic Oncology, Thoraxklinik Heidelberg, Heidelberg University Hospital, Röntgenstraβe 1, D-69126, Heidelberg, Germany.Department of Thoracic Oncology, Thoraxklinik Heidelberg, Heidelberg University Hospital, Röntgenstraβe 1, D-69126, Heidelberg, Germany.Department of Thoracic Oncology, Thoraxklinik Heidelberg, Heidelberg University Hospital, Röntgenstraβe 1, D-69126, Heidelberg, Germany.Institute of Medical and Pharmaceutical Proficiency Assessment, Malakoff Passage, Rheinstraβe 4, D-55116, Mainz, Germany.Institute of Medical and Pharmaceutical Proficiency Assessment, Malakoff Passage, Rheinstraβe 4, D-55116, Mainz, Germany.Department of General Practice and Health Service Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany.

Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

32070311

Citation

Bossert, Jasmin, et al. "Implementation of the Milestones Communication Approach for Patients With Limited Prognosis: Evaluation of Intervention Fidelity." BMC Palliative Care, vol. 19, no. 1, 2020, p. 21.
Bossert J, Wensing M, Thomas M, et al. Implementation of the milestones communication approach for patients with limited prognosis: evaluation of intervention fidelity. BMC Palliat Care. 2020;19(1):21.
Bossert, J., Wensing, M., Thomas, M., Villalobos, M., Jung, C., Siegle, A., Hagelskamp, L., Deis, N., Jünger, J., & Krug, K. (2020). Implementation of the milestones communication approach for patients with limited prognosis: evaluation of intervention fidelity. BMC Palliative Care, 19(1), 21. https://doi.org/10.1186/s12904-020-0527-1
Bossert J, et al. Implementation of the Milestones Communication Approach for Patients With Limited Prognosis: Evaluation of Intervention Fidelity. BMC Palliat Care. 2020 Feb 18;19(1):21. PubMed PMID: 32070311.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Implementation of the milestones communication approach for patients with limited prognosis: evaluation of intervention fidelity. AU - Bossert,Jasmin, AU - Wensing,Michel, AU - Thomas,Michael, AU - Villalobos,Matthias, AU - Jung,Corinna, AU - Siegle,Anja, AU - Hagelskamp,Laura, AU - Deis,Nicole, AU - Jünger,Jana, AU - Krug,Katja, Y1 - 2020/02/18/ PY - 2019/06/05/received PY - 2020/02/14/accepted PY - 2020/2/20/entrez PY - 2020/2/20/pubmed PY - 2020/10/2/medline KW - Advances care planning KW - Communication KW - Lung cancer KW - Patient preferences KW - Prognostic awareness SP - 21 EP - 21 JF - BMC palliative care JO - BMC Palliat Care VL - 19 IS - 1 N2 - BACKGROUND: Despite improvements in diagnostics and therapy, the majority of lung tumours are diagnosed at advanced stage IV with a poor prognosis. Due to the nature of an incurable disease, patients need to engage in shared decision making on advance care planning. To implement this in clinical practice, effective communication between patients, caregivers and healthcare professionals is essential. The Heidelberg Milestones Communication Approach (MCA) is delivered by a specifically trained interprofessional tandem and consists of four milestone conversations (MCs) at pivotal times in the disease trajectory. MC 1 (Diagnosis): i.e. prognosis; MC 2 (Stable disease): i.e. prognostic awareness; MC 3 (Progression): i.e. reassessment; MC 4 (Best supportive care): i.e. end of treatment. In between MCs, follow-up calls are carried out to sustain communication. This study aimed to assess to what extent the MCA was implemented as planned and consolidated in specialized oncology practice. METHODS: A prospective observational process evaluation study was conducted, which focused on the implementation fidelity of the MCA. All MCs during two assessment periods were included. We analysed all written records of the conversations, which are part of the routine documentation during MCs and follow-up calls. Adherence to key aspects of the manual was documented on structured checklists at the beginning of the implementation of the MCA and after 6 months. The analysis was descriptive. Differences between the two assessment periods are analysed with chi-square tests. RESULTS: A total of 133 MCs and 54 follow-up-calls (t1) and of 172 MCs and 92 follow-up calls (t2) were analysed. MC 2 were the most frequently completed conversations (n = 51 and n = 47). Advance care planning was discussed in 26 and 13% of MC 2 in the respective assessment periods; in 31 and 47% of MC 2, prognostic awareness was recorded. The most frequently documented topic in the follow-up calls was the physical condition in patients (82 and 83%). CONCLUSION: The implementation of a trajectory-specific communication concept was largely successful. Additional studies are needed to understand how fidelity could be further improved. TRIAL REGISTRATION: DRKS00013469 / Date of registration: 22.12.2017. SN - 1472-684X UR - https://www.unboundmedicine.com/medline/citation/32070311/Implementation_of_the_milestones_communication_approach_for_patients_with_limited_prognosis:_evaluation_of_intervention_fidelity_ L2 - https://bmcpalliatcare.biomedcentral.com/articles/10.1186/s12904-020-0527-1 DB - PRIME DP - Unbound Medicine ER -