Methods | Results | |
---|---|---|
Step 1 Needs assessment: Objectives: establishing participatory planning groups, conducting the needs assessment, specifying desired programme goals | ♦ Literature review of symptom self-management in patients with cancer ♦ Qualitative study on dealing with chemotherapy-related symptoms at home [3] ♦ One discussion session with professional panel and one with patients and caregivers panel | ♦ Needs structured in PRECEDE-model (Fig. 1) ♦ Reported and observed behavioral problems: patients’ poor/inadequate self-management, poor communication and reporting of chemotherapy-related symptoms ♦ Desired program goals: improving self-management and communication/reporting of chemotherapy-related symptoms |
Step 2 Matrices of proximal programme objectives Objectives: stating behavioral and environmental outcomes of the intervention, defining clear performance objectives (POs), creating matrices of change objectives by crossing POs with determinants | ♦ Outline of matrices of proximal programme objectives by project leader ♦ Review of theory and outline of potential determinants ♦ One discussion session with professional panel and two discussion sessions with patients and caregivers panel | ♦ Consensus on four patient performance objectives (POs): Preventing, monitoring, reporting and managing chemotherapy-related symptoms at home ♦ Consensus reached on vital determinants: Self-efficacy and outcome expectations of patients ♦ Matrices of proximal programme objectives for future program receivers (patients) (example in Table 2) ♦ Definition of nursing objectives to support patients’ performance objectives |
Step 3 Selecting theoretical methods and practical strategies Objectives: generating programme ideas, identifying and selecting theoretical methods, selecting or designing practical applications | ♦ Study of methods and theories [16, 18, 19] ♦ Evaluation of the ideas on methods and strategies yielded in the earlier panel meetings ♦ Systematic review of complex nursing interventions aimed at reducing chemotherapy-related symptom burden [10] ♦ One discussion session with professional panel and one with patients and caregivers panel ♦ One discussion session with nursing panel | ♦ Consensus on principal methods of the intervention: tailoring and motivational interviewing ♦ General outline of the intervention (Fig. 2): Brief motivational intervention, advanced on the basis of estimated individual need ♦ Formulation of additional project objective for the purpose of the intervention: revision of written patient information and advices |
Step 4 Producing programme components Objectives: determining preferences for programme design, creating programme scope and sequence, preparing design, reviewing, developing and pretesting programme materials | Intervention manual development: ♦ Formulating nursing approach at every patient contact in the program ♦ Discussion with project team, nursing panel, 2 onco-psychologists | Final intervention manual produced |
New written patient information development: ♦ Web survey eliciting patient feedback (n = 102, characteristics see Table 3) on information and advice for 19 chemotherapy-related symptoms (question format see Table 1) ♦ First revision and second patient feedback round (n = 21) ♦ Feedback and discussion with healthcare professionals (n = 17) | New booklet produced “Dealing with side effects from chemotherapy at home”, outlining the 4 recommended self-management behaviours and presenting information and (professional and fellow patient) advice on 19 side effects | |
Step 5 Planning for adoption, implementation and sustainability Objectives: identifying potential adopters, stating outcomes for programme use, specifying determinants and creating matrices (defining determinants and change objectives) for programme adoption, implementation and sustainability | Planning for the implementation of the intervention in an intervention study: ♦ Planning selection strategy and criteria for the intervention providers in the study ♦ Translating nurse POs into training programme for the intervention nurses ♦ Outlining communication strategy for clinical nurses and other healthcare professionals | ♦ Selection of 6 intervention nurses ♦ 2-day long training programme for the intervention nurses ♦ Meetings (n = 9) with clinical nurses (n = 114) ♦ Meetings with doctors and paramedics |
Step 6 Planning for intervention evaluation Objectives: describing programme outcomes, writing evaluation questions, developing indicators and measues, specifying evaluation design | Together with the project team: ♦ Translating health and quality of life targets, POs and determinants into study outcomes ♦ Choosing appropriate methods and study design | ♦ Protocol of a mixed-methods study ♦ Qualitative approach to explore patient experience with the intervention: satisfaction with intervention, open questions and semi-structured interviews ♦ Quantitative approach to study intervention effect: experimental before-after study with sequential design Primary outcome: Symptom distress Secondary outcomes: Symptom severity Self-efficacy Outcome expectations Self-care |