Table 7 Description of the MUTUAL intervention according to TIDieR [34]
Timing | Intervention component | What Intervention activities, procedures and processes | How Mode of delivery | Who The intervention provider(s) and participants | Materials Resources/tools that support the intervention activities | |
|---|---|---|---|---|---|---|
1) Preparing for start of intervention | ||||||
Engagement, selection and preparation of stakeholders | 6 months prior to start | Selection research teama | The research team and trainers should be selected | NA | The research team should include persons with experience within ACP, palliative care, conversational techniques, intensive care and implementation of interventions | NA |
6 months prior to start | Initiating ACP intervention | The research team should engage important stakeholders including nurses, physicians, supporting staff and management by discussing experiences within healthcare and consequences of absent goals of care when having to make a decision. Informing potential stakeholders of the goals and logistics of the intervention. Determining necessity and support for implementation of the intervention | In group meetings / staff meetings | 1) Research team 2) Stakeholders | NA | |
5 months prior to start | Selection of participating specialties and HCPs | Informing HCPs of the goal of the intervention, inviting HCPs to think about implementation of the intervention within their own specialty | Both individually and group meetings | 1) Research team 2) HCPs from different specialities | Necessary competencies were listed by the research team with help of an educational expert and specialised nurse from the palliative care team | |
2) Components of the MUTUAL intervention | ||||||
Preparation | After all preparations for the intervention are finalised | 1. Patient selection | Selecting, informing and inviting patients for an ACP conversation | Selection of patient using the surprise question at the outpatient clinic | 1) Treating physician | Surprise question: “Would I be surprised if this patient were to die in the next 12 months?” |
Training part 1 – before start of the intervention Training part 2 – during the first two conversations | 2a. HCP preparation | The first training part consists of two sessions of three hours consisting of different elements including 1) Definition, goals and importance of ACP 2)Background information on intensive care treatment and consequences 3) Training in conversational techniques 4) Logistics of the ACP intervention The second part of the training consists of training on the job. An experienced facilitator joins the first two ACP conversations of the facilitating nurse, which are (de)briefed in a structured manner | Part 1 – in a group Part 2 – individually | Part 1 1) Research team provides training 2) Participants: nurses, treating physicians and supporting staff Part 2 1) Experienced facilitator 2) Facilitating nurse | Training material includes 1) Presentation on definition, goals and importance of ACP 2) Presentation on Intensive Care 3) The conversational manual and presentation on conversational techniques | |
After the patient has been informed and invited | 2b. Patient preparation | The treating physician informs the patient about ACP and invites patient to an ACP conversation during an appointment at the outpatient clinic. The preparatory questionnaire and information folder are handed out by supporting staff | NA | 1) Treating physician 2) Patient and proxy | 1) Information folder explaining goals of the conversation 2) Preparatory questionnaire for patient and proxies to prepare for the conversation. The questionnaire includes questions on the themes of the conversation concerning: understanding of illness, experience of health, quality of life, future and goals of care | |
Initiation and exploration | Scheduled 45’ appointment at outpatient clinic | 3a. ACP conversation – part 1 | Conversation exploring patient preferences and goals of care during a scheduled appointment at the outpatient clinic. First part takes approximately 45 min | Personalised | 1) Trained nurse facilitator 2) Patient and proxy | Conversation manual consisting of seven steps: 1) Introduction of topic 2) Quality of life 3) Goals of care 4) Scenarios 5) Representative |
Scheduled 15’ appointment at outpatient clinic | 3b. ACP conversation – part 2 | Consecutive conversation exploring patient preferences and goals of care. Second part takes approximately 15 min and starts with a summary provided by the facilitating nurse | Multidisciplinary | Multidisciplinary setting 1) Trained nurse facilitator 2) Treating physician 3) Patient and proxy/proxies | Conversational manual step: 6) Summary and conclusion | |
Action | Directly after conversation | 4a. Documentation for patient and general practitioner | The nurse documents the content of the conversation using the format within electronic healthcare system | Individually | 1) Nurse documents patient preferences; 2) The patient receives letter 3) GP receives letter | Conversational manual step: 7) Documentation Standardised letter consisting of several components: A) Quality of life and future expectations B) Preferences and goals of care C) Social support D) Conclusion E) Representative F) Treatment registration |
Directly after conversation | 4b. Documentation in health care system | The treating physician documents ADs using the registration for treatment limitations in the healthcare system | Individually | 1) Treating physician | ADs in health care register | |