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Understanding usual care in randomised controlled trials of complex interventions: A multi-method approach

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Understanding usual care in randomised controlled trials of complex interventions : A multi-method approach. / Yorganci, Emel; Evans, Catherine J; Johnson, Halle; Barclay, Stephen; Murtagh, Fliss Em; Yi, Deokhee; Gao, Wei; Pickles, Andrew; Koffman, Jonathan.

In: Palliative Medicine, Vol. 34, No. 5, 269216320905064, 01.05.2020, p. 667-679.

Research output: Contribution to journalArticle

Harvard

Yorganci, E, Evans, CJ, Johnson, H, Barclay, S, Murtagh, FE, Yi, D, Gao, W, Pickles, A & Koffman, J 2020, 'Understanding usual care in randomised controlled trials of complex interventions: A multi-method approach', Palliative Medicine, vol. 34, no. 5, 269216320905064, pp. 667-679. https://doi.org/10.1177/0269216320905064

APA

Yorganci, E., Evans, C. J., Johnson, H., Barclay, S., Murtagh, F. E., Yi, D., Gao, W., Pickles, A., & Koffman, J. (2020). Understanding usual care in randomised controlled trials of complex interventions: A multi-method approach. Palliative Medicine, 34(5), 667-679. [269216320905064]. https://doi.org/10.1177/0269216320905064

Vancouver

Yorganci E, Evans CJ, Johnson H, Barclay S, Murtagh FE, Yi D et al. Understanding usual care in randomised controlled trials of complex interventions: A multi-method approach. Palliative Medicine. 2020 May 1;34(5):667-679. 269216320905064. https://doi.org/10.1177/0269216320905064

Author

Yorganci, Emel ; Evans, Catherine J ; Johnson, Halle ; Barclay, Stephen ; Murtagh, Fliss Em ; Yi, Deokhee ; Gao, Wei ; Pickles, Andrew ; Koffman, Jonathan. / Understanding usual care in randomised controlled trials of complex interventions : A multi-method approach. In: Palliative Medicine. 2020 ; Vol. 34, No. 5. pp. 667-679.

Bibtex Download

@article{103ad9c6c90d424fbd2676568993751f,
title = "Understanding usual care in randomised controlled trials of complex interventions: A multi-method approach",
abstract = "BACKGROUND: Evaluations of complex interventions compared to usual care provided in palliative care are increasing. Not describing usual care may affect the interpretation of an intervention's effectiveness, yet how it can be described remains unclear.AIM: To demonstrate the feasibility of using multi-methods to describe usual care provided in randomised controlled trials (RCTs) of complex interventions, shown within a feasibility cluster RCT.DESIGN: Multi-method approach comprising usual care questionnaires, baseline case note review and focus groups with ward staff completed at study end. Thematic analysis of qualitative data, descriptive statistics of quantitative data, followed by methodological triangulation to appraise approach in relation to study aim.SETTING/PARTICIPANTS: Four general medical wards chosen from UK hospitals. Purposive sampling of healthcare professionals for usual care questionnaires, and focus groups. Review of 20 patients' notes from each ward who died during admission or within 100 days of discharge.RESULTS: Twenty-three usual care questionnaires at baseline, two focus groups comprising 20 healthcare professionals and 80 case note reviews. Triangulation of findings resulted in understanding the usual care provided to the targeted population in terms of context, structures, processes and outcomes for patients, families and healthcare professionals. Usual care was described, highlighting (1) similarities and embedded practices, (2) heterogeneity and (3) subtle changes in care during the trial within and across sites.CONCLUSIONS: We provide a feasible approach to defining usual care that can be practically adopted in different settings. Understanding usual care enhances the reliability of tested complex interventions, and informs research and policy priorities.",
keywords = "Randomised control trials, as usual, comparison, complex interventions, control, mixed-method, multi-method, treatment, usual care",
author = "Emel Yorganci and Evans, {Catherine J} and Halle Johnson and Stephen Barclay and Murtagh, {Fliss Em} and Deokhee Yi and Wei Gao and Andrew Pickles and Jonathan Koffman",
year = "2020",
month = may,
day = "1",
doi = "10.1177/0269216320905064",
language = "English",
volume = "34",
pages = "667--679",
journal = "Palliative Medicine",
issn = "0269-2163",
number = "5",

}

RIS (suitable for import to EndNote) Download

TY - JOUR

T1 - Understanding usual care in randomised controlled trials of complex interventions

T2 - A multi-method approach

AU - Yorganci, Emel

AU - Evans, Catherine J

AU - Johnson, Halle

AU - Barclay, Stephen

AU - Murtagh, Fliss Em

AU - Yi, Deokhee

AU - Gao, Wei

AU - Pickles, Andrew

AU - Koffman, Jonathan

PY - 2020/5/1

Y1 - 2020/5/1

N2 - BACKGROUND: Evaluations of complex interventions compared to usual care provided in palliative care are increasing. Not describing usual care may affect the interpretation of an intervention's effectiveness, yet how it can be described remains unclear.AIM: To demonstrate the feasibility of using multi-methods to describe usual care provided in randomised controlled trials (RCTs) of complex interventions, shown within a feasibility cluster RCT.DESIGN: Multi-method approach comprising usual care questionnaires, baseline case note review and focus groups with ward staff completed at study end. Thematic analysis of qualitative data, descriptive statistics of quantitative data, followed by methodological triangulation to appraise approach in relation to study aim.SETTING/PARTICIPANTS: Four general medical wards chosen from UK hospitals. Purposive sampling of healthcare professionals for usual care questionnaires, and focus groups. Review of 20 patients' notes from each ward who died during admission or within 100 days of discharge.RESULTS: Twenty-three usual care questionnaires at baseline, two focus groups comprising 20 healthcare professionals and 80 case note reviews. Triangulation of findings resulted in understanding the usual care provided to the targeted population in terms of context, structures, processes and outcomes for patients, families and healthcare professionals. Usual care was described, highlighting (1) similarities and embedded practices, (2) heterogeneity and (3) subtle changes in care during the trial within and across sites.CONCLUSIONS: We provide a feasible approach to defining usual care that can be practically adopted in different settings. Understanding usual care enhances the reliability of tested complex interventions, and informs research and policy priorities.

AB - BACKGROUND: Evaluations of complex interventions compared to usual care provided in palliative care are increasing. Not describing usual care may affect the interpretation of an intervention's effectiveness, yet how it can be described remains unclear.AIM: To demonstrate the feasibility of using multi-methods to describe usual care provided in randomised controlled trials (RCTs) of complex interventions, shown within a feasibility cluster RCT.DESIGN: Multi-method approach comprising usual care questionnaires, baseline case note review and focus groups with ward staff completed at study end. Thematic analysis of qualitative data, descriptive statistics of quantitative data, followed by methodological triangulation to appraise approach in relation to study aim.SETTING/PARTICIPANTS: Four general medical wards chosen from UK hospitals. Purposive sampling of healthcare professionals for usual care questionnaires, and focus groups. Review of 20 patients' notes from each ward who died during admission or within 100 days of discharge.RESULTS: Twenty-three usual care questionnaires at baseline, two focus groups comprising 20 healthcare professionals and 80 case note reviews. Triangulation of findings resulted in understanding the usual care provided to the targeted population in terms of context, structures, processes and outcomes for patients, families and healthcare professionals. Usual care was described, highlighting (1) similarities and embedded practices, (2) heterogeneity and (3) subtle changes in care during the trial within and across sites.CONCLUSIONS: We provide a feasible approach to defining usual care that can be practically adopted in different settings. Understanding usual care enhances the reliability of tested complex interventions, and informs research and policy priorities.

KW - Randomised control trials

KW - as usual

KW - comparison

KW - complex interventions

KW - control

KW - mixed-method

KW - multi-method

KW - treatment

KW - usual care

UR - http://www.scopus.com/inward/record.url?scp=85081576330&partnerID=8YFLogxK

U2 - 10.1177/0269216320905064

DO - 10.1177/0269216320905064

M3 - Article

C2 - 32081088

VL - 34

SP - 667

EP - 679

JO - Palliative Medicine

JF - Palliative Medicine

SN - 0269-2163

IS - 5

M1 - 269216320905064

ER -

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