A complex intervention to support the use of sedative drugs in specialist palliative care: results from the iSedPall pilot study.

Abstract

International studies show intentional sedation to relieve suffering to be a common and relevant treatment in specialist palliative care. The EAPC framework for using sedative drugs has currently been updated and national recommendations have been disseminated. However, there was a lack of hands-on materials targeted for healthcare professionals and of information materials for patients and informal caregivers to ensure patient-centred care. The iSedPall study group developed a complex intervention to further support the use of sedative drugs in specialist palliative care. The following pilot study aimed at examining the feasibility of the intervention being applied in different settings and by different professions. A sequential explanatory mixed-methods design was applied between 02/23 and 01/24. An online survey (pre-post-test) assessed quantitative data on the feasibility of the outcome indicator `confidence in professional skills`, primary feasibility outcomes, and the implementation process. Focus groups added to the quantitative results. Four specialist palliative care services (inpatient and home care) piloted the intervention for nine months. Global mean scores of primary feasibility outcomes proved the intervention as acceptable, appropriate, and feasible for inpatient and home care settings. The outcome indicator seems to be adequate for measuring changes in healthcare professionals` confidence, especially for physicians. The relevance of the intervention, its impact on practice, and the implementation process have been judged heterogeneously. Promoting (e.g., personal exchange, educational materials) and inhibiting factors (e.g., lack of time and technical resources) for implementation have been stated. An implementation study would benefit from adaptations regarding the intervention, study design, and implementation strategy. Especially the nursing perspective has to be considered to a greater extent for strengthening the palliative care approach. Context-specific factors seem to play a key role in implementation. Therefore, training of in-group champions, considering local technical and personal resources, and actively engaging the team could mitigate potential barriers and foster the success. Our findings will inform a full-scale implementation study to further explore the use of the intervention by healthcare professionals in clinical practice. The study was registered in the German Clinical Trials Register (DRKS-ID: DRKS00027241; Date of registration: 10/12/2021; https://www.drks.de/drks_web/setLocale_EN.do).