Timely short-term specialised palliative home care for older people with frailty and their family: a mixed-methods pilot randomised controlled trial and process evaluation

Frailty+ trial group; Kim de Nooijer; Nele Van Den Noortgate; Peter Pype; Lara Pivodic; Lieve Van den Block

doi:10.1136/bmjopen-2023-077495

Timely short-term specialised palliative home care for older people with frailty and their family: a mixed-methods pilot randomised controlled trial and process evaluation

Frailty+ trial group, Kim de Nooijer, Nele Van Den Noortgate, Peter Pype, Lara Pivodic, Lieve Van den Block

Research output: Contribution to journal › Article › peer-review

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Abstract

OBJECTIVE: The primary study aims were to evaluate the implementation, mechanisms and context of a timely short-term specialised palliative care intervention for older people with frailty (Frailty+ intervention) as well as to assess the feasibility of a randomised controlled trial to evaluate Frailty+. Our secondary aim was to describe any preliminary effects of Frailty+.

DESIGN: Pilot randomised controlled trial with process evaluation.

SETTING/PARTICIPANTS: We aimed to recruit 50 adults (≥70 years) with Clinical Frailty Scale score 5-7, and complex care needs and their main family carer, if available, from two Belgian hospitals on discharge.

INTERVENTIONS: Patients were randomised to the Frailty+ intervention alongside standard care or standard care alone.

OUTCOME MEASURES: Implementation and trial feasibility were assessed through interviews, focus groups and quantitative data. The primary outcome to be used in a potential full-scale trial if the study is feasible and implementable was mean change in five palliative care symptoms over 8 weeks.

RESULTS: We enrolled 37 patients (19 intervention, 18 control) and 26 family carers (15 intervention, 11 control). Patients and family carers valued the home visits from palliative care nurses, and nurses saw value in Frailty+. But most patients received only one visit over 8 weeks, and nurses did not organise foreseen multidisciplinary meetings, referring to absence of urgent needs. Many aspects of the trial methods were feasible, but recruitment was challenging. The baseline mean score on the five palliative care symptoms was 6.0 and 5.6 in intervention and control group, respectively; and 4.5 and 4.1 at 8 weeks (adjusted ratio 1.0, ie, no effects on symptoms).

CONCLUSIONS: While Frailty+ was generally welcomed by older people with frailty, families and palliative care nurses, our process evaluation uncovered multiple barriers, mostly rooted in the current organisation of specialised palliative care that is tailored to advanced stages of illness. Ensuring timely access requires efforts beyond timely referral alone, and implies profound organisational and cultural change.

TRIAL REGISTRATION NUMBER: ISRCTN39282347.

Original language	English
Article number	e077495
Pages (from-to)	1-18
Number of pages	18
Journal	BMJ Open
Volume	15
Issue number	2
DOIs	https://doi.org/10.1136/bmjopen-2023-077495
Publication status	Published - 3 Feb 2025

Bibliographical note

© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.

Funding Information:
We would like to thank the patients and family caregivers who participated in this study. We also extend our gratitude to the healthcare staff at the participating hospitals for their involvement in identifying the patients, as well as to the specialised palliative care teams who delivered the Frailty+ intervention. The authors would like to thank Stefanie De Buyser for her statistical advice, Rose Miranda for her assistance with qualitative data analysis and Kim Eecloo, Aurelie Joos and Katlijn Van Mulders for their cooperation in coordinating the study and collecting the data at the participating hospitals. LP is a Senior Postdoctoral Fellow at the Research Foundation-Flanders (FWO), and LVdB is appointed as Francqui Research Professor (Francqui Foundation). This work was supported by the Research Foundation-Flanders [G.0303.16N].

Publisher Copyright:
© Author(s) (or their employer(s)) 2025.

Keywords

Humans
Palliative Care/methods
Male
Aged
Female
Pilot Projects
Home Care Services/organization & administration
Frail Elderly
Aged, 80 and over
Belgium
Caregivers
Frailty
Feasibility Studies
Focus Groups
Process Assessment, Health Care

Access to Document

10.1136/bmjopen-2023-077495Licence: CC BY-NC-ND

2025_deNooijerK_BMJOpenFinal published version, 538 KBLicence: CC BY-NC-ND

Cite this

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title = "Timely short-term specialised palliative home care for older people with frailty and their family: a mixed-methods pilot randomised controlled trial and process evaluation",

abstract = "OBJECTIVE: The primary study aims were to evaluate the implementation, mechanisms and context of a timely short-term specialised palliative care intervention for older people with frailty (Frailty+ intervention) as well as to assess the feasibility of a randomised controlled trial to evaluate Frailty+. Our secondary aim was to describe any preliminary effects of Frailty+.DESIGN: Pilot randomised controlled trial with process evaluation.SETTING/PARTICIPANTS: We aimed to recruit 50 adults (≥70 years) with Clinical Frailty Scale score 5-7, and complex care needs and their main family carer, if available, from two Belgian hospitals on discharge.INTERVENTIONS: Patients were randomised to the Frailty+ intervention alongside standard care or standard care alone.OUTCOME MEASURES: Implementation and trial feasibility were assessed through interviews, focus groups and quantitative data. The primary outcome to be used in a potential full-scale trial if the study is feasible and implementable was mean change in five palliative care symptoms over 8 weeks.RESULTS: We enrolled 37 patients (19 intervention, 18 control) and 26 family carers (15 intervention, 11 control). Patients and family carers valued the home visits from palliative care nurses, and nurses saw value in Frailty+. But most patients received only one visit over 8 weeks, and nurses did not organise foreseen multidisciplinary meetings, referring to absence of urgent needs. Many aspects of the trial methods were feasible, but recruitment was challenging. The baseline mean score on the five palliative care symptoms was 6.0 and 5.6 in intervention and control group, respectively; and 4.5 and 4.1 at 8 weeks (adjusted ratio 1.0, ie, no effects on symptoms).CONCLUSIONS: While Frailty+ was generally welcomed by older people with frailty, families and palliative care nurses, our process evaluation uncovered multiple barriers, mostly rooted in the current organisation of specialised palliative care that is tailored to advanced stages of illness. Ensuring timely access requires efforts beyond timely referral alone, and implies profound organisational and cultural change.TRIAL REGISTRATION NUMBER: ISRCTN39282347.",

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Timely short-term specialised palliative home care for older people with frailty and their family: a mixed-methods pilot randomised controlled trial and process evaluation. / Frailty+ trial group ; de Nooijer, Kim; Van Den Noortgate, Nele et al.
In: BMJ Open, Vol. 15, No. 2, e077495, 03.02.2025, p. 1-18.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Timely short-term specialised palliative home care for older people with frailty and their family

T2 - a mixed-methods pilot randomised controlled trial and process evaluation

AU - Frailty+ trial group

AU - de Nooijer, Kim

AU - Van Den Noortgate, Nele

AU - Pype, Peter

AU - Pivodic, Lara

AU - Van den Block, Lieve

N1 - © Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group. Funding Information: We would like to thank the patients and family caregivers who participated in this study. We also extend our gratitude to the healthcare staff at the participating hospitals for their involvement in identifying the patients, as well as to the specialised palliative care teams who delivered the Frailty+ intervention. The authors would like to thank Stefanie De Buyser for her statistical advice, Rose Miranda for her assistance with qualitative data analysis and Kim Eecloo, Aurelie Joos and Katlijn Van Mulders for their cooperation in coordinating the study and collecting the data at the participating hospitals. LP is a Senior Postdoctoral Fellow at the Research Foundation-Flanders (FWO), and LVdB is appointed as Francqui Research Professor (Francqui Foundation). This work was supported by the Research Foundation-Flanders [G.0303.16N]. Publisher Copyright: © Author(s) (or their employer(s)) 2025.

PY - 2025/2/3

Y1 - 2025/2/3

N2 - OBJECTIVE: The primary study aims were to evaluate the implementation, mechanisms and context of a timely short-term specialised palliative care intervention for older people with frailty (Frailty+ intervention) as well as to assess the feasibility of a randomised controlled trial to evaluate Frailty+. Our secondary aim was to describe any preliminary effects of Frailty+.DESIGN: Pilot randomised controlled trial with process evaluation.SETTING/PARTICIPANTS: We aimed to recruit 50 adults (≥70 years) with Clinical Frailty Scale score 5-7, and complex care needs and their main family carer, if available, from two Belgian hospitals on discharge.INTERVENTIONS: Patients were randomised to the Frailty+ intervention alongside standard care or standard care alone.OUTCOME MEASURES: Implementation and trial feasibility were assessed through interviews, focus groups and quantitative data. The primary outcome to be used in a potential full-scale trial if the study is feasible and implementable was mean change in five palliative care symptoms over 8 weeks.RESULTS: We enrolled 37 patients (19 intervention, 18 control) and 26 family carers (15 intervention, 11 control). Patients and family carers valued the home visits from palliative care nurses, and nurses saw value in Frailty+. But most patients received only one visit over 8 weeks, and nurses did not organise foreseen multidisciplinary meetings, referring to absence of urgent needs. Many aspects of the trial methods were feasible, but recruitment was challenging. The baseline mean score on the five palliative care symptoms was 6.0 and 5.6 in intervention and control group, respectively; and 4.5 and 4.1 at 8 weeks (adjusted ratio 1.0, ie, no effects on symptoms).CONCLUSIONS: While Frailty+ was generally welcomed by older people with frailty, families and palliative care nurses, our process evaluation uncovered multiple barriers, mostly rooted in the current organisation of specialised palliative care that is tailored to advanced stages of illness. Ensuring timely access requires efforts beyond timely referral alone, and implies profound organisational and cultural change.TRIAL REGISTRATION NUMBER: ISRCTN39282347.

AB - OBJECTIVE: The primary study aims were to evaluate the implementation, mechanisms and context of a timely short-term specialised palliative care intervention for older people with frailty (Frailty+ intervention) as well as to assess the feasibility of a randomised controlled trial to evaluate Frailty+. Our secondary aim was to describe any preliminary effects of Frailty+.DESIGN: Pilot randomised controlled trial with process evaluation.SETTING/PARTICIPANTS: We aimed to recruit 50 adults (≥70 years) with Clinical Frailty Scale score 5-7, and complex care needs and their main family carer, if available, from two Belgian hospitals on discharge.INTERVENTIONS: Patients were randomised to the Frailty+ intervention alongside standard care or standard care alone.OUTCOME MEASURES: Implementation and trial feasibility were assessed through interviews, focus groups and quantitative data. The primary outcome to be used in a potential full-scale trial if the study is feasible and implementable was mean change in five palliative care symptoms over 8 weeks.RESULTS: We enrolled 37 patients (19 intervention, 18 control) and 26 family carers (15 intervention, 11 control). Patients and family carers valued the home visits from palliative care nurses, and nurses saw value in Frailty+. But most patients received only one visit over 8 weeks, and nurses did not organise foreseen multidisciplinary meetings, referring to absence of urgent needs. Many aspects of the trial methods were feasible, but recruitment was challenging. The baseline mean score on the five palliative care symptoms was 6.0 and 5.6 in intervention and control group, respectively; and 4.5 and 4.1 at 8 weeks (adjusted ratio 1.0, ie, no effects on symptoms).CONCLUSIONS: While Frailty+ was generally welcomed by older people with frailty, families and palliative care nurses, our process evaluation uncovered multiple barriers, mostly rooted in the current organisation of specialised palliative care that is tailored to advanced stages of illness. Ensuring timely access requires efforts beyond timely referral alone, and implies profound organisational and cultural change.TRIAL REGISTRATION NUMBER: ISRCTN39282347.

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KW - Aged

KW - Female

KW - Pilot Projects

KW - Home Care Services/organization & administration

KW - Frail Elderly

KW - Aged, 80 and over

KW - Belgium

KW - Caregivers

KW - Frailty

KW - Feasibility Studies

KW - Focus Groups

KW - Process Assessment, Health Care

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Timely short-term specialised palliative home care for older people with frailty and their family: a mixed-methods pilot randomised controlled trial and process evaluation

Abstract

Bibliographical note

Keywords

Access to Document

Other files and links

BASGO17: OZR Basisfinanciering voor Grote Onderzoeksgroepen - EOLC

SRP69: SRP-Onderzoekszwaartepunt: Addressing the challenges around serious illness, palliative care and the end of life: public health, health services and clinical innovations

FWOAL810: Developing and evaluating short-term palliative care for frail older people

Questionnaire data frailty+ study - Topic guides, protocol, transcript en codebook

Logbook analysis frailty+ study - Logbooks + codebook

Focus groups frailty+ study - Topic guides, protocol, transcript en codebook

Cite this

Timely short-term specialised palliative home care for older people with frailty and their family: a mixed-methods pilot randomised controlled trial and process evaluation

Abstract

Bibliographical note

Keywords

Access to Document

Other files and links

Projects

BASGO17: OZR Basisfinanciering voor Grote Onderzoeksgroepen - EOLC

SRP69: SRP-Onderzoekszwaartepunt: Addressing the challenges around serious illness, palliative care and the end of life: public health, health services and clinical innovations

FWOAL810: Developing and evaluating short-term palliative care for frail older people

Datasets

Questionnaire data frailty+ study - Topic guides, protocol, transcript en codebook

Logbook analysis frailty+ study - Logbooks + codebook

Focus groups frailty+ study - Topic guides, protocol, transcript en codebook

Cite this