Impact of a team-based versus individual clinician-focused training approach on primary healthcare professionals’ intention to have serious illness conversations with patients: a theory informed process evaluation of a cluster randomized trial

Abstract

ABSTRACTBackgroundCluster Randomized Trials (cRTs) conducted in real-world settings face complex challenges due to diverse practices and populations. Process evaluations alongside cRTs can help explain their results by exploring possible causal mechanisms as the trial proceeds.ObjectiveTo conduct a process evaluation alongside a cRT that compared the impact of team-based vs. individual clinician-focused SICP training on primary healthcare professionals’ (PHCPs) intention to have serious illness conversations with patients.MethodsThe cRT involved 45 primary care practices randomized into a team-based (intervention) or individual clinician-focused training program (comparator) and measured primary outcomes at the patient level: days at home and goal of care. Our theory-informed mixed-methods process evaluation alongside the cRT measured intention to have serious illness conversations with patients among the trained PHCPs using the CPD-Reaction tool. Barriers and facilitators to implementing serious illness conversations were identified through open-ended questions and analyzed using the Theoretical Domains Framework. We used the COM-B framework to perform triangulation of data. We reported results using the CONSORT and GRAMMS reporting guidelines.ResultsOf 535 PHCPs from 45 practices, 373 (69.7%) fully completed CPD-Reaction (30.8% between 25-34 years old; 78.0% women; 54.2% had a doctoral degree; 50.1% were primary care physicians). Mean intention scores for the team-based (n=223) and individual clinician-focused arms (n=150) were 5.97 (Standard Error: 0.11) and 6.42 (Standard Error: 0.13), respectively. Mean difference between arms was 0.0 (95% CI −0.30;0.29; p=0.99) after adjusting for age, education and profession. The team-based arm reported barriers with communication, workflow, and more discomfort in having serious illness conversations with patients.ConclusionsTeam-based training did not outperform individual clinician-focused in influencing PHCPs’ intention to have serious illness conversations. Future team-based interventions could foster behaviour adoption by focusing on interprofessional communication, better organized workflows, and better support and training for non-clinician team members.RegistrationClinicalTrials.gov(ID:NCT03577002).