Full text is available at the source.
Health technology assessment (Winchester, England)··
Testing a pre-surgery program to help reduce drinking before planned bone and joint surgery
Updated
Abstract
Recruitment of eligible participants to the pilot trial was 34%, which fell short of the progression criteria.
- The initial recruitment of eligible patients was low but improved after optimizing recruitment processes.
- Retention of participants was high at 96% during the 6-month follow-up.
- Qualitative analyses indicated that the intervention methods were acceptable to both patients and healthcare professionals.
- Recommendations for improving recruitment were provided based on multimethod analyses.
- The findings suggest feasibility for a definitive trial to assess the effectiveness of a brief behavioural intervention in reducing preoperative alcohol consumption.
Simplified
BACKGROUND: Heavy alcohol consumption is associated with an increased risk of postoperative complications and extended hospital stay. Alcohol consumption therefore represents a modifiable risk factor for surgical outcomes. Brief behavioural interventions have been shown to be effective in reducing alcohol consumption among increased risk and risky drinkers in other health-care settings and may offer a method of addressing preoperative alcohol consumption.
OBJECTIVES: To investigate the feasibility of introducing a screening process to assess adult preoperative drinking levels and to deliver a brief behavioural intervention adapted for the target population group. To conduct a two-arm (brief behavioural intervention plus standard preoperative care vs. standard preoperative care alone), multicentre, pilot randomised controlled trial to assess the feasibility of proceeding to a definitive trial. To conduct focus groups and a national web-based survey to establish current treatment as usual for alcohol screening and intervention in preoperative assessment.
DESIGN: A single-centre, qualitative, feasibility study was followed by a multicentre, two-arm (brief behavioural intervention vs. treatment as usual), individually randomised controlled pilot trial with an embedded qualitative process evaluation. Focus groups and a quantitative survey were employed to characterise treatment as usual in preoperative assessment.
SETTING: The feasibility study took place at a secondary care hospital in the north-east of England. The pilot trial was conducted at three large secondary care centres in the north-east of England.
PARTICIPANTS: Nine health-care professionals and 15 patients (mean age 70.5 years, 86.7% male) participated in the feasibility study. Eleven health-care professionals and 68 patients (mean age 66.2 years, 80.9% male) participated in the pilot randomised trial. An additional 19 health-care professionals were recruited to one of three focus groups, while 62 completed an electronic survey to characterise treatment as usual.
INTERVENTIONS: The brief behavioural intervention comprised two sessions. The first session, delivered face to face in the preoperative assessment clinic, involved 5 minutes of structured brief advice followed by 15-20 minutes of behaviour change counselling, including goal-setting, problem-solving and identifying sources of social support. The second session, an optional booster, took place approximately 1 week before surgery and offered the opportunity to assess progress and boost self-efficacy.
MAIN OUTCOME MEASURES: Feasibility was assessed using rates of eligibility, recruitment and retention. The progression criteria for a definitive trial were recruitment of ≥ 40% of eligible patients and retention of ≥ 70% at 6-month follow-up. Acceptability was assessed using themes identified in qualitative data.
RESULTS: The initial recruitment of eligible patients was low but improved with the optimisation of recruitment processes. The recruitment of eligible participants to the pilot trial (34%) fell short of the progression criteria but was mitigated by very high retention (96%) at the 6-month follow-up. Multimethod analyses identified the methods as acceptable to the patients and professionals involved and offers recommendations of ways to further improve recruitment.
CONCLUSIONS: The evidence supports the feasibility of a definitive trial to assess the effectiveness of brief behavioural intervention in reducing preoperative alcohol consumption and for secondary outcomes of surgical complications if recommendations for further improvements are adopted.
TRIAL REGISTRATION: Current Controlled Trials ISRCTN36257982.
FUNDING: This project was funded by the National Institute for Health Research Health Technology Assessment programme and will be published in full in; Vol. 24, No. 12. See the National Institute for Health Research Journals Library website for further project information. Health Technology Assessment
Related papers
Dec '19
Guided self-help for depression in autistic adults: a feasibility trial
cited by 19 papers
randomized controlled trial
Mar '20
Testing a support program for parents with serious personality challenges whose children have mental health issues
cited by 11 papers
randomized controlled trial
Oct '19
Using the AMBER care plan for hospital patients with uncertain recovery near end of life: a feasibility trial
cited by 18 papers
randomized controlled trial
Aug '24
Health screening clinic to reduce NHS staff absence and working while sick: eTHOS pilot trial
top 30% journal
randomized controlled trial
Sep '19
Testing activity-based therapy for depression after stroke: a feasibility trial
cited by 55 papers
randomized controlled trial