Integrating palliative care and heart failure: a systematic realist synthesis (PalliatHeartSynthesis).

OBJECTIVES: (1) Develop a programme theory of why, for whom and in what contexts integrated palliative care (PC) and heart failure (HF) services work/do not work; (2) use the programme theory to co-produce with stakeholders, intervention strategies to inform best practice and future research. METHODS: A systematic review of all published articles and grey literature using a realist logic of analysis. The search strategy combined terms significant to the review questions: HF, PC and end of life. Documents were included if they were in English and provided data relevant to integration of PC and HF services. Searches were conducted in November 2021 in EMBASE, MEDLINE, PsycINFO, AMED, HMIC and CINAHL. Further relevant documents were identified via monthly alerts (up until April 2023) and the project stakeholder group (patient/carers, content experts and multidisciplinary practitioners). RESULTS: 130 documents were included (86 research, 22 literature reviews, 22 grey literature). The programme theory identified intervention strategies most likely to support integration of PC and HF services. These included protected time for evidence-based PC and HF education from undergraduate/postgraduate level and continuing professional practice; choice of educational setting (eg, online, face-to-face or hybrid); increased awareness and seeing benefits of PC for HF management; conveying the emotive and intellectual need for integrating PC and HF via credible champions; and prioritising PC and HF guidelines in practice. CONCLUSIONS: The review findings outline the required steps to take to increase the likelihood that all key players have the capacity, opportunity and motivation to integrate PC into HF management. PROSPERO REGISTRATION NUMBER: CRD42021240185.

The structure of the Prodromal Questionnaire-16 (PQ-16) in a non-help-seeking youth population: Exploratory and confirmatory factor analyses study.

AIMS: The present study aimed to examine the structure of the Prodromal Questionnaire-16 (PQ-16) in a non-help-seeking youth population through exploratory and confirmatory factor analysis. Previous studies have not examined the structure of this self-report measure in this age group outside a clinical setting. METHODS: Participants (n = 1165) aged 11-19 years were recruited to an epidemiological study of young people in Northern Ireland, and completed the PQ-16 alongside other measures. The dataset was split randomly in two for separate factor analyses. A polychoric correlation matrix was created and exploratory factor analysis was used to identify the optimal number of factors. In addition, based on previous studies, six models were tested through confirmatory factor analysis to determine best fit. A one-factor, 3 two-factor, a three-factor and a four-factor model were all tested. RESULTS: The exploratory factor analysis indicated a two-factor structure of the PQ-16 in this population, which we have labelled 'general unusual experiences' and 'hallucinations'. Confirmatory analysis indicated that the two-factor model identified through the exploratory analysis was the best fit for the data. DISCUSSION: The present study suggests that the structure of the PQ-16 may vary across age groups in non-clinical settings, and adds further support to the validity of the PQ-16 is a cost-effective, easy to administer self-report measure that is suitable for use in non-help-seeking populations as a screening tool for prodromal symptoms.

Integrating palliative care and heart failure: a protocol for a realist synthesis (PalliatHeartSynthesis).

INTRODUCTION: Heart failure affects over 26 million people worldwide with prevalence expected to grow due to an ageing global population. Palliative care can address the holistic needs of patients with heart failure, and integrated palliative care in heart failure management has been indicated to improve outcomes for patients. Despite known benefits for integrated palliative care in heart failure management, implementation is poor across the majority of global health services. Recent systematic reviews have identified the benefits of integrating palliative care into heart failure management and highlighted barriers to implementation. However, there was heterogeneity in terms of countries, healthcare settings, delivery by differing staff across multidisciplinary teams, modes of delivery and different intervention components. METHODS AND ANALYSIS: The aim of this study is to identify how integrated palliative care and heart failure interventions produce desired outcomes, in which contexts, and for which patients. We will undertake a realist synthesis to identify this, using Pawson's five iterative steps. We will recruit an international stakeholder group comprised of healthcare providers and patients with heart failure to advise and provide feedback throughout the review. Our initial realist programme theory sets out the necessary steps needed to accomplish the final intended outcome(s) from the implementation of integrated palliative care and heart failure. This initial programme theory will be shaped through an iterative process of testing and refinement. ETHICS AND DISSEMINATION: Ethical approval is not required for this study. With our stakeholder group, we will coproduce a user guide that outlines practical advice to optimise, tailor and implement interventions designed to integrate palliative care and heart failure, taking into consideration local context, alongside user-friendly summaries of the synthesis findings using short animations to convey complex findings. We will draw on the expertise within the stakeholder group to identify key stakeholders for disseminating to relevant audiences, ensuring outputs are tailored for their respective needs. PROSPERO REGISTRATION NUMBER: CRD42021240185.

The Structure of the Prodromal Questionnaire-16 (PQ-16): Exploratory and confirmatory factor analyses in a general non-help-seeking population sample.

AIMS: To examine the structure of the Prodromal Questionnaire (PQ-16) in a non-help-seeking population through exploratory factor analysis and confirmatory factor analysis. Previous studies have not looked at the structure of this self-report measure outside clinical settings. METHODS: Participants (n = 1045) were recruited through Amazon's Mechanical Turk (MTurk), and then completed the PQ-16. The data set was split randomly in two, one being used for exploratory factor analysis (EFA) and the other for confirmatory factor analysis (CFA). A polychoric correlation matrix was created and EFA was used to explore the factor structure of the PQ-16. Four models were tested through CFA to determine best fit: one, two, three and four-factor models were all analysed. RESULTS: EFA indicated a two-factor structure in the PQ-16 in a non-help-seeking population (with a mean age = 29.7 years). Factor 1 represented perceptual abnormalities/hallucinations and factor 2 general symptoms associated with psychosis-risk. CFA indicated that all the proposed models were suitable fits for the dataset. Fit indices for the three-factor model (factor 1 representing perceptual abnormalities/hallucinations, factor 2 unusual thought content, and factor 3 negative symptom) indicated that it appeared to be a better fit for the data than the one, two, and four factor models. CONCLUSIONS: This study suggests that a three-factor model of the PQ-16 is a better fit than other proposed models in a non-help-seeking population. Future research of the structure of the PQ-16 in this population may benefit from recruiting subjects with a lower mean age than the current study.

Screening for the at-risk mental state in educational settings: A systematic review.

AIM: The at-risk mental state (ARMS) allows clinicians to identify individuals who have an increased risk of developing psychosis. At present, most screening for psychosis-risk is carried out within help-seeking populations; however, screening within educational settings may allow clinicians to identify individuals at-risk earlier and to increase the rate of detection. This review aimed to examine screening for the ARMS in educational settings, with the key questions: what screening tools have been used in educational settings, can screening in educational settings detect individuals with ARMS, what threshold scores in screening tools indicate a positive screen in educational settings, are there comorbid mental health conditions associated with the ARMS in educational settings? METHODS: Searches were carried out in PsycINFO, MEDLINE, EMBASE, Scopus and Web of Science and reference lists of included articles searched. Results were summarized using narrative synthesis. RESULTS: Nine papers were included for narrative synthesis. A variety of screening tools have been used when screening for the ARMS in educational settings. The majority of studies have been conducted in schools. The prevalence of the ARMS reported in ranges from 1% to 8%. CONCLUSIONS: The ARMS indicates the presence of distressing symptoms for which intervention may be beneficial. Screening programmes within educational settings may allow outreach for prodromal symptoms at an earlier stage than clinical settings currently provided for.