INTEGRATE-HTA: Integrated assessment of home based palliative care with and without reinforced caregiver support: ‘A demonstration of INTEGRATE-HTA methodological guidances’

What are the aims of this project?

The INTEGRATE-HTA project aims to develop concepts and methods for a comprehensive, patient-centred, and integrated assessment of complex health technologies that considers

  • effectiveness and economic, sociocultural, ethical, and legal issues,
  • patient preferences and patient-specific moderators of treatment,
  • context and implementation issues.

These concepts and methods were applied in a palliative care case study that examined home based palliative care services with and without an element of caregiver support.

Why is this important?

For complex health technologies decision-makers need assessment of information to be conducted and presented in an integrated way and integration needs to start from the beginning of the assessment.

How will the research be carried out?

The research has been completed using a range of methods, primarily involving evidence synthesis and stakeholder advice.
The case study reports on how we used some of the methods developed within the INTEGRATE-HTA project to assess home based palliative are with and without an additional component of caregiver support (known as “reinforced” (rHBPC) and “non-reinforced” (HBPC) home based palliative care respectively). We assessed:

  • the effectiveness (whether home base palliative care works);
  • the costs,
  • social and cultural factors,
  • ethical aspects,
  • legal aspects,
  • differences between patients including differences in the effectiveness of treatments and differences in preferences.

We also examined aspects of context and implementation related to the situation in which reinforced (rHBPC) and non-reinforced home based palliative care (HBPC) services were provided.
We included lay (i.e. patients, carers and ex-carers with experience of palliative care) and professional stakeholders (i.e. service commissioners, service managers, health and social care professionals and academics working in palliative care) throughout the project.

Timeframe:

The project started on January 1st 2013 and ends 31st December 2015.

Who is undertaking the research?

The INTEGRATE-HTA consortium consists of 7 partners from 5 different countries (England, Germany, Italy, the Netherlands, Norway). Colleagues in Lithuania and Poland have also taken part.

How are stakeholders being engaged?

The case study has demonstrated a range of ways in which stakeholders can be involved throughout the HTA process, some of which were novel. Stakeholders in seven countries highlighted similar issues affecting palliative care which complemented review level evidence and provided clear direction when scoping the project. Stakeholders then provided experiential evidence in several assessment aspects (e.g. the assessment of socio-cultural issues). They were also able to comment on findings of evidence assessment, providing possible explanations for these and identifying gaps in the knowledge base and assisting the research team to understand the implications of the work completed 9e.g. for the effectiveness, moderators of treatment effect and patient preference assessments). Stakeholders also took part in a ‘mock decision making meeting towards the end of the project. Stakeholder involvement potentially increases the impact of the case study on practice as service commissioners took part in face-face, telephone and Skype meetings, as did health and social care professionals, service users and their family carers. Such widespread stakeholder involvement raises the profile of home based palliative care services and the need for caregiver support, potentially initiating discussions about the action that is required to support them or address the issues raised. The added value of stakeholder involvement has been clearly demonstrated in a number of ways. The colloquial evidence provided by stakeholders serves to compliment published / traditional types of evidence.

What will be the outputs from the study?

A number of outputs are planned from the project, including publications and presentations.
Presentations and papers from the project will be listed here.

Refereed Conference Presentations - Abstracts in Print

  1. Brereton, L., Goyder, E., Ingleton, C., Gardiner, C., Chilcott, J., van der Wilt, GJ, Oortwijn, W.J., Mozygemba, K., Lysdahl, K.B., Sacchini, D., Leppert, W. (2014). Patient and public involvement in scope development for a palliative care health technology assessment in Europe. BMJ supportive & palliative care, 4 (Suppl 1), A40-A41. (2014) (Poster presented at the 10th Palliative Care Congress – Harrogate, England 10th – 12th March 2014.)
  2. Brereton, L., Clark, J. D., Ingleton, C., Gardiner, C., Preston, L., Ryan, T. W., Gath, J., Ward, S.E., Goyder, E. (2015) What do we know about different models of specialist palliative care? Findings from a review of reviews. In 14th World Research Congress of the European Association for Palliative Care 8-10 May Copenhagen, Denmark P1-177 (page 106)
  3. Brereton, L., Chilcott, J., Ingleton, C., Gardiner, C., Preston, L., Ward, S., Goyder, E. (2015) Stakeholder involvement in Health Technology Assessment scope development: Contrasting views of patients and professionals about issues affecting the organisation and development of palliative care services In 14th World Research Congress of the European Association for Palliative Care 8-10 May Copenhagen, Denmark P2-327 (page 240)
  4. Leppert W., Stachowiak A , Koszela M., Brereton L. (2015) Preliminary Findings from the Stakeholder Advisory Panel Meetings with Experts and Families in a Project Health Technology Assessment –INTEGRATE in Poland In 14th World Research Congress of the European Association for Palliative Care 8-10 May Copenhagen, Denmark P2-198 (page 214)
  5. Sacchini D., Refolo P., De Nicola M., Brereton L.M., Spagnolo A.G., INTEGRATE-HTA Project Team (2015) Italian Palliative Care Services: The Role of Patients’ and Professionals’ Views in Health Technology Assessment Scope Development In 14th World Research Congress of the European Association for Palliative Care 8-10 May Copenhagen, Denmark P2-335 (page 242)

Refereed Conference Presentations

  1. Burns J., Polus S., Brereton, L., Ward, Susan., Chilcott, J., Pfadenhauer, L., & Rehfuess, E. Making sense of complex interventions: evidence synthesis through harvest plots and post-review expert consultations. Rapid oral presentation led by J. Burns at the 23rd Cochrane Colloquium, Vienna Austria 3rd-7th October 2015.
  2. Wahlster,P., Baltussen, R., Brereton, L., Burns, J., Hofmann, B., Mozygemba, K., Oortwijn, W., Polus, S., Rehfuess, E., van der Wilt, G.J. & Gerhardus, A. (2015) Towards a comprehensive and integrated assessment of complex health technologies: The INTEGRATE-HTA process model presented at the 12th Annual Meeting of Health Technology Assessment international (HTAi) in Oslo, Norway 14th–17th June 2015.
  3. Wahlster,P., Baltussen, R., Brereton, L., Burns, J., Hofmann, B., Mozygemba, K., Oortwijn, W., Polus, S., Rehfuess, E., van der Wilt, G.J. & Gerhardus, A. (2015) How to integrate apples and oranges? – A systematic review of approaches to integrate different dimensions in HTA presented at the 12th Annual Meeting of Health Technology Assessment international (HTAi) in Oslo, Norway 14th–17th June 2015.
  4. Brereton, L., Goyder, E., Ingleton, C., Gardiner, C., Chilcott, J., van der Wilt, GJ, Oortwijn, W.J., Mozygemba, K., Lysdahl, K.B., Sacchini, D., Leppert, W., (2014) International experiences of Patient and Public Involvement (PPI) in the INTEGRATE-HTA project. Oral paper presented at the INVOLVE conference in National Exhibition Centre (NEC) in Birmingham, United Kingdom on the 26 and 27 November 2014.
  5. Cork, S., Gath, J. & Brereton, L. (2014) The Sheffield experience of Patient & Public Involvement (PPI) in the INTEGRATE-HTA Project presented at the INVOLVE conference in Birmingham, United Kingdom on the 26 and 27 November 2014.
  6. Gerhardus, A., Brereton, L., Hofmann, B., Oortwijn, W., Rehfuess, E., Sacchini D. & van der Wilt, G.J. (2014) Integrating Patients’ Perspectives, Context, and Implementation in the Assessment of Complex Health Technologies– presented at the 11th Annual Meeting of Health Technology Assessment international (HTAi) published in " Optimizing patient-centered care in an era of economic uncertainty" (pp. 35-35) held in Washington, United States 16th–18th June 2014..
  7. van der Wilt, G.J., Brereton, L., Chilcott, J., Lysdahl , K.B., Sacchini D. & Mozygemba, K. (2014) Scoping as a means to systematically involve stakeholders in HTA- presented during a panel session at the 11th Annual Meeting of Health Technology Assessment international (HTAi) published in " Optimizing patient-centered care in an era of economic uncertainty" (pp. 1-1) held in Washington, United States 16th–18th June 2014.
  8. Brereton, L., Goyder, E., Ingleton, C., Gardiner, C., Chilcott, J., van der Wilt, GJ, Oortwijn, W.J., Mozygemba, K., Lysdahl, K.B., Sacchini, D., Leppert, W., (2014) ‘Methodological, ethical and governance issues for Patient and Public Involvement in a European health technology assessment of palliative care.’ Poster presented at the 8th World Research Congress of the European Association of Palliative Care – Lleida, Spain 5th – 7th June 2014.
  9. Brereton, L., Goyder, E., Ingleton, C., Gardiner, C., Chilcott, J., van der Wilt, GJ, Oortwijn, W.J., Mozygemba, K., Lysdahl, K.B., Sacchini, D., Leppert, W., (2014) ‘Comparison of topics raised by service commissioners, providers and users in a Health Technology Assessment of palliative care in six European countries..’ Poster presented at the 8th World Research Congress of the European Association of Palliative Care – Lleida, Spain 5th – 7th June 2014.
  10. Goyder, E., Brereton, M.L., Gardiner, C., Mozygemba, K., Sacchini, D., Oortwijn, W.J., Lysdahl, K.B., Rehfuess, E.A., van der Wilt, GJ (2013) ‘Using the best available evidence to inform decision making on complex interventions: Building the future through increasing public and patient involvement in Health Technology Assessment.’ Poster presented at the 6th European Public Health (EUPHA) conference “Health in Europe: Are we there yet? Learning from the past, building the future” – Brussels 13-16th November 2013.

Find out more here http://www.integrate-hta.eu