Lupetu Ives Ntambwe

The study protocol of: 'initiating end of life care in stroke: clinical decision-making around prognosis'

BackgroundThe initiation of end of life care in an acute stroke context should be focused on those patients and families with greatest need. This requires clinicians to synthesise information on prognosis, patterns (trajectories) of dying and patient and family preferences. Within acute stroke, prognostic models are available to identify risks of dying, but variability in dying trajectories makes it difficult for clinicians to know when to commence palliative interventions. This study aims to investigate clinicians’ use of different types of evidence in decisions to initiate end of life care within trajectories typical of the acute stroke population.Methods/designThis two-phase, mixed methods study comprises investigation of dying trajectories in acute stroke (Phase 1), and the use of clinical scenarios to investigate clinical decision-making in the initiation of palliative care (Phase 2). It will be conducted in four acute stroke services in North Wales and North West England. Patient and public involvement is integral to this research, with service users involved at each stage.DiscussionThis study will be the first to examine whether patterns of dying reported in other diagnostic groups are transferable to acute stroke care. The strengths and limitations of the study will be considered. This research will produce comprehensive understanding of the nature of clinical decision-making around end of life care in an acute stroke context, which in turn will inform the development of interventions to further build staff knowledge, skills and confidence in this challenging aspect of acute stroke care.

Interventions for preventing unintended repeat pregnancies among adolescents

This is the protocol for a review and there is no abstract. The objectives are as follows: To identify and evaluate the effectiveness of interventions for preventing repeat unintended pregnancies among adolescents, and to determine the barriers and facilitators for their implementation and uptake. Specific review question are to determine: What are the barriers and facilitators to the acceptability, uptake and implementation of interventions? What factors characterise subgroups who are at greater risk of repeat unintended pregnancies (i.e. what are the predictors of repeat unintended pregnancy)? Which (elements of) interventions appear to be effective, how do they work, in what setting and for whom (conversely, why are they ineffective, why do they not work)? What evidence is there on the relative cost-effectiveness of interventions to prevent teenage pregnancy? What specific methodological challenges does application of health economics to this area raise and how are these challenges being overcome?