Sean O'Connor

Effect of accelerated rehabilitation on function after ankle sprain: randomised controlled trial.

Objective To compare an accelerated intervention incorporating early therapeutic exercise after acute ankle sprains with a standard protection, rest, ice, compression, and elevation intervention. Design Randomised controlled trial with blinded outcome assessor. Setting Accident and emergency department and university based sports injury clinic. Participants 101 patients with an acute grade 1 or 2 ankle sprain. Interventions Participants were randomised to an accelerated intervention with early therapeutic exercise (exercise group) or a standard protection, rest, ice, compression, and elevation intervention (standard group). Main outcome measures The primary outcome was subjective ankle function (lower extremity functional scale). Secondary outcomes were pain at rest and on activity, swelling, and physical activity at baseline and at one, two, three, and four weeks after injury. Ankle function and rate of reinjury were assessed at 16 weeks. Results An overall treatment effect was in favour of the exercise group (P=0.0077); this was significant at both week 1 (baseline adjusted difference in treatment 5.28, 98.75% confidence interval 0.31 to 10.26; P=0.008) and week 2 (4.92, 0.27 to 9.57; P=0.0083). Activity level was significantly higher in the exercise group as measured by time spent walking (1.2 hours, 95% confidence interval 0.9 to 1.4 v 1.6, 1.3 to 1.9), step count (5621 steps, 95% confidence interval 4399 to 6843 v 7886, 6357 to 9416), and time spent in light intensity activity (53 minutes, 95% confidence interval 44 to 60 v 76, 58 to 95). The groups did not differ at any other time point for pain at rest, pain on activity, or swelling. The reinjury rate was 4% (two in each group). Conclusion An accelerated exercise protocol during the first week after ankle sprain improved ankle function; the group receiving this intervention was more active during that week than the group receiving standard care. Trial registration Current Controlled Trials ISRCTN13903946.

The PRICE study (Protection Rest Ice Compression Elevation): design of a randomised controlled trial comparing standard versus cryokinetic ice applications in the management of acute ankle sprain [ISRCTN13903946].

BackgroundCryotherapy (the application of ice for therapeutic purposes) is one of the most common treatment modalities employed in the immediate management of acute soft tissue injury. Despite its widespread clinical use, the precise physiological responses to therapeutic cooling have not been fully elucidated, and effective evidence-based treatment protocols are yet to be established. Intermittent ice applications are thought to exert a significant analgesic effect. This could facilitate earlier therapeutic exercise after injury, potentially allowing for a quicker return to activity. The primary aim of the forthcoming study is therefore to examine the safety and effectiveness of combining intermittent ice applications with periods of therapeutic exercise in the first week after an acute ankle sprain.Methods/DesignThe study is a randomised controlled trial. 120 subjects with an acute grade I or grade II ankle sprain will be recruited from Accident & Emergency and a University based Sports Injury Clinic. Subjects will be randomised under strict double-blind conditions to either a standard cryotherapy (intermittent ice applications with compression) or cryokinetic treatment group (intermittent ice applications with compression and therapeutic exercise). After the first week, treatment will be standardised across groups. Assessor blinding will be maintained throughout the trial. Primary outcome will be function, assessed using the Lower Extremity Functional Scale (LEFS). Additional outcomes will include pain (10 cm Visual Analogue Scale), swelling (modified figure-of-eight method) and activity levels (activ PAL™ physical activity monitor, PAL Technologies, Glasgow, UK). Diagnostic Ultrasound (Episcan-1-200 high frequency ultrasound scanning system, Longport International Ltd, PA) will also be used to assess the degree of soft tissue injury. After baseline assessment subjects will be followed up at 1, 2, 3 & 4 weeks post injury. All data will be analysed using repeated measures analysis of co-variance (ANCOVA).DiscussionThis paper describes the rationale and design of a randomised controlled trial which will examine the effectiveness of two different cryotherapy protocols in the early management of acute ankle sprain.Trial RegistrationISRCTN13903946

Walking Exercise for Chronic Musculoskeletal Pain: Systematic Review and Meta-Analysis

OBJECTIVE To systematically review the evidence examining effects of walking interventions on pain and self-reported function in individuals with chronic musculoskeletal pain. DATA SOURCES Six electronic databases (MEDLINE, CINAHL, PsychINFO, PEDro, Sport Discus, and the Cochrane Central Register of Controlled Trials) were searched from January 1980 to March 2014. STUDY SELECTION Randomized and quasi-randomized controlled trials in adults with chronic low back pain, osteoarthritis, or fibromyalgia comparing walking interventions to a nonexercise or nonwalking exercise control group. DATA EXTRACTION Data were independently extracted using a standardized form. Methodological quality was assessed using the U.S. Preventive Services Task Force system. DATA SYNTHESIS Twenty-six studies (2384 participants) were included, and suitable data from 17 studies were pooled for meta-analysis, with a random effects model used to calculate between-group mean differences and 95% confidence intervals (CIs). Data were analyzed according to the duration of follow-up (short-term, ≤8wk postrandomization; medium-term, >2mo to 12mo; long-term, >12mo). Interventions were associated with small to moderate improvements in pain at short-term (mean difference , -5.31; 95% CI, -8.06 to -2.56) and medium-term (mean difference, -7.92; 95% CI, -12.37 to -3.48) follow-up. Improvements in function were observed at short-term (mean difference, -6.47; 95% CI, -12.00 to -0.95), medium-term (mean difference, -9.31; 95% CI, -14.00 to -4.61), and long-term (mean difference, -5.22; 95% CI, -7.21 to -3.23) follow-up. CONCLUSIONS Evidence of fair methodological quality suggests that walking is associated with significant improvements in outcome compared with control interventions but longer-term effectiveness is uncertain. With the use of the U.S. Preventive Services Task Force system, walking can be recommended as an effective form of exercise or activity for individuals with chronic musculoskeletal pain but should be supplemented with strategies aimed at maintaining participation. Further work is required for examining effects on important health-related outcomes in this population in robustly designed studies.

Epidemiology of Adolescent Rugby Injuries: A Systematic Review

OBJECTIVE Despite recent increases in the volume of research in professional rugby union, there is little consensus on the epidemiology of injury in adolescent players. We undertook a systematic review to determine the incidence, severity, and nature of injury in adolescent rugby union players. DATA SOURCES In April 2009, we performed a computerized literature search on PubMed, Embase, and Cochrane Controlled Trials Register (via Ovid). Population-specific and patient-specific search terms were combined in the form of MEDLINE subject headings and key words (wound

UK Consensus Project on Quality in Palliative Care Day Services

and injur

The Back 2 Activity Trial: education and advice versus education and advice plus a structured walking programme for chronic low back pain

, rugby, adolescent

Quality Indicators for Palliative Day Services: A modified Delphi study

). These were supplemented with related-citation searches on PubMed and bibliographic tracking of primary and review articles. STUDY SELECTION Prospective epidemiologic studies in adolescent rugby union players. DATA SYNTHESIS A total of 15 studies were included, and the data were analyzed descriptively. Two independent reviewers extracted key study characteristics regarding the incidence, severity, and nature of injuries and the methodologic design. CONCLUSIONS Wide variations existed in the injury definitions and data collection procedures. The incidence of injury necessitating medical attention varied with the definition, from 27.5 to 129.8 injuries per 1000 match hours. The incidence of time-loss injury (>7 days) ranged from 0.96 to 1.6 per 1000 playing hours and from 11.4/1000 match hours (>1 day) to 12-22/1000 match hours (missed games). The highest incidence of concussion was 3.3/1000 playing hours. No catastrophic injuries were reported. The head and neck, upper limb, and lower limb were all common sites of injury, and trends were noted toward greater time loss due to upper limb fractures or dislocations and knee ligament injuries. Increasing age, the early part of the playing season, and the tackle situation were most closely associated with injury. Future injury-surveillance studies in rugby union must follow consensus guidelines to facilitate interstudy comparisons and provide further clarification as to where injury-prevention strategies should be focused.

SYSTEMATIC REVIEW AND META-ANALYSIS: EFFECTS OF WALKING EXERCISE IN CHRONIC MUSCULOSKELETAL PAIN

Background: People dying with advanced dementia areoften unable to effectively self-report pain and are at riskof under-assessment which may hinder pain diagnosis andmanagement. Pain assessment tools for use in advanceddementia are available but their use by physicians withdying patients has not been explored.Aims: To explore hospice, secondary and primary carephysicians’ use of pain assessment tools with patientsdying with advanced dementia.Methods: Twenty-three, semi-structured, face-to-facephysician interviews were conducted and transcribed verbatim.Thematic analysis was applied to identify corethemes across healthcare settings. Three researchers verifiedfinal themes.Results: Four key themes emerged: non-use of painassessment tools; perceived limitations of tools; clinicaloutcomes of use and improving pain assessment. Physiciansdid not routinely use pain assessment tools withpatients dying with advanced dementia. Information fromphysical examination, physiological parameters andpatient observation in addition to collateral patient historyfrom families and nursing staff were perceived to providea more reliable and holistic approach to assessment andmanagement. Scoring subjectivity, proxy-reporting andoverreliance on nonverbal and behavioural cues were limitationsassociated with pain tools. Physicians perceived theclinical outcome of pain tool use to be quicker identificationand reporting of pain by nurses. Most physiciansbelieved pain assessment could be improved via betterintegration of secondary, hospice and primary care servicesin addition to ongoing medical education andmentoring.Conclusion: Physicians preferred clinical investigationand collateral patient history from family and other healthprofessionals to assess pain and guide management. Thesefindings have important implications for medical education,practice and health policy.Funding: HSC Research and Development Division, PublicHealth Agency, Northern Ireland.PROJECT TEAM MEMBERS Dr Martin Dempster, Queen’s University Belfast (Joint lead applicant) Dr Noleen McCorry, Marie Curie Hospice, Belfast (Joint lead applicant) Dr Kathy Armour, Marie Curie Hospice, West Midlands Professor Joanna Coast, University of Birmingham Professor Joachim Cohen, Vrije Universiteit, Brussels Dr Michael Donnelly, Queen’s University Belfast Dr Anne Finucane, Marie Curie Hospice, Edinburgh Dr Joan Fyvie, Marie Curie Hospice, Belfast Dr Louise Jones, Royal Free & University College Medical School Professor George Kernohan, University of Ulster Dr Kathleen Leemans, Vrije Universiteit, Brussels Dr Sean O’Connor, Queen’s University Belfast Professor David Oxenham Dr Paul Perkins, Sue RyderBackground: Management of advanced chronic obstructive pulmonary disease (COPD) should relieve symptoms, optimise daily functioning and reduce carer burden. Health care professional (HCP) barriers and facilitators to meeting patient and carer needs exist but our understanding of them is limited, and we don’t know stakeholder views of actionable responses to them. Aim: To identify barriers and facilitators to HCPs’ ability to meet patient and carer needs in advanced COPD, and stakeholder views of actionable responses to them. Method: HCPs were nominated by a population-based cohort of patients participating in the multiple-perspective mixed-method Living with Breathlessness Study. We purposively sampled 45 HCPs for topic-guided interviews: medical and nursing specialists and generalists from primary and secondary care. Verbatim transcripts analysed with framework approach. National stakeholder workshop (October 2015) will review actionable responses. Results: Barriers and facilitators to meeting needs exist at operational, professional and patient levels, varying by professional group and setting. Barriers included: the drive of organisational and medical agenda, focus on prognostication and patient categorisation, time constraints, lack of confidence and skills in psychological support and end of life conversations, lack of patient support needs assessment, lack of referable services, service location, managing expectations (commissioners and patients), and non-compliance. Facilitators included: longevity of patient-HCP relationships, listening skills, accessibility and patient expertise. Some HCPs described the facilitative effect of the study interviews for reflection on their clinical practice. Stakeholder views of actionable-responses will be reported. Conclusion: Actioning stakeholder-endorsed responses to HCP barriers and facilitators to meeting needs could improve care and support of patients and carers living with advanced COPD.Background: Palliative and end of life care research is an underdeveloped research area. The importance of setting research priorities has been recognized internationally, however to date, this has largely been led by researchers and academics. James Lind Alliance advocate an approach to research priority setting whereby patients, carers and clinicians work together to agree the most important questions.Aim: To identify and prioritise research questions for palliative and end of life care from the perspective of patients, carers and health care professionals in Ireland.Method: Mixed methods four stage approach.Stage 1: was part of a larger national study, which involved a survey focused on uncertainties of care, (n=1403 responses), subsequently categorized as interventional questions, into a list of questions (n=83).Stage 2: An online survey asking user/carer organizations and professional groups in Ireland to rate these questions in terms of low to high priority (n=168 responses).Stage 3: Involved a final prioritization workshop, using nominal group technique undertaken with user/carers (n=16), resulting in the identification of the top ten research priority for Ireland. Stage 4: Comprised a strategic workshop with academics, researchers and funders from the island of Ireland, to develop action plans for each of the areas.Results: The top ten areas were identified and include aspects such as co-ordination of care; out of hours; care at home; pain and symptom management, palliative care and non-cancer and advanced care planning.Conclusions: This process enables researchers to demonstrate that their research is relevant, targeted and valuable to the people who most need it. We will report preliminary findings on the process and types of questions proposed. Discussion with key stakeholders contributes to better co-ordination, seeking to address the highest priority areas together.Funded: AIIHPC, larger study led by Marie Curie UKGood communication is of utmost importance in all forms of cancer care and especially so in the palliative context. To render the ungraspable graspable, metaphors are frequently used drawing on the ...Background: The experience of care transitions for family carers of a relative living with dementia do not necessarily lessen once their relative is admitted to a care home.Goals of care and end of life care decisions need to be made. The process of reaching these decisions can be significantly challenging.Aim: To explore the experience of family carers responsible for decision-making on behalf of a relative living with advanced dementia through their transitions from the community into a care home.Method: Carers of a resident living with dementia were offered an individual interview in a qualitative study within a randomised trial evaluating an Advanced Care Planning intervention in care homes in Northern Ireland,UK. Twenty participants completed a semi-structured audio recorded interview, from which transcripts were thematically analysed.Results: Interviews highlighted that carers were at differentstages of the decision-making process for their relative’s carewhen they were admitted to the care home. Some had previouslydiscussed end of life care wishes with their relative,whereas others had to make an informed choice for the care without prior discussions. The emotional impact of this transition varied from high levels of stress and extreme guilt, to a sense of relief that their relative was content and safe in their new setting. Some carers reported that this decision process left them feeling isolated due to family conflict, but support was also available for others from their new ‘family’:the care home staff. However, reports of poor communication with and amongst staff, and inconsistencies of healthcare provision were an additional source of distress.Conclusion: Key findings which require further investigation include: holding goals of care decision-making earlier in the dementia disease trajectory; recognition of family dynamics; the need for improved knowledge to facilitate informed decision-making, and improving communication with and between staff.Background: Evidence suggests that end-of-life care in heart failure is poor, characterized by high levels of symptoms, inadequate support and poor quality of life. Family carers play a crucial role in supporting advanced HF patients yet there is a lack of knowledge on the needs and experiences of carers for this group of patients.Aim: To examine the palliative care needs, quality of life, perceived burden and level of preparedness of carers of people living with advanced heart failure.Methods: A sequential confirmatory mixed methods approach comprising two phases.Phase 1: Postal survey with carers identified via a database of patients living with advanced heart failure (NYHA Classification III-IV, ejection fraction < 40% and ⩾ 1 unscheduled hospital admission in the previous 12 months) across Ireland. Data included measures of depression, anxiety, QoL, perceived social support and illness beliefs, caregiver burden, needs assessment and preparedness for caregiving. Inclusion criteria: carers identified by the patient as the main person who provides care.Phase 2: semi structured face to face interviews with carers (n=20). Thematic analysis of verbatim transcripts was used to identify emergent themes. Descriptive and inferential data analysis using SPSS was undertaken.Results: 82 carer responses was obtained (response rate 47%). Nearly one third of the carers experienced moderate to severe levels of depression and anxiety and their quality of life was impacted by their caregiving role. They spent a considerable time on caregiving tasks with over 60% spending over 50 hours per week. Themes from the qualitative interviews indicated that the carers considered that their life is on hold; expressing feelings of isolation and frustration at a perceived lack of support.Conclusions: Carer’s needs are variable depending on the patients’ medical stability. A holistic approach is needed to support these carers.Funding: Health Research Board & AIIHPC.Background: Patient-reported outcome measurements are important for measuring changes in patients’ health over time, evaluating the quality of care given, and improving the quality of care service. ...Background: User involvement is widely promotedwithin health and social care policy as an effective meansof developing patient-centred services. This has, however,particular challenges for palliative care, as patients arelikely to be experiencing poor health, are psychologicallyvulnerable and socially isolated. Nevertheless this is animportant agenda for palliative care to address. Voices-4Care is a user/carer Forum comprised of: patients serviceusers, carers or former carers, and people from the widercommunity across the island of Ireland.Aim: To evaluate the implementation process, contributionand lessons learnt from a Voices4Care initiative thathave wider international relevance.Method: A mixed methods approach comprised of fourstrands of work. Phase 1: Review of the literature on modelsof user involvement; Phase 2: secondary analysis anddocument review of user involvement activities and process;Phase 3: Two focus group with members of user/carer Forum (n= 14) and Phase 4: Key stakeholder telephoneinterviews with policy and hospice representatives(n=10) were conducted. Thematic analysis of verbatimtranscripts was used to identify emergent themes.Results: it was found that the Forum provided a supportivecontext in which the voices of users and carers could be heard,valued and contribute to mutual sharing of information andexperiences. The impact of the forum was identified at personal,practice and policy levels. The personal level developeda sense of empowerment whilst the practice level challengedprofessional complacency and triggered discussions.The policy level was considered as more aspirational withpotential for further development. Challenges were notedhowever with sustainability and building on progress to date.Conclusions: Organisational cultures need to be supportiveof user involvement and dedicated resources; leadershipand openness are key factors for sustainabilityThe UK Consensus Project on Quality in Palliative Care Day Services is funded by MarieCurie and based at Queen’s University, Belfast. It is being carried out in collaboration with anumber of other academic institutions and key stakeholder organizations. The project willinvolve and take into account the perspectives of a range of different stakeholders and itsoutcomes will be relevant to patients, family members, palliative care professionals, andpolicy makers. The aim is to use an expert consensus process to develop a set of qualityindicators for assessment of all aspects [structure, process and outcomes] of quality of care in Palliative Care Day Services. This expert panel will include around 20 people from all over the UK who work in, or have experience of day services. The panel will include a wide range of different professionals and volunteers, as well as people who have experience of attending day services as a patient, a carer or family member.Agreement on a quality indicator set will be reached using the RAND/UCLA Appropriateness Method [1], a method of reaching consensus based on differing opinions. The first stage of the process will involve a panel of 20 experts individually considering and rating the appropriateness of potential quality indicators. Ratings will be based on their own experience and knowledge, as well as a series of evidence summary tables drawn up based on a systematic review carried out to identify existing indicators relevant to palliative care day services. Ratings will be analysed and summarised in advance of the second round, at an expert panel meeting. At this meeting quality indicators and their preliminary ratings will be discussed and re-rated. All ratings will be made anonymously. Unlike other consensus development processes, complete agreement is not required. During the meeting, discussions will be focused specifically on any areas of disagreement, in order to understand how and why the variation was found. Indicators will be considered to be “appropriate” if they have a median rating of 7 or more without disagreement. Disagreement will be defined as more than 30% of panel members give a rating of 3 or less to a potential indicator. An indicator will be considered as “not appropriate” if its median score is 3 or less without disagreement (disagreement being when 30% or more of the ratings are 7 or more). When the median rating is between 4 and 6, or if disagreement is observed, the appropriateness of the indicator will be considered as uncertain and it will be discussed at the panel meeting. The following options will be offered to the panel members: acceptance of a quality indicator, rejection or adjustment of a quality indicator, and merging multiple indicators into a single quality indicator. Panel members will also be asked to identify additional indicators not on the original list, modify existing indicators that may require re-wording and remove those perceived to be irrelevant. Following this discussion, a revised list of indictors will be developed, and panel members will re-rate the appropriateness of each. Panel members will also be asked to rate the feasibility or practicability of measuring each indicator in a typical day service setting using the same 9-point scale. At the end of the process, a set of quality indicators will be developed that passed the first round of individual rating as well as the second-round discussion. This set of quality indicators will be sent to the expert panel by e-mail after the meeting, as well as to other stakeholders, for final approval. Following this, further work will be conducted to develop and test the suitability of a toolkit which can be used to measure quality indicators in palliative care day services.Background: Evidence suggests ACP can improve thecare provided to people with dementia in long-term caresettings (LTCSs), facilitating their participation in caredecisions. However, few people with dementia haveengaged in ACP, despite it being advocated by internationalpolicy. The role of health care professionals is integralto addressing this deficit, therefore further understandingof their perspective is needed.Aim: To examine registered nursing home managers(RMs) knowledge & attitudes in relation to ACP for peoplewith dementia in LTCSs.Design: A cross-sectional postal survey was carried out aspart of a larger scale sequential explanatory mixed methodsstudy. An adapted survey instrument was used, developedthrough incorporation of results from an in-depthanalysis of the literature & consultation with key experts inACP & dementia. Principal component analysis was conducted,revealing 6 components.Setting/participants: All registered nursing home managersemployed by homes caring for people with dementiaacross Northern Ireland (n=178).Results: Response rate of 66% achieved(n=116). Thelevel of knowledge in relation to ACP was poor, with correspondinglow levels of confidence reported. A lack ofclarity surrounding who should lead the process was evident.Varying levels of support impacted on practice. Thepositive influence of ACP training was evident, with subsequentincreased perceived control reported. However,RMs struggle with the ethical dilemma created when outweighingthe potential benefits of ACP to the person withdementia with the desire to protect them.Conclusions: Whilst RMs recognise the potential benefitsof ACP, intention to engage is influenced by several interrelatedfactors, making implementation in practice complex.Enhanced understanding of the factors which influencetheir perspective will contribute to the developmentof future educational support and guidance, in order toimprove facilitation of ACP in this setting.Objective: Despite increasing levels of research evidencebeing generated in palliative care, there appear to be severalbarriers to the implementation of research in practice.The aim of this project was to review knowledge transferand exchange (KTE) frameworks used in health settingsand assess their relevance to palliative care.Methods: In line with PRISMA guidelines, a systematicscoping review was developed to search articles included insix electronic databases (including MEDLINE, EMBASE,CINAHL and PsycINFO) for four terms (knowledge, transfer,framework, healthcare) and their variations.Results: The search identified 4288 abstracts, with 294eligible for full-text screening, resulting in 79 papers analysed.Studies were published between 1985 and 2014 (twothirds since 2006); the majority were conducted in North America. In total 87 models were indicated, with the PromotingAction on Research Implementation in Health ServicesFramework (PARIHS) being the most common (n =15).The key components of the models include a partnershipor collaborative approach to KTE, focus on the needsof the audience, and an awareness of different modes ofcommunication. The papers were appraised for relevanceto the palliative care and it was found that the study or thetarget population were relevant in many of the papers. Thecomponents most relevant to palliative care were used toestablish a proposed model of KTE for palliative care.Conclusions: The model offers guidance as to effectiveways of translating different types of research knowledgeto care providers and stakeholders, and could be utilised inhospital, community and home based settings as well as toinform future research. It is recommended that researchersadopt this model of KTE for palliative care in futureresearch to ensure that research is conducted with knowledgetransfer in mind.Background: Palliative care day services (typically known as “day hospices”) are provided routinely across Europe. Due largely to the historically localised nature of development, there is wide variability in the organisation and content of services, which militates against strategic planning and development.Aims: We aimed to address this knowledge deficit by identifying core service provision within one country by mapping three regional providers of palliative care day services. Methods: A retrospective, observational study design, using the Donabedian quality framework, involved two components. Firstly, a review of local policy and operational documents at each site provided information on the structure of each service (how care is organised). This covered four key areas: service organisational structure; funding arrangements and expenditure; staffing and management structure, and; other information relevant to estimating the costs of service delivery. Secondly, a retrospective review of the clinical records of patients referred to the service at each site delivered information on the process of care (what is provided). Using reported attendance figures, cases were randomly selected according to a proportionate regime. Results: The review covers key features of: the local-level patient populations, including socio-economic and diagnostic profile; referral, allocation and discharge; all interventions offered; service uptake, and; contextual information onpatient circumstances, need and preferences for care. Itdelivers a comprehensive body of evidence concerning thestructure and process of UK palliative care day services.Conclusions:Our study makes a fundamental contributionto a previously limited evidence base on the organisation,content and mechanisms of delivery of palliative care dayservices.Background: Evidence indicates that people nearing endof life fear loss of dignity and a central tenet of palliativecare is to help people die with dignity. The Dignity CareIntervention (DCI), based on the Chochinov theoreticalmodel of dignity care, comprises four components: educationmanual; patient dignity inventory, reflective questionsand care actions.Aim: To evaluate the usability and acceptability of a DignityCare Intervention (DCI) delivered by communitynurses for people with advanced and life limitingconditions.Method: Mixed methods research design, with threephases.Phase 1: Semi-structured, face-to-face interviews withpatient/carer dyads (n=18),Phase 2: four focus groups with (n=24) and an onlinesurvey with community nurses (n=27),Phase 3: analysis of completed DCI tools (n=27). Datawere analysed using thematic analysis of verbatim transcriptsand descriptive statistical analysis.Results: The DCI was acceptable to the communitynurses. It contributed to the overall assessment of palliativecare patients; identified areas that might not otherwisehave been identified; supported communication andassisted the nurses to provide holistic end of life care. Concernshowever were expressed that the tool ‘opened a canof worms’ initiating difficult conversations for which thenurses felt unprepared. The patients however found thatthe tool helped them to identify and consider future needsand were happy to discuss death and dying.Conclusion: The DCI helped nurses to delivered individualisedholistic care. Whilst all the nurses wished to continueto use the DCI, there were barriers identified such asthe time taken to complete; the identification of suitablepatients and the need for more training to enable them toinitiate difficult conversations on dignity conserving careand end of life care.Background & aim: The evidence-base for educational interventions to support informal carers and enhance their caregiving capacity is limited. Our aim was to develop an evidence-based educational intervention on breathlessness in advanced disease for carers. Method: Stage 1: Qualitative in-depth interviews with purposive sample of 25 patient-carer dyads from two disease groups (COPD and cancer) to identify educational needs and intervention preferences. Stage 2: One-day multidisciplinary workshop with 13 clinical experts to identify evidence-based content and acceptability and feasibility of potential delivery modes. Stage 3: Two half-day workshops (one COPD and one cancer) with 10 carers and seven patients to review intervention content, format, and language. Qualitative data analysis used a Framework approach. Results: Carers wanted to learn about breathlessness. Six key topics emerged from patient-carer dyad interviews: understanding breathlessness, de-escalating anxiety and panic, keeping active, living positively, managing infections (in COPD), and knowing what to expect in the future. There was wide variation in how carers wanted to learn, but written resources were less popular than face-to-face, group, video and web-based learning. Carers wanted an intervention that drew on both clinical expertise and peer-carer experience. In general, they wanted to learn with the patient. Building on these findings, the clinical expert workshop identified evidence-based content for the six topics and discussed a potential web-based platform to facilitate multiple modes of access e.g. via clinicians, established support groups, or by carers independently. Carer workshops endorsed the need for the intervention, its content and format, and refined its language and presentation style. Conclusion: Developed with carer, patient and clinician expertise this educational intervention on breathlessness has the potential to be highly relevant and acceptable to carers.