The Michael Mason Prize: Development and feasibility testing of a complex intervention to improve adherence to fracture prevention medicine using a person-centred approach

Objectives

The i mproving uptake of Fra cture P revention treatments (iFraP) intervention consists of an osteoporosis decision support tool (DST), clinician skills training, and information resources, to improve shared decision-making (SDM) about, and uptake of, osteoporosis medicines in Fracture Liaison Services (FLS). This paper details the development and feasibility of the prototype intervention.

Methods

Intervention development was underpinned by (1) theories of SDM, medicines adherence, and behaviour change; (2) integrated findings from six discrete development studies; and (3) extensive public contributor, patient, and clinician contribution to identify key ‘needs’ for the intervention to address and the intervention’s content, functionality and scope.

Feasibility testing was conducted at one FLS. Intervention consultations were observed and audio recorded, and interviews completed with FLS clinicians and patients to explore perceived acceptability and feasibility.

Results

Intervention development identified patient and clinician unmet needs for personalised and evidence-based information about osteoporosis, its consequences, and its treatment within and after FLS consultations, to facilitate clinical and SDM about medicines. The prototype intervention was designed to meet identified needs and overcome barriers to use.

Clinicians delivered the prototype iFraP intervention in 10 consultations with consenting patients. Findings demonstrated that the intervention was acceptable and feasible to deliver, with potential to improve patient outcomes. The intervention was refined to support implementation.

Conclusion

The multi-facilitated approach to intervention development and testing ensured that the iFraP intervention was acceptable and feasible for use in UK FLS to support SDM about osteoporosis medicines. The iFraP trial will evaluate implementation, and cost and clinical effectiveness.

Key messages

• Verbal and written communications concerning osteoporosis are currently confusing, technical and impede decision-making and medicine uptake

• Key barriers to implementing shared decision-making and decision aids include clinician goals, professional roles and contextual factors

• A decision tool with clinician training and information resources was co-designed, acceptable, and addressed identified needs and barriers