ObjectiveThe prevalence of children needing palliative or end-of-life care is increasing. However, no comprehensive tool exists to assess the experiences of such care. We describe the development and testing of VOICES-Children (VOICES-C): the first questionnaire to assess care experiences of palliative and end-of-life services for children aged 0 to 18 years in the last 3 months of life.MethodsVOICES-Children was developed in 3 phases: (1) a literature review of care quality domains, parent interviews, healthcare professional (HCP) focus-groups/interviews, data integration, and prototype development; (2) prototype testing through HCP and parent interviews; and (3) completion of VOICES-C. In phase 1, 24 parents were interviewed, 38 HCPs (critical care nurses, physicians, palliative care staff, and specialist palliative care service staff) participated in focus groups, and 3 took part in an interview. Participants were recruited from 2 neonatal intensive care units, 2 pediatric intensive care units, 1 cardiac intensive care unit, and a children's specialist palliative care service. In phase 2, 10 HCPs and 14 parents were interviewed.ResultsData integration identified 19 meta-themes, including the importance of space, and the timing and amount of information. Testing demonstrated that VOICES-C captured parent experiences effectively. The final questionnaire comprised 83 questions about home care, the pediatric setting, and experiences of the last 2 days of life.ConclusionsVOICES-Children uses literature, experience data, and parental insights to produce a robust questionnaire of pediatric end-of-life care experience, administered postbereavement, that can be applied across healthcare settings. By assessing quality, services can be improved and inequities in delivery reduced.

Core Outcome Sets (COS) are used by researchers to enable synthesis and comparison of results from trials in similar patient groups and contexts. Around 50

Compression therapy is the evidence-based treatment for healing venous leg ulcers. However, it is not routinely applied in many UK hospitals. This paper explores hospital staff's' perspectives of venous leg ulcer care provision where compression therapy is not routinely applied. A semi-structured interview study was conducted with 11 participants, drawn from a larger study, who confirmed that their respective hospitals did not apply compression therapy to inpatients with venous leg ulcers. The interviews were analysed using reflexive thematic analysis. Findings indicate that venous leg ulcer care in hospitals was de-prioritised, which, along with structural and organisational constraints, affected clinicians' engagement and focus on it in their hospitals. This de-prioritisation also led to a lack of formal leg ulcer training in hospitals. However, some clinicians showed remarkable empathy for patients derived from their clinical professionalism and deep understanding of their suffering. To help hospital clinicians and senior managers prioritise venous leg ulcer care, it is crucial to first understand their clinical practise priorities. Secondly, understanding how some hospitals implement compression therapy could be beneficial for those where it is not routine practise. Further research should focus on better understanding clinicians and senior managers' clinical priorities and the structural and organisational constraints in real-world settings, ideally in hospitals where compression therapy is a routine practise. Most importantly, the study highlighted key questions for hospital leaders and policymakers: consider fostering the established clinicians' empathy before it is too late.

Background Antiseizure medications (ASMs) are the primary treatment for controlling seizures in children with epilepsy (CWE). Despite their proven effectiveness, non-adherence to ASMs remains a major challenge. The aim of this study is to synthesise qualitative data using the theoretical domains framework (TDF) to identify the behavioural mechanisms associated with ASM adherence in CWE. This will then inform the development of a theory-informed ASM adherence intervention. Methods This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search was conducted in CINAHL, PubMed, SCOPUS, EMBASE and PsycINFO databases. The Critical Appraisal Skills Programme was used to assess the quality of the included studies. Qualitative findings relating to barriers and enablers of ASMs were extracted, analysed and synthesised using NVivo V.14 and mapped to the TDF. Behaviour change techniques (BCTs) associated with identified TDF domains were identified using the Theory and Techniques Tool. Results 19 studies were included: 17 qualitative and two mixed-methods studies. A total of 83 factors were identified comprising 51 barriers and 32 enablers. Key factors included poor communication between prescribers and parents ( social influences ); unpleasant taste, large tablet size and access to ASMs ( environmental context and resources ); fear of addiction ( beliefs about consequences ); inferiority related to ASM use ( emotion ); parental prompting ( memory, attention and decision processes ); and understanding of treatment purpose ( knowledge ). Across different countries, there was contrasting evidence on belief about consequences. Conclusion These findings provide broad descriptions of the determinants of non-adherence enabling direct linkage to evidence-based BCTs and therefore ultimate creation of theory-informed interventions. PROSPERO registration number CRD42024600476.

Background As researchers strive to conduct culturally competent and equitable research, there remains a lack of actionable guidance across the research lifecycle. Increasingly, funding bodies require evidence of such approaches, yet a clear, practical direction for effective research practice is often lacking.Aim To develop a practical framework, grounded in Meleis' cultural competence criteria, to guide all stages of the research lifecycle.Methods Databases PsycINFO, ERIC, PubMed, Web of Science Core Collection and Google Scholar were searched (August-October 2025) for English-language publications applying Meleis' framework in research contexts. Narrative and thematic analysis synthesised identified applications into draft recommendations and measures across five research stages. A modified Delphi process with 31 experts (community leads, researchers, policymakers and translators) in two survey rounds and a consensus workshop was then used to refine and finalise items, producing a co-developed framework of actionable, measurable recommendations for culturally competent research with minoritised and/or diverse groups.Results The review identified eight studies, yielding 41 applications of Meleis' criteria. These were distilled into 29 draft recommendations and measures, which were further refined through Delphi consensus to 25 recommendations and 25 measures, offering practice-ready guidance across research focus, recruitment, measurement, analysis and dissemination. Contextuality was rated critical in four stages, highlighting how cultural identities shape engagement. Language was strongly prioritised in focus, recruitment and measurement, with emphasis on diverse, well-funded interpretation and transcription strategies. Empowerment and reciprocation were noted as underused but essential for legitimacy and impact, particularly in focus and dissemination. Continuous cultural humility training was endorsed, reinforcing critiques of competence as a static skill. During consensus discussions, recommendations initially framed as optional ('could') were reframed as compulsory ('should'). The final framework is available as an accessible online resource.Conclusions Using consensus, an evidence-based, culturally competent research framework was co-designed; it comprised 25 recommendations that are actionable, measurable and adaptable by researchers, policymakers, community leads and others. This framework represents a crucial step towards fostering equitable and impactful research practice.Patient or Public Contribution A patient and public involvement group of three patients from minoritised backgrounds and two health professionals met twice to review findings, refine components and provide feedback on language, accessibility and usability.

Background:People with Parkinson's (PwP) experience disproportionately higher rates of hospitalisation, where they encounter many medication-related challenges. Although interventions have been developed to address these issues, medication-related problems persist, and the patient's voice is largely absent from their design. Objectives:To explore medication-related priorities during hospitalisation from the perspective of PwP to inform the development of future patient-led interventions. Methods:A systematic review using meta-ethnography was conducted and registered with PROSPERO. A SPICE-informed search (Setting, Perspective, Intervention, Comparison, Evaluation) was undertaken across MEDLINE, PsycINFO, CINAHL, Embase and Google Scholar in June 2025. Eligible qualitative and mixed-method studies explored the perspectives of PwP regarding inpatient medication-related care. Two reviewers independently screened studies using Covidence. First- and second-order constructs were synthesised into third-order constructs representing medication-related priorities. Reporting followed Enhancing Meta-Ethnography Reporting Guidance (eMERGe), and methodological quality was appraised using the Critical Appraisal Skills Programme (CASP) checklist. Results:Four studies met the inclusion criteria. Four overarching themes reflected the core medication-related priorities of PwP during hospitalisation: timely and accurate medication administration, autonomy, access to skilled and knowledgeable staff, and advocacy to support patient needs. These priorities informed the development of an interpretive conceptual framework illustrating the interaction between PwP medication-related priorities and hospital systems. Conclusions:Findings suggest the need to strengthen systems supporting timely medication administration, enable self-administration where appropriate, promote flexibility and person-centred care, and implement Parkinson's clinical champions to advocate for and support PwP throughout hospitalisation.

Compression therapy is the cornerstone, first-line effective evidence-based treatment for healing and managing venous leg ulcers. However, compression therapy is inconsistently applied in hospitals. This paper explores the experiences of a diverse group of clinicians and senior managers applying compression therapy in hospitals across the United Kingdom. A semi-structured qualitative interview study was conducted with 19 participants, drawn from a larger study, who confirmed that their respective hospitals apply compression therapy to inpatients with venous leg ulcers. The interviews were analysed using reflexive thematic analysis. Analysis generated four key themes: Patients 'slip through the net', Prioritisation in Hospital Care, A 'blind Spot' within Healthcare System and Motivation to Deliver Care. Patients 'slip through the net' refers to inpatients with venous leg ulcers face unequal access to compression therapy both within and between hospitals. Prioritisation in Hospital Care indicates how certain diseases are given greater emphasis within healthcare systems. A 'blind Spot' in Healthcare System described failing to implement compression therapy has created a critical underlying 'blind spot' within the NHS healthcare systems. Motivation to Deliver Care refers to a deep commitment to providing compression therapy, driven by clinicians' inherent dedication and ethical obligation towards improving patient quality of care. The study identified key challenges influencing the application of compression therapy in acute hospitals despite its routine use. These include the lottery of care, systemic inequities, unclear ownership, interprofessional disputes and organisational priorities. It also demonstrated the significant role of passion, motivation and moral responsibility encouraging clinicians to implement compression therapy despite these systemic barriers.

AIM:To identify and describe the barriers and enablers to nurses routinely screening for dysphagia in hospital and map these to domains in the Theoretical Domains Framework. DESIGN:Systematic review with meta-ethnography. DATA BASE SOURCES:CINAHL, Embase, PubMed, Scopus, Clinical Trials and World Health Organisation trials registry (database inception to November 2024). METHODS:The review protocol was registered on PROSPERO (CRD42024608080). Studies set in stroke and older adult wards were included. Data were coded as barriers or enablers, mapped to the original authors' themes and then synthesised into higher-level themes. Barrier and enabler codes were also mapped to domains in the Theoretical Domains Framework. RESULTS:From 6750 studies identified, six were included. None of the included papers were conducted in an older adult ward setting. Four high-level themes were developed: (i) The surrounding environment, (ii) Variation in practice, (iii) Influence of knowledge and skills, and (iv) The value of dysphagia screening. Identified barriers and enablers were predominantly mapped to 'Environmental context and resources,' 'Knowledge,' 'Beliefs about capabilities' and 'Beliefs about consequences' Theoretical Domains Framework domains. CONCLUSIONS:For successful dysphagia screening, nurses require adequate training, a standardised screening tool and sufficient environmental support. Further work is required to contextualise these findings specifically to older adult ward settings. IMPACT:To introduce routine nurse screening for dysphagia into different contexts, this paper provides guidance on how to set up and create a theory informed service. Mapping of barriers and enablers to the Theoretical Domains Framework can facilitate the development of a behaviour change intervention through the framework's linkage to a taxonomy of behaviour changes strategies. REPORTING METHOD:ENhancing Transparency in REporting the synthesis of Qualitative research. PATIENT OR PUBLIC CONTRIBUTION:Patient and public involvement focused on interpretation of findings, ensuring the review identified patient-relevant priorities. TRIAL REGISTRATION:PROSPERO registration number: CRD42024608080.

Dilated cardiomyopathy (DCM) and hypertrophic cardiomyopathy (HCM) are heart muscle diseases with largely opposing structural and functional phenotypes. Yet, both may lead to the same devastating outcomes of advanced heart failure and life-threatening arrhythmias. Using genome-wide association data from 9,365 DCM cases, 5,900 HCM cases, and over 1.2 million controls, we show that DCM and HCM are largely inversely associated across multiple genomic levels. Modeling both disorders as opposing genetic entities, in case-case GWAS approaches, we identify 100 loci (17 novel) underlying the cardiomyopathy spectrum. Several loci map to potential therapeutic targets (e.g., ADM, CACNA2D2), and polygenic risk scores derived from these data show strong discrimination between DCM and HCM patients in external datasets (AUC 0.78-0.84; AUPRC ~ 0.85). The pervasive opposing associations suggest that cardiomyocyte-directed therapies may often have opposite effects in DCM versus HCM. Nevertheless, a shared-effect analysis reveals a single locus - near the calcium-buffering gene CASQ2 - and also identifies a concordant genomic component associated with cardiometabolic health and extracardiac risk factors. By leveraging the shared and opposing genetic mechanisms of DCM and HCM, our work defines the genomic architecture of major cardiomyopathy subtypes and suggests new directions for therapeutics and precision medicine in heart failure.

Design A qualitative study using uni-professional focus groups, forming the first stage of a multi-phase co-design project to develop a model of care for early sling removal after conservatively managed proximal humerus fracture.Setting Focus groups were conducted online via Microsoft Teams with participants from a wide geographical spread across multiple United Kingdom National Health Service Trusts.Participants Healthcare professionals (n = 23), including orthopaedic surgeons, therapists (physio and occupational), and nurses, recruited through purposive sampling.Intervention Three focus groups explored healthcare professionals' perspectives on early sling removal in the non-operative management of proximal humerus fractures. Patient and public involvement and engagement work informed study design, identifying the need to first understand professionals' viewpoints before engaging patients and progressing to consensus co-design.Main measures Data were collected through focus groups supported by pre-session forms and analysed thematically following Braun and Clarke's framework using NVivo software.Results Three overarching themes were identified: Navigating pain and fear, clinician confidence, and early engagement. Fear of patient harm and high pain levels in the early weeks were barriers to early sling removal. Confidence was influenced by experience, fracture severity and limited evidence, with hierarchical decision-making by surgeons. Participants considered enablers to be consistent messaging, early education, and reassurance to support both clinicians and patients.Conclusions Whilst healthcare professionals recognise benefits of earlier sling removal, implementation is limited by pain, uncertainty, and hierarchical decision-making. These findings highlight the need for multidisciplinary, co-designed pathways. There is a need next to explore patient perspectives to inform future co-designed pathways.

Analyses using repeat hospitalizations (HFHs) are common in heart failure trials and typically assume that such repeat events occur randomly over time. Also, many think that using repeat events enhances statistical power. This article challenges those assumptions, using data from 4 heart failure trials of sodium-glucose cotransporter 2 inhibitors. We found marked within-patient time clustering of repeat events: risks of subsequent HFH and cardiovascular death are markedly elevated following a hospitalization, especially early on. The Lin-Wei-Yang-Ying and negative binomial models do not account for this. Alternative approaches using area under the curve and win ratio methods for the composite of cardiovascular death and all HFHs strengthened the treatment effect. But still, time-to-first event analyses tended to give the strongest evidence. Overall, some commonly used repeat event analyses appear not to be the best. It is time to rethink how best to use repeat events data in heart failure trials.

Marginalised communities (including minoritised ethnic groups and people with lower socioeconomic status) often present with a late cancer stage at diagnosis, affecting survival. This is due to many factors including cultural barriers, mistrust of health services and low levels of cancer awareness. Communities Against Cancer (CAC) aimed to promote cancer awareness and healthy lifestyles and help-seeking behaviours for marginalised communities through a grant-scheme that provided funding for community-led projects, which ran from 1st January 2021 – 31st December 2022. This paper reports findings from a study that assessed whether CAC met its aims and the characteristics of successfully delivered projects. A qualitative approach was used involving interviews and observations of meetings and community activities, supported by documentary analysis of minutes, grant applications, reports and quantitative descriptions of grant-level data. Participants included representatives from the funder and grant distributor, community advocates, applicants and recipients of CAC funding. Thirty-seven people were interviewed, all of whom were invited to a second follow-up interview. Twenty-one participants agreed to a second interview, resulting in 58 interviews in total. Interview transcripts and observation fieldnotes were analysed thematically. CAC community grants encouraged: 1) healthy behaviours (e.g. families on low incomes reported healthier diets); 2) screening and PSA testing uptake (e.g. a group representing neurodivergent people created a film of a breast screening unit, encouraging attendance); 3) awareness of signs and symptoms (e.g. one radio station for South Asian communities broadcast an episode on signs of prostate cancer, their most downloaded programme); 4) help seeking behaviours (e.g. one South Asian community group held meetings with pharmacists, primary care and hospital staff, building trust with local services). Seven characteristics were identified for successful projects (defined as meeting at least one of the initiative’s aims: raising awareness of healthy behaviours, screening uptake, awareness of signs and symptoms, and help-seeking behaviour). The characteristics were: 1) projects are designed with an understanding of the community; 2) effective planning before delivery; 3) projects are co-created with the community; 4) alignment with group values; 5) building community members’ confidence; 6) effective communication; 7) adaptability and evaluation. The community-based grant model adopted by CAC enabled community members to self-define effective strategies to deliver cancer messages to their communities. As a result, the CAC initiative met its aims of promoting cancer awareness, encouraging healthy lifestyles and help-seeking behaviours by ensuring activites were fully tailored and co-created with marginalised communities.

Polypharmacy is prevalent in older people residing in care homes. Deprescribing, reducing or stopping harmful or unnecessary medicines, leads to improvements in patient- and health-system-orientated outcomes. This study identified the barriers and enablers to pharmacists proactively deprescribing in United Kingdon care homes. It draws on methods from behavioural science. Twenty-nine participants who had previously taken part in a deprescribing randomised control trial (sixteen pharmacists, six primary care doctors, and seven care home managers) were interviewed. Data were mapped to the Theoretical Domains Framework to understand pharmacists’ deprescribing behaviour. Barriers were deprescribing seen as risky and perceived resistance to deprescribing by residents, their families, and care home staff. Enablers were seeing benefits from deprescribing, part of a pharmacists’ role, and endorsement from a doctor. Ways to change pharmacist behaviour were identified from a suite of behaviour change techniques (BCT). Using a modified Nominal Group Technique, 15 staff (six pharmacists, five primary care doctors, and four care home managers) naïve to deprescribing interventions completed an online survey to assess the feasibility and acceptability of implementing the 27 BCTs. Seven BCTs achieved a more that 80% consensus on all implementation criteria. In a consensus workshop, the staff group discussed practical ways the BCTs might work in primary care practice. Fourteen UK policy and practice leaders worked with the researchers to develop recommendations from the consensus workshop into a policy briefing. In conclusion, this study provides detail on using a theory-informed approach to translate research into policy to inform deprescribing practices.

(1) Background: Medication shortages have become increasingly common in the UK. However, there is limited evidence regarding the experiences of people with epilepsy and their caregivers during these shortages. The aim of this study is to explore the extent and impact of ASM shortages on people with epilepsy and their caregivers across the UK. (2) Methods: A cross-sectional online survey was distributed between January and April, 2024 by epilepsy charities. Participants included people with epilepsy and caregivers. The survey collected demographic information, types of ASM respondents were prescribed, experiences of shortages, and the impact of shortages. Data were analysed descriptively, and subgroup analyses were conducted by medication type. (3) Results: A total of 1549 responded, of whom 1312 were people with epilepsy and their carers who were included in the analysis with a mean age of 43 years. A total of 941 respondents (71.7%) reported difficulty obtaining their prescribed ASM in the past year. Shortages were most frequently reported for sodium valproate (60.8%), lamotrigine (65.2%), carbamazepine (92.6%), clobazam (82.6%), topiramate (81.5%), zonisamide (74.0%), levetiracetam (62.8%), lacosamide (71.0%), and brivaracetam (70.5%). A total of 529 (40.4%) of the participants reported that stress and/or anxiety caused by medication shortages was associated with recurrent seizures. We did not ask whether patients missed medications because of these difficulties. (4) Conclusions: ASM shortages are a widespread issue for people with epilepsy in the UK, leading to treatment disruptions and psychological distress. Addressing supply change limitations and identifying effective approaches to preventing the substitution of ASMs brands by clinicians may potentially reduce this problem.

Background:To protect care home residents the World Health Organisation recommends that 75 % of care home staff are vaccinated for influenza. In the UK this value is less than 30 %. Previously reported interventions have not been informed by theory and usually only addressed one or two known barriers to uptake. Using behavioural science, we worked with care home staff to develop an intervention which addressed all barriers at both individual and care home level. Methods:We developed an online questionnaire, derived from the literature, asking staff about barriers and facilitators of flu vaccination. These were prioritised (based on frequency and distinctiveness), then mapped to the Theoretical Domains Framework. Relevant behaviour change techniques were identified. Care home staff selected and designed behaviour change techniques according to affordability, practicability, effectiveness, acceptability, safety and equity (APEASE) via an online questionnaire and workshop. Results:The prioritised barriers were: lack of time to get vaccinated; insufficient vaccine supplies; vaccination costs; a lack of peers getting vaccinated and beliefs that staff do not need vaccination and that it is ineffective. Six behaviour change techniques were selected and developed into a multi-component intervention: (behaviour change technique 1, Restructure of the physical environment) Free, in care home vaccination clinics for staff; (behaviour change techniques 2-4, Information about health consequences, Salience of consequences and information about others' approval) information campaign featuring care home staff highlighting non-vaccination risks, (behaviour change techniques 5-6, Information about health consequences and Credible source) information campaign featuring primary care doctor challenging misconceptions. Conclusions:We developed the first theory and evidence-based intervention specifically to facilitate care home staff flu vaccination uptake. Feasibility and acceptability testing of the intervention followed by definitive trial to assess efficacy in care homes is necessary to inform policy decision-making.

Influenza (flu) vaccination rates of Care home staff (CHS) in England are consistently lower (≈ 15

BACKGROUND:Chronic Obstructive Pulmonary Disease (COPD) is associated with low health-related quality of life and high costs to healthcare systems, particularly due to hospital admissions and exacerbations. Medicines, inhalers especially, reduce the risk of hospitalisations and exacerbations, but factors influencing medicine-taking behaviours are not fully understood. AIM:To explore experiences of people with COPD related to medicines, and followingly identify and characterise any barriers and enablers related to medicine-taking behaviours using the Theoretical Domains Framework (TDF). METHOD:Semi-structured qualitative interviews were conducted and included ten people with COPD who had previously been admitted to hospital. Systematic text condensation was used inductively in the primary analysis of the interviews. In the secondary analysis, meaning units from the primary analysis were mapped to the TDF and summarised as barriers and enablers. RESULTS:Five major themes were developed in the primary analysis: (1) health literacy and information needs, (2) patient autonomy, (3) lack of access to medicines, (4) lack of effect from medicines, and (5) experiences of medicines-related issues. In the secondary analysis, thirteen barriers and nine enablers were mapped to nine out of the fourteen domains of the TDF. CONCLUSION:People with COPD experience challenges related to medicines which need to be addressed by researchers and healthcare providers. The identified barriers and enablers mapped to the TDF can guide and inform future design of interventions and health care services.

The management of heart failure (HF) has undergone a paradigm shift from conventional stepwise methods of initiation and the up-titration of HF therapy towards an early, more intensive initiation of pharmacotherapy to improve the prognosis. The aim of this study was to compare the outcomes of patients at the Liverpool Heart and Chest Hospital (LHCH), with new diagnosis of HF, who were reviewed by the inpatient heart failure team (HFT), compared to patients that were not reviewed. A retrospective review of the electronic records of patients admitted with a new diagnosis of HF to the LHCH from May to December 2023 was performed. Admission drugs were similar, apart from betablockers, which were more frequent in the non-HFT group (58% vs. 24.2%; p = 0.002). The length of inpatient stay was longer in the HFT group (median 5.5 days vs. 3 days; p = 0.001) and more likely to be on all four pillars of HF medical therapy (96.8% vs. 0; p < 0.001) within 30 days of discharge. The 30-day and 6-month mortality outcomes were not significantly different. Patients reviewed by the HFT were significantly more likely to receive the four pillars of HF therapy within 30 days of their diagnosis compared to their counterparts at the expense of a longer length of stay.

BACKGROUND:Care home staff's (CHS's) influenza vaccination rate in England is 30%-40%, below the 75% WHO recommendation. We describe the effectiveness of a theory-informed and feasibility-tested intervention (in-home clinics; posters/videos to address vaccination hesitancy and care home financial incentives for uptake) to improve CHS vaccination rates. METHOD:Recruited care homes in England with CHS vaccination rates <40% were randomised at the home level for intervention or control. Assuming a change in CHS vaccinated from 55% to 75%, 20% attrition, and 90% power, we required 39 homes per arm. Monthly data were collected throughout flu season. The difference in vaccination rates between the arms was compared using the intention-to-treat principle and a random effect logistic regression model. FINDINGS:The mean % vaccination rate was 28.6% in control (n = 35) and 32.7% in intervention (n = 35) [odds ratio (OR) = 1.29, 95% confidence interval (CI): 0.68-0.4, P = .435]. In a sub-analysis, including only homes receiving at least one clinic, control was 28.6% (n = 35) and intervention was 41.7% (n = 23) (OR = 2.08, 95% CI: 0.67-2.70, P = .045). INTERPRETATION:No effect on vaccination status was demonstrated. Within homes receiving clinics, a significant increase was observed. Process evaluation evidence suggests that starting 3 months into the influenza season partially explains this. Further evaluation initiating FluCare earlier is warranted.

BACKGROUND:CompreHensive geriAtRician-led MEdication Review (CHARMER) is a behaviour change intervention designed to address the determinants of geriatricians and pharmacists deprescribing in hospital. CHARMER comprises a deprescribing action plan, deprescribing briefings, videos of successful deprescribing consultations, deprescribing case studies workshop and a deprescribing performance dashboard. This study aimed to evaluate the feasibility of undertaking a CHARMER definitive trial and inform primary outcome measure selection (90-day hospital readmission or patient quality of life (QoL)). METHODS:A two-arm purposive allocation feasibility study was undertaken in four hospitals (three intervention, one control). Intervention fidelity and acceptability, outcome data completeness and quality were evaluated alongside acceptability of data collection methods. The process evaluation explored these via interviews with staff and patients. Data were used to inform primary outcome measure selection. RESULTS:Eighteen geriatricians and pharmacists received the CHARMER intervention and 318 patients admitted to study wards were enrolled. 90-day hospital readmission data were available for 290 (91.2 %) patients. Sixty-six (20.8 %) were approached for consent to complete QoL measures; 25 (37.9 %) consented and 13 (52 %) completed at baseline and 90-day follow up. All intervention components were implemented with acceptable fidelity; hospitals were unfamiliar with implementing action plans and unclear who should be involved with implementing the dashboard, leading to delays. CONCLUSIONS:The CHARMER intervention is feasible to implement and given the low patient consent rate, 90-day readmission rate is the most appropriate primary outcome measure. Minor refinements to guidance will facilitate hospitals to undertake activities for implementation that are unfamiliar. CLINICAL TRIAL REGISTRATION:The study was registered on ISRCTN (ISRCTN11899506).