Here is the structured PICO analysis for the twenty-second article you uploaded:
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Full Title (verbatim and exact):
“Timely short-term specialized palliative care service intervention for older people with frailty and their family carers in primary care: Development and modelling of the frailty+ intervention using theory of change”
De Nooijer K, Pivodic L, Van Den Noortgate N, et al.
Palliative Medicine (2021); 35(10): 1961–1974
DOI: https://doi.org/10.1177/02692163211040187
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Type of Article:
Development and modelling study of a complex intervention (pre-trial phase)
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PICO Analysis:
Population:
- Older people (aged ≥70 years) with frailty and complex needs living at home
- Inclusion criteria included:
- Clinical Frailty Scale score of 5–7
- At least one unresolved or complex issue in one of four palliative care domains (physical, psychosocial, spiritual, existential)
- Recent hospitalisation and planned discharge to home
- Also included family carers of these individuals
- Targeted care within primary care settings in Flanders, Belgium
Intervention:
The Frailty+ intervention—a timely, short-term, specialised palliative care service, comprising:
Core Component:
- 1–4 home visits over 8 weeks by a specialised palliative care nurse
- Multidisciplinary team meetings for collaborative planning
- Goal-oriented, holistic, and proactive care
- Person-centred and family-inclusive approach
- Integration with GP and community care teams
- Advance care planning and emergency response plans included
Implementation Components:
- Stakeholder engagement (GPs, geriatricians, nurses)
- Regional awareness and buy-in
- Staff training and interprofessional collaboration development
- Screening and referral system using standardised criteria
Comparator:
- No comparator group—this was a developmental study
- A pilot RCT was planned subsequently (Trial registration: ISRCTN39282347)
Outcome:
1. Person-centred outcomes:
- Expected (not yet measured in this paper):
- Increased sense of security in care (reported by patients and carers)
- Improved wellbeing
- Fewer unmet needs and symptoms
- Longer stay at home
- Enhanced continuity of care
- Reduced hospitalisations
2. Process outcomes:
- Identification of key preconditions for success:
- Timely patient identification
- GP referral and legal consent
- Buy-in from community and hospital staff
- Indicators and measures were to be tested in follow-up feasibility work
3. Health system outcomes:
- Hypothesised effects:
- Increased integration of palliative care into community-based care
- Greater job satisfaction among healthcare providers
- Assumptions for scalability:
- Free access to palliative home care
- 24/7 availability
- Coordination within regional healthcare structures
Summary Conclusion:
This article presents the Frailty+ intervention—a structured, short-term, nurse-led palliative care model designed for older adults with frailty and their carers in primary care. Using a participatory Theory of Change approach, the study detailed the intervention logic, components, and stakeholder requirements. While not yet tested for clinical outcomes, the design integrates palliative, geriatric, and goal-oriented care in a collaborative model aiming to improve holistic wellbeing, security in care, and health system integration. A pilot trial is underway to assess feasibility, fidelity, and preliminary effectiveness.
Life In The Slower Lane 
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