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Article

Developing an Evidence and Theory Based Multimodal Integrative Intervention for the Management of Renal Cachexia: A Theory of Change

by
Carolyn Blair
1,
Adrian Slee
2,
Andrew Davenport
3,
Denis Fouque
4,
William Johnston
5,
Kamyar Kalantar-Zadeh
6,
Peter Maxwell
7,
Clare McKeaveney
1,
Robert Mullan
8,
Helen Noble
1,
Sam Porter
9,
David Seres
10,
Joanne Shields
11,
Ian Swaine
12,
Miles Witham
13 and
Joanne Reid
1,*
1
School of Nursing and Midwifery, Queen’s University Belfast, Belfast BT9 7BL, UK
2
Division of Medicine, Faculty of Medical Sciences, University College London, London WC1E 6BT, UK
3
UCL Department of Renal Medicine Royal Free Hospital, University College London, London WC1E 6BT, UK
4
Division of Nephrology, Dialysis and Nutrition, Hôpital Lyon Sud and University of Lyon, 69495 Lyon, France
5
Renal Arts Group, School of Nursing and Midwifery, Queen’s University Belfast, Belfast BT9 7BL, UK
6
Irvine Division of Nephrology, Hypertension and Kidney Transplantation, University of California, Orange, CA 92868, USA
7
Centre for Public Health, Queen’s University Belfast, Belfast BT12 6BA, UK
8
Renal Unit, Antrim Area Hospital, Northern Health & Social Care Trust, Antrim BT41 2RL, UK
9
Department of Social Sciences and Social Work, Bournemouth University, Bournemouth BH12 5BB, UK
10
Institute of Human Nutrition and Department of Medicine, Columbia University Irving Medical Center, New York, NY 10032, USA
11
Regional Nephrology Unit, Belfast City Hospital, Belfast Health & Social Care Trust, Belfast BT9 7AB, UK
12
School of Human Sciences, University of Greenwich, London SE9 2UG, UK
13
AGE Research Group, NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust and Newcastle University, Newcastle NE4 6BE, UK
 
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Author to whom correspondence should be addressed.
Healthcare 2022, 10(12), 2344; https://doi.org/10.3390/healthcare10122344
Submission received: 7 October 2022 / Revised: 4 November 2022 / Accepted: 9 November 2022 / Published: 22 November 2022
(This article belongs to the Special Issue Cachexia and Chronic Disease)
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Abstract

In this study, we aimed to develop a theoretical framework for a multimodal, integrative, exercise, anti-inflammatory and dietary counselling (MMIEAD) intervention for patients with renal cachexia with reference to how this addresses the underlying causal pathways for renal cachexia, the outcomes anticipated, and how these will be evaluated. We used a Theory of Change (ToC) approach to guide six steps. Step 1 included inputs from a workshop to obtain key stakeholder views on the potential development of a multimodal intervention for renal cachexia. Step 2 included the findings of a mixed-methods study with Health Care Practitioners (HCPs) caring for individuals with End Stage Kidney Disease (ESKD) and cachexia. Step 3 included the results from our systematic literature review on multimodal interventions for cachexia management. In step 4, we used the body of our research team’s cachexia research and wider relevant research to gather evidence on the specific components of the multimodal intervention with reference to how this addresses the underlying causal pathways for renal cachexia. In steps 5 and 6 we developed and refined the ToC map in consultation with the core research team and key stakeholders which illustrates how the intervention components of MMIEAD interact to achieve the intended long-term outcomes and anticipated impact. The results of this study provide a theoretical framework for the forthcoming MMIEAD intervention for those with renal cachexia and in subsequent phases will be used to determine whether this intervention is effective. To the best of our knowledge no other multimodal intervention trials for cachexia management have reported a ToC. Therefore, this research may provide a useful framework and contribute to the ongoing development of interventions for cachexia management.
Keywords: cachexia; kidney disease; renal disease; end-stage kidney disease; theory of change; personal and public involvement; complex intervention; multimodal intervention cachexia; kidney disease; renal disease; end-stage kidney disease; theory of change; personal and public involvement; complex intervention; multimodal intervention

Share and Cite

MDPI and ACS Style

Blair, C.; Slee, A.; Davenport, A.; Fouque, D.; Johnston, W.; Kalantar-Zadeh, K.; Maxwell, P.; McKeaveney, C.; Mullan, R.; Noble, H.; et al. Developing an Evidence and Theory Based Multimodal Integrative Intervention for the Management of Renal Cachexia: A Theory of Change. Healthcare 2022, 10, 2344. https://doi.org/10.3390/healthcare10122344

AMA Style

Blair C, Slee A, Davenport A, Fouque D, Johnston W, Kalantar-Zadeh K, Maxwell P, McKeaveney C, Mullan R, Noble H, et al. Developing an Evidence and Theory Based Multimodal Integrative Intervention for the Management of Renal Cachexia: A Theory of Change. Healthcare. 2022; 10(12):2344. https://doi.org/10.3390/healthcare10122344

Chicago/Turabian Style

Blair, Carolyn, Adrian Slee, Andrew Davenport, Denis Fouque, William Johnston, Kamyar Kalantar-Zadeh, Peter Maxwell, Clare McKeaveney, Robert Mullan, Helen Noble, and et al. 2022. "Developing an Evidence and Theory Based Multimodal Integrative Intervention for the Management of Renal Cachexia: A Theory of Change" Healthcare 10, no. 12: 2344. https://doi.org/10.3390/healthcare10122344

APA Style

Blair, C., Slee, A., Davenport, A., Fouque, D., Johnston, W., Kalantar-Zadeh, K., Maxwell, P., McKeaveney, C., Mullan, R., Noble, H., Porter, S., Seres, D., Shields, J., Swaine, I., Witham, M., & Reid, J. (2022). Developing an Evidence and Theory Based Multimodal Integrative Intervention for the Management of Renal Cachexia: A Theory of Change. Healthcare, 10(12), 2344. https://doi.org/10.3390/healthcare10122344

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