A qualitative enquiry into participants' and practitioners' experiences in the Australian Liver FaIlurE trial

The Australian Liver FaIlurE (ALFIE) trial, a multicentre, randomised controlled trial, assessed the efficacy of a nurse-coordinated model of care to reduce liver-related emergency admissions (LREAs) in patients with decompensated cirrhosis. The model of care was delivered by a specialist nurse, including intensive postdischarge monitoring, linkage to multidisciplinary care, rapid access to care pathway, enhanced education and self-management support.

To examine the experiences of participants and practitioners in the ALFIE trial to understand its impact, barriers and areas for improvement.

A qualitative semistructured interview analysis nested within the ALFIE trial.

A purposeful sample of 15 patients, 14 controls and 12 staff.

Thematic analysis of interview transcripts.

Interventional participants and the nurses perceived the care provided as personalised, holistic and continuous. The intervention enabled the development of robust therapeutic relationships and trust that promoted participant engagement and risk factor modification. It helped intervention participants navigate the busy hospital system. The control participants desired more education and a personal contact to deal with emergencies. With respect to the intervention, nurses felt that their support helped reduce LREAs and improve care, but it was overwhelming. A number of barriers and systemic issues were identified. Suggestions for improvement of the intervention model included increased staffing, improved mental health support and communication pathways with primary care practitioners.

The ALFIE trial was well received by nurses and participants. It met the needs of intervention participants and the health system through easy-to-navigate, personalised, holistic and ongoing care. The study identified barriers and systemic improvement areas.

ACTRN12617001293358.