Development of the TANDEM intervention for Chronic Obstructive Pulmonary Disease: reporting on the pre-pilot phase

Background: The importance of detailing the development phase of complex behavioural interventions is increasingly recognized but typically underperformed. Aim: To describe the development, including pre-pilot, of a tailored intervention for individuals with COPD and mild/moderate depression and/or anxiety, based on cognitive behavioural approaches and leading onto routine pulmonary rehabilitation. Methods: The TANDEM intervention, informed by previous interventions for this population (The Lung Manual and SPACE), combines both psychological and self-management approaches for individuals with comorbid COPD and anxiety and/or depression. It was presented to 8 health care professionals (HCPs) and 7 patients through interviews or focus groups to elicit reactions to the intervention, and challenges to be considered. A pre-pilot study including training 3 respiratory nurses and delivery to 6 patients was conducted before revision of the intervention. Results: All participants endorsed the TANDEM approach. Improvements to patient facing materials were made following feedback. The need to assess HCPs’ interpersonal skills and competency using video feedback was identified during training. Trialing intervention delivery highlighted minimizing the period between intervention training and delivery, and the importance of supervision. Conclusions: The pre-pilot study has enabled significant refinement of the TANDEM intervention prior to piloting. This may prove key to successful, cost-effective, implementation within the larger planned randomized controlled trial. Funding: NIHR HTA 13/146/02