Facilitators and barriers to implementation of a patient and staff reported measure for screening of palliative concerns of patients with heart failure: a qualitative analysis using the Consolidated Framework for Implementation Research.

IF 2.7 Q2 HEALTH CARE SCIENCES & SERVICES
Palliative Care and Social Practice Pub Date : 2023-12-01 eCollection Date: 2023-01-01 DOI:10.1177/26323524231214814
Shirlyn Hui-Shan Neo, Jasmine Yun-Ting Tan, Elaine Swee-Ling Ng, Sungwon Yoon
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引用次数: 0

Abstract

Background: Screening patients with patient-reported outcome measures allows identification of palliative care concerns. The Integrated Palliative Care Outcome Scale (IPOS) was developed in the United Kingdom for this purpose. Tools developed in another setting might not be readily usable locally. We previously evaluated the validity and reliability of the IPOS in our cardiology setting. However, it remains uncertain what factors would influence the subsequent implementation of IPOS for routine screening of patients with advanced heart failure in future practice.

Objectives: This study aimed to identify the factors that could affect the IPOS implementation for patients with advanced heart failure.

Design: This was a qualitative study conducted at the National Heart Centre Singapore.

Methods: Patients with advanced heart failure who participated in our previous IPOS validation study were purposively recruited for semi-structured interviews. Healthcare workers caring for these patients and involved in the testing of the IPOS tool were also invited for interviews. The interviews were analyzed thematically and mapped to the Consolidated Framework for Implementation Research (CFIR).

Results: Our analysis identified six potential facilitators and six potential barriers to implementation across five major domains of the CFIR (intervention characteristics, inner setting, outer setting, individual characteristics, and process). Facilitators include: (i) perception of utility, (ii) perception of minimal complexity, (iii) perception of relatability, (iv) conducive culture, (v) dedicated resources, and (vi) advocates for implementation. Barriers include: (i) need for adaptation, (ii) mindsets/role strains, (iii) resource constraints, (iv) cultural concerns, (v) individual needs, and (vi) change process.

Conclusion: Institutions could focus on cultivating appropriate perceptions and conducive cultures, providing dedicated resources for implementation and introducing facilitators to advocate for implementation. Adaptation of IPOS to suit workflows and individual needs, consideration of change processes, and systemic changes to alleviate cultural, resource, and staff role strains would improve IPOS uptake during actual implementation in clinical services.

Trial registration: Not applicable.

实施患者和工作人员报告的心力衰竭患者姑息治疗筛查措施的促进因素和障碍:使用实施研究统一框架的定性分析。
背景:筛选患者与患者报告的结果措施可以确定姑息治疗的关注。综合姑息治疗结果量表(IPOS)是为此目的在英国开发的。在另一种环境中开发的工具可能不容易在当地使用。我们之前评估了IPOS在我们的心脏病学环境中的有效性和可靠性。然而,在未来的实践中,仍不确定哪些因素会影响IPOS在晚期心力衰竭患者常规筛查中的后续实施。目的:本研究旨在确定影响晚期心力衰竭患者IPOS实施的因素。设计:这是一项在新加坡国立心脏中心进行的定性研究。方法:有意招募参加我们之前IPOS验证研究的晚期心力衰竭患者进行半结构化访谈。照顾这些患者并参与IPOS工具测试的卫生保健工作者也被邀请接受采访。对访谈进行了主题分析,并将其映射到实施研究综合框架(CFIR)。结果:我们的分析确定了五个主要领域(干预特征、内部环境、外部环境、个体特征和过程)实施CFIR的六个潜在促进因素和六个潜在障碍。促进因素包括:(i)效用感知,(ii)最小复杂性感知,(iii)相关性感知,(iv)有利文化,(v)专用资源,以及(vi)实施倡导者。障碍包括:(i)适应需求,(ii)心态/角色压力,(iii)资源限制,(iv)文化关注,(v)个人需求,以及(vi)变革进程。结论:机构应注重培养适当的观念和有利的文化,为实施提供专门的资源,并引入促进者来倡导实施。调整IPOS以适应工作流程和个人需求,考虑变革流程,以及系统性变革以减轻文化、资源和工作人员角色压力,将改善IPOS在临床服务实际实施过程中的吸收。试验注册:不适用。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Palliative Care and Social Practice
Palliative Care and Social Practice Nursing-Advanced and Specialized Nursing
CiteScore
2.90
自引率
0.00%
发文量
37
审稿时长
9 weeks
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