Contextual factors that influence adoption and sustainment of self-management support in cancer survivorship care: a practical application of theory with qualitative interviews.

IF 5.6 1区 医学 Q1 HEALTH CARE SCIENCES & SERVICES
Nickola Pallin, John Browne, Roisin Connolly, Josephine Hegarty, Sheena McHugh
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引用次数: 0

Abstract

Background: Self-management support (SMS) is a recommended component of cancer survivorship care that improves health-related quality of life and reduces healthcare utilisation. However, widespread implementation has been difficult to achieve, with a gap in the literature on system-wide implementation efforts. This study examines contextual factors perceived to influence SMS adoption and sustainment in cancer centres in the Republic of Ireland.

Method: Semistructured interviews were conducted with 47 key informants from 20 cancer organisations across community and hospital settings. Participants were asked to report the level of adoption and sustainment of SMS at their organisation. This information was used to categorise organisations as low, medium or high implementers. We conducted cross-case analysis following the principles of Framework Analysis. Using the Consolidated Framework for Implementation Research as a menu of constructs, we examined factors influencing adoption and sustainment and variation in levels of implementation.

Results: National policy, external accreditation, external financing opportunities and the presence of champions in organisations are influential early in the implementation process driving adoption. Healthcare provider-led programmes and evidence of SMS improving patient outcomes and aligning with an organisation's priorities are necessary to secure buy-in, particularly among senior leadership. An organisational culture of entrepreneurship enables adoption and sustainment, with resources and a culture supporting staff well-being enabling sustainment.

Conclusion: While national policy is a driver, additional factors related to programme attributes and local contextual features such as the presence of champions, organisational readiness and culture influence implementation. The results may be used for future evaluations of SMS implementation in cancer survivorship care and to inform the development of tailored implementation strategies.

影响在癌症幸存者护理中采用和维持自我管理支持的环境因素:定性访谈理论的实际应用。
背景:自我管理支持(SMS)是癌症幸存者护理的一个推荐组成部分,可提高与健康相关的生活质量并减少医疗保健的使用。然而,广泛的实施一直难以实现,有关全系统实施工作的文献也存在空白。本研究探讨了影响爱尔兰共和国癌症中心采用和维持 SMS 的环境因素:对来自社区和医院的 20 家癌症机构的 47 名关键信息提供者进行了结构化访谈。参与者被要求报告其所在机构采用和维持 SMS 的程度。根据这些信息,我们将机构分为低、中、高实施者。我们按照框架分析的原则进行了跨案例分析。我们使用实施研究综合框架作为构建菜单,研究了影响采用和持续实施的因素以及实施水平的差异:结果:国家政策、外部认证、外部融资机会以及组织中是否存在倡导者在实施过程的早期对采用具有影响。医疗服务提供者主导的计划以及 SMS 能够改善患者疗效并与组织优先事项相一致的证据,是确保获得支持的必要条件,尤其是在高层领导中。组织内的创业文化有利于采用和持续,而支持员工福利的资源和文化则有利于持续:虽然国家政策是一个驱动因素,但与计划属性和当地环境特征有关的其他因素,如是否有拥护者、组织准备情况和文化,也会影响计划的实施。这些结果可用于今后对癌症幸存者护理中短信服务实施情况的评估,并为制定有针对性的实施策略提供参考。
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来源期刊
BMJ Quality & Safety
BMJ Quality & Safety HEALTH CARE SCIENCES & SERVICES-
CiteScore
9.80
自引率
7.40%
发文量
104
审稿时长
4-8 weeks
期刊介绍: BMJ Quality & Safety (previously Quality & Safety in Health Care) is an international peer review publication providing research, opinions, debates and reviews for academics, clinicians and healthcare managers focused on the quality and safety of health care and the science of improvement. The journal receives approximately 1000 manuscripts a year and has an acceptance rate for original research of 12%. Time from submission to first decision averages 22 days and accepted articles are typically published online within 20 days. Its current impact factor is 3.281.
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