临床医生对肿瘤姑息治疗开放笔记的看法:一项混合方法研究。

IF 3.5 2区 医学 Q2 CLINICAL NEUROLOGY
Joanna Veazey Brooks PhD, MBE , Delisia Chapman-Brown MPH , Amanda Thimmesch BA , Elizabeth Wulff-Burchfield MD , Christian Sinclair MD , Daniel English MSGH , Heather Nelson-Brantley PhD, RN, NEA-BC, CNE
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引用次数: 0

摘要

背景:《21世纪治愈法案》互操作性和信息封锁规则(IBR)的目标值得称赞,即提高与患者共享健康信息和患者知情决策的透明度,但支持IBR实施的策略却很少。在缺乏循证指南的情况下,卫生系统和姑息治疗临床医生只能自行指导IBR的实施。目的:我们试图了解临床医生在肿瘤学和姑息治疗中使用IBR的观点和经验。方法:采用收敛平行混合方法设计,对临床医生进行调查和访谈。结果:来自某机构的29名临床医生参与了本研究。数据显示出三个主题:(1)对伤害的特殊担忧;(2)为响应IBR而进行的文件变更;(3)分享笔记作为一个有用的工具。我们发现临床医生看到了IBR的好处和担忧。肿瘤学临床医生更担心检测结果的敏感性,而姑息治疗临床医生更担心家庭会议记录和预后信息的敏感性。结论:我们的研究结果表明,临床医生对IBR的体验比临床医生在社论中表达的最初担忧更微妙。此外,我们的研究表明,在IBR中捕捉特定专业经验的重要性,因为关注点可能不同。未来的研究应继续围绕IBR的实施检查临床医生和组织实践,以确定最大化患者和临床医生利益的最佳实践,同时最大限度地减少意外伤害。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Clinician Perspectives on Open Notes in Oncology Palliative Care: A Mixed-Methods Study

Context

The 21st Century Cures Act Interoperability and Information Blocking Rule (IBR) has the laudable goal of increased transparency in sharing health information with patients and informed decision-making by patients, yet strategies to support IBR implementation are sparse. Without evidence-based guidelines, health systems and palliative care clinicians have been left to navigate implementation of the IBR on their own.

Objectives

We sought to understand clinician perspectives and experiences with the IBR in oncology and palliative care.

Methods

We used a convergent parallel mixed method design with clinician surveys and interviews.

Results

29 clinicians from one institution participated in the study. Three themes emerged from the data: 1) specialty-specific worry about harm; 2) documentation changes in response to the IBR; and 3) sharing notes as a helpful tool. We found that clinicians see benefits and concerns around the IBR. Oncology clinicians worried more about the sensitivity of test results while palliative care clinicians worried more about the sensitivity of information included in documentation of family meetings and of prognostic information.

Conclusion

Findings from our study indicate that clinicians’ experience with the IBR is more nuanced than the initial worry expressed by clinicians in editorials. Additionally, our study shows the importance of capturing specialty-specific experiences with the IBR, as concerns can differ. Future research should continue to examine clinician and organizational practices around implementation of the IBR to identify best practices for maximizing patient and clinician benefit while minimizing unintended harm.
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来源期刊
CiteScore
8.90
自引率
6.40%
发文量
821
审稿时长
26 days
期刊介绍: The Journal of Pain and Symptom Management is an internationally respected, peer-reviewed journal and serves an interdisciplinary audience of professionals by providing a forum for the publication of the latest clinical research and best practices related to the relief of illness burden among patients afflicted with serious or life-threatening illness.
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