METHODS: The pathway was implemented in one family practice in Alberta, two family practices in British Columbia (BC), and one BC internal medicine outpatient clinic. Physicians and allied health professionals delivered structured pathway visits based on the Serious Illness Conversation Guide. Twelve physicians and one social worker participated in interviews or focus groups at the end of the study period. Qualitative data were coded inductively using an iterative approach, with regular meetings between coders.
RESULTS: Clinicians described experiences with the ACP care pathway, impact at the clinician level, and impact at the patient level. Within each domain, clinicians described barriers and facilitators experienced during implementation. Clinicians also reflected candidly about potential for future implementation and the sustainability of the pathway.
CONCLUSIONS: While the pathway was implemented slightly differently between provinces, core experiences were that implementation of the pathway, and integration with current practice, were feasible. Across settings, similar themes recurred regarding usefulness of the pathway structure and its tools, impact on clinician confidence and interactions with patients, teamwork and task delegation, compatibility with existing workflow, and patient preparation and readiness. Clinicians were supportive of ACP and of the pathway.
BACKGROUND: The study was prospectively registered with clinicaltrials.gov (NCT03508557). Registered April 25, 2018. https://classic.
RESULTS: gov/ct2/show/NCT03508557 .
方法:该途径在艾伯塔省的一个家庭实践中实施,不列颠哥伦比亚省(BC)的两个家庭做法,和一家BC内科门诊。医师和专职卫生专业人员根据《严重疾病对话指南》进行了结构化的路径访问。研究结束时,十二名医生和一名社会工作者参加了访谈或焦点小组。定性数据使用迭代方法进行归纳编码,编码器之间的定期会议。
结果:临床医生描述了ACP护理途径的经验,在临床医生层面的影响,以及对患者水平的影响。在每个域中,临床医生描述了实施过程中遇到的障碍和促进者。临床医生还坦率地反映了未来实施的潜力和途径的可持续性。
结论:虽然各省之间的路径实施略有不同,核心经验是路径的实施,并与当前实践相结合,是可行的。跨设置,关于途径结构及其工具的有用性,类似的主题再次出现,对临床医生信心和与患者互动的影响,团队合作和任务授权,与现有工作流的兼容性,和病人的准备和准备。临床医生支持ACP和该途径。
背景:该研究在clinicaltrials.gov(NCT03508557)进行了前瞻性登记。2018年4月25日注册。https://经典。
结果:gov/ct2/show/NCT03508557。