PDF(Pubmed)
Abstract：
BACKGROUND: Palliative care aims to improve the quality of life for people with life-limiting illnesses. Advance care planning conversations that establish a patient\'s wishes and preferences for care are part of a person-centered approach. Internationally, electronic health record systems are digital interventions used to record and share patients\' advance care plans across health care services and settings. They aim to provide tools that support electronic information sharing and care coordination. Within the United Kingdom, Electronic Palliative Care Coordination Systems (EPaCCS) are an example of this. Despite over a decade of policy promoting EPaCCS nationally, there has been limited implementation and consistently low levels of use by health professionals.
OBJECTIVE: The aim of this study is to explore the factors that influence the implementation of EPaCCS into routine clinical practice across different care services and settings in 2 major regions of England.
METHODS: A qualitative interview study design was used, guided by Normalization Process Theory (NPT). NPT explores factors affecting the implementation of complex interventions and consists of 4 primary components (coherence, cognitive participation, collective action, and reflexive monitoring). Health care and social care practitioners were purposively sampled based on their professional role and work setting. Individual web-based semistructured interviews were conducted. Data were analyzed using thematic framework analysis to explore issues which affected the implementation of EPaCCS across different settings at individual, team, organizational, and technical levels.
RESULTS: Participants (N=52) representing a range of professional roles were recruited across 6 care settings (hospice, primary care, care home, hospital, ambulatory, and community). In total, 6 themes were developed which mapped onto the 4 primary components of NPT and represented the multilevel influences affecting implementation. At an individual level, these included (1) EPaCCS providing a clear and distinct way of working and (2) collective contributions and buy-in. At a team and organizational level, these included (3) embedding EPaCCS into everyday practice and (4) championing driving implementation. At a technical level, these included (5) electronic functionality, interoperability, and access. Breakdowns in implementation at different levels led to variations in (6) confidence and trust in EPaCCS in terms of record accuracy and availability of access.
CONCLUSIONS: EPaCCS implementation is influenced by individual, organizational, and technical factors. Key challenges include problems with access alongside inconsistent use and engagement across care settings. EPaCCS, in their current format as digital advance care planning systems are not consistently facilitating electronic information sharing and care coordination. A redesign of EPaCCS is likely to be necessary to determine configurations for their optimal implementation across different settings and locations. This includes supporting health care practitioners to document, access, use, and share information across multiple care settings. Lessons learned are relevant to other forms of digital advance care planning approaches being developed internationally.
OBJECTIVE: The aim of this study is to explore the factors that influence the implementation of EPaCCS into routine clinical practice across different care services and settings in 2 major regions of England.
METHODS: A qualitative interview study design was used, guided by Normalization Process Theory (NPT). NPT explores factors affecting the implementation of complex interventions and consists of 4 primary components (coherence, cognitive participation, collective action, and reflexive monitoring). Health care and social care practitioners were purposively sampled based on their professional role and work setting. Individual web-based semistructured interviews were conducted. Data were analyzed using thematic framework analysis to explore issues which affected the implementation of EPaCCS across different settings at individual, team, organizational, and technical levels.
RESULTS: Participants (N=52) representing a range of professional roles were recruited across 6 care settings (hospice, primary care, care home, hospital, ambulatory, and community). In total, 6 themes were developed which mapped onto the 4 primary components of NPT and represented the multilevel influences affecting implementation. At an individual level, these included (1) EPaCCS providing a clear and distinct way of working and (2) collective contributions and buy-in. At a team and organizational level, these included (3) embedding EPaCCS into everyday practice and (4) championing driving implementation. At a technical level, these included (5) electronic functionality, interoperability, and access. Breakdowns in implementation at different levels led to variations in (6) confidence and trust in EPaCCS in terms of record accuracy and availability of access.
CONCLUSIONS: EPaCCS implementation is influenced by individual, organizational, and technical factors. Key challenges include problems with access alongside inconsistent use and engagement across care settings. EPaCCS, in their current format as digital advance care planning systems are not consistently facilitating electronic information sharing and care coordination. A redesign of EPaCCS is likely to be necessary to determine configurations for their optimal implementation across different settings and locations. This includes supporting health care practitioners to document, access, use, and share information across multiple care settings. Lessons learned are relevant to other forms of digital advance care planning approaches being developed internationally.
摘要：
背景：姑息治疗旨在改善患有限制生命的疾病患者的生活质量。建立患者对护理的愿望和偏好的提前护理计划对话是以人为本方法的一部分。国际上,电子健康记录系统是数字干预措施，用于记录和共享跨医疗服务和设置的患者预先护理计划。它们旨在提供支持电子信息共享和护理协调的工具。在英国，电子姑息治疗协调系统（EPaCCS）就是一个例子。尽管十多年来在全国范围内推广EPaCCS的政策，实施有限，卫生专业人员的使用水平一直很低。
目的：本研究的目的是探讨影响在英格兰两个主要地区的不同护理服务和环境中，将EPaCCS纳入常规临床实践的因素。
方法：采用定性访谈研究设计，以规范化过程理论(NPT)为指导。《不扩散条约》探讨了影响实施复杂干预措施的因素，包括4个主要组成部分(一致性，认知参与，集体行动,和自反监测)。根据其职业角色和工作环境，有目的地对医疗保健和社会护理从业人员进行采样。进行了个人基于网络的半结构化访谈。使用主题框架分析对数据进行了分析，以探索影响个人不同环境下EPaCCS实施的问题，团队,组织，和技术水平。
结果：代表一系列专业角色的参与者（N=52）在6个护理机构（临终关怀，初级保健,疗养院,医院,走动,和社区）。总的来说,制定了6个主题，这些主题映射到《不扩散核武器条约》的4个主要组成部分，并代表了影响执行的多层次影响。在个人层面,这些措施包括（1）EPaCCS提供了一个清晰和独特的工作方式和（2）集体贡献和支持。在团队和组织层面，其中包括（3）将EPaCCS嵌入日常实践中，以及（4）倡导驾驶实施。在技术层面,这些包括(5)电子功能，互操作性，和访问。在不同级别的实施中的故障导致了(6)在记录准确性和访问可用性方面对EPaCCS的信心和信任的变化。
结论：EPaCCS实施受个人影响，组织，和技术因素。主要挑战包括访问问题以及整个护理环境的使用和参与不一致。EPaCCS,以其目前的格式，作为数字预先护理计划系统，并不能始终如一地促进电子信息共享和护理协调。EPaCCS的重新设计可能是必要的，以确定其跨不同设置和位置的最佳实施的配置。这包括支持卫生保健从业人员记录，access,使用,并在多个护理环境中共享信息。吸取的经验教训与国际上正在开发的其他形式的数字预先护理计划方法有关。
目的：本研究的目的是探讨影响在英格兰两个主要地区的不同护理服务和环境中，将EPaCCS纳入常规临床实践的因素。
方法：采用定性访谈研究设计，以规范化过程理论(NPT)为指导。《不扩散条约》探讨了影响实施复杂干预措施的因素，包括4个主要组成部分(一致性，认知参与，集体行动,和自反监测)。根据其职业角色和工作环境，有目的地对医疗保健和社会护理从业人员进行采样。进行了个人基于网络的半结构化访谈。使用主题框架分析对数据进行了分析，以探索影响个人不同环境下EPaCCS实施的问题，团队,组织，和技术水平。
结果：代表一系列专业角色的参与者（N=52）在6个护理机构（临终关怀，初级保健,疗养院,医院,走动,和社区）。总的来说,制定了6个主题，这些主题映射到《不扩散核武器条约》的4个主要组成部分，并代表了影响执行的多层次影响。在个人层面,这些措施包括（1）EPaCCS提供了一个清晰和独特的工作方式和（2）集体贡献和支持。在团队和组织层面，其中包括（3）将EPaCCS嵌入日常实践中，以及（4）倡导驾驶实施。在技术层面,这些包括(5)电子功能，互操作性，和访问。在不同级别的实施中的故障导致了(6)在记录准确性和访问可用性方面对EPaCCS的信心和信任的变化。
结论：EPaCCS实施受个人影响，组织，和技术因素。主要挑战包括访问问题以及整个护理环境的使用和参与不一致。EPaCCS,以其目前的格式，作为数字预先护理计划系统，并不能始终如一地促进电子信息共享和护理协调。EPaCCS的重新设计可能是必要的，以确定其跨不同设置和位置的最佳实施的配置。这包括支持卫生保健从业人员记录，access,使用,并在多个护理环境中共享信息。吸取的经验教训与国际上正在开发的其他形式的数字预先护理计划方法有关。
