背景:临床实践指南可帮助卫生专业人员(HP)做出决定。开发成本高昂,许多指南未在临床环境中实施.本文介绍了对环境因素的评估,以告知澳大利亚一家癌症医院癌症相关性疲劳(CRF)的常见和令人困扰的问题的临床指南实施策略。
方法:涉及消费者和多学科HP的访谈和焦点小组的定性调查探讨了加拿大CRF指南的主要建议。四个惠普焦点小组审查了一项具体建议的可行性,而消费者焦点小组检查了管理CRF的经验和偏好。使用旨在加速实施研究的快速内容分析方法对录音进行了分析。执行战略以执行研究综合框架为指导。
结果:5名消费者和31名多学科HP参加了8次访谈和5个焦点小组。疲劳管理的主要HP障碍是知识和时间不足;缺乏可访问的筛查和管理工具或转诊途径。消费者障碍包括在短期健康咨询期间优先控制癌症,有限的耐力,以延长或额外的访问解决疲劳,和惠普对疲劳的态度。最佳疲劳管理的支持者与现有的医疗保健实践保持一致,增加HP对CRF指南和工具的了解,并改善转诊途径。消费者重视他们的惠普解决疲劳作为治疗的一部分,个人疲劳预防或管理计划,包括自我监控。消费者更喜欢在诊所预约和使用远程健康咨询之外的疲劳管理。
结论:应尝试减少障碍和利用指南使用推动者的策略。方法应包括(1)为繁忙的惠普提供可访问的知识和实践资源,(2)患者及其HP的时间有效的过程,以及(3)过程与现有实践的一致性。癌症护理的资金必须提供最佳实践支持护理。
BACKGROUND: Clinical practice
guidelines assist health professionals\' (HPs) decisions. Costly to develop, many
guidelines are not implemented in clinical settings. This paper describes an evaluation of contextual factors to inform clinical
guideline implementation strategies for the common and distressing problem of cancer-related fatigue (CRF) at an Australian cancer hospital.
METHODS: A qualitative inquiry involving interviews and focus groups with consumers and multidisciplinary HPs explored key Canadian CRF guideline recommendations. Four HP focus groups examined the feasibility of a specific recommendation, while a
consumer focus group examined experiences and preferences for managing CRF. Audio recordings were analysed using a rapid method of content analysis designed to accelerate implementation research. Strategies for implementation were guided by the Consolidated Framework for Implementation Research.
RESULTS: Five consumers and 31 multidisciplinary HPs participated in eight interviews and five focus groups. Key HP barriers to fatigue management were insufficient knowledge and time; and lack of accessible screening and management tools or referral pathways.
Consumer barriers included priority for cancer control during short health consultations, limited stamina for extended or extra visits addressing fatigue, and HP attitudes towards fatigue. Enablers of optimal fatigue management were alignment with existing healthcare practices, increased HP knowledge of CRF guidelines and tools, and improved referral pathways. Consumers valued their HPs addressing fatigue as part of treatment, with a personal fatigue prevention or management plan including self-monitoring. Consumers preferred fatigue management outside clinic appointments and use of telehealth consultations.
CONCLUSIONS: Strategies that reduce barriers and leverage enablers to guideline use should be trialled. Approaches should include (1) accessible knowledge and practice resources for busy HPs, (2) time efficient processes for patients and their HPs and (3) alignment of processes with existing practice. Funding for cancer care must enable best practice supportive care.