Wright Frances C, Gagliardi Anna R, Fraser Novlette, Quan May Lynn
Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
Surg Innov. 2011 Dec;18(4):379-86. doi: 10.1177/1553350611409063. Epub 2011 Jul 7.
Sentinel lymph node biopsy (SLNB) has been unevenly adopted into practice in Canada. In this qualitative study, the authors explored individual, institutional, and policy factors that may have influenced SLNB adoption. This information will guide interventions to improve SLNB implementation.
Qualitative methodology was used to examine factors influencing SLNB adoption. Grounded theory guided data collection and analysis. Semistructured interviews were based on Roger's diffusion of innovation theory. Purposive and snowball sampling was used to identify participants. Semistructured telephone interviews were conducted with urban, rural, academic, and community health care providers and administrators to ensure all perspectives and motivations were explored. Two individuals independently analyzed data and achieved consensus on emerging themes and their relationship.
A total of 43 interviews were completed with 21 surgeons, 5 pathologists, 7 nuclear medicine physicians, and 10 administrators. Generated themes included awareness of SLNB with the exception of some administrators, acknowledged advantage of SLNB, SLNB compatibility with beliefs regarding axillary staging, acknowledgment that SLNB was a complex innovation to adopt, extensive trialing of SLNB prior to adoption, observable benefits with SLNB, acknowledgment that hospital-level administrative support enabled adoption, desire for a provincial policy supporting SLNB to assist in hospital-level adoption, requirement of a local high-volume breast surgery champion who communicated extensively with team to facilitate local adoption, and need for credentialing of SLNB to ensure quality.
SLNB is a complex innovation to adopt. Successful adoption was assisted by a high-volume breast cancer surgical champion, interprofessional communication, and administrative support.
前哨淋巴结活检（SLNB）在加拿大的临床应用情况参差不齐。在这项定性研究中，作者探讨了可能影响SLNB应用的个人、机构和政策因素。这些信息将指导相关干预措施，以改善SLNB的实施情况。
采用定性研究方法来考察影响SLNB应用的因素。扎根理论指导数据收集与分析。半结构化访谈基于罗杰斯的创新扩散理论。采用目的抽样和滚雪球抽样来确定参与者。对城市、农村、学术及社区医疗服务提供者和管理人员进行了半结构化电话访谈，以确保探讨所有观点和动机。两名研究人员独立分析数据，并就新出现的主题及其关系达成共识。
共完成了43次访谈，访谈对象包括21名外科医生、5名病理学家、7名核医学医生和10名管理人员。得出的主题包括：除部分管理人员外，对SLNB的认知；认可SLNB的优势；SLNB与腋窝分期相关观念的契合度；承认SLNB是一项难以采用的复杂创新；在采用前对SLNB进行了广泛试验；观察到SLNB的益处；承认医院层面的行政支持有助于采用；希望出台省级政策支持SLNB以协助医院层面的采用；需要当地有一位大量开展乳腺癌手术的倡导者，其与团队进行广泛沟通以促进当地采用；以及需要对SLNB进行资质认证以确保质量。
SLNB是一项难以采用的复杂创新。大量开展乳腺癌手术的倡导者、跨专业沟通和行政支持有助于成功采用。
