Demiris George, Parker Oliver Debra, Capurro Daniel, Wittenberg-Lyles Elaine
*Address correspondence to George Demiris, School of Nursing, University of Washington, Seattle, WA 98195. E-mail:
Gerontologist. 2014 Apr;54(2):163-71. doi: 10.1093/geront/gnt022. Epub 2013 Apr 4.
This article provides a general introduction to implementation science-the discipline that studies the implementation process of research evidence-in the context of hospice and palliative care. By discussing how implementation science principles and frameworks can inform the design and implementation of intervention research, we aim to highlight how this approach can maximize the likelihood for translation and long-term adoption in clinical practice settings. We present 2 ongoing clinical trials in hospice that incorporate considerations for translation in their design and implementation as case studies for the implications of implementation science. This domain helps us better understand why established programs may lose their effectiveness over time or when transferred to other settings, why well-tested programs may exhibit unintended effects when introduced in new settings, or how an intervention can maximize cost-effectiveness with strategies for effective adoption. All these challenges are of significance to hospice and palliative care, where we seek to provide effective and efficient tools to improve care services. The emergence of this discipline calls for researchers and practitioners to carefully examine how to refine current and design new and innovative strategies to improve quality of care.
本文在临终关怀与姑息治疗的背景下,对实施科学——一门研究研究证据实施过程的学科——进行了总体介绍。通过讨论实施科学原则和框架如何为干预研究的设计与实施提供信息,我们旨在强调这种方法如何能最大程度地提高在临床实践环境中转化和长期采用的可能性。我们介绍了两项正在进行的临终关怀临床试验,它们在设计和实施过程中纳入了对转化的考量,以此作为实施科学影响的案例研究。该领域有助于我们更好地理解为何既定项目可能会随着时间推移或转移到其他环境中而失去效力,为何经过充分测试的项目在引入新环境时可能会出现意外效果,或者一项干预措施如何通过有效采用策略实现成本效益最大化。所有这些挑战对临终关怀与姑息治疗都具有重要意义,因为我们致力于提供有效且高效的工具来改善护理服务。这一学科的出现要求研究人员和从业者仔细审视如何完善现有策略,并设计新的创新策略以提高护理质量。