Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
Int J Eat Disord. 2014 Jan;47(1):32-9. doi: 10.1002/eat.22185. Epub 2013 Sep 14.
To explore the decision-making processes involved in the uptake and implementation of evidence-based treatments (EBTs), namely, family-based treatment (FBT), among therapists and their administrators within publically funded eating disorder treatment programs in Ontario, Canada.
Fundamental qualitative description guided sampling, data collection, and analytic decisions. Forty therapists and 11 administrators belonging to a network of clinicians treating eating disorders completed an in-depth interview regarding the decision-making processes involved in EBT uptake and implementation within their organizations. Content analysis and the constant comparative technique were used to analyze interview transcripts, with 20% of the data independently double-coded by a second coder.
Therapists and their administrators identified the importance of an inclusive change culture in evidence-based practice (EBP) decision-making. Each group indicated reluctance to make EBP decisions in isolation from the other. Additionally, participants identified seven stages of decision-making involved in EBT adoption, beginning with exposure to the EBT model and ending with evaluating the impact of the EBT on patient outcomes. Support for a stage-based decision-making process was in participants' indication that the stages were needed to demonstrate that they considered the costs and benefits of making a practice change. Participants indicated that EBTs endorsed by the Provincial Network for Eating Disorders or the Academy for Eating Disorders would more likely be adopted.
Future work should focus on integrating the important decision-making processes identified in this study with known implementation models to increase the use of low-cost and effective treatments, such as FBT, within eating disorder treatment programs.
探索加拿大安大略省公共资助的饮食失调治疗项目中的治疗师及其管理人员在采用和实施基于证据的治疗方法（EBT），即家庭为基础的治疗（FBT）时所涉及的决策过程。
基本的定性描述引导了抽样、数据收集和分析决策。来自一个治疗饮食失调症的临床医生网络的 40 名治疗师和 11 名管理人员完成了一项深入访谈，内容涉及他们所在组织中采用和实施 EBT 的决策过程。采用内容分析和不断比较技术对访谈记录进行分析，其中 20%的数据由第二位编码员独立进行双重编码。
治疗师及其管理人员确定了在基于证据的实践（EBP）决策中包含广泛的变革文化的重要性。每个群体都表示不愿意在与其他群体隔离的情况下做出 EBP 决策。此外，参与者确定了采用 EBT 的七个决策阶段，从接触 EBT 模型开始，以评估 EBT 对患者结果的影响结束。支持基于阶段的决策过程是基于参与者的指示，即需要这些阶段来证明他们考虑了进行实践变革的成本和收益。参与者表示，省级饮食失调网络或饮食失调学会认可的 EBT 更有可能被采用。
未来的工作应侧重于将本研究中确定的重要决策过程与已知的实施模型相结合，以增加在饮食失调治疗项目中采用低成本和有效的治疗方法，如 FBT。
