Charles-Le Moyne Hospital Research Centre, Greenfield Park, QC J4K 0A8, Canada.
Implement Sci. 2014 Jun 17;9:76. doi: 10.1186/1748-5908-9-76.
Interdisciplinary teamwork (ITW) is designed to promote the active participation of several disciplines in delivering comprehensive cancer care to patients. ITW provides mechanisms to support continuous communication among care providers, optimize professionals' participation in clinical decision-making within and across disciplines, and foster care coordination along the cancer trajectory. However, ITW mechanisms are not activated optimally by all teams, resulting in a gap between desired outcomes of ITW and actual outcomes observed. The aim of the present study is to identify the conditions underlying outcome production by ITW in local oncology teams.
This retrospective multiple case study will draw upon realist evaluation principles to explore associations among context, mechanisms and outcomes (CMO). The cases are nine interdisciplinary cancer teams that participated in a previous study evaluating ITW outcomes. Qualitative data sources will be used to construct a picture of CMO associations in each case. For data collection, reflexive focus groups will be held to capture patients' and professionals' perspectives on ITW, using the guiding question, 'What works, for whom, and under what circumstances?' Intra-case analysis will be used to trace associations between context, ITW mechanisms, and patient outcomes. Inter-case analysis will be used to compare the different cases' CMO associations for a better understanding of the phenomenon under study.
This multiple case study will use realist evaluation principles to draw lessons about how certain contexts are more or less likely to produce particular outcomes. The results will make it possible to target more specifically the actions required to optimize structures and to activate the best mechanisms to meet the needs of cancer patients. This project could also contribute significantly to the development of improved research methods for conducting realist evaluations of complex healthcare interventions. To our knowledge, this study is the first to use CMO associations to improved empirical and theoretical understanding of interdisciplinary teamwork in oncology, and its results could foster more effective implementation in clinical practice.
跨学科团队合作（ITW）旨在促进多个学科积极参与为患者提供全面的癌症护理。ITW 提供了支持护理提供者之间持续沟通的机制，优化了专业人员在学科内和跨学科参与临床决策的能力，并促进了癌症治疗过程中的护理协调。然而，并非所有团队都能最佳地激活 ITW 机制，导致 ITW 的期望结果与实际观察到的结果之间存在差距。本研究旨在确定本地肿瘤学团队中 ITW 产生结果的条件。
本回顾性多案例研究将借鉴现实主义评估原则，探讨背景、机制和结果（CMO）之间的关联。案例是参与先前评估 ITW 结果的研究的九个跨学科癌症团队。将使用定性数据来源来构建每个案例中 CMO 关联的图片。为了收集数据，将举行反思性焦点小组，以捕捉患者和专业人员对 ITW 的看法，使用的指导问题是“什么有效，对谁有效，在什么情况下有效？” 个案内分析将用于追踪背景、ITW 机制和患者结果之间的关联。案例间分析将用于比较不同案例的 CMO 关联，以更好地理解研究中的现象。
本多案例研究将使用现实主义评估原则，从中吸取有关某些背景更有可能或不太可能产生特定结果的经验教训。研究结果将能够更有针对性地采取行动，以优化结构并激活最佳机制，以满足癌症患者的需求。该项目还可以为开发用于对复杂医疗干预措施进行现实主义评估的改进研究方法做出重大贡献。据我们所知，这项研究首次使用 CMO 关联来改进对肿瘤学中跨学科团队合作的经验和理论理解，其结果可以促进在临床实践中更有效地实施。
