Winder Rachel, Richards Suzanne H, Campbell John L, Richards David A, Dickens Chris, Gandhi Manish, Wright Christine, Turner Katrina
University of Exeter Medical School, Exeter, St Luke's Campus, Exeter, EX1 2LU UK.
Royal Devon and Exeter NHS Foundation Trust, Barrack Road, Exeter, EX2 5DW UK.
Pilot Feasibility Stud. 2017 Feb 13;3:9. doi: 10.1186/s40814-017-0123-1. eCollection 2017.
Patients who experience a cardiac event are at higher risk of developing depression than the general population. Despite this, cardiac rehabilitation (CR) programmes do not provide a systematic approach to psychological care for depression. The CADENCE study aimed to develop and pilot an enhanced psychological care (EPC) intervention consisting of behavioural activation (BA) and mental health care coordination. Following original research commissioning guidance, the intervention was planned to be embedded in routine care and delivered by CR nurses to patients with depression attending CR. This paper describes how qualitative methods were used to develop, embed and refine the intervention.
This feasibility study involved three CR teams. Observations were made of CR nurses delivering usual care, of EPC training given to nurses, and of supervision sessions provided to the CR nurses. Four nurses were interviewed shortly after their EPC training, and three were interviewed again 6-7 months later having delivered EPC to patients. All nine patients recruited to receive EPC were interviewed. Analyses of the observation notes and interview transcripts focused on how the intervention could be improved in terms of its acceptability and implementation.
Variations were found between the CR teams regarding patient waiting list times, how CR was delivered, what facilities were available and how many CR sessions were offered to patients. EPC was acceptable to both nurses and patients. However, nurses struggled to provide this additional care within their existing workload and resources, and patients' disrupted progression through the CR programme affected EPC delivery. Limited time and availability of private space meant nurses also delivered EPC by telephone, which was viewed as a pragmatic solution but less preferable than face-to-face. Nurses indicated that patients struggled with some of the written materials. Findings were used to revise the intervention to become a protocol of care coordination which included guided self-help BA.
Insights gained through conducting interviews and observations enabled us to identify barriers to the implementation of EPC, and to modify the intervention to facilitate its delivery within existing services whilst remaining acceptable to both nurses and patients. The multiple method, iterative approach used was key to the success of this qualitative study.
ISRCTN34701576 Registered 29/05/2014.
经历心脏事件的患者患抑郁症的风险高于普通人群。尽管如此，心脏康复（CR）项目并未提供针对抑郁症的系统心理护理方法。CADENCE研究旨在开发并试行一种强化心理护理（EPC）干预措施，该措施包括行为激活（BA）和心理健康护理协调。根据原始研究委托指南，该干预措施计划融入常规护理，并由CR护士提供给参加CR的抑郁症患者。本文描述了如何使用定性方法来开发、融入和完善该干预措施。
这项可行性研究涉及三个CR团队。观察了CR护士提供常规护理的情况、对护士进行的EPC培训以及为CR护士提供的督导会议。四名护士在接受EPC培训后不久接受了访谈，三名护士在为患者提供EPC 6至7个月后再次接受了访谈。所有九名招募接受EPC的患者都接受了访谈。对观察记录和访谈转录本的分析集中在如何从可接受性和实施方面改进干预措施。
在CR团队之间发现了患者等待名单时间、CR的实施方式、可用设施以及提供给患者的CR疗程数量方面的差异。EPC对护士和患者来说都是可以接受的。然而，护士们难以在现有的工作量和资源范围内提供这种额外的护理，并且患者在CR项目中的进展中断影响了EPC的提供。有限的时间和私人空间可用性意味着护士也通过电话提供EPC，这被视为一种务实的解决方案，但不如面对面方式可取。护士表示患者在一些书面材料方面存在困难。研究结果被用于修订干预措施，使其成为一种护理协调方案，其中包括指导性自助BA。
通过进行访谈和观察获得的见解使我们能够识别EPC实施的障碍，并修改干预措施以促进其在现有服务中提供，同时保持护士和患者都能接受。所采用的多方法、迭代方法是这项定性研究成功的关键。
ISRCTN34701576，于2014年5月29日注册。
