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实施用于向全科医生报告的肺癌多学科团队标准化模板:一项混合方法研究。

Implementation of a lung cancer multidisciplinary team standardised template for reporting to general practitioners: a mixed-method study.

作者信息

Rankin Nicole M, Collett Gemma K, Brown Clare M, Shaw Tim J, White Kahren M, Beale Philip J, Trevena Lyndal J, Anderiesz Cleola, Barnes David J

机构信息

Sydney Medical School, Sydney Catalyst Translational Cancer Research Centre, University of Sydney, Camperdown, New South Wales, Australia.

Cancer Services, Royal Prince Alfred Hospital, Sydney Local Health District, Camperdown, New South Wales, Australia.

出版信息

BMJ Open. 2017 Dec 28;7(12):e018629. doi: 10.1136/bmjopen-2017-018629.

Abstract

OBJECTIVES

Few interventions have been designed that provide standardised information to primary care clinicians about the diagnostic and treatment recommendations resulting from cancer multidisciplinary team (MDT) (tumour board) meetings. This study aimed to develop, implement and evaluate a standardised template for lung cancer MDTs to provide clinical information and treatment recommendations to general practitioners (GPs). Specific objectives were to (1) evaluate template feasibility (acceptability, appropriateness and timeliness) with GPs and (2) document processes of preimplementation, implementation and evaluation within the MDT setting.

DESIGN

A mixed-method study design using structured interviews with GPs and qualitative documentation of project logs about implementation processes.

SETTING

Two hospitals in Central Sydney, New South Wales, Australia.

PARTICIPANTS

61 GPs evaluated the template. Two lung cancer MDTs, consisting of 33 clinicians, and eight researchers participated in template development and implementation strategy.

RESULTS

The MDT-reporting template appears to be a feasible way of providing clinical information to GPs following patient presentation at a lung cancer MDT meeting. Ninety-five per cent of GPs strongly agreed or agreed that the standardised template provided useful and relevant information, that it was received in a timely manner (90%) and that the information was easy to interpret and communicate to the patient (84%). Implementation process data show that the investment made in the preimplementation stage to integrate the template into standard work practices was a critical factor in successful implementation.

CONCLUSIONS

This study demonstrates that it is feasible to provide lung cancer MDT treatment recommendations to GPs through implementation of a standardised template. A simple intervention, such as a standardised template, can help to address quality gaps and ensure that timely information is communicated between tertiary and primary care healthcare providers.

摘要

目的

很少有干预措施能为基层医疗临床医生提供关于癌症多学科团队(MDT,肿瘤委员会)会议所产生的诊断和治疗建议的标准化信息。本研究旨在开发、实施和评估一种用于肺癌MDT的标准化模板,以向全科医生(GP)提供临床信息和治疗建议。具体目标是:(1)评估全科医生对模板的可行性(可接受性、适当性和及时性);(2)记录MDT环境下实施前、实施和评估的过程。

设计

采用混合方法研究设计,对全科医生进行结构化访谈,并对关于实施过程的项目日志进行定性记录。

地点

澳大利亚新南威尔士州悉尼市中心的两家医院。

参与者

61名全科医生对模板进行了评估。两个肺癌MDT,由33名临床医生组成,以及8名研究人员参与了模板开发和实施策略。

结果

在肺癌MDT会议上患者就诊后,向全科医生提供临床信息时,MDT报告模板似乎是一种可行的方式。95%的全科医生强烈同意或同意标准化模板提供了有用且相关的信息,信息接收及时(90%),且信息易于解读并与患者沟通(84%)。实施过程数据表明,在实施前阶段为将模板整合到标准工作流程中所做的投入是成功实施的关键因素。

结论

本研究表明,通过实施标准化模板向全科医生提供肺癌MDT治疗建议是可行的。一种简单的干预措施,如标准化模板,有助于弥补质量差距,并确保三级医疗和基层医疗服务提供者之间及时沟通信息。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4c49/5770820/829224a93f30/bmjopen-2017-018629f01.jpg

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