Bilodeau Karine, Tremblay Dominique, Durand Marie-José
Faculty of Medicine and Health Sciences, Université de Sherbrooke, Longueuil, QC, Canada.
Hôpital Charles-LeMoyne Research Center, Longueuil, QC, Canada.
J Multidiscip Healthc. 2018 Feb 1;11:75-83. doi: 10.2147/JMDH.S152947. eCollection 2018.
Many recommendations have been made regarding survivorship care provided by teams of primary care professionals. However, the nature of that follow-up, including support for return-to-work (RTW) after cancer, remains largely undefined. As implementation problems are frequently context-related, a pilot study was conducted to describe the contexts, according to Grol and Wensing, in which a new intervention is to be implemented. This pilot study is the first of three steps in intervention development planning.
In-depth semi-structured interviews (n=6) were carried out with stakeholders selected for their knowledgeable perspective of various settings, such as hospitals, primary care, employers, and community-based organizations. Interviews focused on participants' perceptions of key contextual facilitators and barriers to consider for the deployment of an RTW intervention in a primary care setting. Data from interviews were transcribed and analyzed. A content analysis was performed based on an iterative process.
An intervention supporting the process of RTW in primary care makes sense for participants. Results suggest that important levers are present in organizational, professional, and social settings. However, many barriers, mainly related to organizational settings, have been identified, eg, distribution of tasks for survivor follow-up, continuity of information, and coordination of care between specialized oncology care and general primary care.
To develop and deploy the intervention, recommendations that emerged from this pilot study for overcoming barriers were identified, eg, training (professionals, survivors, and employers), the use of communication tools, and adopting a practice guide for survivor care. The results were also helpful in focusing on the relevance of an intervention supporting the RTW process as a component of primary care for survivors.
关于初级保健专业人员团队提供的癌症生存护理，已经提出了许多建议。然而，这种后续护理的性质，包括对癌症后重返工作岗位（RTW）的支持，在很大程度上仍不明确。由于实施问题通常与具体情况相关，因此根据格罗尔和温辛的方法进行了一项试点研究，以描述新干预措施将要实施的具体情况。这项试点研究是干预措施开发规划三个步骤中的第一步。
对从医院、初级保健、雇主和社区组织等不同背景中挑选出来的、具有专业知识的利益相关者进行了6次深入的半结构化访谈。访谈重点关注参与者对在初级保健环境中部署RTW干预措施时需要考虑的关键背景促进因素和障碍的看法。对访谈数据进行了转录和分析。基于迭代过程进行了内容分析。
对参与者来说，在初级保健中支持RTW过程的干预措施是有意义的。结果表明，在组织、专业和社会环境中存在重要的推动因素。然而，也发现了许多障碍，主要与组织环境有关，例如癌症幸存者后续护理的任务分配、信息的连续性以及专科肿瘤护理与普通初级保健之间的护理协调。
为了开发和部署该干预措施，确定了本试点研究中提出的克服障碍的建议，例如培训（专业人员、幸存者和雇主）、使用沟通工具以及采用幸存者护理实践指南。这些结果也有助于关注支持RTW过程的干预措施作为幸存者初级保健组成部分的相关性。
