Pinto Cathryn, Bristowe Katherine, Witt Jana, Davies Joanna M, de Wolf-Linder Susanne, Dawkins Marsha, Guo Ping, Higginson Irene J, Daveson Barbara, Murtagh Fliss E M
Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK.
Zurich University of Applied Sciences (ZHAW), School of Health Professions, Institute of Nursing, Winterthur, Switzerland.
Ann Palliat Med. 2018 Oct;7(Suppl 3):S137-S150. doi: 10.21037/apm.2018.09.02.
Routine use of outcome measures in palliative care is recommended to demonstrate and improve quality of care. The use of outcome measures is relatively recent in UK specialist palliative care services and understanding their use in practice is key to successful implementation. We therefore aimed to explore how patient-centred outcome measures are used in specialist palliative care, and identify key considerations for implementation.
Multi-method qualitative study (semi-structured interviews and non-participant observation). Patients, family caregivers and health professionals were purposively sampled from nine specialist palliative care services (hospice, hospital and community settings) in London, UK. Framework analysis, informed by the Consolidated Framework for Implementation Research (CFIR), was undertaken.
Thirty eight interviews and nine observations were conducted. Findings are presented according to the five CFIR domains: (I) intervention: participants highlighted advantages, disadvantages and appropriateness of outcome measures in palliative care; (II) outer setting: policy and national drivers are necessary to encourage use of outcome measures; (III) inner setting: information technology infrastructure, organisational drive, and support from peers and leadership were institutional factors that shaped the use of outcome measures; (IV) individual: clear rationale for using outcome measures and skills to use them in practice were essential; (V) implementation: stepwise introduction of outcome measures, regular feedback sessions, and champions/facilitators were important to strengthen routine use.
All CFIR domains need consideration for effective implementation. Outcome data needs to be fed back to and interpreted for professionals in order to improve and sustain outcome data collection, and drive meaningful improvements in palliative care.
推荐在姑息治疗中常规使用结局指标以证明并提高护理质量。在英国专科姑息治疗服务中，结局指标的使用相对较新，了解其在实践中的应用是成功实施的关键。因此，我们旨在探讨以患者为中心的结局指标在专科姑息治疗中的使用方式，并确定实施的关键考虑因素。
多方法定性研究（半结构化访谈和非参与观察）。从英国伦敦的九个专科姑息治疗服务机构（临终关怀机构、医院和社区机构）中有意抽取患者、家庭照顾者和卫生专业人员作为样本。采用基于实施研究综合框架（CFIR）的框架分析方法。
进行了38次访谈和9次观察。根据CFIR的五个领域呈现研究结果：（I）干预：参与者强调了结局指标在姑息治疗中的优点、缺点和适用性；（II）外部环境：政策和国家驱动因素对于鼓励使用结局指标是必要的；（III）内部环境：信息技术基础设施、组织驱动力以及同行和领导层的支持是影响结局指标使用的机构因素；（IV）个人：使用结局指标的明确理由以及在实践中使用它们的技能至关重要；（V）实施：逐步引入结局指标、定期反馈会议以及倡导者/促进者对于加强常规使用很重要。
为有效实施，CFIR的所有领域都需要考虑。结局数据需要反馈给专业人员并为其进行解读，以改进和维持结局数据收集，并推动姑息治疗取得有意义的改善。
