对影响结直肠手术后医护人员营养处方决策因素的定性探索。
A qualitative exploration of factors influencing medical staffs' decision-making around nutrition prescription after colorectal surgery.
作者信息
Rattray Megan, Roberts Shelley, Desbrow Ben, Wullschleger Martin, Robertson Tayla, Hickman Ingrid, Marshall Andrea P
机构信息
School of Allied Health Sciences, Griffith University, Gold Coast Campus, QLD, 4222, Australia.
School of Allied Health Sciences, Griffith University and Gold Coast Hospital and Health Service, Griffith, QLD, 4222, Australia.
出版信息
BMC Health Serv Res. 2019 Mar 19;19(1):178. doi: 10.1186/s12913-019-4011-7.
BACKGROUND
Enhanced Recovery After Surgery (ERAS) guidelines recommend early oral feeding with nutritionally adequate diets after surgery. However, studies have demonstrated variations in practice and poor adherence to these recommendations among patients who have undergone colorectal surgery. Given doctors are responsible for prescribing patients' diets after surgery, this study explored factors which influenced medical staffs' decision-making regarding postoperative nutrition prescription to identify potential behaviour change interventions.
METHODS
This qualitative study involved one-on-one, semi-structured interviews with medical staff involved in prescribing nutrition for patients following colorectal surgery across two tertiary teaching hospitals. Purposive sampling was used to recruit participants with varying years of clinical experience. The Theoretical Domains Framework (TDF) underpinned the development of a semi-structured interview guide. Interviews were audio recorded, with data transcribed verbatim before being thematically analysed. Emergent themes and sub-themes were discussed by all investigators to ensure consensus of interpretation.
RESULTS
Twenty-one medical staff were interviewed, including nine consultants, three fellows, four surgical trainees and five junior medical doctors. Three overarching themes emerged from the data: (i) Prescription preferences are influenced by perceptions, experience and training; (ii) Modifying prescription practices to align with patient-related factors; and (iii) Peers influence prescription behaviours and attitudes towards nutrition.
CONCLUSIONS
Individual beliefs, patient-related factors and the social influence of peers (particularly seniors) appeared to strongly influence medical staffs' decision-making regarding postoperative nutrition prescription. As such, a multi-faceted approach to behaviour change is required to target individual and organisational barriers to enacting evidence-based feeding recommendations.
背景
术后加速康复（ERAS）指南建议术后尽早口服营养充足的饮食。然而，研究表明，在接受结直肠手术的患者中，实际做法存在差异，对这些建议的依从性较差。鉴于医生负责为患者开术后饮食处方，本研究探讨了影响医务人员术后营养处方决策的因素，以确定潜在的行为改变干预措施。
方法
这项定性研究包括对两家三级教学医院中为结直肠手术患者开营养处方的医务人员进行一对一的半结构化访谈。采用目的抽样法招募具有不同临床经验年限的参与者。理论领域框架（TDF）为半结构化访谈指南的制定提供了支持。访谈进行了录音，数据逐字转录后进行主题分析。所有研究人员讨论了新出现的主题和子主题，以确保解释的一致性。
结果
共访谈了21名医务人员，包括9名顾问、3名研究员、4名外科实习医生和5名初级医生。数据中出现了三个总体主题：（i）处方偏好受认知、经验和培训的影响；（ii）根据与患者相关的因素调整处方做法；（iii）同行影响处方行为和对营养的态度。
结论
个人信念、与患者相关的因素以及同行（尤其是上级）的社会影响似乎强烈影响医务人员术后营养处方的决策。因此，需要采取多方面的行为改变方法，以针对实施循证喂养建议的个人和组织障碍。
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