Centre for Person Centred Research, Auckland University of Technology, Auckland, New Zealand.
BMC Health Serv Res. 2020 Jan 30;20(1):69. doi: 10.1186/s12913-020-4920-5.
Following a neurological event, people's long-term health and well-being is hampered by a system that struggles to deliver person-centred communication and coordinated care and fails to harness individual and family capability to live well with the condition. We aimed to implement and evaluate a toolkit package to support these processes for people with long-term neurological conditions.
This is a multi-phased study drawing on the principles of participatory research. In this pilot phase, the toolkit package was introduced to clinicians, who introduced it to clients in four neurorehabilitation settings (inpatient and community-based). Individual and focus group interviews were carried out with clients (n = 10) and clinicians (n = 9). Data were categorised by the four components of Normalisation Process Theory (NPT), and data within each component was then coded inductively. This analysis was used to inform revisions to the toolkit package and wider implementation processes.
There was widespread support for the principles underpinning the toolkit package from clients and clinicians. However, it was less clear how the client toolkit could support these principles in clinical practice which impacted buy-in. The flexibility of use of the client toolkit, which we encouraged, made it difficult for clinicians and clients to be clear about its purpose and for clinicians to operationalise in practice. Clinicians and clients identified a number of barriers that limited the time, energy and work users were able or prepared to invest, to the extent that uptake of the toolkit package was modest. Use of the toolkit package appeared more likely when clinicians perceived it to augment existing processes (e.g. goal setting) rather than detract from 'doing' therapy. This analysis was used to inform revisions to the toolkit package, including simplification of the client toolkit, development of videos with examples of use and a modular and reflective training package for clinical services. The refinements were intended to improve sense-making and minimise the cognitive barriers associated with implementation of a new intervention.
Understanding how supporting the client toolkit could add value to the therapeutic encounter was necessary for clinicians to invest time and perceive the worth of the toolkit package.
ANZCTR: ACTRN12614000537651. Registered 21 May, 2014.
在发生神经事件后，由于系统难以提供以患者为中心的沟通和协调护理，并且未能利用个人和家庭的能力来改善疾病状况，患者的长期健康和幸福感受到阻碍。我们旨在实施和评估一整套工具包，以支持长期神经疾病患者的这些流程。
这是一项多阶段研究，借鉴了参与式研究的原则。在试点阶段，将工具包介绍给临床医生，然后由临床医生在四个神经康复环境（住院和社区）中将其介绍给患者。对患者（n=10）和临床医生（n=9）进行了个人访谈和焦点小组访谈。根据规范化进程理论（NPT）的四个组成部分对数据进行分类，然后对每个组成部分的数据进行归纳编码。此分析用于为工具包包的修订和更广泛的实施过程提供信息。
患者和临床医生广泛支持工具包包的基础原则。但是，在临床实践中，客户工具包如何支持这些原则尚不清楚，这影响了采用度。我们鼓励客户工具包的灵活使用，这使得临床医生和患者难以明确其目的，并且难以在实践中进行操作。临床医生和患者确定了一些限制用户投入时间、精力和工作的障碍，以至于工具包包的采用率较低。当临床医生认为工具包包可以增强现有流程（例如设定目标）而不是减损“治疗”时，使用工具包包的可能性更大。对工具包包的修订包括简化客户工具包、开发使用示例的视频以及为临床服务提供模块化和反思性培训包，这是基于上述分析进行的。这些改进旨在提高意义建构能力并最小化与新干预措施实施相关的认知障碍。
了解支持客户工具包如何为治疗性相遇增加价值，对于临床医生投入时间并感知工具包包的价值是必要的。
澳大利亚新西兰临床试验注册中心：ACTRN12614000537651。注册于 2014 年 5 月 21 日。
