Institute of Nursing Science, Department Public Health, University of Basel, Switzerland; Department of Medicine I, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany.
Institute of Nursing Science, Department Public Health, University of Basel, Switzerland.
Eur J Oncol Nurs. 2020 Apr;45:101723. doi: 10.1016/j.ejon.2020.101723. Epub 2020 Jan 22.
We report on our contextual analysis's methodology, as a first step of an implementation science project aiming to develop, implement, and test the effectiveness of an integrated model of care in SteM-cell transplantatIon faciLitated by eHealth (SMILe).
We applied an explanatory sequential mixed-methods design including clinicians and patients of the University Hospital Freiburg, Germany. Data were collected from 3/2017 to 1/2018 via surveys in 5 clinicians and 60 adult allogeneic stem-cell transplantation patients. Subsequently, we conducted 3 clinician focus groups and 10 patient interviews. Data analysis followed a 3-step process: (1) creating narrative descriptions, tables, and maps; (2) mapping key observational findings per dimension of the eHealth-enhanced Chronic-Care Model; (3) reflecting on how findings affect our choice of implementation strategies.
Current clinical practice is mostly acute care driven, with no interdisciplinarity and weak chronic illness management. Gaps were apparent in the dimensions of self-management support and delivery-system design. Health behaviors that would profit from support include medication adherence, physical activity and infection prevention. The theme "being alone and becoming an expert" underpinned patients need to increase support in hospital-to-home transitions. Patients reported insecurity about recognizing, judging and acting upon symptoms. The theme "eHealth as connection not replacement" underscores the importance of eHealth augmenting, not supplanting human contact. Synthesis of our key observational findings informed eight implementation strategies.
Stakeholders are willing towards a chronic care-focused approach and open for eHealth support. The contextual information provides a basis for the SMILe model's development and implementation.
我们报告了我们的语境分析方法，这是一个实施科学项目的第一步，旨在开发、实施和测试通过电子健康促进的干细胞移植综合护理模式（SMILe）的有效性。
我们采用了一种解释性顺序混合方法设计，包括德国弗赖堡大学医院的临床医生和患者。数据于 2017 年 3 月至 2018 年 1 月通过对 5 名临床医生和 60 名成年异基因干细胞移植患者的调查收集。随后，我们进行了 3 次临床医生焦点小组和 10 次患者访谈。数据分析遵循 3 个步骤：（1）创建叙事描述、表格和地图；（2）按电子健康增强的慢性病管理模型的维度映射关键观察结果；（3）反思这些发现如何影响我们选择实施策略。
目前的临床实践主要以急性护理为导向，没有跨学科性，慢性病管理薄弱。在自我管理支持和交付系统设计方面存在差距。需要支持的健康行为包括药物依从性、体育锻炼和感染预防。“独自行动，成为专家”这一主题反映了患者在从医院到家庭过渡期间需要增加支持的需求。患者报告对识别、判断和处理症状缺乏安全感。“电子健康作为联系而非替代”这一主题强调了电子健康增强而不是替代人际接触的重要性。我们的关键观察结果综合为八项实施策略提供了依据。
利益相关者愿意采取以慢性病为重点的方法，并对电子健康支持持开放态度。背景信息为 SMILe 模型的开发和实施提供了基础。
