Sugalski Aaron J, Lo Tammy, Beauchemin Melissa, Grimes Allison C, Robinson Paula D, Walsh Alexandra M, Santesso Nancy, Dang Ha, Fisher Brian T, Wrightson Andrea Rothfus, Yu Lolie C, Sung Lillian, Dupuis L Lee
University of Texas Health Science Center at San Antonio, San Antonio, USA.
Department of Research and Evaluation, Kaiser Permanente, Pasadena, USA.
Implement Sci Commun. 2021 Sep 16;2(1):106. doi: 10.1186/s43058-021-00200-2.
Clinical practice guideline (CPG)-consistent care improves patient outcomes, but CPG implementation is poor. Little is known about CPG implementation in pediatric oncology. This study aimed to understand supportive care CPG implementation facilitators and barriers at pediatric oncology National Cancer Institute (NCI) Community Oncology Research Program (NCORP) institutions.
Healthcare professionals at 26 pediatric, Children's Oncology Group-member, NCORP institutions were invited to participate in face-to-face focus groups. Serial focus groups were held until saturation of ideas was reached. Supportive care CPG implementation facilitators and barriers were solicited using nominal group technique (NGT), and implementation of specific supportive care CPG recommendations was discussed. Notes from each focus group were analyzed using a directed content analysis. The top five themes arising from an analysis of NGT items were identified, first from each focus group and then across all focus groups.
Saturation of ideas was reached after seven focus groups involving 35 participants from 18 institutions. The top five facilitators of CPG implementation identified across all focus groups were organizational factors including charging teams with CPG implementation, individual factors including willingness to standardize care, user needs and values including mentorship, system factors including implementation structure, and implementation strategies including a basis in science. The top five barriers of CPG implementation identified were organizational factors including tolerance for inconsistencies, individual factors including lack of trust, system factors including administrative hurdles, user needs and values including lack of inclusivity, and professional including knowledge gaps.
Healthcare professionals at pediatric NCORP institutions believe that organizational factors are the most important determinants of supportive care CPG implementation. They believe that CPG-consistent supportive care is most likely to be delivered in organizations that prioritize evidence-based care, provide structure and resources to implement CPGs, and eliminate implementation barriers.
ClinicalTrials.gov Identifier: NCT02847130. Date of registration: July 28, 2016.
遵循临床实践指南（CPG）的治疗可改善患者预后，但CPG的实施情况不佳。关于儿科肿瘤学领域CPG的实施情况，人们了解甚少。本研究旨在了解儿科肿瘤学国家癌症研究所（NCI）社区肿瘤学研究项目（NCORP）机构中支持性治疗CPG实施的促进因素和障碍。
邀请26家儿科、儿童肿瘤学组成员、NCORP机构的医疗保健专业人员参加面对面的焦点小组讨论。持续进行焦点小组讨论，直至观点饱和。使用名义小组技术（NGT）征求支持性治疗CPG实施的促进因素和障碍，并讨论具体支持性治疗CPG建议的实施情况。使用定向内容分析法分析每个焦点小组的记录。确定从NGT项目分析中得出的前五个主题，首先从每个焦点小组中确定，然后在所有焦点小组中确定。
在涉及来自18家机构的35名参与者的七个焦点小组讨论后，观点达到饱和。在所有焦点小组中确定的CPG实施的前五个促进因素是组织因素，包括让团队负责CPG实施；个人因素，包括标准化治疗的意愿；用户需求和价值观，包括指导；系统因素，包括实施结构；以及实施策略，包括科学依据。确定的CPG实施的前五个障碍是组织因素，包括对不一致的容忍度；个人因素，包括缺乏信任；系统因素，包括行政障碍；用户需求和价值观，包括缺乏包容性；以及专业因素，包括知识差距。
儿科NCORP机构的医疗保健专业人员认为，组织因素是支持性治疗CPG实施的最重要决定因素。他们认为，在优先考虑循证治疗、提供实施CPG的结构和资源并消除实施障碍的组织中，最有可能提供符合CPG的支持性治疗。
ClinicalTrials.gov标识符：NCT02847130。注册日期：2016年7月28日。
