Department of Surgery, Western Precinct, Melbourne Medical School, The University of Melbourne, Melbourne, Australia.
Department of Nutrition and Dietetics, Western Health, Melbourne, Australia.
BMC Health Serv Res. 2022 Feb 25;22(1):256. doi: 10.1186/s12913-022-07466-9.
Implementation studies of complex interventions such as nutrition care pathways are important to health services research, as they support translation of research into practice. There is limited research regarding implementation of a nutrition care pathway in an upper gastrointestinal (UGI) cancer population. The aim of this study was to comprehensively evaluate the implementation process of a perioperative nutrition care pathway in UGI cancer surgery using The Consolidated Framework for Implementation Research (CFIR).
This was a mixed methods implementation study conducted during a pilot study of a standardised nutrition care pathway across four major hospitals between September 2018 to August 2019. Outcome measures included five focus groups among study dietitians (n = 4-8 per group), and quantitative satisfaction surveys from multi-disciplinary team (MDT) members (n = 14) and patients (n = 18). Focus group responses were analysed thematically using the CFIR constructs, which were used as a priori codes. Survey responses were summarised using means and standard deviations. A convergent parallel mixed methods approach according to CFIR domains and constructs was used to integrate qualitative and quantitative data.
Qualitative data demonstrated that dietitian perceptions primarily aligned with five CFIR constructs (networks and communications, structural characteristics, adaptability, compatibility and patient needs/resources), indicating a complex clinical and implementation environment. Challenges to implementation mostly related to adapting the pathway, and the compatibility of nutrition coordination to existing aspects of care within each setting. Identified benefits from dietitian qualitative data and MDT survey responses included increased engagement between the dietitian and MDT, and a more proactive approach to nutrition care. Patients were highly satisfied with the service, with the majority of survey items being rated highly (≥4 of a possible 5 points).
The nutrition care pathway was perceived to be beneficial by key stakeholders. Based on the findings, sustainability and compliance to this model of care may be achieved with improved systems level coordination and communication.
营养护理路径等复杂干预措施的实施研究对卫生服务研究很重要，因为它们支持将研究转化为实践。关于在上消化道（UGI）癌症人群中实施营养护理路径的研究有限。本研究的目的是使用实施研究综合框架（CFIR）全面评估 UGI 癌症手术中围手术期营养护理路径的实施过程。
这是一项混合方法实施研究，在 2018 年 9 月至 2019 年 8 月期间，在四家主要医院进行了一项标准化营养护理路径的试点研究。结果措施包括研究营养师的五个焦点小组（每组 4-8 人），以及多学科团队（MDT）成员（n=14）和患者（n=18）的定量满意度调查。焦点小组的回应使用 CFIR 结构进行了主题分析，这些结构被用作先验代码。调查回应使用平均值和标准偏差进行总结。根据 CFIR 领域和结构，采用收敛平行混合方法来整合定性和定量数据。
定性数据表明，营养师的看法主要与五个 CFIR 结构（网络和沟通、结构特征、适应性、兼容性和患者需求/资源）一致，表明这是一个复杂的临床和实施环境。实施面临的挑战主要与适应路径以及营养协调与每个环境中现有护理方面的兼容性有关。从营养师定性数据和 MDT 调查回应中确定的好处包括营养师与 MDT 之间的互动增加，以及对营养护理的更积极方法。患者对该服务非常满意，大多数调查项目的评分都很高（满分 5 分，得分为 4 分或以上）。
利益相关者认为营养护理路径是有益的。根据研究结果，通过改善系统层面的协调和沟通，可能实现这种护理模式的可持续性和合规性。
