Division of Behavioral Sciences, National Cancer Center Institute for Cancer Control, National Cancer Center, 5-1-1 Tsukiji,Chuo-ku, Tokyo, 104-0045, Japan.
Faculty of Human Sciences, Tokiwa University, 1-430-1, Miwa, Mito-shi, Ibaraki, 310-8585, Japan.
BMJ Open. 2022 Jun 6;12(6):e055473. doi: 10.1136/bmjopen-2021-055473.
Chemotherapy-induced nausea and vomiting (CINV) decrease patients' quality of life and negatively impact treatment outcomes. Although standard prophylactic antiemetic therapy for acute CINV recommended by guidelines is effective, poor guideline implementation is a worldwide problem. In Japan, prophylactic antiemetic therapy is relatively well implemented for chemotherapy associated with high emetogenic risk, while implementation gaps are observed for that with low emetogenic risk.Although most reports on factors influencing appropriate antiemetic prescription focus on physicians' attitudes and behaviours, a more comprehensive exploration is needed since chemotherapy is expected to involve pharmacists, nurses and eventually hospital directors. The purpose of this qualitative study is to comprehensively explore the factors that influence the implementation of appropriate prophylactic antiemetic procedures at cancer care hospitals in Japan.
This study is a hospital-based qualitative study using semistructured individual interviews. The target population will be hospital directors, and chiefs (including proxies) of departments of oncology and/or chemotherapy, pharmacy and nursing, working in the hospitals, selected by purposive sampling. We will obtain information on antiemetics in chemotherapy regimens, antiemetic routine use and awareness of guidelines using prequestionnaires. Interviews will then be conducted online using an interview guide. The Consolidated Framework for Implementation Research will be used to collect and analyse the interview data. We will also create new codes inductively, as required. In addition, we will refer to the aggregate results of the Quality Indicator survey to determine the implementation of recommended antiemetic prescriptions for each hospital and discuss the relationship with influencing factors.
This study has been approved by the National Cancer Centre Ethics Approval Committee (approval number: 2020-305). The study findings will be disseminated via peer-reviewed journal publications and presentations to academics, policy-makers, and clinicians at scientific conferences.
化疗引起的恶心和呕吐（CINV）会降低患者的生活质量，并对治疗结果产生负面影响。尽管指南推荐的标准预防急性 CINV 的止吐治疗是有效的，但指南的实施不佳是一个全球性的问题。在日本，针对高致吐风险的化疗，预防性止吐治疗相对较好，但对于低致吐风险的化疗，实施差距仍然存在。尽管大多数关于影响适当止吐处方因素的报告都集中在医生的态度和行为上，但由于化疗预计将涉及药剂师、护士，最终还会涉及院长，因此需要更全面的探索。本定性研究的目的是全面探讨影响日本癌症护理医院适当预防性止吐程序实施的因素。
本研究是一项基于医院的定性研究，采用半结构式个体访谈。采用目的抽样法，选择医院院长以及肿瘤学和/或化疗、药学和护理部门的主任（包括代理人）作为目标人群。我们将通过预调查问卷获取关于化疗方案中止吐剂、止吐常规使用和指南意识的信息。然后，我们将使用访谈指南在线进行访谈。我们将使用实施研究综合框架来收集和分析访谈数据。如有必要，我们将归纳性地创建新的代码。此外，我们还将参考质量指标调查的综合结果，确定每家医院推荐止吐处方的实施情况，并讨论与影响因素的关系。
本研究已获得国家癌症中心伦理审查委员会的批准（批准号：2020-305）。研究结果将通过同行评议的期刊发表和学术会议上向学者、政策制定者和临床医生展示来传播。
