Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa, ON, Canada.
Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada.
Can J Anaesth. 2022 Nov;69(11):1375-1389. doi: 10.1007/s12630-022-02298-x. Epub 2022 Aug 17.
Preoperative frailty assessment is recommended by multiple practice guidelines and may improve outcomes, but it is not routinely performed. The barriers and facilitators of routine preoperative frailty assessment have not been formally assessed. Our objective was to perform a theory-guided evaluation of barriers and facilitators to preoperative frailty assessment.
This was a research ethics board-approved qualitative study involving physicians who perform preoperative assessment (consultant and resident anesthesiologists and consultant surgeons). Semistructured interviews were conducted by a trained research assistant informed by the Theoretical Domains Framework to identify barriers and facilitators to frailty assessment. Interview transcripts were independently coded by two research assistants to identify specific beliefs relevant to each theoretical domain.
We interviewed 28 clinicians (nine consultant anesthesiologists, nine consultant surgeons, and ten anesthesiology residents). Six domains (Knowledge [100%], Social Influences [96%], Social Professional Role and Identity [96%], Beliefs about Capabilities [93%], Goals [93%], and Intentions [93%]) were identified by > 90% of respondents. The most common barriers identified were prioritization of other aspects of assessment (e.g., cardio/respiratory) and a lack of awareness of evidence and guidelines supporting frailty assessment. The most common facilitators were a high degree of familiarity with frailty, recognition of the importance of frailty assessment, and strong intentions to perform frailty assessment.
Barriers and facilitators to preoperative frailty assessment are multidimensional, but generally consistent across different types of perioperative physicians. Knowledge of barriers and facilitators can guide development of evidence-based strategies to increase frailty assessment.
多项实践指南建议进行术前虚弱评估，这可能会改善预后，但该评估并未常规进行。术前虚弱评估的障碍和促进因素尚未得到正式评估。我们的目的是使用理论指导方法评估术前虚弱评估的障碍和促进因素。
这是一项经研究伦理委员会批准的定性研究，涉及进行术前评估的医生（顾问麻醉师和顾问外科医生以及住院医师）。由经过培训的研究助理根据理论领域框架进行半结构化访谈，以确定虚弱评估的障碍和促进因素。访谈记录由两名研究助理独立编码，以确定与每个理论领域相关的特定信念。
我们采访了 28 名临床医生（9 名顾问麻醉师、9 名顾问外科医生和 10 名麻醉学住院医师）。有 6 个领域（知识[100%]、社会影响[96%]、社会专业角色和身份[96%]、能力信念[93%]、目标[93%]和意图[93%]）得到了超过 90%的受访者的认同。确定的最常见障碍是优先考虑评估的其他方面（例如，心肺），以及对支持虚弱评估的证据和指南缺乏认识。最常见的促进因素是对虚弱的高度熟悉、对虚弱评估重要性的认识以及进行虚弱评估的强烈意图。
术前虚弱评估的障碍和促进因素是多维度的，但在不同类型的围手术期医生中基本一致。了解障碍和促进因素可以指导制定基于证据的策略来增加虚弱评估。
