医疗机构人员在门诊实施多学科及时开展预立医疗照护计划谈话的障碍和促进因素（MUTUAL 干预）：一项序贯探索性混合方法研究。

Barriers and facilitators for healthcare professionals to the implementation of Multidisciplinary Timely Undertaken Advance Care Planning conversations at the outpatient clinic (the MUTUAL intervention): a sequential exploratory mixed-methods study.

机构信息

Department of Intensive Care, Gelderse Vallei hospital, Ede, Netherlands.

Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands.

出版信息

BMC Palliat Care. 2023 Mar 15;22(1):24. doi: 10.1186/s12904-023-01139-y.

DOI:10.1186/s12904-023-01139-y

PMID:36922796

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10015131/

Abstract

BACKGROUND

Advance Care Planning (ACP) enables patients to define and discuss their goals and preferences for future medical treatment and care. However, the structural implementation of ACP interventions remains challenging. The Multidisciplinary Timely Undertaken Advance Care Planning (MUTUAL) intervention has recently been developed which takes into account existing barriers and facilitators. We aimed to evaluate the MUTUAL intervention and identify the barriers and facilitators healthcare professionals experience in the implementation of the MUTUAL intervention and also to identify suggestions for improvement.

METHODS

We performed a sequential exploratory mixed-methods study at five outpatient clinics of one, 300-bed, non-academic hospital. Firstly, semi-structured interviews were performed with a purposive sample of healthcare professionals. The content of these interviews was used to specify the Measurement Instrument for Determinants of Innovations (MIDI). The MIDI was sent to all healthcare professionals. The interviews and questionnaires were used to clarify the results.

RESULTS

Eleven healthcare professionals participated in the interviews and 37 responded to the questionnaire. Eight barriers and 20 facilitators were identified. Healthcare professionals agreed that the elements of the MUTUAL intervention are clear, correct, complete, and simple - and the intervention is relevant for patients and their proxies. The main barriers are found within the user and the organisational domain. Barriers related to the organisation include: inadequate replacement of staff, insufficient staff, and insufficient time to introduce and invite patients. Several suggestions for improvement were made.

CONCLUSION

Our results show that healthcare professionals positively evaluate the MUTUAL intervention and are very receptive to implementing the MUTUAL intervention. Taking into account the suggestions for improvement may enhance further implementation.

摘要

背景

预先医疗照护计划（ACP）使患者能够定义和讨论他们对未来医疗和护理的目标和偏好。然而，ACP 干预措施的结构实施仍然具有挑战性。最近开发了多学科及时进行预先医疗照护计划（MUTUAL）干预措施，该措施考虑了现有的障碍和促进因素。我们旨在评估 MUTUAL 干预措施，并确定医疗保健专业人员在实施 MUTUAL 干预措施时遇到的障碍和促进因素，以及确定改进建议。

方法

我们在一家 300 张床位的非学术性医院的五个门诊诊所进行了一项顺序探索性混合方法研究。首先，对医疗保健专业人员进行了目的抽样的半结构式访谈。这些访谈的内容用于指定创新决定因素测量工具（MIDI）。MIDI 发送给所有医疗保健专业人员。访谈和问卷调查用于澄清结果。

结果

11 名医疗保健专业人员参加了访谈，37 名回复了问卷。确定了 8 个障碍和 20 个促进因素。医疗保健专业人员一致认为，MUTUAL 干预措施的要素清晰、正确、完整且简单，并且该干预措施与患者及其代理人相关。主要障碍存在于用户和组织领域内。与组织相关的障碍包括：人员更替不足、人员不足以及介绍和邀请患者的时间不足。提出了一些改进建议。