美国物理治疗协会乳腺癌相关淋巴水肿诊断与干预临床实践指南实施的障碍与促进因素

Barriers and facilitators to implementation of APTA's breast cancer-related lymphedema diagnosis and intervention clinical practice guidelines.

作者信息

Campione Elizabeth, Wampler Meredith, Bolch Charlotte A, Krzak Joseph J

机构信息

Physical Therapy Program, Midwestern University, Downers Grove, IL, USA.

Program in Physical Therapy, Oregon State University - Cascades, Bend, OR, USA.

出版信息

J Cancer Surviv. 2025 Feb;19(1):397-406. doi: 10.1007/s11764-023-01475-1. Epub 2023 Oct 18.

DOI:10.1007/s11764-023-01475-1

PMID:37853271

Abstract

PURPOSE

The purpose of this study was to identify barriers and facilitators influencing implementation of the diagnosis and intervention clinical practice guidelines (CPGs) related to the management of patients with breast cancer-related lymphedema (BCRL).

METHODS

A descriptive, cross-sectional web-based survey was conducted. Participants included physical therapists and assistants who were members of the APTA's Academy of Oncologic Physical Therapy and Lymphology Association of North America. Desriptive statisitcs were computed for all demographic and barriers and facilitators data. Individual exploratory factor analyses (EFA) were performed on survey items for both CPGs to identify themes of barriers and facilitators to implementation.

RESULTS

A total of 180 respondents completed the survey. 34.9% of respondents read the diagnosis CPG and 22.4% read the intervention CPG. A total of 77.8% reported that they did not have issues in changing their clinical routines and 69.5% did not have resistance working according to CPGs. The EFA resulted in 3 themes for each CPG, accounting for 46% of the variance for the diagnostic CPG and 54% of the variance for the intervention CPG. The 3 themes, clinician characteristics, patient demographics, therapist practice setting and beliefs/values, were weighted differently for each EFA.

CONCLUSION

Most respondents did not read either CPG, however, report a willingness to make changes to clinical practice and utilization of CPGs. For those who have attempted to implement the CPGs, this study was the first to identify the barriers and facilitators impacting the implementation of the CPGs related to the management of BCRL.

IMPLICATIONS FOR CANCER SURVIVORS

The results will inform the development of targeted implementation strategies to improve access to and adherence to recommendations from the CPGs ultimately improving the efficiency and efficacy of care delivery to patients.

摘要

目的

本研究旨在确定影响乳腺癌相关淋巴水肿（BCRL）患者管理的诊断和干预临床实践指南（CPG）实施的障碍和促进因素。

方法

开展了一项基于网络的描述性横断面调查。参与者包括美国物理治疗协会肿瘤物理治疗学会和北美淋巴学会的物理治疗师和助理。对所有人口统计学以及障碍和促进因素数据进行描述性统计。对两个CPG的调查项目分别进行个体探索性因素分析（EFA），以确定实施的障碍和促进因素主题。

结果

共有180名受访者完成了调查。34.9%的受访者阅读了诊断CPG，22.4%的受访者阅读了干预CPG。共有77.8%的受访者表示他们在改变临床常规方面没有问题，69.5%的受访者在按照CPG工作时没有抵触情绪。EFA为每个CPG得出了3个主题，占诊断CPG方差的46%，干预CPG方差的54%。这3个主题，即临床医生特征、患者人口统计学、治疗师执业环境和信念/价值观，在每个EFA中的权重不同。