Neo Shirlyn Hui-Shan, Tan Jasmine Yun-Ting, Ng Elaine Swee-Ling, Yoon Sungwon
Division of Supportive and Palliative Care, National Cancer Centre Singapore, Level 4, 11 Hospital Crescent, Singapore 169610, Singapore.
Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore, Singapore.
Palliat Care Soc Pract. 2023 Dec 1;17:26323524231214814. doi: 10.1177/26323524231214814. eCollection 2023.
Screening patients with patient-reported outcome measures allows identification of palliative care concerns. The Integrated Palliative Care Outcome Scale (IPOS) was developed in the United Kingdom for this purpose. Tools developed in another setting might not be readily usable locally. We previously evaluated the validity and reliability of the IPOS in our cardiology setting. However, it remains uncertain what factors would influence the subsequent implementation of IPOS for routine screening of patients with advanced heart failure in future practice.
This study aimed to identify the factors that could affect the IPOS implementation for patients with advanced heart failure.
This was a qualitative study conducted at the National Heart Centre Singapore.
Patients with advanced heart failure who participated in our previous IPOS validation study were purposively recruited for semi-structured interviews. Healthcare workers caring for these patients and involved in the testing of the IPOS tool were also invited for interviews. The interviews were analyzed thematically and mapped to the Consolidated Framework for Implementation Research (CFIR).
Our analysis identified six potential facilitators and six potential barriers to implementation across five major domains of the CFIR (intervention characteristics, inner setting, outer setting, individual characteristics, and process). Facilitators include: (i) perception of utility, (ii) perception of minimal complexity, (iii) perception of relatability, (iv) conducive culture, (v) dedicated resources, and (vi) advocates for implementation. Barriers include: (i) need for adaptation, (ii) mindsets/role strains, (iii) resource constraints, (iv) cultural concerns, (v) individual needs, and (vi) change process.
Institutions could focus on cultivating appropriate perceptions and conducive cultures, providing dedicated resources for implementation and introducing facilitators to advocate for implementation. Adaptation of IPOS to suit workflows and individual needs, consideration of change processes, and systemic changes to alleviate cultural, resource, and staff role strains would improve IPOS uptake during actual implementation in clinical services.
Not applicable.
使用患者报告结局量表对患者进行筛查有助于识别姑息治疗问题。综合姑息治疗结局量表（IPOS）就是英国为此目的而开发的。在其他环境中开发的工具在当地可能无法直接使用。我们之前评估了IPOS在我们心脏病学环境中的有效性和可靠性。然而，在未来实践中，哪些因素会影响IPOS在晚期心力衰竭患者常规筛查中的后续实施仍不确定。
本研究旨在确定可能影响晚期心力衰竭患者IPOS实施的因素。
这是一项在新加坡国立心脏中心进行的定性研究。
有目的地招募参与我们之前IPOS验证研究的晚期心力衰竭患者进行半结构化访谈。还邀请了照顾这些患者并参与IPOS工具测试的医护人员进行访谈。对访谈进行主题分析，并映射到实施研究综合框架（CFIR）。
我们的分析在CFIR的五个主要领域（干预特征、内部环境、外部环境、个体特征和过程）中确定了六个潜在的促进因素和六个潜在的障碍。促进因素包括：（i）对效用的认知，（ii）对最低复杂性的认知，（iii）对相关性的认知，（iv）有利的文化，（v）专用资源，以及（vi）实施倡导者。障碍包括：（i）需要调整，（ii）思维模式/角色压力，（iii）资源限制，（iv）文化问题，（v）个体需求，以及（vi）变革过程。
机构可以专注于培养适当的认知和有利的文化，为实施提供专用资源，并引入促进者来倡导实施。调整IPOS以适应工作流程和个体需求，考虑变革过程，以及进行系统性变革以减轻文化、资源和员工角色压力，将提高IPOS在临床服务实际实施过程中的采用率。
不适用。
