Department of Palliative Medicine, LMU University Hospital, LMU Munich, Munich, Germany.
Department of Palliative Medicine, University Medical Center, Georg August University Goettingen, Goettingen, Germany.
BMC Palliat Care. 2024 Jan 3;23(1):1. doi: 10.1186/s12904-023-01329-8.
Standardised use of patient-centred outcome measures (PCOMs) improves aspects of quality of care. Normalization Process Theory (NPT) considers the social (inter-)actions of implementation processes operationalised through four constructs: coherence-building, cognitive participation, collective action and reflexive monitoring. The aim of the study was to identify barriers and enablers for the successful use of PCOMs in specialist palliative home care (SPHC) using NPT, to collect clinically meaningful and reliable data to improve patient outcomes.
Qualitative study using semi-structured interviews with palliative care professionals from German SPHC teams who participated in a study using PCOMs. Data were analysed using Framework analysis, and contextualised within NPT.
Seventeen interviews across five teams were conducted. Some teams already had an understanding of what PCOMs are and how to use them, based on previous experience. In other teams, this understanding developed through the perception of the benefits (coherence). Participation and engagement depended on individuals and was decisive for coherence-building. The attitude of the management level also played a major role (cognitive participation). Integration of PCOMs into everyday clinical practice varied and depended on the manifestation of the first two constructs and other already established routines (collective action). In the context of appraisal, both positive (e.g. focus on patient) and negative aspects (e.g. additional work) of using PCOMs were mentioned (reflexive monitoring).
Although benefits of using PCOMs were partly recognised, not all teams continued standardised use. Here, not only the social (inter-)actions, but also the influence of the context (working environment) were decisive. Future implementation strategies should consider integrating PCOMs in existing electronic patient records, education sessions supporting coherence-building, internal facilitators/local champions, and ensuring frequent data analyses as it is beneficial and increases the readiness of using PCOMs.
标准化使用以患者为中心的结局测量（PCOMs）可以改善医疗服务质量的各个方面。常规化进程理论（NPT）将实施过程的社会（相互）作用通过四个构建来操作：凝聚构建、认知参与、集体行动和反思性监测。本研究旨在使用 NPT 识别在专科姑息治疗家庭护理（SPHC）中成功使用 PCOMs 的障碍和促进因素，以收集有临床意义且可靠的数据，从而改善患者结局。
对参与使用 PCOMs 研究的德国 SPHC 团队的姑息治疗专业人员进行半结构式访谈的定性研究。使用框架分析法对数据进行分析，并在 NPT 框架内进行情境化分析。
在五个团队中进行了 17 次访谈。一些团队已经基于之前的经验，了解了 PCOMs 的用途和使用方法。在其他团队中，通过对益处（凝聚）的感知，这种理解得到了发展。参与和投入取决于个人，对凝聚构建具有决定性作用。管理层的态度也起着重要作用（认知参与）。PCOMs 融入日常临床实践的程度各不相同，取决于前两个构建的表现以及其他已建立的常规（集体行动）。在评估背景下，提到了使用 PCOMs 的积极方面（例如关注患者）和消极方面（例如额外工作）（反思性监测）。
尽管使用 PCOMs 的益处部分得到了认可，但并非所有团队都继续进行标准化使用。在这里，不仅是社会（相互）作用，而且还有工作环境等因素也具有决定性。未来的实施策略应考虑将 PCOMs 整合到现有的电子患者记录中，提供支持凝聚构建的教育课程，设立内部促进者/当地拥护者，并确保经常进行数据分析，因为这是有益的，可以提高使用 PCOMs 的准备度。
