Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia.
School of Nursing, Guilin Medical University, Guilin, Guangxi, China.
Health Expect. 2024 Aug;27(4):e14151. doi: 10.1111/hex.14151.
Quality improvement (QI) programs based on person-centred outcome measures (PCOMs) play an important role in promoting optimal palliative care. However, routine use of PCOMs has been slow and difficult to implement, including within QI programs.
This study aimed to identify implementation strategies that support the implementation of PCOMs as routine practice in hospital-based palliative care, as well as the implementation theories, models and frameworks (TMFs) guiding the design of these implementation strategies.
A scoping review was conducted in accordance with the Joanna Briggs Institute (JBI) Scoping Review framework. Four databases (Medline, CINAHL, Scopus and PubMed) were systematically searched for literature published between 1 January 1990 and 8 March 2024.
One hundred and fifteen unique implementation strategies, identified from 11 included studies, were mapped onto the 73 Expert Recommendations for Implementing Change (ERIC) discrete implementation strategies, covering 52% of the ERIC strategies. The most commonly used categories were train and educate stakeholders, and support clinicians, followed by develop stakeholder interrelationships and use evaluation and iterative strategies. Three key themes emerged: what to do; how to do it; and who to do it with. Only four studies employed TMFs to guide the design of the implementation strategies in this review.
To promote the implementation of PCOM-based QI programs, strategies should be developed based on identified/potential barriers and facilitators by using rigorous TMFs. The components of the implementation strategies must be reported transparently and consistently to enable replication and measurement in future research and practice.
This scoping review does not directly involve patients or the general public in its design or execution. However, it is part of an implementation study aimed at integrating the Palliative Care Outcome Collaboration (PCOC) model into routine clinical practice at a cancer hospital in China. Before the formal implementation, palliative care professionals from this hospital highlighted the need for a comprehensive analysis of existing evidence to support the effective adoption of the PCOC model in their specific clinical setting.
以患者为中心的结局测量（PCOM）为基础的质量改进（QI）项目在促进最佳姑息治疗方面发挥着重要作用。然而，PCOM 的常规使用一直缓慢且难以实施，包括在 QI 项目中。
本研究旨在确定支持将 PCOM 作为常规实践纳入基于医院的姑息治疗的实施策略，以及指导这些实施策略设计的实施理论、模型和框架（TMF）。
根据乔安娜·布里格斯研究所（JBI）的范围审查框架进行了范围审查。系统地检索了 1990 年 1 月 1 日至 2024 年 3 月 8 日期间发表的文献，使用了 4 个数据库（Medline、CINAHL、Scopus 和 PubMed）。
从 11 项纳入研究中确定了 115 种独特的实施策略，这些策略被映射到 73 项专家推荐实施变革（ERIC）离散实施策略上，涵盖了 ERIC 策略的 52%。最常用的类别是培训和教育利益相关者，并支持临床医生，其次是发展利益相关者的相互关系和使用评估和迭代策略。出现了三个关键主题：做什么；怎么做；以及与谁一起做。本综述中只有四项研究使用了 TMF 来指导实施策略的设计。
为了促进基于 PCOM 的 QI 项目的实施，应根据使用严格的 TMF 确定/潜在的障碍和促进因素制定策略。实施策略的组成部分必须透明和一致地报告，以便在未来的研究和实践中进行复制和衡量。
本范围审查在其设计或执行中不直接涉及患者或公众。然而，它是将姑息治疗结果协作组织（PCOC）模型纳入中国一家癌症医院常规临床实践的实施研究的一部分。在正式实施之前，该医院的姑息治疗专业人员强调需要对现有证据进行全面分析，以支持在其特定临床环境中有效采用 PCOC 模型。
