Cicely Saunders Institute, Kings College London, London, United Kingdom.
Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom.
J Med Internet Res. 2024 Aug 16;26:e50217. doi: 10.2196/50217.
Palliative care aims to improve the quality of life for people with life-limiting illnesses. Advance care planning conversations that establish a patient's wishes and preferences for care are part of a person-centered approach. Internationally, electronic health record systems are digital interventions used to record and share patients' advance care plans across health care services and settings. They aim to provide tools that support electronic information sharing and care coordination. Within the United Kingdom, Electronic Palliative Care Coordination Systems (EPaCCS) are an example of this. Despite over a decade of policy promoting EPaCCS nationally, there has been limited implementation and consistently low levels of use by health professionals.
The aim of this study is to explore the factors that influence the implementation of EPaCCS into routine clinical practice across different care services and settings in 2 major regions of England.
A qualitative interview study design was used, guided by Normalization Process Theory (NPT). NPT explores factors affecting the implementation of complex interventions and consists of 4 primary components (coherence, cognitive participation, collective action, and reflexive monitoring). Health care and social care practitioners were purposively sampled based on their professional role and work setting. Individual web-based semistructured interviews were conducted. Data were analyzed using thematic framework analysis to explore issues which affected the implementation of EPaCCS across different settings at individual, team, organizational, and technical levels.
Participants (N=52) representing a range of professional roles were recruited across 6 care settings (hospice, primary care, care home, hospital, ambulatory, and community). In total, 6 themes were developed which mapped onto the 4 primary components of NPT and represented the multilevel influences affecting implementation. At an individual level, these included (1) EPaCCS providing a clear and distinct way of working and (2) collective contributions and buy-in. At a team and organizational level, these included (3) embedding EPaCCS into everyday practice and (4) championing driving implementation. At a technical level, these included (5) electronic functionality, interoperability, and access. Breakdowns in implementation at different levels led to variations in (6) confidence and trust in EPaCCS in terms of record accuracy and availability of access.
EPaCCS implementation is influenced by individual, organizational, and technical factors. Key challenges include problems with access alongside inconsistent use and engagement across care settings. EPaCCS, in their current format as digital advance care planning systems are not consistently facilitating electronic information sharing and care coordination. A redesign of EPaCCS is likely to be necessary to determine configurations for their optimal implementation across different settings and locations. This includes supporting health care practitioners to document, access, use, and share information across multiple care settings. Lessons learned are relevant to other forms of digital advance care planning approaches being developed internationally.
姑息治疗旨在提高生命有限的患者的生活质量。预先护理计划对话建立了患者对护理的意愿和偏好，这是以人为本方法的一部分。在国际上，电子健康记录系统是用于记录和在医疗保健服务和环境中共享患者预先护理计划的数字干预措施。它们旨在提供支持电子信息共享和护理协调的工具。在英国，电子姑息治疗协调系统（EPaCCS）就是一个例子。尽管十多年来一直在推行全国性的 EPaCCS 政策，但在卫生专业人员中的实施情况有限，使用率一直很低。
本研究旨在探讨影响在英格兰两个主要地区的不同护理服务和环境中常规临床实践中实施 EPaCCS 的因素。
使用基于规范过程理论（NPT）的定性访谈研究设计。NPT 探讨了影响复杂干预措施实施的因素，包括 4 个主要组成部分（一致性、认知参与、集体行动和反思性监测）。根据专业角色和工作环境，有目的地抽取医疗保健和社会护理从业者作为参与者。进行了基于网络的半结构化个人访谈。使用主题框架分析对数据进行分析，以探讨影响不同环境中 EPaCCS 实施的个人、团队、组织和技术层面的问题。
参与者（N=52）代表了一系列专业角色，他们来自 6 个护理环境（临终关怀、初级保健、护理院、医院、门诊和社区）。总共开发了 6 个主题，这些主题映射到 NPT 的 4 个主要组成部分，并代表了影响实施的多层次影响。在个人层面上，这些影响包括（1）EPaCCS 提供了一种清晰独特的工作方式和（2）集体贡献和投入。在团队和组织层面上，这些影响包括（3）将 EPaCCS 融入日常实践和（4）支持推动实施。在技术层面上，这些影响包括（5）电子功能、互操作性和可访问性。在不同层面上的实施中断导致（6）对 EPaCCS 的记录准确性和访问可用性的信心和信任方面存在差异。
EPaCCS 的实施受到个人、组织和技术因素的影响。关键挑战包括访问问题以及在护理环境中不一致的使用和参与。EPaCCS 作为数字预先护理计划系统，目前并未始终如一地促进电子信息共享和护理协调。可能需要重新设计 EPaCCS，以确定其在不同设置和地点的最佳实施配置。这包括支持医疗保健从业者在多个护理环境中记录、访问、使用和共享信息。吸取的经验教训与国际上正在开发的其他形式的数字预先护理计划方法有关。
