Reale Sophie, Turner Rebecca R, Steed Liz, Taylor Steph J C, Rosario Derek J, Bourke Liam, Morrissey Dylan, Innes Aidan Q, Sutton Eileen
Allied Health Professions, College of Health, Wellbeing & Life Sciences, Sheffield Hallam University, Sheffield, UK.
Division of Medical Education, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
Implement Sci Commun. 2024 Sep 2;5(1):94. doi: 10.1186/s43058-024-00629-1.
The National Institute for Health and Care Excellence (NICE) recommend that men with prostate cancer on androgen deprivation therapy (ADT) are offered twice weekly supervised aerobic and resistance exercise to address side effects of treatment. However, supervised exercise is not routinely offered in standard clinical practice. The STAMINA programme grant for applied research (PGfAR) has been designed to evaluate whether this recommendation can be delivered within standard NHS care. This paper describes how future implementation of NICE recommendations within the NHS was explored during complex intervention development to enable evaluation of a lifestyle intervention.
Two stakeholder workshops were conducted to explore factors pertinent to future implementation of the STAMINA Lifestyle intervention (SLI). Normalisation Process Theory (NPT) provided the theoretical framework for discussion and analysis. Stakeholder workshop 1 focussed on intervention coherence and buy-in. Stakeholder workshop 2 explored barriers and facilitators for embedding SLI into the context of the NHS, with delivery partner Nuffield Health, in the future.
Workshops were attended by healthcare professionals (n = 16), exercise professionals (n = 17), members of public involved in PPI including patients (n = 12), health psychologists (n = 2), clinical commissioners (n = 4), cancer charities (n = 3), a cancer alliance (n = 1) and health economist (n = 1). Stakeholders agreed that professional training packages should emphasise the uniqueness of the SLI and underpinning theory and evidence (Coherence). To further engagement, the use of STAMINA champions and information about the delivery partner were recommended to enhance confidence and knowledge (Cognitive participation). Furthermore, a simple communication (Collective Action) and progress reporting system (Reflexive Monitoring) was suggested to fit into existing infrastructure within the NHS and community partner.
Application of NPT within two stakeholder workshops enhanced complex intervention development. Context-specific strategies to support implementation of SLI within the context of a trial were proposed, sensed-checked, and considered acceptable. The organisational implications of embedding and sustaining the intervention in preparation for wider NHS roll-out were considered (if proven to be effective) and will be explored in the qualitative component of a process evaluation underpinned by NPT.
(ISRCTN: 46385239 ). Registered on July 30, 2020.
英国国家卫生与临床优化研究所（NICE）建议，接受雄激素剥夺疗法（ADT）的前列腺癌男性患者应每周接受两次有监督的有氧运动和抗阻运动，以应对治疗的副作用。然而，在标准临床实践中，有监督的运动并非常规提供。应用研究项目资助（PGfAR）的耐力（STAMINA）计划旨在评估这一建议能否在英国国家医疗服务体系（NHS）的标准护理中得以实施。本文描述了在复杂干预措施开发过程中，如何探索NHS未来实施NICE建议的情况，以便对生活方式干预措施进行评估。
举办了两次利益相关者研讨会，以探讨与耐力生活方式干预措施（SLI）未来实施相关的因素。常态化过程理论（NPT）为讨论和分析提供了理论框架。利益相关者研讨会1聚焦于干预的连贯性和认同。利益相关者研讨会2探讨了未来将SLI纳入NHS环境并与交付伙伴纳菲尔德健康组织合作时的障碍和促进因素。
参加研讨会的人员包括医疗保健专业人员（n = 16）、运动专业人员（n = 17）、参与患者和公众参与（PPI）的公众成员（n = 12）、健康心理学家（n = 2）、临床专员（n = 4）、癌症慈善机构（n = 3）、一个癌症联盟（n = 1）和健康经济学家（n = 1）。利益相关者一致认为，专业培训包应强调SLI的独特性以及基础理论和证据（连贯性）。为了进一步促进参与，建议使用耐力项目倡导者以及关于交付伙伴的信息，以增强信心和知识（认知参与）。此外，还建议采用一个简单的沟通（集体行动）和进展报告系统（反思性监测），以适应NHS和社区伙伴现有的基础设施。
在两次利益相关者研讨会上应用NPT加强了复杂干预措施的开发。提出了在试验背景下支持SLI实施的针对具体情况的策略，进行了合理性检查，并被认为是可接受的。考虑了在为NHS更广泛推广做准备时嵌入和维持干预措施的组织影响（如果被证明是有效的），并将在以NPT为基础的过程评估的定性部分进行探讨。
（国际标准随机对照试验编号：46385239）。于2020年7月30日注册。
