Ho Leonard, Kwong Ming Hong, Li Angus S C, Nilsen Per, Ho Fai Fai, Zhong Claire C W, Wong Charlene H L, Lin Wai Ling, Chung Vincent C H
Jockey Club School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.
Department of Medicine, Health and Caring Sciences, Linköping University, Linköping, Sweden.
Front Public Health. 2024 Aug 30;12:1414297. doi: 10.3389/fpubh.2024.1414297. eCollection 2024.
Current evidence supports the use of integrative oncology (IO) interventions in cancer supportive care. The demand for outpatient IO services in Hong Kong is expected to soar following the surge in cancer incidence due to population ageing. This study identified the factors influencing the delivery and utilisation of outpatient IO from local stakeholders' perspectives and developed corresponding implementation strategies.
This study involved two sequential stages. First, with individual semi-structured interviews guided by the Theoretical Domains Framework (TDF), we explored stakeholders' views on the barriers to and facilitators for implementing IO. Second, guided by a TDF-based qualitative data analysis of interview transcripts, we performed intervention mapping to develop Behaviour Change Wheel-based implementation strategies that may overcome the barriers and strengthen the facilitators.
We interviewed 31 stakeholders, including traditional Chinese medicine (TCM) practitioners ( = 8), biomedically-trained doctors ( = 7), nurses ( = 6), administrators ( = 4), caregivers ( = 4), and pharmacists ( = 2). The key local factors influencing outpatient IO are (1) lacking nursing and administrative workforce supporting IO service delivery, (2) lacking awareness of IO services among healthcare professionals, administrators, patients, and caregivers, and (3) lacking knowledge among healthcare professionals of herb-drug interaction and herbal toxicities.
We recommended a multi-faceted implementation strategies package that included arranging funding to train, recruit, and retain nursing and administrative staff, devolving resources into promoting interprofessional collaborations and evidence on IO effectiveness and safety, integrating evidence on herb-drug interactions and herbal toxicities into automated electronic health record systems monitored by pharmacists with dual qualifications in TCM and conventional pharmacy.
目前的证据支持在癌症支持治疗中使用整合肿瘤学（IO）干预措施。由于人口老龄化导致癌症发病率激增，预计香港对门诊IO服务的需求将大幅上升。本研究从当地利益相关者的角度确定了影响门诊IO服务提供和利用的因素，并制定了相应的实施策略。
本研究包括两个连续阶段。首先，在理论领域框架（TDF）指导下进行个体半结构化访谈，我们探讨了利益相关者对实施IO的障碍和促进因素的看法。其次，在基于TDF的访谈记录定性数据分析指导下，我们进行干预映射，以制定基于行为改变轮的实施策略，这些策略可能克服障碍并加强促进因素。
我们采访了31名利益相关者，包括中医从业者（n = 8）、接受过生物医学培训的医生（n = 7）、护士（n = 6）、管理人员（n = 4）、护理人员（n = 4）和药剂师（n = 2）。影响门诊IO的关键当地因素包括：（1）缺乏支持IO服务提供的护理和行政人员；（2）医疗保健专业人员、管理人员、患者和护理人员对IO服务缺乏认识；（3）医疗保健专业人员缺乏草药-药物相互作用和草药毒性方面的知识。
我们推荐了一个多方面的实施策略包，包括安排资金培训、招聘和留住护理和行政人员，投入资源促进跨专业合作以及IO有效性和安全性的证据，将草药-药物相互作用和草药毒性的证据整合到由具有中医和传统药学双重资格的药剂师监控的自动化电子健康记录系统中。
