探索数字预立医疗计划系统的背景假设、干预措施及结果：一种用于理解实施与评估的变革理论方法
Exploring the contextual assumptions, interventions and outcomes of digital advance care planning systems: A theory of change approach to understand implementation and evaluation.
作者信息
Bradshaw Andy, Allsop Matthew J, Birtwistle Jacqueline, Evans Catherine J, Relton Samuel D, Richards Suzanne H, Twiddy Maureen, Foy Robbie, Millares Martin Pablo, Yardley Sarah, Sleeman Katherine E
机构信息
Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK.
Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.
出版信息
Palliat Med. 2024 Dec;38(10):1144-1155. doi: 10.1177/02692163241280134. Epub 2024 Sep 21.
BACKGROUND
Digital advance care planning systems are used internationally to document and share patients' wishes and preferences to inform care delivery. However, their use is impeded by a limited understanding of factors influencing implementation and evaluation.
AIM
To develop mid-range programme theory to account for technological, infrastructure and human factor influences on digital advance care planning systems.
DESIGN
Exploratory qualitative research design incorporating Theory of Change workshops that explored contextual assumptions affecting digital advance care planning in practice. A mid-range programme theory was developed through thematic framework analysis using the Non-adoption, Abandonment, Scale-up, Spread and Sustainability (NASSS) framework, generating a conceptual model depicting contextual assumptions, interventions and outcomes influencing implementation.
PARTICIPANTS
A total of 38 participants (16 from London, 14 from West Yorkshire and 8 online) including patients, carers and health and care professionals (including those with commissioning responsibilities).
RESULTS
A conceptual model was generated depicting five distinct components relating to digital advance care planning system use: (sociocultural, technical and structural prerequisites; recognition of the clinical need for conversation; having conversations and documenting decisions; accessing, actioning and amending; and using data to support evaluation, use and implementation). There were differences and uncertainty relating to what digital advance care planning systems are, who they are for and how they should be evaluated.
CONCLUSIONS
Digital advance care planning lacks shared beliefs and practices, despite these being essential for complex technology implementation. Our mid-range programme theory can guide their further development and application by considering technological, infrastructure and human factor influences to optimise their implementation.
背景
数字预立医疗计划系统在国际上被用于记录和分享患者的意愿与偏好，以为医疗服务提供信息。然而，对影响其实施和评估的因素了解有限，阻碍了该系统的使用。
目的
构建中程项目理论，以解释技术、基础设施和人为因素对数字预立医疗计划系统的影响。
设计
探索性定性研究设计，纳入变革理论研讨会，探讨影响数字预立医疗计划实际应用的背景假设。通过使用非采用、废弃、扩大规模、传播和可持续性（NASSS）框架进行主题框架分析，开发了一个中程项目理论，生成了一个描述影响实施的背景假设、干预措施和结果的概念模型。
参与者
共有38名参与者（16名来自伦敦，14名来自西约克郡，8名在线参与），包括患者、护理人员以及健康和护理专业人员（包括负责委托工作的人员）。
结果
生成了一个概念模型，描绘了与数字预立医疗计划系统使用相关的五个不同组成部分：（社会文化、技术和结构前提条件；认识到进行对话的临床必要性；进行对话并记录决策；访问、采取行动和修改；以及使用数据支持评估、使用和实施）。关于数字预立医疗计划系统是什么、针对谁以及应如何评估，存在差异和不确定性。
结论
尽管共享信念和实践对于复杂技术的实施至关重要，但数字预立医疗计划缺乏这些。我们的中程项目理论可以通过考虑技术、基础设施和人为因素的影响来指导其进一步发展和应用，以优化其实施。
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