Hobden Georgina, Tang Eugene Yee Hing, Demeyere Nele
Department of Experimental Psychology, University of Oxford, Oxford, UK.
Population Health Sciences Institute, Newcastle University, Newcastle, UK.
BMC Health Serv Res. 2024 Oct 1;24(1):1162. doi: 10.1186/s12913-024-11551-6.
Enhancing long-term support for post-stroke cognitive impairment is a top research priority. Addressing current gaps in UK post-stroke cognitive care provision requires a pragmatic and scalable intervention that can be integrated within the existing stroke care pathway. This study aimed to develop consensus on an initial set of core features for a UK-based monitoring and psychoeducational intervention for cognitive changes after stroke.
An expert panel of UK healthcare professionals and researchers participated in an online modified Delphi survey. Candidate intervention features were identified from clinical guidelines, existing literature, research team/collaborator expertise, and PPI group lived experience. Survey participants indicated whether they agreed/disagreed/had no opinion about including each candidate feature in the intervention and free-text responses were invited. We analysed responses for consensus (≥ 75% agreement) using descriptive statistics, with items not reaching consensus carried into subsequent rounds. Template analysis was used to identify similarities/differences in viewpoints for items that did not reach consensus.
Three survey rounds were completed by 36, 29 and 26 participants, respectively. Participants agreed reviews should include a stroke-specific cognitive screen (97% agree) and assessment of other psychological changes (low mood, anxiety, fatigue: 94%, 90%, 89% agree, respectively). They agreed stroke survivors should be offered at least one review, regardless of their cognitive profile in hospital. They agreed on the importance of various cognition-focused psychoeducation topics, and formal (100% agree) and informal (79% agree) training for those conducting reviews. Consensus was not reached on the review mode (in person/remote options: 67% agree), offering reviews one-year post-discharge to patients without acute cognitive impairments (68% disagree), or including a dementia screen (63% disagree) and/or neuropsychological assessment battery (58% disagree). However, there were similarities in participant viewpoints. For example, participants emphasised the importance of onwards referral where clinically indicated. CONCLUSIONS: The UK-based post-stroke monitoring and psychoeducation intervention was originally conceptualised as a cognitive care pathway, but expert participants agreed on the importance of simultaneously addressing related psychological changes (e.g. low mood, anxiety). There was clear consensus on a minimum set of intervention features. Recommendations outlined here may usefully inform local service improvements.
加强对中风后认知障碍的长期支持是首要研究重点。解决英国中风后认知护理提供方面当前存在的差距，需要一种务实且可扩展的干预措施，该措施能够整合到现有的中风护理路径中。本研究旨在就一套针对英国中风后认知变化的监测和心理教育干预的初始核心特征达成共识。
一个由英国医疗保健专业人员和研究人员组成的专家小组参与了一项在线改良德尔菲调查。从临床指南、现有文献、研究团队/合作者的专业知识以及患者和公众参与（PPI）小组的生活经验中确定候选干预特征。调查参与者表明他们是否同意/不同意/对将每个候选特征纳入干预措施没有意见，并邀请他们提供自由文本回复。我们使用描述性统计分析回复以达成共识（≥75%的同意率），未达成共识的项目进入后续轮次。模板分析用于识别未达成共识项目的观点异同。
三轮调查分别有36名、29名和26名参与者完成。参与者一致认为评估应包括特定于中风的认知筛查（97%同意）以及对其他心理变化（情绪低落、焦虑、疲劳）的评估（分别为94%、90%、89%同意）。他们一致认为，无论中风幸存者在医院的认知状况如何，都应至少接受一次评估。他们认同各种以认知为重点的心理教育主题的重要性，以及对进行评估的人员进行正式（100%同意）和非正式（79%同意）培训的重要性。在评估方式（面对面/远程选项：67%同意）、对出院后一年无急性认知障碍的患者进行评估（68%不同意）、纳入痴呆筛查（63%不同意）和/或神经心理评估量表（58%不同意）方面未达成共识。然而，参与者的观点存在相似之处。例如，参与者强调在临床指征明确时进行进一步转诊的重要性。
基于英国的中风后监测和心理教育干预最初被构想为一种认知护理路径，但专家参与者一致认为同时解决相关心理变化（如情绪低落、焦虑）很重要。在一套最低限度的干预特征方面达成了明确共识。此处概述的建议可能有助于为当地服务改进提供参考。
