Lin Yu Hsuan, Chen Tzu Chun
Department of Applied Sociology, Nanhua University, No.55, Sec.1, Nanhua Rd., Dalin Township, Chiayi County, 622301, Taiwan.
Cancer Center, Ditmanson Medical Foundation Chia-Yi Christian Hospital, No. 539, Zhongxiao Rd., East Dist., Chiayi City, 600566, Taiwan.
BMC Health Serv Res. 2024 Dec 26;24(1):1653. doi: 10.1186/s12913-024-12144-z.
In cancer care, the use of clinical practice guidelines (CPGs) has been shown to improve the quality and effectiveness of medical services. To facilitate physicians' adherence to these guidelines, Taiwan established the position of oncology case manager (OCM) in 2010, one of whose responsibilities is to monitor physicians' compliance. However, there have been few explorations of their experiences and the barriers they face in facilitating guideline implementation.
The aim of this study was to explore how OCMs carry out their roles in facilitating the implementation of CPGs in Taiwan and the challenges they encounter in this process.
In this study, a qualitative interpretative phenomenological analysis (IPA) approach focusing on interpreting phenomena was adopted. The subjects were eight OCMs from the same hospital in Taiwan. Data collection primarily involved conducting interviews, supplemented by document analysis.
The analysis revealed the following challenges for OCMs in the process of facilitating guideline implementation: (1) Local production: Self-directed exploration leads to significant pressure. (2) Operational modes: Difficulties arise in the "low-ranking overseeing high-ranking" approach. (3) Accountability mechanisms: OCMs are saddled with the chore of managing evaluation.
CONCLUSION/PRACTICAL IMPLICATIONS: Guidelines are vital tools to ensure the quality of cancer care. However, based on the experiences of OCMs, shortcomings in institutional design, hierarchical organizational culture, misconceptions about the role of OCMs, and a lack of support from management have been identified as key obstacles in the implementation process. Suggestions of ways to address these challenges and promote successful guideline implementation are proposed.
在癌症护理中，临床实践指南（CPG）的使用已被证明可提高医疗服务的质量和有效性。为促进医生遵守这些指南，台湾于2010年设立了肿瘤病例经理（OCM）一职，其职责之一是监督医生的合规情况。然而，对于他们在促进指南实施方面的经验以及所面临的障碍，鲜有探索。
本研究旨在探讨台湾的OCM如何在促进CPG实施中发挥作用以及他们在此过程中遇到的挑战。
本研究采用了一种侧重于解释现象的定性解释现象学分析（IPA）方法。研究对象是来自台湾同一家医院的八名OCM。数据收集主要通过访谈进行，并辅以文件分析。
分析揭示了OCM在促进指南实施过程中面临的以下挑战：（1）本地生产：自主探索带来巨大压力。（2）运作模式：“低级别监督高级别”的方式存在困难。（3）问责机制：OCM承担着管理评估的琐事。
结论/实际意义：指南是确保癌症护理质量的重要工具。然而，根据OCM的经验，制度设计的缺陷、层级组织文化、对OCM角色的误解以及管理层缺乏支持已被确定为实施过程中的关键障碍。本文提出了应对这些挑战并促进指南成功实施的方法建议。
