Guccione Lisa, Best Stephanie, Fullerton Sonia, Aranda Sanchia, Francis Jill J
Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Australia.
Sir Peter MacCallum Department of Oncology, Faculty of Medicine, Dentistry and Health Science, The University of Melbourne, Melbourne, Australia.
BMC Health Serv Res. 2025 Jan 21;25(1):115. doi: 10.1186/s12913-025-12240-8.
The provision of healthcare is complex. When evidence-practice gaps are identified, interventions to improve practice across multi-level systems are required. These interventions often consist of multiple interacting components and behaviours. To effectively address these complexities, it is crucial to first identify the specific roles and actions required at each stage of the intervention. This approach enables a thorough examination of what is working well and what needs to be optimised. The action, actor, context, target, time (AACTT) framework provides a consistent approach to identifying key elements such as 'who' (actor) does 'what' (action), 'where' (context), 'to or with whom' (target) and 'when' (time). To our knowledge the AACTT has not yet been applied: 1) to specify complex interventions across patient journeys; and 2) to investigate consumer views, despite the importance of patient-centred care.
Using advance care planning (ACP) as an exemplar complex healthcare process, we describe a method for using the AACTT framework to 1) map a complex model of care across a patient journey 2) capture the consumer perspective; and 3) operationalise these perspectives by comparing across groups and identifying alignments or misalignments.
Two groups were recruited (healthcare professionals and consumers). Informed by the AACTT framework, four focus groups discussed the process of ACP across existing care pathways. Maps visually representing the perspectives and preferences of healthcare professionals and consumers were co-created iteratively. Qualitative data was deductively coded to the AACTT framework and inductively coded to identify themes within domains. Maps were circulated for critical feedback and refined.
Healthcare professional (n-13) and consumer perspectives (n = 11) highlighted what is 'currently occurring' in practice, what is 'not occurring', and what 'should be occurring' to align practice with consumer preferences of care. Comparing participant perspectives identified that most misalignment occurred within the actor, context, and time domains. Misalignment was found predominantly in actions 'occurring sometimes', with no converging perspectives reported for the context and time domains.
This novel application of the AACTT framework systematically brings in the consumer voice in ways that may influence the delivery of care. This approach to specifying healthcare professional and consumer perspectives across a complex care pathway identifies barriers that are not found with traditional mapping methods or in current applications of the AACTT framework.
医疗保健的提供十分复杂。当发现证据与实践之间存在差距时，就需要采取干预措施来改善多层次系统中的实践。这些干预措施通常由多个相互作用的组成部分和行为构成。为了有效应对这些复杂性，首先确定干预每个阶段所需的具体角色和行动至关重要。这种方法能够全面审视哪些方面运行良好以及哪些方面需要优化。行动、行动者、背景、目标、时间（AACTT）框架提供了一种一致的方法来确定关键要素，例如“谁”（行动者）做“什么”（行动）、“在哪里”（背景）、“对谁或与谁一起”（目标）以及“何时”（时间）。据我们所知，AACTT尚未应用于：1）明确患者就医过程中的复杂干预措施；2）调查消费者的观点，尽管以患者为中心的护理很重要。
以预先护理计划（ACP）作为复杂医疗保健过程的示例，我们描述一种使用AACTT框架的方法，以：1）绘制患者就医过程中的复杂护理模型；2）获取消费者的观点；3）通过跨组比较并确定一致性或不一致性来将这些观点付诸实践。
招募了两组人员（医疗保健专业人员和消费者）。在AACTT框架的指导下，四个焦点小组讨论了现有护理途径中的ACP过程。通过迭代共同创建直观展示医疗保健专业人员和消费者观点及偏好的图谱。对定性数据进行演绎编码以符合AACTT框架，并进行归纳编码以识别各领域内的主题。将图谱分发以获取关键反馈并进行完善。
医疗保健专业人员（n = 13）和消费者的观点（n = 11）突出显示了实践中“当前正在发生的”、“未发生的”以及为使实践与消费者的护理偏好保持一致“应该发生的”情况。比较参与者的观点发现，大多数不一致发生在行动者、背景和时间领域。不一致主要出现在“有时发生”的行动中，在背景和时间领域未报告有趋同的观点。
AACTT框架的这种新颖应用以可能影响护理提供的方式系统地纳入了消费者的声音。这种在复杂护理途径中明确医疗保健专业人员和消费者观点的方法识别出了传统图谱绘制方法或当前AACTT框架应用中未发现的障碍。
